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Wang T, Gnanaprakasam JNR, Chen X, Kang S, Xu X, Sun H, Liu L, Rodgers H, Miller E, Cassel TA, Sun Q, Vicente-Muñoz S, Warmoes MO, Lin P, Piedra-Quintero ZL, Guerau-de-Arellano M, Cassady KA, Zheng SG, Yang J, Lane AN, Song X, Fan TWM, Wang R. Inosine is an alternative carbon source for CD8 +-T-cell function under glucose restriction. Nat Metab 2020; 2:635-647. [PMID: 32694789 PMCID: PMC7371628 DOI: 10.1038/s42255-020-0219-4] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [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: 09/10/2019] [Accepted: 04/30/2020] [Indexed: 12/15/2022]
Abstract
T cells undergo metabolic rewiring to meet their bioenergetic, biosynthetic and redox demands following antigen stimulation. To fulfil these needs, effector T cells must adapt to fluctuations in environmental nutrient levels at sites of infection and inflammation. Here, we show that effector T cells can utilize inosine, as an alternative substrate, to support cell growth and function in the absence of glucose in vitro. T cells metabolize inosine into hypoxanthine and phosphorylated ribose by purine nucleoside phosphorylase. We demonstrate that the ribose subunit of inosine can enter into central metabolic pathways to provide ATP and biosynthetic precursors, and that cancer cells display diverse capacities to utilize inosine as a carbon source. Moreover, the supplementation with inosine enhances the anti-tumour efficacy of immune checkpoint blockade and adoptive T-cell transfer in solid tumours that are defective in metabolizing inosine, reflecting the capability of inosine to relieve tumour-imposed metabolic restrictions on T cells.
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Affiliation(s)
- Tingting Wang
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - J N Rashida Gnanaprakasam
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Xuyong Chen
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Siwen Kang
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Xuequn Xu
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Hua Sun
- The Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Lingling Liu
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Hayley Rodgers
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Ethan Miller
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Teresa A Cassel
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Qiushi Sun
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Sara Vicente-Muñoz
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Marc O Warmoes
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Penghui Lin
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Zayda Lizbeth Piedra-Quintero
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, College of Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Mireia Guerau-de-Arellano
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, College of Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Kevin A Cassady
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Song Guo Zheng
- Division of Rheumatology and Immunology, Department of Internal Medicine at Ohio State University of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Jun Yang
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew N Lane
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Xiaotong Song
- The Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA.
- Icell Kealex Therapeutics, Houston, TX, USA.
| | - Teresa W-M Fan
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology, Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
| | - Ruoning Wang
- Center for Childhood Cancer & Blood Diseases, Hematology/Oncology & BMT, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
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Rodgers H, Shaw L, Bhattarai N, Cant R, Drummond A, Ford GA, Forster A, Francis R, Hills K, Howel D, Laverty AM, McKevitt C, McMeekin P, Price C, Stamp E, Stevens E, Vale L. 137A trial to evaluate an eXTended RehAbilitation service for Stroke patients (EXTRAS): main patient results. Age Ageing 2019. [DOI: 10.1093/ageing/afz001.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Rodgers
- Newcastle University
- Northumbria Healthcare NHS Foundation Trust
- Newcastle upon Tyne Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | - C Price
- Newcastle University
- Northumbria Healthcare NHS Foundation Trust
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Rodgers H, Scott O. National Lung Cancer Audit patient booklet impact assessment: an evaluation. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rodgers H, Scott O, Beckett P, Navani N, Dickinson R. Development of the first patient-level National Lung Cancer Audit 2016 key findings for patient and carers. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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White PM, Lenthall R, McConachie N, Bhalla A, James M, Dinsmore J, Rodgers H, Rowland-Hill C. Commentary on: Implementing mechanical thrombectomy for acute ischaemic stroke in the UK. Clin Radiol 2016; 72:123-125. [PMID: 27989377 DOI: 10.1016/j.crad.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/07/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Affiliation(s)
- P M White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; British Society of Neuroradiologists, UK; UK Neurointerventional Group, UK.
| | - R Lenthall
- British Society of Neuroradiologists, UK; Department of Neuroradiology, Queen's Medical Centre, Nottingham, UK
| | - N McConachie
- Department of Neuroradiology, Queen's Medical Centre, Nottingham, UK; UK Neurointerventional Group, UK
| | - A Bhalla
- Stroke Medicine, Guys and St Thomas Hospital, London, UK; British Association of Stroke Physicians, UK
| | - M James
- British Association of Stroke Physicians, UK; Stroke Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - J Dinsmore
- Department of Anaesthesia, St George's Hospital, London, UK; Neuro Anaesthesia & Critical Care Society of Great Britain and Ireland, UK
| | - H Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; British Association of Stroke Physicians, UK
| | - C Rowland-Hill
- British Society of Neuroradiologists, UK; Neuroradiology Department, Hull and East Yorkshire Hospitals NHS Trust, UK
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Reid DB, Chapple LS, O'Connor SN, Bellomo R, Buhr H, Chapman MJ, Davies AR, Eastwood GM, Ferrie S, Lange K, McIntyre J, Needham DM, Peake SL, Rai S, Ridley EJ, Rodgers H, Deane AM. The effect of augmenting early nutritional energy delivery on quality of life and employment status one year after ICU admission. Anaesth Intensive Care 2016; 44:406-12. [PMID: 27246942 DOI: 10.1177/0310057x1604400309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Augmenting energy delivery during the acute phase of critical illness may reduce mortality and improve functional outcomes. The objective of this sub-study was to evaluate the effect of early augmented enteral nutrition (EN) during critical illness, on outcomes one year later. We performed prospective longitudinal evaluation of study participants, initially enrolled in The Augmented versus Routine approach to Giving Energy Trial (TARGET), a feasibility study that randomised critically ill patients to 1.5 kcal/ml (augmented) or 1.0 kcal/ml (routine) EN administered at the same rate for up to ten days, who were alive at one year. One year after randomisation Short Form-36 version 2 (SF-36v2) and EuroQol-5D-5L quality of life surveys, and employment status were assessed via telephone survey. At one year there were 71 survivors (1.5 kcal/ml 38 versus 1.0 kcal/ml 33; P=0.55). Thirty-nine (55%) patients consented to this follow-up study and completed the surveys (n = 23 and 16, respectively). The SF-36v2 physical and mental component summary scores were below normal population means but were similar in 1.5 kcal/ml and 1.0 kcal/ml groups (P=0.90 and P=0.71). EuroQol-5D-5L data were also comparable between groups (P=0.70). However, at one-year follow-up, more patients who received 1.5 kcal/ml were employed (7 versus 2; P=0.022). The delivery of 1.5 kcal/ml for a maximum of ten days did not affect self-rated quality of life one year later.
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Affiliation(s)
- D B Reid
- Intensive Care Registrar, Royal Adelaide Hospital, Adelaide, South Australia
| | - L S Chapple
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland
| | - S N O'Connor
- Research Manager, Intensive Care Unit, Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia
| | - R Bellomo
- Intensive Care Consultant, Austin Hospital, Melbourne, Victoria
| | - H Buhr
- Research Manager, Intensive Care Service, Royal Prince Alfred Hospital, Sydney, New South Wales
| | - M J Chapman
- Director of Research, Department of Intensive Care Medicine, Royal Adelaide Hospital, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia
| | - A R Davies
- Research Fellow, Department of Epidemiology and Preventative Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria
| | - G M Eastwood
- Research Manager, Department of Intensive Care, Austin Hospital, Melbourne, Victoria
| | - S Ferrie
- Critical Care Dietitian, Intensive Care Service, Royal Prince Alfred Hospital, Sydney, New South Wales
| | - K Lange
- Biostatistician, Discipline of Medicine, University of Adelaide, Adelaide, South Australia
| | - J McIntyre
- Research Coordinator, Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia
| | - D M Needham
- Medical Director, Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, USA
| | - S L Peake
- Senior Intensive Care Clinician, Discipline of Acute Care Medicine, University of Adelaide, Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia
| | - S Rai
- Intensive Care Specialist, The Canberra Hospital, Canberra, Australian Capital Territory
| | - E J Ridley
- Nutrition Program Manager, Department of Epidemiology and Preventative Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria
| | - H Rodgers
- Research Coordinator, The Canberra Hospital, Canberra, Australian Capital Territory
| | - A M Deane
- Department of Intensive Care Medicine, Royal Adelaide Hospital, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia
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Boote J, Jones Z, McKevitt CJ, Wallace-Watson C, Rodgers H. Stroke Survivor and Carer Involvement in, and Engagement with, Studies Adopted onto the NIHR Stroke Research Network Portfolio: Questionnaire Survey. Int J Stroke 2014; 10:E6-7. [DOI: 10.1111/ijs.12379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Boote
- Patient Experience and Public Involvement, Centre for Research into Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Z. Jones
- NIHR Clinical Research Network: Stroke, Newcastle, UK
| | - C. J. McKevitt
- Health and Social Care Research, King's College London, London, UK
| | | | - H. Rodgers
- Stroke Care, Newcastle University, Newcastle Upon Tyne, UK
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Langhorne P, Fearon P, Ronning OM, Kaste M, Palomaki H, Vemmos K, Kalra L, Indredavik B, Blomstrand C, Rodgers H, Dennis MS, Salman RAS, Blomstrand C, Indredavik B, Kalra L, Kaste M, Palomaki H, Rodgers H, Ronning M, Vemmos K, Asplund K, Berman P, Blomstrand C, Britton M, Cabral N, Cavallini A, Dey P, Hamrin E, Hankey G, Indredavik B, Kalra L, Kaste M, Laursen S, Ma R, Patel N, Rodgers H, Ronning M, Sivenius J, Stevens R, Sulter G, Svensson A, Vemmos K, Wood-Dauphinee S, Yagura H. Stroke Unit Care Benefits Patients With Intracerebral Hemorrhage. Stroke 2013; 44:3044-9. [DOI: 10.1161/strokeaha.113.001564] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Langhorne
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Patricia Fearon
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Ole M. Ronning
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Markku Kaste
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Heikki Palomaki
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Kostos Vemmos
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Lalit Kalra
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Bent Indredavik
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Christian Blomstrand
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Helen Rodgers
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Martin S. Dennis
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Rustam Al-Shahi Salman
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
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Ogunbo B, Ogun SA, Ushewokunze S, Mendelow AD, Rodgers H, Walker R. How can we improve the management of stroke in Nigeria, Africa? African Journal of Neurological Sciences 2008. [DOI: 10.4314/ajns.v24i2.7571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- H Rodgers
- School of Clinical Medical Sciences, University of Newcastle upon Tyne, UK.
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Abstract
L Stobbart and colleagues examine newspaper coverage of adverse events in the TGN1412 trial
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Affiliation(s)
- L Stobbart
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4HH
| | - M J Murtagh
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4HH
| | - T Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4HH
| | - G A Ford
- Stroke Research Group, Institute for Ageing and Health, Clinical Research Facility, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
| | - S J Louw
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Department of General Internal Medicine, Freeman Hospital, Newcastle upon Tyne NE7 7DN
| | - H Rodgers
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Department of General Internal Medicine, Freeman Hospital, Newcastle upon Tyne NE7 7DN
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Thomson R, Greenaway J, Chinn DJ, Wood R, Rodgers H. The impact of implementing national hypertension guidelines on prevalence and workload in primary care: a population-based survey of older people. J Hum Hypertens 2005; 19:683-9. [PMID: 15920451 DOI: 10.1038/sj.jhh.1001896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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
Recently revised UK and US hypertension guidelines have reduced thresholds for both diagnosis and treatment and differ in their recommendations. We have used data from a random, stratified community-based sample of 4784 people aged 65 years and over to compare the prevalence of treatable hypertension and the potential impact on patients and primary care from using current guidelines. BHS, NICE and JNC7 guidelines were applied to blood pressures obtained from primary care medical records (94%) or measured at a screening clinic (6%). Risk factors were obtained by questionnaire and from medical records, supplemented by epidemiological data. Workload was estimated for a representative practice population of 10 000 patients. Blood pressures were obtained on 4514 patients (94%). Prevalence of treatable hypertension was over 67%. Compared to BHS4, prevalence estimates using NICE guidelines were comparable for men but significantly lower for women (P<0.05). They were significantly higher using JNC7 compared with BHS4 and NICE guidance (P<0.05). A general practice of 10 000 patients could expect 1287 older hypertensive patients using BHS4 guidelines and 1231 patients using NICE guidelines. Under BHS4, an extra 94 patients will require annual, rather than 5-yearly review compared with that using the previous guideline. In conclusion, implementation of BHS4 guidelines, with their revised thresholds for diagnosis, will not add materially to the prevalence of treatable hypertension compared to previous BHS3 guidelines but will have a major impact on practice workload. Use of NICE guidelines in preference to BHS4 will result in GPs treating fewer patients and reviewing untreated patients less often.
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Affiliation(s)
- R Thomson
- School of Population and Health Sciences (Epidemiology and Public Health) Medical School, Framlington Place, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
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Johnson U, Landau D, Lindgren-Turner J, Smith N, Meir I, Howe R, Rodgers H, Davit S, Deehan C. Real time 3D surface imaging for the analysis of respiratory motion during radiotherapy. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Previous reports have shown an association between snoring and stroke but it is not clear whether this reflects confounding factors nor whether the association is attributable to obstructive sleep apnoea (OSA). We performed a case-control study of 181 patients admitted to hospital with first-ever stroke and community control subjects matched individually for age, sex and general practitioner. Subjects were interviewed with a structured questionnaire to identify snoring, daytime sleepiness and stroke risk factors. The association between snoring alone and stroke was not statistically significant: odds ratio (95% CI) 1.44 (0.88, 2.41). Daytime sleepiness was, however, significantly associated with stroke: odds ratio 3.07 (1.65, 6.08). Multiple logistic regression showed that hypertension, current smoking, taking alcohol regularly (negatively) and a higher Epworth sleepiness score were independently associated with stroke. The results suggest that the previously reported association between 'simple' snoring and stroke might have been due to poor controlling for confounding variables. Our study suggests an association with greater sleepiness prestroke, the cause of which is unclear, although OSA is a possible candidate.
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Affiliation(s)
- D P Davies
- Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK
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15
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Abstract
PURPOSE To evaluate the feasibility and effectiveness of early supported discharge (ESD) following acute stroke. METHOD An ESD scheme was compared to conventional rehabilitation in a randomized controlled trial. All patients admitted with acute stroke were considered for inclusion. Eighty-eight (20.2%) were found to be eligible and 82 were randomized either to early supported discharge (n = 42) or conventional rehabilitation (n = 40). The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale. The General Health Questionnaire, the Montgomery Aasberg Depression Rating Scale, mortality, placement and patient and career satisfaction served as secondary outcome measures. RESULTS Median length of stay was reduced from 31 days in the conventional hospital rehabilitation group to 22 days in the early supported discharge group (p = 0.09). No differences were found regarding primary outcome. The General Health Questionnaire score showed a significant difference in favour of the early supported discharge group at three months (19.5/24, p = 0.02), but not at six. At six months, the proportion of patients being dead or in institution showed a trend of being higher in the conventional rehabilitation group (OR 3.8, 95% CI 0.8-23). CONCLUSIONS Early supported discharge after stroke is feasible and it is possible that it has benefits compared with conventional rehabilitation.
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Affiliation(s)
- E Bautz-Holter
- Department of Physical Medicine and Rehabilitation, Ullevaal Hospital, Oslo, Norway.
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16
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Abstract
BACKGROUND An increase in the prevalence of neurological disability puts pressure on service providers to restrict costs associated with rehabilitation. Spasticity is an important neurological impairment for which many novel and expensive treatment options now exist. The antispastic effects of these techniques remain unexplored due to a paucity of valid outcome measures. AIM To develop a biomechanical measure of resistance to passive movement, which could be used in routine clinical practice, and to examine the validity of the modified Ashworth scale. STUDY DESIGN Repeated measure cross-section study on 16 subjects who had a unilateral stroke one-week previously and had no elbow contractures. OUTCOME MEASURES Simultaneous measurement of resistance to passive movement using a custom built measuring device and the modified Ashworth scale. Passive range of movement and velocity were also measured. The "catch", a phenomenon associated with the modified Ashworth scale, was identified by the assessor using a horizontal visual analogue scale and biomechanically quantified using the residual calculated from a linear regression technique. RESULTS Half the study population had a modified Ashworth score greater than zero. The association between the two measures was poor (kappa=0.366). The speed and range of passive movement were greater in subjects with modified Ashworth score "0" (P<0.05). Resistance to passive movement was higher in the impaired arm (P<0.05) and tended to decrease with repeated measures and increasing speeds. CONCLUSIONS A device to measure resistance to passive movement at the elbow was developed. The modified Ashworth scale may not provide a valid measure of spasticity but a measure of resistance to passive movement in an acute stroke population. RELEVANCE Spasticity is an important neurological impairment for which many novel and expensive treatment options are being made available. There is a paucity of clinically usable outcomes to measure spasticity. A device to measure resistance to passive movement at the elbow, which was more reliable than the modified Ashworth scale was developed. This device may provide a much needed objective clinical measure to evaluate the efficacy of antispasticity treatment.
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Affiliation(s)
- A D Pandyan
- Centre for Rehabilitation and Engineering Studies, University of Newcastle, Stephenson Building, NE1 7RU, Newcastle upon Tyne, UK.
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Price CI, Rodgers H, Franklin P, Curless RH, Johnson GR. Glenohumeral subluxation, scapula resting position, and scapula rotation after stroke: a noninvasive evaluation. Arch Phys Med Rehabil 2001; 82:955-60. [PMID: 11441385 DOI: 10.1053/apmr.2001.23826] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 11/11/2022]
Abstract
OBJECTIVES To determine whether scapular downward tilt (ScDT) and dynamic scapular lateral rotation (ScLR) in subjects with and without stroke is associated with subluxation, and to prove the reliability of a Scapula Locator System in an elderly population. DESIGN Repeated measures of ScLR by 2 observers. SETTING Outpatient rehabilitation department of a district general hospital. PARTICIPANTS To test device reliability, 5 healthy men (mean age +/- standard deviation, 72 +/- 5 yr). To test scapula position, 30 stroke patients (19 men, 11 women; mean age, 73 +/- 6 yr) and 15 healthy controls (12 men, 3 women; mean age, 62 +/- 6 yr). INTERVENTIONS The control subjects' ScDT was compared with stroke subjects' ScDT after stratification according to 3 patterns of ScLR symmetry and the presence of palpable glenohumeral subluxation. MAIN OUTCOME MEASURES For device reliability, 3-way analysis of variance. For scapula position, triangulated location by Scapula Locator System of acromion, inferior angle, and root of the scapular spine; then measurement of scapula motion to determine symmetry, lag, or lead. RESULTS The inter- and intraobserver reliability of the Scapula Locator System device was high (1% of variance each). Normal ScDT was positive (left side: 10.94 degrees +/- 2.62 degrees; right side: 9.69 degrees +/- 4.36 degrees ), indicating a downward-facing glenoid fossa. This finding was unchanged by stroke (10.46 degrees +/- 2.42 degrees ). All controls and 16 stroke subjects had symmetry between shoulders for ScLR rate and ScDT. Two other patterns (p <.01) of ScLR were found after stroke: 8 subjects had a slower rate of affected arm ScLR (lag) with a correspondingly greater ScDT on the affected side (2.61 degrees +/- 6.7 degrees ); 6 subjects had a faster rate of affected arm ScLR (lead) but with an upward-facing glenoid fossa on the affected side (ScDT: -11.84 degrees +/- 8.48 degrees ). No significant inter- or intrasubject difference in ScDT existed in the 6 cases of glenohumeral subluxation. CONCLUSIONS The scapula normally tilts downward with or without stroke. The effect of stroke is similar on tonic (ScDT) and phasic (ScLR) control of scapula position. Subluxation is not linked with a particular scapular resting position after stroke.
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Affiliation(s)
- C I Price
- North Tyneside General Hospital, North Shields, UK.
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Affiliation(s)
- H Rodgers
- Department of Medicine (Geriatrics) and Department of Epidemiology and Public Health, 21 Claremont Place, The University, Newcastle upon Tyne NE2 4AA, UK
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Chappel D, Bailey J, Stacy R, Rodgers H, Thomson R. Implementation and evaluation of local-level priority setting for stroke. Public Health 2001; 115:21-9. [PMID: 11402348 DOI: 10.1038/sj.ph.1900711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2000] [Indexed: 11/09/2022]
Abstract
We aimed to develop and evaluate a prioritisation process to combine the evidence base with stakeholder involvement within a stroke programme for a Health Improvement Programme (HImP). Implementation involved: formation of a district stroke group (DSG); review of the evidence; survey of DSG members; survey of other key professionals; consensus within the DSG; consultation with local users of the service. Evaluation was through semi-structured interviews and documentary analysis. The process was accepted as appropriate and valuable by the majority of participants, and a district HImP implementation group allocated pound sterling 100 000 for stroke development as a result of this process. However, some felt that stroke itself had been an imposed, rather than an agreed, local priority. The priority setting process was not clear to all participants and change of personnel, particularly in the NHS trusts, led to some perceived lack of ownership. Professionals from secondary care participated, but later criticised the process when they felt that the priorities in the HImP could limit their ability to access money for other service developments. The user consultation days occurred too late to influence the 1999/2002 HImP. We have shown that it is possible to develop an approach that is broadly accepted by stakeholders and balance the evidence base with local ownership. The participation of stakeholders, clarity of procedures, local ownership and awareness of local politics are important in effective priority setting. The model developed will be of value in other settings.
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Affiliation(s)
- D Chappel
- Department of Epidemiology and Public Health, School of Health Sciences, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
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Abstract
Epidemiological studies indicate that the prevalence of "wheeze" is very high in early childhood. However, it is clear that parents and clinicians frequently use the term "wheeze" for a range of audible respiratory noises. The commonest audible sounds originating from the lower airways in infancy are ruttles, which differ from classical wheeze in that the sound is much lower in pitch, with a continuous rattling quality and lacking any musical features. The aim of this study was to clearly differentiate wheeze and ruttles objectively using acoustic analysis. Lung sounds were recorded in 15 infants, seven with wheeze and eight with ruttles, using a small sensitive piezoelectric accelerometer, and information relating to the respiratory cycle was obtained using inductive plethysmography. The acoustic signals were analysed using a fast fourier transformation technique (Respiratory Acoustics Laboratory Environment programme). The acoustic properties of the two noises were shown to be quite distinct, the classical wheeze being characterized by a sinusoidal waveform with one or more distinct peaks in the power spectrum display; the ruttle is represented by an irregular nonsinusoidal waveform with diffuse peaks in the power spectrum and with increased sound intensity at a frequency of <600 Hz. It is important for clinicians and epidemiologists to recognize that there are distinct types of audible respiratory noise in early life with characteristic acoustic properties.
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Affiliation(s)
- H E Elphick
- Paediatric Respiratory Unit, Sheffield Children's Hospital, Western Bank, UK
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Bond J, Gregson B, Smith M, Lecouturier J, Rousseau N, Rodgers H. Predicting place of discharge from hospital for patients with a stroke or hip fracture on admission. J Health Serv Res Policy 2000; 5:133-9. [PMID: 11183623 DOI: 10.1177/135581960000500303] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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: 11/17/2022]
Abstract
OBJECTIVES To determine the predictive power of patient and service characteristics on place of discharge following hospital admission for an acute stroke and for hip fracture. METHODS Prospective cohort of 440 acute stroke and 572 hip fracture patients aged 65 years or over admitted from home to six district general hospitals and associated community hospitals, three in the North and three in the South of England. RESULTS Age, marital status, living arrangements, mental health status at admission, pre-admission self-rated disability, pre-admission use of home-care services, post-admission staff assessments of functional dependency as measured by Barthel Index and of confusion as measured by the modified Crichton Royal Behavioural Rating Scale and nursing staffs' expectation of place of discharge are all significantly related to place of discharge for stroke and hip fracture participants. Logistic regression correctly predicted discharge destination for 87% of stroke patients from data available at time of admission and 83% of hip fracture patients. Of the 30% of stroke patients discharged to an institution, the model correctly predicted 73%. However, of the 19% of hip fracture patients discharged to an institution, only 28% were correctly predicted. CONCLUSIONS Data about older patients admitted to hospital with an acute condition should be routinely collected by hospital staff to inform clinical management and to permit risk-adjusted audit.
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Affiliation(s)
- J Bond
- Centre for Health Services Research, Institute for the Health of the Elderly, University of Newcastle upon Tyne, UK
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Rodgers H, Oliver SE, Dobson R, Thomson RG. A regional collaborative audit of the practice and outcome of carotid endarterectomy in the United Kingdom. Northern Regional Carotid Endarterectomy Audit Group. Eur J Vasc Endovasc Surg 2000; 19:362-9. [PMID: 10801369 DOI: 10.1053/ejvs.1999.1053] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 11/11/2022]
Abstract
OBJECTIVES To evaluate performance and outcome of carotid endarterectomy (CEA) against agreed audit standards within one English health region. Design a prospective collaborative audit over twelve months (November 1994 to October 1995) involving all surgeons undertaking CEA within one English health region. METHODS Audit standards were agreed by all participating surgeons at the outset based on existing national guidelines. Data were abstracted from clinical notes. Outcomes were reviewed by clinicians 30 days post-surgery. A confidential individualised report of the results was provided to each surgeon. A survey of participating surgeons sought to evaluate the audit process. RESULTS Ten surgeons performed 139 CEAs on 134 individuals (64% men). Median per surgeon was 12 (range 1-44). Audit standards were generally achieved: 114 (82%) patients had symptomatic carotid stenosis of 70-99%, 14 (10%) were asymptomatic. The median time from first referral to hospital to operation was 4.8 months (interquartile range 3.0-7.3). The rate of disabling stroke or death at 30 days was 2.2% (95% confidence interval (CI) 0.4-6.4%). Surgeons valued the audit. CONCLUSIONS The study showed that in the study area CEA was performed predominantly on high-risk patients with low subsequent surgical mortality.
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Affiliation(s)
- H Rodgers
- Department of Medicine, The Medical School, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
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Affiliation(s)
- H Rodgers
- Department of Medicine (Geriatrics), University of Newcastle upon Tyne.
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Abstract
OBJECTIVES Clinical studies investigating shoulder complaints have found that active exercises and passive manipulation are not equally effective treatments, perhaps because active and passive movements align the individual shoulder girdle components differently. This study sought to investigate whether a significant difference exists in scapulohumeral rhythm of the healthy shoulder when the humerus is elevated actively or passively. STUDY DESIGN Both shoulders of 10 healthy volunteers (9 men; mean age 50 yrs) were studied using an electromagnetic coordinate system to locate the position of the scapula relative to the humerus and trunk. Scapula position in three dimensions was recorded at 10 degrees intervals during active and passive humeral elevation in the coronal plane between 10 degrees and 50 degrees. Each shoulder was measured three times. RESULTS Analysis of variance showed that in all three planes of scapula movement (lateral rotation, backward tip, and retraction) the components of variance attributable to the differences in active and passive movement were less than 5%. CONCLUSIONS During humeral elevation between 10 degrees and 50 degrees no significant difference exists between active and passive shoulder complex motion in healthy individuals. These findings may help to explain why passive manipulation is an effective treatment for shoulder complaints.
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Affiliation(s)
- C I Price
- North Tyneside General Hospital, North Shields, UK
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Rodgers H, Atkinson C, Bond S, Suddes M, Dobson R, Curless R. Randomized controlled trial of a comprehensive stroke education program for patients and caregivers. Stroke 1999; 30:2585-91. [PMID: 10582982 DOI: 10.1161/01.str.30.12.2585] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.2] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We report the findings of a randomized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program (SEP) for patients and their informal carers. METHODS Two hundred four patients admitted with acute stroke and their 176 informal carers were randomized to receive an invitation to the SEP or to receive conventional stroke unit care. The SEP consisted of one 1-hour small group educational session for inpatients followed by six 1-hour sessions after discharge. The primary outcome measure was patient- and carer-perceived health status (SF-36) at 6 months after stroke. Knowledge of stroke, satisfaction with services, emotional outcome, disability, and handicap and were secondary outcome measures. RESULTS Only 51 of 108 (47%) surviving patients randomized to the SEP completed the program, as did 20 of 93 (22%) informal carers of surviving patients. Perceived health status (Short Form 36 [SF-36] health survey) scores were similar for SEP patients and controls. Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group (P=0.04). Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls (patients, P=0.02; carers, P=0. 01). Patients in the SEP group were more satisfied with the information that they had received about stroke (P=0.004). There were no differences in emotional or functional outcomes between groups. CONCLUSIONS Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services, this was not associated with an improvement in their perceived health status. Indeed, the social functioning of informal carers randomized to the SEP was less than in the control group.
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Affiliation(s)
- H Rodgers
- School of Clinical Medical Science and the School of Health Sciences, University of Newcastle on Tyne, England
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26
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Pandyan AD, Johnson GR, Price CI, Curless RH, Barnes MP, Rodgers H. A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity. Clin Rehabil 1999; 13:373-83. [PMID: 10498344 DOI: 10.1191/026921599677595404] [Citation(s) in RCA: 498] [Impact Index Per Article: 19.9] [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: 11/05/2022]
Abstract
BACKGROUND The Ashworth Scale and the modified Ashworth Scale are the primary clinical measures of spast city. A prerequisite for using any scale is a knowledge of its characteristics and limitations, as these will play a part in analysing and interpreting the data. Despite the current emphasis on treating spasticity, clinicians rarely measure it. OBJECTIVES To determine the validity and the reliability of the Ashworth and modified Ashworth Scales. STUDY DESIGN A theoretical analysis following a structured literature review (key words: Ashworth; Spasticity; Measurement) of 40 papers selected from the BIDS-EMBASE, First Search and Medline databases. CONCLUSIONS The application of both scales would suggest that confusion exists on their characteristics and limitations as measures of spasticity. Resistance to passive movement is a complex measure that will be influenced by many factors, only one of which could be spasticity. The Ashworth Scale (AS) can be used as an ordinal level measure of resistance to passive movement, but not spasticity. The modified Ashworth Scale (MAS) will need to be treated as a nominal level measure of resistance to passive movement until the ambiguity between the '1' and '1+' grades is resolved. The reliability of the scales is better in the upper limb. The AS may be more reliable than the MAS. There is a need to standardize methods to apply these scales in clinical practice and research.
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Affiliation(s)
- A D Pandyan
- Centre for Rehabilitation and Engineering Studies, University of Newcastle upon Tyne, UK.
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Abstract
BACKGROUND AND PURPOSE Visual analogue scales (VAS) have been used for the subjective measurement of mood, pain, and health status after stroke. In this study we investigated how stroke-related impairments could alter the ability of subjects to answer accurately. METHODS Consent was obtained from 96 subjects with a clinical stroke (mean age, 72.5 years; 50 men) and 48 control subjects without cerebrovascular disease (mean age, 71.5 years; 29 men). Patients with reduced conscious level or severe dysphasia were excluded. Subjects were asked to rate the tightness that they could feel on the (unaffected) upper arm after 3 low-pressure inflations with a standard sphygmomanometer cuff, which followed a predetermined sequence (20 mm Hg, 40 mm Hg, 0 mm Hg). Immediately after each change, they rated the perceived tightness on 5 scales presented in a random order: 4-point rating scale (none, mild, moderate, severe), 0 to 10 numerical rating scale, mechanical VAS, horizontal VAS, and vertical VAS. Standard tests recorded deficits in language, cognition, and visuospatial awareness. RESULTS Inability to complete scales with the correct pattern was associated with any stroke (P<0.001). There was a significant association between success using scales and milder clinical stroke subtype (P<0.01). Within the stroke group, logistic regression analysis identified significant associations (P<0.05) between impairments (cognitive and visuospatial) and inability to complete individual scales correctly. CONCLUSIONS Many patients after a stroke are unable to successfully complete self-report measurement scales, including VAS.
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Affiliation(s)
- C I Price
- North Tyneside General Hospital, Departments of Medicine, University of Newcastle, Newcastle Upon Tyne, UK.
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Abstract
BACKGROUND There are limited data available on the prevalence of stroke in the United Kingdom. Such data are important for the assessment of the health needs of the population. This study aimed to determine the prevalence of stroke and the prevalence of associated dependence in a district of northern England. METHODS This was a two-stage point prevalence study. A valid screening questionnaire was used to identify stroke survivors from an age- and sex-stratified sample of the population aged 45 years and over in a family health services authority district. This was followed by assessment of stroke patients with scales of disability and handicap. RESULTS The overall prevalence of stroke was found to be 17.5/1000 (95 per cent confidence interval (CI) 17.0, 18.0). The prevalence of stroke-associated dependence was 11.7/1000 (95 per cent CI 11.3, 12.1). Self-reported comorbidity was most commonly due to circulatory and musculoskeletal disorders. CONCLUSIONS The prevalence of stroke in this district is considerably higher than current guidelines and previous results suggest. Nevertheless, the result from this study combined with that from a previous study in another district in the United Kingdom should allow those interested in epidemiologically based health needs assessment to make reasonable estimates of the burden of stroke in their area.
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Affiliation(s)
- P G O'Mahony
- Department of Medicine (Geriatrics), University of Newcastle, Newcastle upon Tyne
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Sudlow M, Thomson R, Kenny RA, Rodgers H. A community survey of patients with atrial fibrillation: associated disabilities and treatment preferences. Br J Gen Pract 1998; 48:1775-8. [PMID: 10198488 PMCID: PMC1313272] [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: 02/11/2023] Open
Abstract
BACKGROUND Anticoagulants are effective in preventing stroke in those with atrial fibrillation, but most patients remain untreated. AIM To investigate the prevalence of disability, cognitive impairment, and problems with compliance in a representative sample of the elderly with atrial fibrillation, and to determine whether they would want treatment and how they would like services to be arranged. METHOD In a survey of a random sample of 4843 elderly subjects, those with atrial fibrillation were identified using electrocardiograms. Views on treatment were obtained using a structured interview. Disability was assessed using the Office of Population Censuses and Surveys Disability Scale and cognitive status using the Mini Mental State Examination. General practitioners were asked, via questionnaire, for their views on each subject's compliance. RESULTS Two hundred and seven elderly people with atrial fibrillation were identified. Almost all subjects expressed a willingness to undertake treatment to prevent stroke and preferred blood testing performed outside of hospital. Disability (82.7%), cognitive impairment (25.7%), and problems with compliance (25.0%) were common, but the prevalence of these difficulties was not substantially different from the general elderly population, and in many cases they could be overcome (e.g. only 10% of subjects had problems with compliance and no-one who could help them to comply). CONCLUSIONS Most elderly people with atrial fibrillation would accept treatment to prevent stroke. Disability, cognitive impairment, and problems with compliance may make it difficult to treat this patient group. An increase in the use of anticoagulants should be accompanied by the development of services appropriate to this frail population.
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Affiliation(s)
- M Sudlow
- Department of Medicine, School of Clinical Medical Studies, University of Newcastle upon Tyne
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Abstract
BACKGROUND Anticoagulants are effective in the prevention of stroke in atrial fibrillation and flutter (AF). We aimed to find out the prevalence of AF in the UK and to estimate the proportion of patients with AF who might benefit from anticoagulation. METHODS We screened with electrocardiography a random sample of 4843 people from the community aged 65 years and older for AF. Participants with AF had further investigations to identify risk factors for stroke and contraindications to anticoagulants. We used three sets of criteria to assess risk and eligibility for anticoagulation. FINDINGS 228 (4.7%) participants had AF. According to analyses derived from risk stratifications based on the Stroke Prevention in Atrial Fibrillation (SPAF) study 61% of these patients would have benefited from anticoagulation, 49% according to pooled analysis of trial results, and 41% according to the inclusion criteria for the SPAF 3 study. Anticoagulants were used by 1114 (23%) of all patients and were least used among elderly women, who may be the most likely to benefit. Echocardiography would be useful to assess the need for anticoagulation only in patients younger than 75 years with no contraindications to treatment and no clinical risk factors for stroke. INTERPRETATION Anticoagulants seem to be underused and misdirected in treatment of AF, according to various criteria. Efforts to promote and support wider and more appropriate use of anticoagulants would seem to be justified, and should decrease the incidence of stroke amongst elderly patients.
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Affiliation(s)
- M Sudlow
- Department of Medicine, School of Clinical Medical Sciences, University of Newcastle upon Tyne, UK
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Bond J, Gregson B, Smith M, Rousseau N, Lecouturier J, Rodgers H. Outcomes following acute hospital care for stroke or hip fracture: how useful is an assessment of anxiety or depression for older people? Int J Geriatr Psychiatry 1998; 13:601-10. [PMID: 9777424 DOI: 10.1002/(sici)1099-1166(199809)13:9<601::aid-gps827>3.0.co;2-b] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the association between severe life events and mental health outcomes following acute hospital care for older patients with acute stroke or fractured neck of femur. DESIGN Prospective longitudinal survey of stroke and hip fracture patients admitted to hospital from admission to 6-month follow-up. SETTING Six district general hospitals, three in the North and three in the South of England. PARTICIPANTS 642 patients admitted to hospital with an acute stroke (268) or hip fracture (374) resident in a private household at 6 months follow-up. MAIN OUTCOME MEASURES Hospital Anxiety and Depression Scale, cognitive items of the Survey Psychiatric Assessment Scale, Clackmannan Disability Scale, Severe Life Events Inventory, Wenger Social Support Network Typology. RESULTS 47% of 6-month survivors of stroke or hip fracture resident in private households had a possible psychiatric illness: dementia (13%), anxiety or depression (41%). 57% had severe or very severe disability and 48% experienced additional life events (17% two or more) after hospital admission. Severe disability was strongly associated with a higher prevalence of anxiety (p < 0.0005) or depression (p < 0.0001). Social contact was associated with a lower prevalence of anxiety (p < 0.01) or depression (p < 0.0001) and social support network type was strongly associated with depression (p < 0.001) but not anxiety (p = 0.096). Number of severe life events was associated with anxiety (p < 0.001) but not depression (p = 0.058). CONCLUSION Disability is probably a more robust outcome measure than assessments of mental health for older people in uncontrolled studies.
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Affiliation(s)
- J Bond
- School of Health Sciences, University of Newcastle upon Tyne, UK.
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Sudlow M, Rodgers H, Kenny RA, Thomson R. Identification of patients with atrial fibrillation in general practice: a study of screening methods. BMJ 1998; 317:327-8. [PMID: 9685281 PMCID: PMC28628 DOI: 10.1136/bmj.317.7154.327] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M Sudlow
- School of Clinical Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA.
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Sudlow M, Thwaites B, Rodgers H, Thomson R, Kenny R. Atrial Fibrillation or Flutter (AF): Prevalence and Eligibility for Anticoagulants. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_2.51-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Price C, Franklin P, Curless R, Johnson G, Rodgers H. A non-invasive examination ot scapula motion in affected and unaffected shoulders after stroke: correlations with pain, muscle tone and subluxation. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_2.48-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rodgers H, Thomson R, Kenny R, Sudlow M. A Community Survey of Subjects with Atrial Fibrillation (AF): Associated Disabilities and Treatment Preferences. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_2.51-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Dysphagia is a frequent consequence of acute stroke. Previous studies have demonstrated better clinical outcomes for patients managed by dysphagia teams, which have always included a speech and language therapist (SLT). This study compares dysphagia management for stroke patients in two hospitals with differing involvement of SLTs in dysphagia services. There was a trend towards better identification of dysphagia, more complete documentation of nutrition and hydration management, less risky dysphagia management and less perceived need for chest physiotherapy at the hospital with locally-based SLT provision, compared with the hospital with extra-contractual referral (ECR) for SLT dysphagia assessment. The specific contribution of the SLT in the dysphagia team is discussed.
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Affiliation(s)
- C Lucas
- Speech and Language Therapy Department, North Tees General Hospital, Stockton on Tees
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Gani A, Rodgers H, Dobson R, Murphy J, Herd B, James O, Thomson R. The Tees Stroke Register: The Value of Multiple Sources of Case Ascertainment. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_2.54-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sudlow M, Rodgers H, Kenny R, Thomson R. Identification of Patients with Atrial Fibrillation or Flutter (Af) in the Community: A Study of Screening Methods. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_2.47-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Davies D, Oates J, Close P, Rodgers H, James O, Gibson G. Obstructive Sleep Apnoea and Stroke. A Case-Control Study in First-Ever Stroke. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_1.p66-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
INTRODUCTION The Medical Outcomes Study short form 36 health survey (SF-36) is being increasingly used and recommended as a suitable measure of subjective health status. However, it is unlikely that any measure will be appropriate for all groups. We wished to determine the suitability of the SF-36 for assessing quality of life in older stroke patients. METHODS A screening questionnaire was used to identify prevalent cases of stroke from a random sample of 2000 subjects aged 45 years and over. The SF-36 was included as part of a self-completion questionnaire posted to each stroke patient. Data quality indicators were analysed. RESULTS We identified 104 cases of stroke and the response rate for the SF-36 questionnaires sent was 83%. Completion rates for individual items ranged from 66 to 96%. All items in the role physical and role emotional scales had completion rates < 75%. The percentage of subjects for whom an individual scale score could be computed ranged from 67 to 96%, being lowest for the role physical and role emotional scales. Floor effects were high (> 15%) for these two scales and for the social functioning and physical functioning scales. Ceiling effects were substantial (> 15%) for the two role effect scales and for social functioning and bodily pain. CONCLUSIONS This study has shown high response rates from older stroke patients to a postal questionnaire incorporating the SF-36. The poor completion rates and consequent inability to compute scores for a large proportion of responders in certain scales raises concerns about the perceived relevance of these sections. Results for the response effects suggest that, on its own, the instrument is not suitable for assessing outcome. When data quality indicators were examined, it appears that postal administration of the SF-36 is not appropriate for assessing quality of life of older stroke patients.
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Affiliation(s)
- P G O'Mahony
- Department of Medicine (Geriatric Medicine), University of Newcastle, Newcastle upon Tyne, UK
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Rodgers H, Soutter J, Kaiser W, Pearson P, Dobson R, Skilbeck C, Bond J. Early supported hospital discharge following acute stroke: pilot study results. Clin Rehabil 1997; 11:280-7. [PMID: 9408667 DOI: 10.1177/026921559701100403] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [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: 02/05/2023]
Abstract
OBJECTIVE To establish the feasibility and method of evaluation of an early supported hospital discharge policy for patients with acute stroke. DESIGN A randomized controlled trial comparing an early supported discharge service to conventional care. SETTING Three acute hospitals in Newcastle upon Tyne. SUBJECTS Ninety-two eligible patients with acute stroke admitted between 1 February 1995 and 31 January 1996. MAIN OUTCOME MEASURES Placement, length of stay, readmission rates, mortality, functional ability (Nottingham Extended Activities of Daily Living (ADL) Scale), handicap (Oxford Handicap Scale), global health status (Dartmouth Coop Function Charts) and carer stress (General Health Questionnaire 30 item). RESULTS The median length of stay for patients randomized to early supported discharge was 13 days compared to 22 days in the conventional care group (p = 0.02). The median Barthel ADL index at seven days post stroke of patients randomized to early supported discharge was 15, and 13 for those randomized to conventional care (NS). At three months post stroke the median Nottingham EADL score of patients randomized to early supported discharge was 10 compared to 7 for those who received conventional care (NS). There were no statistically significant differences in the global health status of patients or carer stress. CONCLUSION An early supported discharge service following acute stroke with individualized rehabilitation in the community is feasible and can be evaluated by a randomized controlled trial but a larger multicentre trial is needed before such a service is widely adopted.
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Affiliation(s)
- H Rodgers
- School of Health Sciences, Medical School, University of Newcastle, Newcastle upon Tyne, UK
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Smith M, Rousseau N, Lecouturier J, Gregson B, Bond J, Rodgers H. Are older people satisfied with discharge information? Nurs Times 1997; 93:52-3. [PMID: 9386521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this article we report the views of older discharged patients who have had a stroke or have fractured the neck of their femur on the information they were given about their condition and treatment while in hospital. Structured face-to-face interviews carried out 10 days after discharge contained some open-ended questions. Responses to a question on information were coded according to whether they were indicative of satisfaction. These responses were also analysed qualitatively to identify themes: 41% reported satisfaction with information and 40% dissatisfaction. The responses of the remaining 19% could not be coded either way. Views indicative of dissatisfaction were more likely to be expressed by subjects with the poorest outcomes and those who had experienced most ward moves. All staff should be vigilant in ensuring that information is always clearly conveyed to the most frail patients.
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Affiliation(s)
- M Smith
- School of Health Sciences, University of Newcastle upon Tyne
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Gregson BA, Smith M, Lecouturier J, Rousseau N, Rodgers H, Bond J. Issues of recruitment and maintaining high response rates in a longitudinal study of older hospital patients in England--pathways through care study. J Epidemiol Community Health 1997; 51:541-8. [PMID: 9425465 PMCID: PMC1060541 DOI: 10.1136/jech.51.5.541] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 02/05/2023]
Abstract
STUDY OBJECTIVES To describe and discuss the methods used to recruit and maintain an unbiased sample of older discharged hospital patients in a study of the process and outcomes of hospital care. DESIGN Prospective longitudinal interview study of consecutive patients admitted to hospital over a 12 month period and followed up for six months. Interviews took place in hospital five days after admission, at home 10 days after discharge, and six months after admission. SETTING Six hospital locations: three in the north of England and three in the south. PARTICIPANTS People aged 65 and over admitted to hospital with a new stroke or fractured neck of femur, their significant other, and nursing staff caring for them. MAIN RESULTS Of 3105 patients referred to the study, 2111 were eligible and 1671 (79%) were recruited. Recruited stroke patients were younger than those not recruited and rates differed between locations for both stroke and fractured neck of femur. By six months after admission 25% had died. Outcome data were obtained for 85% of the surviving patients. Patients who died were older and frailer before admission. Among survivors, outcome data for stroke patients were less likely to be obtained for men, those more able initially, and those who were married. Response rates to each interview differed according to respondent types. Interviews were more likely to be obtained with significant others than patients. Patients who were not able to be interviewed were older and frailer; significant others were less likely to be interviewed if the patients were younger and more able. CONCLUSIONS High response rates can be achieved with very frail older people if strategies are adopted to maintain their interest and if self reported data are supplemented by interviewing significant others.
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Affiliation(s)
- B A Gregson
- School of Health Sciences and Institute for the Health of the Elderly, University of Newcastle upon Tyne
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Pfeffer N, Alderson P, Campbell H, Boyd KM, Surry SAM, Cullinan T, Squire SB, Hawley R, Macfarlane S, Agbaje S, Beeching NJ, Wyatt GB, Koning KD, Gray N, Hayward C, Ali A, Bianco AE, Taylor M, Brabin B, Coulter JBS, Daly MDB, Elbourne D, Snowdon C, Garcia J, Epstein K, Sloat B, Mohanna K, Woodcock T, Norman J, Sikorski J, Watson R, Wilson P, House A, Knapp P, Williamson C, Sutton GC, Garvican L, Wilson R, Malin A, Lockwood D, Mhlongo SWP, Mdingi GV, Ashcroft R, Toth B, Mant J, Winner S, Carter J, Wade DT, Stott DJ, Langhorne P, Rodgers H, Rutter D, Brewin T, Barer D. Informed consent. BMJ 1997. [DOI: 10.1136/bmj.315.7102.247] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stott DJ, Langhorne P, Rodgers H. Informed consent. Two stage randomisation and consent would overcome many problems. BMJ 1997; 315:253. [PMID: 9253294 PMCID: PMC2127142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Sudlow M, Rodgers H, Kenny RA, Thomson R. Population based study of use of anticoagulants among patients with atrial fibrillation in the community. BMJ 1997; 314:1529-30. [PMID: 9183202 PMCID: PMC2126760 DOI: 10.1136/bmj.314.7093.1529] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M Sudlow
- Department of Medicine, Medical School, University of Newcastle upon Tyne
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Rodgers H, Sudlow M, Dobson R, Kenny RA, Thomson RG. Warfarin anticoagulation in primary care: a regional survey of present practice and clinicians' views. Br J Gen Pract 1997; 47:309-10. [PMID: 9219409 PMCID: PMC1313007] [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: 02/04/2023] Open
Abstract
The demand for anticoagulation services is rising. Warfarin anticoagulation has been shown to reduce the risk of stroke in patients with non-valvular atrial fibrillation by 68%. This raises issues about how services are best organized to initiate and monitor anticoagulation in this potentially large group of patients. We report the results of a regional postal survey undertaken to describe the views of general practitioners and consultants regarding warfarin anticoagulation in light of this potentially high increase in demand.
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Affiliation(s)
- H Rodgers
- Department of Medicine, University of Newcastle upon Tyne
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Bhopal R, Rankin J, McColl E, Thomas L, Kaner E, Stacy R, Pearson P, Vernon B, Rodgers H. The vexed question of authorship: views of researchers in a British medical faculty. BMJ 1997; 314:1009-12. [PMID: 9112845 PMCID: PMC2126416] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess knowledge, views, and behaviour of researchers on criteria for authorship and causes and control of gift authorship. DESIGN Interview survey of stratified sample of researchers. SETTING University medical faculty. SUBJECTS 66 staff (94% response rate) comprising several levels of university academic and research appointments. MAIN OUTCOME MEASURES Awareness and use of criteria for authorship, views on which contributions to research merit authorship, perceptions about gift authorship and strategies for reducing it, and experiences of authorship problems. RESULTS 50 (76%) respondents supported criteria for authorship, but few knew about or used available criteria. Of the five people who could specify all three criteria of the International Committee of Medical Journal Editors, only one knew that all criteria had to be met. Forty one respondents (62%) disagreed with this stipulation. A range of practical and academic contributions were seen as sufficient for authorship. Gift authorship was perceived as common, promoted by pressure to publish, to motivate research teams, and to maintain working relationships. A signed statement justifying authorship and a published statement of the contribution of each author were perceived as practical ways of tackling gift authorship. Most researchers had experienced problems with authorship, most commonly the perception that authorship had been deserved but not awarded (49%). CONCLUSION There seems to be a gap between editors' criteria for authorship and researchers' practice. Lack of awareness of criteria is only a partial explanation. Researchers give more weight than editors to practical research contributions. Future criteria should be agreed by researchers and not be imposed by editors.
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Affiliation(s)
- R Bhopal
- Department of Epidemiology and Public Health, School of Health Sciences, University of Newcastle, Newcastle Upon Tyne
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