1
|
Manoukian S, Mason H, Hagen S, Kearney R, Goodman K, Best C, Elders A, Melone L, Dwyer L, Dembinsky M, Khunda A, Guerrero KL, McClurg D, Norrie J, Thakar R, Bugge C. Cost-effectiveness of 2 Models of Pessary Care for Pelvic Organ Prolapse: Findings From the TOPSY Randomized Controlled Trial. Value Health 2024:S1098-3015(24)00118-9. [PMID: 38492924 DOI: 10.1016/j.jval.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Pelvic organ prolapse is the descent of one or more reproductive organs from their normal position, causing associated negative symptoms. One conservative treatment option is pessary management. This study aimed to to investigate the cost-effectiveness of pessary self-management (SM) when compared with clinic-based care (CBC). A decision analytic model was developed to extend the economic evaluation. METHODS A randomized controlled trial with health economic evaluation. The SM group received a 30-minute SM teaching session, information leaflet, 2-week follow-up call, and a local helpline number. The CBC group received routine outpatient pessary appointments, determined by usual practice. The primary outcome for the cost-effectiveness analysis was incremental cost per quality-adjusted life year (QALY), 18 months post-randomization. Uncertainty was handled using nonparametric bootstrap analysis. In addition, a simple decision analytic model was developed using the trial data to extend the analysis over a 5-year period. RESULTS There was no significant difference in the mean number of QALYs gained between SM and CBC (1.241 vs 1.221), but mean cost was lower for SM (£578 vs £728). The incremental net benefit estimated at a willingness to pay of £20 000 per QALY gained was £564, with an 80.8% probability of cost-effectiveness. The modeling results were consistent with the trial analysis: the incremental net benefit was estimated as £4221, and the probability of SM being cost-effective at 5 years was 69.7%. CONCLUSIONS Results suggest that pessary SM is likely to be cost-effective. The decision analytic model suggests that this result is likely to persist over longer durations.
Collapse
Affiliation(s)
- Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University.
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University
| | | | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University
| | - Catherine Best
- Faculty of Health Sciences and Sport, University of Stirling
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University
| | - Lynn Melone
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University
| | - Lucy Dwyer
- Manchester University NHS Foundation Trust
| | - Melanie Dembinsky
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University
| | | | | | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh
| | | | - Carol Bugge
- Department of Nursing and Community Health, Glasgow Caledonian University
| |
Collapse
|
2
|
Mitchell EJ, Campbell E, Goodman K, Taylor J, Youssouf NFJ, Wakefield N. Time for a proper career pathway for clinical trial managers? Trials 2023; 24:565. [PMID: 37658456 PMCID: PMC10472544 DOI: 10.1186/s13063-023-07598-1] [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] [Received: 07/11/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023] Open
Affiliation(s)
- E J Mitchell
- Nottingham Clinical Trials Unit, Applied Health Research Building, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - E Campbell
- Nottingham Clinical Trials Unit, Applied Health Research Building, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - K Goodman
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0NA, UK
| | - J Taylor
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - N F J Youssouf
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - N Wakefield
- Nottingham Clinical Trials Unit, Applied Health Research Building, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| |
Collapse
|
3
|
Graham M, Goodman K. Commentary on my personal experience of patient and public involvement in the TOPSY trial. Trials 2023; 24:228. [PMID: 36964637 PMCID: PMC10038772 DOI: 10.1186/s13063-023-07254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Affiliation(s)
| | - Kirsteen Goodman
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
| |
Collapse
|
4
|
Dwyer L, Bugge C, Hagen S, Goodman K, Agur W, Dembinsky M, Graham M, Guerrero K, Hemming C, Khunda A, McClurg D, Melone L, Thakar R, Kearney R. Theoretical and practical development of the TOPSY self-management intervention for women who use a vaginal pessary for pelvic organ prolapse. Trials 2022; 23:742. [PMID: 36064727 PMCID: PMC9446823 DOI: 10.1186/s13063-022-06681-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pelvic organ prolapse (POP) is a common condition in women, where the downward descent of pelvic organs into the vagina causes symptoms which impacts quality of life. Vaginal pessaries offer an effective alternative to surgery for the management of POP. However, the need for regular follow-up can be burdensome for women and requires significant healthcare resources. The TOPSY study is a randomised controlled trial which aims to determine the clinical and cost-effectiveness of self-management of vaginal pessaries. This paper describes the theoretical and practical development of the self-management intervention. Methods The intervention was developed using the MRC complex intervention framework, normalisation process theory (NPT) and self-management theory. The intervention aims to boost perceived self-efficacy in accordance with Bandura’s social cognitive theory and is guided by the tasks and skills Lorig and Hollman describe as necessary to self-manage a health condition. Results The TOPSY intervention was designed to support women to undertake the medical management, role management and emotional management of their pessary. The six self-management skills described by Lorig and Hollman: problem-solving, decision-making, resource utilisation, formation of a patient-provider partnership role, action planning and self-tailoring, are discussed in detail, including how women were supported to achieve each task within the context of pessary self-management. The TOPSY intervention includes a self-management support session with a pessary practitioner trained in intervention delivery, a follow-up phone call 2 weeks later and ongoing telephone or face-to-face support as required by the woman initiated by contacting a member of the research team. Conclusions The TOPSY study intervention was developed utilising the findings from a prior service development project, intervention development and self-efficacy theory, relevant literature, clinician experience and feedback from pessary using women and members of the public. In 2022, the findings of the TOPSY study will provide further evidence to inform this important aspect of pessary management. Trial registration ISRCTN Registry ISRCTN62510577. Registered on June 10, 2017
Collapse
Affiliation(s)
- Lucy Dwyer
- The Warrell Unit, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Carol Bugge
- Health Sciences & Sport, University of Stirling, Stirling, UK
| | - Suzanne Hagen
- Nursing, Midwifery & Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Kirsteen Goodman
- Nursing, Midwifery & Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Wael Agur
- NHS Ayrshire & Arran, Crosshouse Hospital, Kilmarnock, UK.,School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | | | | | - Karen Guerrero
- Department of Urogynaecology, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Christine Hemming
- Aberdeen Maternity Hospital & Aberdeen Royal Infirmary, Grampian University Hospitals NHS Trust, Aberdeen, UK
| | - Aethele Khunda
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Doreen McClurg
- Nursing, Midwifery & Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lynn Melone
- Nursing, Midwifery & Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Ranee Thakar
- Croydon Health Services NHS Trust, Croydon University Hospital, Croydon, UK
| | - Rohna Kearney
- The Warrell Unit, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | |
Collapse
|
5
|
Mitchell EJ, Goodman K, Wakefield N, Cochran C, Cockayne S, Connolly S, Desai R, Hartley S, Lawton SA, Oatey K, Rhodes S, Savage JS, Taylor J, Youssouf NFJ. Clinical trial management: a profession in crisis? Trials 2022; 23:357. [PMID: 35477835 PMCID: PMC9044377 DOI: 10.1186/s13063-022-06315-8] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Clinical trial managers play a vital role in the design and conduct of clinical trials in the UK. There is a current recruitment and retention crisis for this specialist role due to a complex set of factors, most likely to have come to a head due to the COVID-19 pandemic. Academic clinical trial units and departments are struggling to recruit trial managers to vacant positions, and multiple influences are affecting the retention of this highly skilled workforce. Without tackling this issue, we face major challenges in the delivery on the Department of Health and Social Care's Future of UK Clinical Research Delivery implementation plan. This article, led by a leading network of and for UK Trial Managers, presents some of the issues and ways in which national stakeholders may be able to address this.
Collapse
Affiliation(s)
- E J Mitchell
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - K Goodman
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0NA, UK
| | - N Wakefield
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - C Cochran
- Centre for Healthcare and Randomised Controlled Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, AB23 2ZD, UK
| | - S Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - S Connolly
- Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - R Desai
- King's Ophthalmology Research Unit, King's College Hospital, London, SE5 9RS, UK
| | - S Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - S A Lawton
- Keele Clinical Trials Unit, School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - K Oatey
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, EH16 4UX, UK
| | - S Rhodes
- Exeter Clinical Trials Unit, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - J S Savage
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - J Taylor
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - N F J Youssouf
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
6
|
Bihari A, Goodman K, Wine E, Kroeker K. A65 PREDICTING TRANSITION SUCCESS IN YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE: PRELIMINARY RESULTS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859389 DOI: 10.1093/jcag/gwab049.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Patients diagnosed with inflammatory bowel disease (IBD) in childhood present more often with extensive disease, are more likely to be admitted to hospital and are less adherent with clinic appointments. Due to these risks, a smooth, uninterrupted transition from pediatric to adult care should be a priority. We have conducted interviews with providers, patients, and parents about their opinions on indicators of successful transition. Themes of successful transition that emerged included independence in seeking care and disease management. Characterizing successful transition based on stakeholder input makes it possible to monitor its achievement and identify its determinants. Aims This study aims to: 1) describe the frequency of success indicators in transitioned patients and 2) identify predictors associated with success indicators. We hypothesize that patients with more experience in pediatric care (e.g., younger age at diagnosis or on biologics) are more likely to achieve success. Methods We conducted a retrospective medical chart review to obtain data on patients who transitioned to adult care between January, 2014 - September, 2019 at the University of Alberta. We abstracted potential predictors, including social and disease factors, at first adult appointment which had notes on pediatric history. We chose available success indicators related to two themes: independence in seeking care (e.g., attending appointments, communicating for oneself) and disease management (e.g., lab work frequency and medication adherence). We abstracted selected success indicators within a two-year period from first appointment in adult care. We used Poisson and logistic regression to estimate incidence rate ratios (IR) and odds ratios (OR) for the association of potential predictors with success indicators. Results We reviewed medical charts of 99 patients. At first adult appointment, the median age at diagnosis was 14.5 years old (IQR: 13.2 – 15.9) and 57.6% of patients were on biologic agents. Within two years, 42.4% of patients required a change to a different therapy, 22.2% had at least two instances where a parent called on their behalf, and 16.2% had notes of medication nonadherence in adult care. Regression analysis (Table 1) estimated that patients who lived > 100km from clinic had a lab work incidence rate in the first year that was two-thirds that of patients who lived closer. Strong predictors of non-adherence in adult care included chart notes on pediatric medication non-adherence (OR~12) and, inversely, taking biologics (OR=0.34). Conclusions These results identified factors that could be used to identify patients likely to have poor outcomes following transition to adult care. These are preliminary results; we plan to analyze a total of 350 medical charts. ![]()
Funding Agencies None
Collapse
Affiliation(s)
- A Bihari
- University of Alberta, Edmonton, AB, Canada
| | - K Goodman
- University of Alberta, Edmonton, AB, Canada
| | - E Wine
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - K Kroeker
- University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
7
|
Piper M, Van Court B, Mueller A, Nguyen D, Gadwa J, Bickett T, Schulick R, Messersmith W, Del Chiaro M, Goodman K, Dent A, Kedl R, Lenz L, Karam S. P-218 STAT3 signaling inhibition in regulatory T cells improves immune response to RT in PDAC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.272] [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] Open
|
8
|
Bihari A, Hamidi N, Seow C, Goodman K, Wine E, Kroeker K. A98 DEFINING TRANSITION SUCCESS ACCORDING TO YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The incidence of childhood-onset inflammatory bowel disease (IBD) diagnoses is increasing in Canada; therefore, more patients will need to transition from pediatric into adult care. The literature on transition in IBD patients has focused mainly on preparation and while transition success is often referenced, it is not clearly defined. Prior research on IBD transition success has only focused on the perspectives of the health care providers. Taking into consideration that transition is a process that greatly relies on patient involvement, patient perspectives should be represented in defining its success.
Aims
The primary aim is to understand patients’ perspectives on the outcomes that characterize a successful transition from pediatric to adult care.
Methods
This study paired a theoretical position of naturalistic inquiry with the method of qualitative description. Purposive sampling was used to recruit patients from IBD clinics at the University of Alberta and the University of Calgary. Inclusion criteria included transition within the last two years, diagnoses with IBD for at least a year prior to transitioning, and absence of comorbidities. Virtual semi-structured interviews were conducted using an established interview guide. Interviews were transcribed verbatim and then analyzed concurrently with data collection by latent content analysis using NVivo computer software. Participant recruitment and data analysis continued until no further themes emerged from the data, which signaled that thematic saturation was achieved.
Results
Thematic saturation was achieved after 17 interviews. Among participants, 58.8% were female; 47% had a diagnosis of Crohn’s, 47% of ulcerative colitis, and one individual was diagnosed with both. The median age at diagnosis was 15 years (IQR, 3.5). The majority (94%) of participants viewed their transition as being successful. Overall, the major themes that emerged from the data were: 1. relationship with one’s adult care team, characterized predominantly as the patient being comfortable with their new team; 2. health outcomes, characterized by disease remaining stable, and medication adherence; 3. independence in one’s care, characterized by making and attending appointments on their own, asking questions and in general having an awareness about your health and disease; 4. care stability, characterized by no drop off in care, and regular contact and follow up by their provider.
Conclusions
Young adults with IBD define pediatric transition success in four themes: relationship with care team, health outcomes, independence in one’s care, and care stability. Through understanding what transition success looks like from the patients’ perspectives, health care providers can help patients achieve success as they define it.
Funding Agencies
None
Collapse
Affiliation(s)
- A Bihari
- University of Alberta, Edmonton, AB, Canada
| | - N Hamidi
- University of Calgary, Calgary, AB, Canada
| | - C Seow
- University of Calgary, Calgary, AB, Canada
| | - K Goodman
- University of Alberta, Edmonton, AB, Canada
| | - E Wine
- University of Alberta, Edmonton, AB, Canada
| | - K Kroeker
- University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
9
|
Harris J, Goodman K, Haghandish A, Martin C, King J. Cardiac tele-rehabilitation programs: a study of women participation in rural settings. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2020.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
10
|
Bugge C, Kearney R, Dembinsky M, Khunda A, Graham M, Agur W, Breeman S, Dwyer L, Elders A, Forrest M, Goodman K, Guerrero K, Hemming C, Mason H, McClurg D, Melone L, Norrie J, Thakar R, Hagen S. The TOPSY pessary self-management intervention for pelvic organ prolapse: a study protocol for the process evaluation. Trials 2020; 21:836. [PMID: 33032651 PMCID: PMC7542744 DOI: 10.1186/s13063-020-04729-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 09/08/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Process evaluations have become a valued component, alongside clinical trials, of the wider evaluation of complex health interventions. They support understanding of implementation, and fidelity, related to the intervention and provide valuable insights into what is effective in a practical setting by examining the context in which interventions are implemented. The TOPSY study consists of a large multi-centre randomised controlled trial comparing the effectiveness of pessary self-management with clinic-based care in improving women's condition-specific quality of life, and a nested process evaluation. The process evaluation aims to examine and maximise recruitment to the trial, describe intervention fidelity and explore participants' and healthcare professionals' experiences. METHODS The trial will recruit 330 women from approximately 17 UK centres. The process evaluation uses a mixed-methods approach. Semi-structured interviews will be conducted with randomised women (18 per randomised group/n = 36), women who declined trial participation but agreed to interview (non-randomised women) (n = 20) and healthcare professionals recruiting to the trial (n ~ 17) and delivering self-management and clinic-based care (n ~ 17). The six internal pilot centres will be asked to record two to three recruitment discussions each (total n = 12-18). All participating centres will be asked to record one or two self-management teaching appointments (n = 30) and self-management 2-week follow-up telephone calls (n = 30). Process data (quantitative and qualitative) will be gathered in participant completed trial questionnaires. Interviews will be analysed thematically and recordings using an analytic grid to identify fidelity to the intervention. Quantitative analysis will be predefined within the process evaluation analysis plan. DISCUSSION The wide variety of pessary care delivered across the UK for women with pelvic organ prolapse presents specific localised contexts in which the TOPSY interventions will be implemented. Understanding this contextual variance is central to understanding how and in what circumstances pessary self-management can be implemented (should it be effective). The inclusion of non-randomised women provides an innovative way of collecting indispensable information about eligible women who decline trial participation, allowing broader contextualisation and considerations of generalisability of trial findings. Methodological insights from examination of recruitment processes and mechanisms have the potential to inform recruitment mechanisms and future recruitment strategies and study designs. TRIAL REGISTRATION ISRCTN62510577 . Registered on 6 October 2017.
Collapse
Affiliation(s)
- Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.
| | - Rohna Kearney
- The Warrell Unit, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Faculty of Biology Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Melanie Dembinsky
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Aethele Khunda
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Margaret Graham
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Wael Agur
- NHS Ayrshire & Arran, Crosshouse Hospital, School of Medicine, Dentistry & Nursing, University of Glasgow, Kilmarnock, UK
| | - Suzanne Breeman
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Lucy Dwyer
- The Warrell Unit, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Mark Forrest
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Karen Guerrero
- Department of Urogynaecology, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Christine Hemming
- Grampian University Hospitals NHS Trust, Aberdeen Maternity Hospital & Aberdeen Royal Infirmary, Aberdeen, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lynn Melone
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - John Norrie
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Ranee Thakar
- Croydon Health Services NHS Trust, Croydon University Hospital, Croydon, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
11
|
Hagen S, Kearney R, Goodman K, Melone L, Elders A, Manoukian S, Agur W, Best C, Breeman S, Dembinsky M, Dwyer L, Forrest M, Graham M, Guerrero K, Hemming C, Khunda A, Mason H, McClurg D, Norrie J, Karachalia-Sandri A, Thakar R, Bugge C. Clinical and cost-effectiveness of vaginal pessary self-management compared to clinic-based care for pelvic organ prolapse: protocol for the TOPSY randomised controlled trial. Trials 2020; 21:837. [PMID: 33032644 PMCID: PMC7542756 DOI: 10.1186/s13063-020-04738-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background Pelvic organ prolapse (or prolapse) is a common condition in women where the pelvic organs (bladder, bowel or womb) descend into the vagina and cause distressing symptoms that adversely affect quality of life. Many women will use a vaginal pessary to treat their prolapse symptoms. Clinic-based care usually consists of having a pessary fitted in a primary or secondary care setting, and returning approximately every 6 months for healthcare professional review and pessary change. However, it is possible that women could remove, clean and re-insert their pessary themselves; this is called self-management. This trial aims to assess if self-management of a vaginal pessary is associated with better quality of life for women with prolapse when compared to clinic-based care. Methods This is a multicentre randomised controlled trial in at least 17 UK centres. The intervention group will receive pessary self-management teaching, a self-management information leaflet, a follow-up phone call and access to a local telephone number for clinical support. The control group will receive the clinic-based pessary care which is standard at their centre. Demographic and medical history data will be collected from both groups at baseline. The primary outcome is condition-specific quality of life at 18 months’ post-randomisation. Several secondary outcomes will also be assessed using participant-completed questionnaires. Questionnaires will be administered at baseline, 6, 12 and 18 months’ post-randomisation. An economic evaluation will be carried out alongside the trial to evaluate cost-effectiveness. A process evaluation will run parallel to the trial, the protocol for which is reported in a companion paper. Discussion The results of the trial will provide robust evidence of the effectiveness of pessary self-management compared to clinic-based care in terms of improving women’s quality of life, and of its cost-effectiveness. Trial registration ISRCTN Registry ISRCTN62510577. Registered on June 10, 2017.
Collapse
Affiliation(s)
- Suzanne Hagen
- Research Unit, Glasgow Caledonian University, Glasgow, UK.
| | - Rohna Kearney
- The Warrell Unit, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,University Institute of Human Development, Faculty of Medical Human Sciences, University of Manchester, Manchester, UK
| | | | - Lynn Melone
- Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Wael Agur
- NHS Ayrshire & Arran, Crosshouse Hospital, Kilmarnock, UK.,School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Catherine Best
- NMAHP Research Unit, unit 13 Scion House, University of Stirling Innovation Park, Stirling, UK
| | - Suzanne Breeman
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | | | - Lucy Dwyer
- The Warrell Unit, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,University Institute of Human Development, Faculty of Medical Human Sciences, University of Manchester, Manchester, UK
| | - Mark Forrest
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Margaret Graham
- Patient and Public Involvement (PPI) representative, Dunlop, UK
| | - Karen Guerrero
- Department of Urogynaecology, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Christine Hemming
- Aberdeen Maternity Hospital & Aberdeen Royal Infirmary, Grampian University Hospitals NHS Trust, Aberdeen, UK
| | - Aethele Khunda
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Doreen McClurg
- Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - John Norrie
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | | | - Ranee Thakar
- Croydon Health Services NHS Trust, Croydon University Hospital, Croydon, UK
| | - Carol Bugge
- Health Sciences & Sport, University of Stirling, Stirling, UK
| |
Collapse
|
12
|
Cronin O, Subedi D, Forsyth L, Goodman K, Lewis SC, Keerie C, Walker A, Porteous M, Cetnarskyj R, Ranganath LR, Selby PL, Hampson G, Chandra R, Ho S, Tobias JH, Young-Min SA, McKenna MJ, Crowley RK, Fraser WD, Tang J, Gennari L, Nuti R, Brandi ML, Del Pino-Montes J, Devogelaer JP, Durnez A, Isaia GC, Di Stefano M, Rubio JB, Guanabens N, Seibel MJ, Walsh JP, Kotowicz MA, Nicholson GC, Duncan EL, Major G, Horne A, Gilchrist NL, Ralston SH. Characteristics of Early Paget's Disease in SQSTM1 Mutation Carriers: Baseline Analysis of the ZiPP Study Cohort. J Bone Miner Res 2020; 35:1246-1252. [PMID: 32176830 DOI: 10.1002/jbmr.4007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/25/2020] [Accepted: 03/10/2020] [Indexed: 12/26/2022]
Abstract
Mutations in SQSTM1 are strongly associated with Paget's disease of bone (PDB), but little is known about the clinical characteristics of those with early disease. Radionuclide bone scans, biochemical markers of bone turnover, and clinical characteristics were analyzed in SQSTM1 mutation carriers who took part in the Zoledronic acid in the Prevention of Paget's disease (ZiPP) study. We studied 222 individuals, of whom 54.9% were female, with mean ± SE age of 50.1 ± 0.6 years. Twelve SQSTM1 mutations were observed, including p.Pro392Leu, which was present in 141 of 222 (63.5%) subjects. Bone scan examination revealed evidence of PDB in 20 subjects (9.0%), ten of whom (50%) had a single affected site. Participants with lesions were older than those without lesions but the difference was not significant (53.6 ± 9.1 versus 49.8 ± 8.9; p = .07). The mean age of participants with lesions was not significantly different from the age at which their parents were diagnosed with PDB (55 years versus 59 years, p = .17). All individuals with lesions were asymptomatic. Serum concentrations of total alkaline phosphatase (ALP) normalized to the upper limit of normal in each center were higher in those with lesions (0.75 ± 0.69 versus 0.42 ± 0.29 arbitary units; p < .0001). Similar findings were observed for other biochemical markers of bone turnover, but the sensitivity of ALP and other markers in detecting lesions was poor. Asymptomatic PDB is present in about 9% of SQSTM1 mutation carriers by the fifth decade. Further follow-up of this cohort will provide important information on the natural history of early PDB and its response to treatment. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Owen Cronin
- Rheumatic Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Deepak Subedi
- Department of Radiology and Nuclear Medicine, Western General Hospital, Edinburgh, UK
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Nine Edinburgh Bioquarter, Edinburgh, UK
| | - Kirsteen Goodman
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Nine Edinburgh Bioquarter, Edinburgh, UK
| | - Steff C Lewis
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Nine Edinburgh Bioquarter, Edinburgh, UK
| | - Catriona Keerie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Nine Edinburgh Bioquarter, Edinburgh, UK
| | - Allan Walker
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Nine Edinburgh Bioquarter, Edinburgh, UK
| | - Mary Porteous
- South East Scotland Molecular Genetics Service, Western General Hospital, Edinburgh, UK
| | | | | | - Peter L Selby
- Department of Medicine, Manchester Royal Infirmary, Manchester, UK
| | - Geeta Hampson
- Department of Chemical Pathology and Metabolic Bone Clinic, Department of Rheumatology, Guy's and St. Thomas' Hospital, London, UK
| | - Rama Chandra
- Clinical Biochemistry, King's College Hospital, London, UK
| | - Shu Ho
- The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, UK
| | - Jon H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Malachi J McKenna
- Endocrinology Department, St. Vincent's University Hospital, Dublin, Republic of Ireland.,St Vincent's University Hospital and University College Dublin, Dublin, Republic of Ireland
| | - Rachel K Crowley
- Endocrinology Department, St. Vincent's University Hospital, Dublin, Republic of Ireland.,St Vincent's University Hospital and University College Dublin, Dublin, Republic of Ireland
| | - William D Fraser
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jonathan Tang
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Sienna, Sienna, Italy
| | - Rannuccio Nuti
- Department of Medicine, Surgery and Neurosciences, University of Sienna, Sienna, Italy
| | - Maria-Luisa Brandi
- Department of Internal Medicine, University Hospital of Careggi, Florence, Italy
| | | | | | - Anne Durnez
- Clinique Universitaires Saint-Luc, Brussels, Belgium
| | - Giovanni Carlo Isaia
- Geriatrics and Metabolic Bone Diseases, AOU San Giovanni Battista di Torino Corso, Torino, Italy
| | - Marco Di Stefano
- Geriatrics and Metabolic Bone Diseases, AOU San Giovanni Battista di Torino Corso, Torino, Italy
| | | | - Nuria Guanabens
- Department of Rheumatology, Hospital Clinic, CIBERehd, Barcelona, Spain
| | - Markus J Seibel
- Department of Endocrinology and Metabolism, Concord Repatriation General Hospital, Sydney, Australia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia.,Medical School, The University of Western Australia, Crawley, Australia
| | - Mark A Kotowicz
- Department of Endocrinology and Diabetes, Deakin University, Geelong, Australia
| | - Geoffrey C Nicholson
- Rural Clinical School Research Centre, Darlin Heights, The University of Queensland, Brisbane, Australia
| | - Emma L Duncan
- Endocrinology Department, Royal Brisbane and Woman's Hospital, Herston, Australia.,Translational Genomics Group, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - Gabor Major
- Rheumatology, Bone and Joint Institute, Royal Newcastle Center, New Lambton Heights, Australia.,University of Newcastle, Callaghan, Australia
| | - Anne Horne
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nigel L Gilchrist
- The CGM Research Trust, The Princess Margaret Hospital, Christchurch, New Zealand
| | - Stuart H Ralston
- Rheumatic Diseases Unit, Western General Hospital, Edinburgh, UK.,Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Nine Edinburgh Bioquarter, Edinburgh, UK.,Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| |
Collapse
|
13
|
Crowley E, Treweek S, Banister K, Breeman S, Constable L, Cotton S, Duncan A, El Feky A, Gardner H, Goodman K, Lanz D, McDonald A, Ogburn E, Starr K, Stevens N, Valente M, Fernie G. Using systematic data categorisation to quantify the types of data collected in clinical trials: the DataCat project. Trials 2020; 21:535. [PMID: 32546192 PMCID: PMC7298750 DOI: 10.1186/s13063-020-04388-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data collection consumes a large proportion of clinical trial resources. Each data item requires time and effort for collection, processing and quality control procedures. In general, more data equals a heavier burden for trial staff and participants. It is also likely to increase costs. Knowing the types of data being collected, and in what proportion, will be helpful to ensure that limited trial resources and participant goodwill are used wisely. AIM The aim of this study is to categorise the types of data collected across a broad range of trials and assess what proportion of collected data each category represents. METHODS We developed a standard operating procedure to categorise data into primary outcome, secondary outcome and 15 other categories. We categorised all variables collected on trial data collection forms from 18, mainly publicly funded, randomised superiority trials, including trials of an investigational medicinal product and complex interventions. Categorisation was done independently in pairs: one person having in-depth knowledge of the trial, the other independent of the trial. Disagreement was resolved through reference to the trial protocol and discussion, with the project team being consulted if necessary. KEY RESULTS Primary outcome data accounted for 5.0% (median)/11.2% (mean) of all data items collected. Secondary outcomes accounted for 39.9% (median)/42.5% (mean) of all data items. Non-outcome data such as participant identifiers and demographic data represented 32.4% (median)/36.5% (mean) of all data items collected. CONCLUSION A small proportion of the data collected in our sample of 18 trials was related to the primary outcome. Secondary outcomes accounted for eight times the volume of data as the primary outcome. A substantial amount of data collection is not related to trial outcomes. Trialists should work to make sure that the data they collect are only those essential to support the health and treatment decisions of those whom the trial is designed to inform.
Collapse
Affiliation(s)
- Evelyn Crowley
- Health Research Board Clinical Research Facility, University of Cork, Cork, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Suzanne Breeman
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Lynda Constable
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anne Duncan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Adel El Feky
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Doris Lanz
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Emma Ogburn
- Primary Care Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Kath Starr
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Natasha Stevens
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Marie Valente
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gordon Fernie
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
14
|
Mitchell E, Goodman K, Hartley S, Hickey H, McDonald AM, Meadows HM, Rhodes S, Taylor J, Wakefield N, Farrell B. Where do we go from here? - Opportunities and barriers to the career development of trial managers: a survey of UK-based trial management professionals. Trials 2020; 21:384. [PMID: 32375851 PMCID: PMC7203789 DOI: 10.1186/s13063-020-04316-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Clinical trials commonly have a dedicated trial manager and effective trial management is essential to the successful delivery of high-quality trials. Trial managers have diverse experience and currently there is no standardised structured career pathway. The UK Trial Managers’ Network (UKTMN) surveyed its members to understand what is important to them with respect to career development since this would be important in the development of any initiative intended to develop a skilled workforce. Methods We conducted an online survey of UKTMN members, who are trial management professionals, working on academic-led trials in the UK. Members were asked what they perceive as opportunities and barriers to career development. Two reminders were sent to facilitate completion of the survey, and responders were offered the opportunity to enter a prize draw for waived fees at the UKTMN annual meeting. Data were analysed descriptively by using Stata (version 15.1), and free-text responses were reviewed for themes. Results The survey was sent to 819 UKTMN members; 433 responses were received, although 13 were from non-UKTMN members; thus 420 respondents' data were included in analyses. Respondents were representative of UKTMN membership; however, more responses were received by trial managers based in registered clinical trials units (CTUs). The top three opportunities for career development were (i) training, (ii) helping design trials and (iii) undertaking relevant qualifications. The top three barriers were (i) funding, (ii) few opportunities to get involved in development activities aside from managing a trial and (iii) unclear organisational career pathway. Almost all respondents (401/420, 95.4%) considered career development either very or quite important. Although all respondents had a day-to-day role in managing trials, there was huge disparity between job titles. Conclusion Career development is important to trial managers yet there is a lack of a structured pathway. The enablers and disablers to career development for trial managers should be clearly considered by the clinical trial community and, in particular, employers, sponsors and funders in order to develop a highly skilled workforce of trial managers, who are key to the delivery of trials.
Collapse
Affiliation(s)
- Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Helen Hickey
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, L69 3BX, UK
| | - Alison M McDonald
- Centre for Healthcare Randomised Trials (CHaRT) Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Helen M Meadows
- Cancer Research UK & UCL Cancer Trials Centre & Institute of Clinical Trials & Methodology, UCL, 90 Tottenham Court Rd, London, UK
| | - Shelley Rhodes
- Exeter Clinical Trials Unit (ExeCTU), University of Exeter, St Luke's Campus, Exeter, Devon, EX1 2LU, UK
| | - Jodi Taylor
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Natalie Wakefield
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Barbara Farrell
- National Perinatal Epidemiology Unit, Clinical Trials Unit, University of Oxford, Richard Doll Building, Headington, Oxford, OX3 7LF, UK
| | | |
Collapse
|
15
|
Cronin O, Forsyth L, Goodman K, Lewis SC, Keerie C, Walker A, Porteous M, Cetnarskyj R, Ranganath LR, Selby PL, Hampson G, Chandra R, Ho S, Tobias JH, Young-Min S, McKenna MJ, Crowley RK, Fraser WD, Gennari L, Nuti R, Brandi ML, Del Pino-Montes J, Devogelaer JP, Durnez A, Isaia G, Di Stefano M, Guañabens N, Blanch J, Seibel MJ, Walsh JP, Kotowicz MA, Nicholson GC, Duncan EL, Major G, Horne A, Gilchrist NL, Boers M, Murray GD, Charnock K, Wilkinson D, Russell RGG, Ralston SH. Zoledronate in the prevention of Paget's (ZiPP): protocol for a randomised trial of genetic testing and targeted zoledronic acid therapy to prevent SQSTM1-mediated Paget's disease of bone. BMJ Open 2019; 9:e030689. [PMID: 31488492 PMCID: PMC6731944 DOI: 10.1136/bmjopen-2019-030689] [Citation(s) in RCA: 12] [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] [Received: 03/29/2019] [Revised: 07/13/2019] [Accepted: 07/31/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Paget's disease of bone (PDB) is characterised by increased and disorganised bone remodelling affecting one or more skeletal sites. Complications include bone pain, deformity, deafness and pathological fractures. Mutations in sequestosome-1 (SQSTM1) are strongly associated with the development of PDB. Bisphosphonate therapy can improve bone pain in PDB, but there is no evidence that treatment alters the natural history of PDB or prevents complications. The Zoledronate in the Prevention of Paget's disease trial (ZiPP) will determine if prophylactic therapy with the bisphosphonate zoledronic acid (ZA) can delay or prevent the development of PDB in people who carry SQSTM1 mutations. METHODS AND ANALYSIS People with a family history of PDB aged >30 years who test positive for SQSTM1 mutations are eligible to take part. At the baseline visit, participants will be screened for the presence of bone lesions by radionuclide bone scan. Biochemical markers of bone turnover will be measured and questionnaires completed to assess pain, health-related quality of life (HRQoL), anxiety and depression. Participants will be randomised to receive a single intravenous infusion of 5 mg ZA or placebo and followed up annually for between 4 and 8 years at which point baseline assessments will be repeated. The primary endpoint will be new bone lesions assessed by radionuclide bone scan. Secondary endpoints will include changes in biochemical markers of bone turnover, pain, HRQoL, anxiety, depression and PDB-related skeletal events. ETHICS AND DISSEMINATION The study was approved by the Fife and Forth Valley Research Ethics Committee on 22 December 2008 (08/S0501/84). Following completion of the trial, a manuscript will be submitted to a peer-reviewed journal. The results of this trial will inform clinical practice by determining if early intervention with ZA in presymptomatic individuals with SQSTM1 mutations can prevent or slow the development of bone lesions with an adverse event profile that is acceptable. TRIAL REGISTRATION NUMBER ISRCTN11616770.
Collapse
Affiliation(s)
- Owen Cronin
- Department of Rheumatology, Western General Hospital, Edinburgh, UK
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kirsteen Goodman
- Glasgow Caledonian University School of Nursing Midwifery and Community Health, Glasgow, UK
| | - Steff C Lewis
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Catriona Keerie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Allan Walker
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mary Porteous
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | - Shu Ho
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - Jon H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | - William D Fraser
- Department of Medicine Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Luigi Gennari
- University of Siena Faculty of Medicine and Surgery, Siena, Italy
| | - Ranuccio Nuti
- University of Siena Faculty of Medicine and Surgery, Siena, Italy
| | | | | | | | - Anne Durnez
- Rheumatology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
- Algemeen Ziekenhuis Jan Portaels, Vilvoorde, Belgium
| | | | | | - Núria Guañabens
- Rheumatology Department, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | | | - Markus J Seibel
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Bone Research Program, ANZAC Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Mark A Kotowicz
- Department of Endocrinology and Diabetes, Barwon Health, Geelong, Victoria, Australia
| | - Geoffrey C Nicholson
- Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
| | - Emma L Duncan
- Department of Endocrinology and Diabetes, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Woolloongabba, Queensland, Australia
| | - Gabor Major
- Royal Newcastle Centre John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Anne Horne
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Maarten Boers
- Epidemiology & Biostatistics, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Gordon D Murray
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - R Graham G Russell
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Stuart H Ralston
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
16
|
McClurg D, Harris F, Goodman K, Doran S, Hagen S, Treweek S, Norton C, Coggrave M, Norrie J, Rauchhaus P, Donnan P, Emmanuel A, Manoukian S, Mason H. Abdominal massage plus advice, compared with advice only, for neurogenic bowel dysfunction in MS: a RCT. Health Technol Assess 2019; 22:1-134. [PMID: 30375324 DOI: 10.3310/hta22580] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Between 50% and 80% of people with multiple sclerosis (PwMS) experience neurogenic bowel dysfunction (NBD) (i.e. constipation and faecal incontinence) that affects quality of life and can lead to hospitalisation. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of abdominal massage plus advice on bowel symptoms on PwMS compared with advice only. A process evaluation investigated the factors that affected the clinical effectiveness and possible implementation of the different treatments. DESIGN A randomised controlled trial with process evaluation and health economic components. Outcome analysis was undertaken blind. SETTING The trial took place in 12 UK hospitals. PARTICIPANTS PwMS who had 'bothersome' NBD. INTERVENTION Following individualised training, abdominal massage was undertaken daily for 6 weeks (intervention group). Advice on good bowel management as per the Multiple Sclerosis Society advice booklet was provided to both groups. All participants received weekly telephone calls from the research nurse. MAIN OUTCOME MEASURES The primary outcome was the difference between the intervention and control groups in change in the NBD score from baseline to week 24. Secondary outcomes were measured via a bowel diary, adherence diary, the Constipation Scoring System, patient resource questionnaire and the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). RESULTS A total of 191 participants were finalised, 189 of whom were randomised (two participants were finalised in error) (control group, n = 99; intervention group, n = 90) and an intention-to-treat analysis was performed. The mean age was 52 years (standard deviation 10.83 years), 81% (n = 154) were female and 11% (n = 21) were wheelchair dependent. Fifteen participants from the intervention group and five from the control group were lost to follow-up. The change in NBD score by week 24 demonstrated no significant difference between groups [mean difference total score -1.64, 95% confidence interval (CI) -3.32 to 0.04; p = 0.0558]; there was a significant difference between groups in the change in the frequency of stool evacuation per week (mean difference 0.62, 95% CI 0.03 to 1.21; p = 0.039) and in the number of times per week that participants felt that they emptied their bowels completely (mean difference 1.08, 95% CI 0.41 to 1.76; p = 0.002), in favour of the intervention group. Of participant interviewees, 75% reported benefits, for example less difficulty passing stool, more complete evacuations, less bloated, improved appetite, and 85% continued with the massage. A cost-utility analysis conducted from a NHS and patient cost perspective found in the imputed sample with bootstrapping a mean incremental outcome effect of the intervention relative to usual care of -0.002 quality-adjusted life-years (QALYs) (95% CI -0.029 to 0.027 QALYs). In the same imputed sample with bootstrapping, the mean incremental cost effect of the intervention relative to usual care was £56.50 (95% CI -£372.62 to £415.68). No adverse events were reported. Limitations include unequal randomisation, dropout and the possibility of ineffective massage technique. CONCLUSION The increment in the primary outcome favoured the intervention group, but it was small and not statistically significant. The economic analysis identified that the intervention was dominated by the control group. Given the small improvement in the primary outcome, but not in terms of QALYs, a low-cost version of the intervention might be considered worthwhile by some patients. FUTURE WORK Research is required to establish possible mechanisms of action and modes of massage delivery. TRIAL REGISTRATION Current Controlled Trials ISRCTN85007023 and NCT03166007. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 58. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Doreen McClurg
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Harris
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Selina Doran
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Shaun Treweek
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - John Norrie
- Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Peter Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Anton Emmanuel
- National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
17
|
Jones B, Vinogradskiy Y, Campbell W, Ding Y, Schefter T, Goodman K, Miften M. OC-0301 Real-time kV image guidance in the treatment of pancreatic SBRT: quantifying the purpose and impact. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30721-2] [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: 11/29/2022]
|
18
|
Veldhuyzen van Zanten S, Morse A, Morse J, Girgis S, Assi A, Fagan-Garcia K, Geary J, Goodman K. A6 TREATMENT TRIAL RESULTS FROM COMMUNITY H. PYLORI PROJECTS IN ARCTIC CANADA. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - A Morse
- University of Alberta, Edmonton, AB, Canada
| | - J Morse
- University of Alberta, Edmonton, AB, Canada
| | - S Girgis
- University of Alberta, Edmonton, AB, Canada
| | - A Assi
- University of Alberta, Edmonton, AB, Canada
| | | | - J Geary
- University of Alberta, Edmonton, AB, Canada
| | - K Goodman
- University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
19
|
Silva M, Chibbar R, Walter J, Goodman K, Keshteli AH, Valcheva RS, Dieleman LA. A159 A SURVEY FOR THE USE OF PROBIOTICS, PREBIOTICS AND DIETARY FIBRE SUPPLEMENTS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Silva
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Chibbar
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - J Walter
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Goodman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - A Hassanzadeh Keshteli
- Centre of Excellence for Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, AB, Canada
| | - R S Valcheva
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
20
|
Amin A, Prosser C, Kroeker KI, Wang H, Shalapay C, Dhami N, Fedorak DK, Halloran BP, Dieleman LA, Goodman K, Fedorak R, Huang V. A147 COMBINING INFLIXIMAB TROUGH LEVELS AND FECAL CALPROTECTIN LEVELS WITH CLINICAL DATA HAS THE POTENTIAL TO GUIDE CLINICAL DECISION-MAKING IN IMPROVING OUTCOMES FOR INFLAMMATORY BOWEL DISEASE PATIENTS ON MAINTENANCE INFLIXIMAB. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Amin
- (Core) Internal Medicine Program, University of Alberta, Edmonton, AB, Canada
| | - C Prosser
- University of Alberta, Edmonton, AB, Canada
| | | | - H Wang
- Surgery, University of Alberta, Edmonton, AB, Canada
| | - C Shalapay
- University of Alberta, Edmonton, AB, Canada
| | - N Dhami
- University of Alberta, Edmonton, AB, Canada
| | - D K Fedorak
- Divison of Gastroenterolgy, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Goodman
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Los Alamos National Laboratory, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
21
|
Kao DH, Roach B, Silva M, Beck P, Rioux KP, Madsen K, Goodman K, Xu H, Chang H, Louie T. A15 A PROSPECTIVE, NON-INFERIORITY, MULTI-CENTER, RANDOMIZED TRIAL COMPARING COLONOSCOPY VS ORAL CAPSULE DELIVERED FECAL MICROBIOTA TRANSPLANTATION (FMT) FOR RECURRENT CLOSTRIDIUM DIFFICILE INFECTION (RCDI). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D H Kao
- University of Alberta, Edmonton, AB, Canada
| | - B Roach
- University of Alberta, Edmonton, AB, Canada
| | - M Silva
- University of Calgary, Calgary, AB, Canada
| | - P Beck
- University of Calgary, Calgary, AB, Canada
| | - K P Rioux
- University of Calgary, Calgary, AB, Canada
| | - K Madsen
- University of Alberta, Edmonton, AB, Canada
| | - K Goodman
- University of Alberta, Edmonton, AB, Canada
| | - H Xu
- Indiana University, Indianapolis, IN
| | - H Chang
- University of Alberta, Edmonton, AB, Canada
| | - T Louie
- University of Calgary, Calgary, AB, Canada
| |
Collapse
|
22
|
Tan A, Goodman K, Walker A, Hudson J, MacLennan GS, Selby PL, Fraser WD, Ralston SH. Long-Term Randomized Trial of Intensive Versus Symptomatic Management in Paget's Disease of Bone: The PRISM-EZ Study. J Bone Miner Res 2017; 32:1165-1173. [PMID: 28176386 DOI: 10.1002/jbmr.3066] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/30/2016] [Accepted: 12/11/2016] [Indexed: 11/11/2022]
Abstract
It has been suggested that normalization of bone turnover may improve clinical outcome in Paget's disease of bone (PDB) by preventing complications such as fractures and the development of osteoarthritis. Here we investigated the long-term effects of a treatment strategy that aimed to normalize bone turnover in PDB with that of symptomatic treatment. The study group comprised 502 subjects who were enrolled into a 3-year extension of the Paget's Disease: Randomized Trial of Intensive versus Symptomatic Management (PRISM) study. Intensive bisphosphonate therapy was continued in 270 of these subjects with the aim of normalizing bone turnover using zoledronic acid as the treatment of first choice. Symptomatic treatment continued in 232 subjects in whom bisphosphonates were only given for the treatment of bone pain. The primary outcome was fracture and secondary outcomes were orthopedic procedures, quality of life, and bone pain, adjusted for baseline characteristics. Serum total alkaline phosphatase (ALP) concentrations were significantly lower in the intensive group on entry to the study and the differences between groups increased as the study progressed. There were no clinically important differences in quality of life measures or bone pain between the treatment groups. Intensive treatment was associated with a nonsignificant increase in fracture risk (hazard ratio = 1.90; 95% CI, 0.91 to 3.98; p = 0.087), orthopedic procedures (1.81; 95% CI, 0.71 to 4.61; p = 0.214), and serious adverse events (relative risk 1.28; 95% CI, 0.96 to 1.42). We conclude that long-term intensive bisphosphonate therapy confers no clinical benefit over symptomatic therapy and is associated with a nonsignificant increase in the risk of fractures, orthopedic events, and serious adverse events. The results of this study suggest that in patients with established PDB, bisphosphonate therapy should focus on control of symptoms rather than suppression of bone turnover. © 2016 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Adrian Tan
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Kirsteen Goodman
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Allan Walker
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Peter L Selby
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Stuart H Ralston
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK.,Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
| | | |
Collapse
|
23
|
McClurg D, Goodman K, Hagen S, Harris F, Treweek S, Emmanuel A, Norton C, Coggrave M, Doran S, Norrie J, Donnan P, Mason H, Manoukian S. Abdominal massage for neurogenic bowel dysfunction in people with multiple sclerosis (AMBER - Abdominal Massage for Bowel Dysfunction Effectiveness Research): study protocol for a randomised controlled trial. Trials 2017; 18:150. [PMID: 28356133 PMCID: PMC5372315 DOI: 10.1186/s13063-017-1890-y] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 03/10/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a life-long condition primarily affecting younger adults. Neurogenic bowel dysfunction (NBD) occurs in 50-80% of these patients and is the term used to describe constipation and faecal incontinence, which often co-exist. Data from a pilot study suggested feasibility of using abdominal massage for the relief of constipation, but the effectiveness remains uncertain. METHODS/DESIGN This is a multi-centred patient randomised superiority trial comparing an experimental strategy of once daily abdominal massage for 6 weeks against a control strategy of no massage in people with MS who have stated that their constipation is bothersome. The primary outcome is the Neurogenic Bowel Dysfunction Score at 24 weeks. Both groups will receive optimised advice plus the MS Society booklet on bowel management in MS, and will continue to receive usual care. Participants and their clinicians will not be blinded to the allocated intervention. Outcome measures are primarily self-reported and submitted anonymously. Central trial staff who will manage and analyse the trial data will be unaware of participant allocations. Analysis will follow intention-to-treat principles. DISCUSSION This pragmatic randomised controlled trial will demonstrate if abdominal massage is an effective, cost-effective and viable addition to the treatment of NBD in people with MS. TRIAL REGISTRATION ClinicalTrials.gov, ISRCTN85007023 . Registered on 10 June 2014.
Collapse
Affiliation(s)
- Doreen McClurg
- NMAHP RU, Glasgow Caledonian University, A603 Govan Mbeki Building, Glasgow, G4 0BA UK
| | - Kirsteen Goodman
- NMAHP RU, Glasgow Caledonian University, A603 Govan Mbeki Building, Glasgow, G4 0BA UK
| | - Suzanne Hagen
- NMAHP RU, Glasgow Caledonian University, A603 Govan Mbeki Building, Glasgow, G4 0BA UK
| | | | - Sean Treweek
- Centre for Healthcare Randomised Trials (CHaRT) Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anton Emmanuel
- University College Hospital, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | | | | | - Selina Doran
- NMAHP RU, Glasgow Caledonian University, A603 Govan Mbeki Building, Glasgow, G4 0BA UK
| | - John Norrie
- Centre for Healthcare Randomised Trials (CHaRT) Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Peter Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
24
|
Goodman K, Miles L. Collaborating with finnish nursing students: Expanding nursing education
and global health. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.226] [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: 11/29/2022] Open
|
25
|
Campbell W, Miften M, Schefter T, Goodman K, Jones B. TH-CD-207A-04: Optimized Respiratory Gating for Abnormal Breathers in Pancreatic SBRT. Med Phys 2016. [DOI: 10.1118/1.4958173] [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: 11/07/2022] Open
|
26
|
Jones B, Campbell W, Stumpf P, Amini A, Schefter T, Kavanagh B, Goodman K, Miften M. Patient-specific motion management and adaptive respiratory gating in Pancreatic SBRT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31576-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
27
|
Hastings EV, Girgis S, Goodman K. Community-Based Research on H.pylori Infection in the Canadian Arctic: Findings Show a High Prevalence of Severe Gastritis. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.568] [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
|
28
|
Ben-Aharon I, Pelossof R, Elkabets M, Battaglin F, Goodman K, Yaeger R, Saltz L, Schultz N, Solit D, Garcia-Aguilar J, Cercek A. 2189 Early onset colorectal cancer - does the difference lie in epigenetics? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31108-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
29
|
Alam SR, Lewis SC, Zamvar V, Pessotto R, Dweck MR, Krishan A, Goodman K, Oatey K, Harkess R, Milne L, Thomas S, Mills NM, Moore C, Semple S, Wiedow O, Stirrat C, Mirsadraee S, Newby DE, Henriksen PA. Perioperative elafin for ischaemia-reperfusion injury during coronary artery bypass graft surgery: a randomised-controlled trial. Heart 2015; 101:1639-45. [PMID: 26310261 PMCID: PMC4621368 DOI: 10.1136/heartjnl-2015-307745] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022] Open
Abstract
Background Elafin is a potent endogenous neutrophil elastase inhibitor that protects against myocardial inflammation and injury in preclinical models of ischaemic-reperfusion injury. We investigated whether elafin could inhibit myocardial ischaemia-reperfusion injury induced during coronary artery bypass graft (CABG) surgery. Methods and results In a randomised double-blind placebo-controlled parallel group clinical trial, 87 patients undergoing CABG surgery were randomised 1:1 to intravenous elafin 200 mg or saline placebo administered after induction of anaesthesia and prior to sternotomy. Myocardial injury was measured as cardiac troponin I release over 48 h (area under the curve (AUC)) and myocardial infarction identified with MRI. Postischaemic inflammation was measured by plasma markers including AUC high-sensitive C reactive protein (hs-CRP) and myeloperoxidase (MPO). Elafin infusion was safe and resulted in >3000-fold increase in plasma elafin concentrations and >50% inhibition of elastase activity in the first 24 h. This did not reduce myocardial injury over 48 h (ratio of geometric means (elafin/placebo) of AUC troponin I 0.74 (95% CI 0.47 to 1.15, p=0.18)) although post hoc analysis of the high-sensitive assay revealed lower troponin I concentrations at 6 h in elafin-treated patients (median 2.4 vs 4.1 μg/L, p=0.035). Elafin had no effect on myocardial infarction (elafin, 7/34 vs placebo, 5/35 patients) or on markers of inflammation: mean differences for AUC hs-CRP of 499 mg/L/48 h (95% CI −207 to 1205, p=0.16), and AUC MPO of 238 ng/mL/48 h (95% CI −235 to 711, p=0.320). Conclusions There was no strong evidence that neutrophil elastase inhibition with a single-dose elafin treatment reduced myocardial injury and inflammation following CABG-induced ischaemia-reperfusion injury. Trial registration number (EudraCT 2010-019527-58, ISRCTN82061264).
Collapse
Affiliation(s)
- S R Alam
- British Heart Foundation/Centre for Population Health Sciences, University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
| | - S C Lewis
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - V Zamvar
- Department of Cardio-thoracic Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - R Pessotto
- Department of Cardio-thoracic Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - M R Dweck
- British Heart Foundation/Centre for Population Health Sciences, University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
| | - A Krishan
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - K Goodman
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - K Oatey
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - R Harkess
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - L Milne
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - S Thomas
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - N M Mills
- British Heart Foundation/Centre for Population Health Sciences, University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
| | - C Moore
- Department of Cardio-thoracic Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - S Semple
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - O Wiedow
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - C Stirrat
- British Heart Foundation/Centre for Population Health Sciences, University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
| | - S Mirsadraee
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - D E Newby
- British Heart Foundation/Centre for Population Health Sciences, University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - P A Henriksen
- British Heart Foundation/Centre for Population Health Sciences, University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
| |
Collapse
|
30
|
|
31
|
McBride OMB, Berry C, Burns P, Chalmers RTA, Doyle B, Forsythe R, Garden OJ, Goodman K, Graham C, Hoskins P, Holdsworth R, MacGillivray TJ, McKillop G, Murray G, Oatey K, Robson JMJ, Roditi G, Semple S, Stuart W, van Beek EJR, Vesey A, Newby DE. MRI using ultrasmall superparamagnetic particles of iron oxide in patients under surveillance for abdominal aortic aneurysms to predict rupture or surgical repair: MRI for abdominal aortic aneurysms to predict rupture or surgery-the MA(3)RS study. Open Heart 2015; 2:e000190. [PMID: 25932334 PMCID: PMC4410138 DOI: 10.1136/openhrt-2014-000190] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Population screening for abdominal aortic aneurysms (AAA) halves the associated mortality and has led to the establishment of national screening programmes. Prediction of aneurysm growth and rupture is challenging and currently relies on serial diameter measurements with ultrasound. Recently, a novel MRI-based technique using ultrasmall superparamagnetic particles of iron oxide (USPIO) has demonstrated considerable promise as a method of identifying aneurysm inflammation and expansion. Methods and analysis The MA3RS study is a prospective observational multicentre cohort study of 350 patients with AAA in three centres across Scotland. All participants will undergo MRI with USPIO and aneurysm expansion will be measured over 2 years with CT in addition to standard clinical ultrasound surveillance. The relationship between mural USPIO uptake and subsequent clinical outcomes, including expansion, rupture and repair, will be evaluated and used to determine whether the technique augments standard risk prediction markers. To ensure adequate sensitivity to answer the primary question, we need to observe 130 events (composite of rupture or repair) with an estimated event rate of 41% over 2 years of follow-up. The MA3RS study is currently recruiting and expects to report in 2017. Discussion This is the first study to evaluate the use of USPIO-enhanced MRI to provide additional information to aid risk prediction models in patients with AAA. If successful, this study will lay the foundation for a large randomised controlled trial targeted at applying this technique to determine clinical management. Trial registration number Current Controlled Trials: ISRCTN76413758.
Collapse
Affiliation(s)
- Olivia M B McBride
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow , Glasgow , UK
| | - Paul Burns
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Roderick T A Chalmers
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Barry Doyle
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Rachael Forsythe
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - O James Garden
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Kirsteen Goodman
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Catriona Graham
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Peter Hoskins
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | | | - Thomas J MacGillivray
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Graham McKillop
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Gordon Murray
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Katherine Oatey
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Jennifer M J Robson
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow , Glasgow , UK
| | - Giles Roditi
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow , Glasgow , UK
| | - Scott Semple
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Wesley Stuart
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow , Glasgow , UK
| | - Edwin J R van Beek
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Alex Vesey
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - David E Newby
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| |
Collapse
|
32
|
Zhang P, Goodman K, Han Q, Yamada J, Mageras G, Yorke E. Setting Action Levels for Abdominal Stereotactic Body Radiation Therapy Monitored With Frequent kV Imaging Surveillance. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
33
|
Liu F, Yorke E, Mageras G, Goodman K. SU-E-J-226: Propagation of Pancreas Target Contours On Respiratory Correlated CT Images Using Deformable Image Registration. Med Phys 2014. [DOI: 10.1118/1.4888279] [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: 11/07/2022] Open
|
34
|
Albagha OME, Visconti MR, Alonso N, Wani S, Goodman K, Fraser WD, Gennari L, Merlotti D, Gianfrancesco F, Esposito T, Rendina D, di Stefano M, Isaia G, Brandi ML, Giusti F, Del Pino-Montes J, Corral-Gudino L, Gonzalez-Sarmiento R, Ward L, Rea SL, Ratajczak T, Walsh JP, Ralston SH. Common susceptibility alleles and SQSTM1 mutations predict disease extent and severity in a multinational study of patients with Paget's disease. J Bone Miner Res 2013; 28:2338-46. [PMID: 23658060 DOI: 10.1002/jbmr.1975] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 04/06/2013] [Accepted: 04/24/2013] [Indexed: 11/08/2022]
Abstract
Paget's disease of bone (PDB) has a strong genetic component. Here, we investigated possible associations between genetic variants that predispose to PDB and disease severity. Allelic variants identified as predictors of PDB from genome-wide association studies were analyzed in 1940 PDB patients from the United Kingdom, Italy, Western Australia, and Spain. A cumulative risk allele score was constructed by adding the variants together and relating this to markers of disease severity, alone and in combination with SQSTM1 mutations. In SQSTM1-negative patients, risk allele scores in the highest tertile were associated with a 27% increase in disease extent compared with the lowest tertile (p < 0.00001) with intermediate values in the middle tertile (20% increase; p = 0.0007). The effects were similar for disease severity score, which was 15% (p = 0.01) and 25% (p < 0.00001) higher in the middle and upper tertiles, respectively. Risk allele score remained a significant predictor of extent and severity when SQSTM-positive individuals were included, with an effect size approximately one-third of that observed with SQSTM1 mutations. A genetic risk score was developed by combining information from both markers, which identified subgroups of individuals with low, medium, and high levels of severity with a specificity of 70% and sensitivity of 55%. Risk allele scores and SQSTM1 mutations both predict extent and severity of PDB. It is possible that with further refinement, genetic profiling may be of clinical value in identifying individuals at high risk of severe disease who might benefit from enhanced surveillance and early intervention.
Collapse
Affiliation(s)
- Omar M E Albagha
- Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Moore J, Dholakia A, Kimberly E, Wang L, Koong A, Goodman K, Herman J, McNutt T. Multi-institutional/Technique Dose Comparisons Using Overlap Volume Histograms for Difficulty Normalization. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1645] [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: 11/24/2022]
|
36
|
Regmi R, Lovelock D, Zhang P, Pham H, Xiong J, Yorke E, Goodman K, Wu A, Mageras G. MO-F-WAB-02: Constancy of Time Lag Relationship Between External and Internal Signal in Abdominal Tumor Sites. Med Phys 2013. [DOI: 10.1118/1.4815291] [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: 11/07/2022] Open
|
37
|
Regmi R, Lovelock D, Hunt M, Zhang P, Pham H, Xiong J, Yorke E, Goodman K, Mageras G. TU-C-213CD-04: Tracking Implanted Fiducials Using Kilovoltage (kV) Projection Images: A Feasibility Study. Med Phys 2012. [DOI: 10.1118/1.4735931] [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: 11/07/2022] Open
|
38
|
Kincaid R, Yorke E, Goodman K, Rimner A, Wu A, Mageras G. TU-C-213CD-08: Investigation of Gated Cone-Beam CT to Reduce Respiratory Motion Blurring in Images of Thorax and Abdomen. Med Phys 2012. [DOI: 10.1118/1.4735935] [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: 11/07/2022] Open
|
39
|
Liu F, Zhang Q, Hu Y, Goodman K, Mageras G. TU-E-BRA-09: Evaluation of a Patient-Specific Respiratory Motion Model in Thoracic and Abdominal Phantom and Patient CT Images. Med Phys 2012; 39:3912. [DOI: 10.1118/1.4735969] [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: 11/07/2022] Open
|
40
|
Kincaid R, Yorke E, Goodman K, Wu A, Mageras G. 289 INVESTIGATION OF A GATED CONE-BEAM CT TECHNIQUE TO REDUCE RESPIRATORY MOTION BLURRING IN ABDOMINAL SITES. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
41
|
Huguet F, Yorke E, Davidson M, Zhang Z, Jackson A, Mageras G, Wu A, Goodman K. Étude des mouvements des tumeurs du pancréas et de leurs marqueurs potentiels par scanographie quadridimensionnelle : implication pour la radiothérapie guidée par l’image. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
McNamara J, Lovelock D, Yorke E, Goodman K, Rimner A, Mageras G. TH-C-BRC-12: Correcting Drift in Target Position during Radiotherapy via Computer-Controlled Couch Adjustments on a C-Arm Linac. Med Phys 2011. [DOI: 10.1118/1.3613529] [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: 11/07/2022] Open
|
43
|
Albagha OME, Wani SE, Visconti MR, Alonso N, Goodman K, Brandi ML, Cundy T, Chung PYJ, Dargie R, Devogelaer JP, Falchetti A, Fraser WD, Gennari L, Gianfrancesco F, Hooper MJ, Van Hul W, Isaia G, Nicholson GC, Nuti R, Papapoulos S, Montes JDP, Ratajczak T, Rea SL, Rendina D, Gonzalez-Sarmiento R, Di Stefano M, Ward LC, Walsh JP, Ralston SH. Genome-wide association identifies three new susceptibility loci for Paget's disease of bone. Nat Genet 2011; 43:685-9. [PMID: 21623375 DOI: 10.1038/ng.845] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [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] [Received: 11/19/2010] [Accepted: 05/04/2011] [Indexed: 12/20/2022]
Abstract
Paget's disease of bone (PDB) is a common disorder characterized by focal abnormalities of bone remodeling. We previously identified variants at the CSF1, OPTN and TNFRSF11A loci as risk factors for PDB by genome-wide association study. Here we extended this study, identified three new loci and confirmed their association with PDB in 2,215 affected individuals (cases) and 4,370 controls from seven independent populations. The new associations were with rs5742915 within PML on 15q24 (odds ratio (OR) = 1.34, P = 1.6 × 10(-14)), rs10498635 within RIN3 on 14q32 (OR = 1.44, P = 2.55 × 10(-11)) and rs4294134 within NUP205 on 7q33 (OR = 1.45, P = 8.45 × 10(-10)). Our data also confirmed the association of TM7SF4 (rs2458413, OR = 1.40, P = 7.38 × 10(-17)) with PDB. These seven loci explained ∼13% of the familial risk of PDB. These studies provide new insights into the genetic architecture and pathophysiology of PDB.
Collapse
Affiliation(s)
- Omar M E Albagha
- Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Santoro J, Yorke E, Amols H, Rosenzweig K, Goodman K, McNamara J, Pham H, Mageras G. Using Respiration-correlated Cone Beam CT (RC-CBCT) Scans to Correct Target Positioning Errors in Radiotherapy of Thoracic Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1550] [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]
|
45
|
Visconti MR, Langston AL, Alonso N, Goodman K, Selby PL, Fraser WD, Ralston SH. Mutations of SQSTM1 are associated with severity and clinical outcome in paget disease of bone. J Bone Miner Res 2010; 25:2368-73. [PMID: 20499339 DOI: 10.1002/jbmr.132] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Paget disease of bone (PDB) is a common disorder characterized by increased bone turnover at one of more sites throughout the skeleton. Genetic factors play an important role in the pathogenesis of PDB, and the most important predisposing gene is SQSTM1, which is mutated in about 10% of patients. Here we investigated the relationship between SQSTM1 mutation status, disease severity, and clinical outcome in 737 patients who took part in a randomized study of two different management strategies for the disease. Mutations of SQSTM1 were detected in 80 of 737 (10.9%) patients. Mutation carriers had an earlier age at diagnosis (59.4 ± 11.5 versus 65.0 ± 10.4 years, p < .0001) and a greater number of affected bones (3.2 ± 1.2 versus 2.1 ± 1.2, p < .001) and more commonly required orthopedic surgery (26.2% versus 16.1%, p = .024) and bisphosphonate therapy (86.3% versus 75.2%, p = .01) than those without mutations. Quality of life, as assessed by the short-form-36 (SF36) physical summary score, was significantly reduced in carriers (34.0 ± 11.3 versus 37.1 ± 11.4, p = .036). During the study, fractures were more common in carriers (12.5% versus 5.3%, p = .011), although most of these occurred in unaffected bone. This study demonstrates that SQSTM1 mutations are strongly associated with disease severity and complications of PDB. Genetic testing for SQSTM1 mutations may be of value in identifying individuals at risk of developing severe disease, but further studies will be required to determine if a program of genetic testing and early intervention in these individuals would be cost-effective or be of benefit in preventing these complications.
Collapse
Affiliation(s)
- Micaela Rios Visconti
- Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
46
|
Minsky B, Khalid N, Thomas C, Kachnic L, Crozier C, Owen J, Wilson J, Goodman K. Quality Research in Radiation Oncology (QRRO): A Patterns of Care Analysis of Clinical Performance Measures in the Management of Gastric Cancer (GC). Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
47
|
Tiplady B, Goodman K, Cummings G, Lyle D, Carrington R, Battersby C, Ralston SH. Patient-Reported Outcomes in Rheumatoid Arthritis. The Patient: Patient-Centered Outcomes Research 2010. [DOI: 10.2165/11535590-000000000-00000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
48
|
Santoro J, Yorke E, Rosenzweig K, Goodman K, McNamara J, Pham H, Mageras G. SU-DD-A3-01: Comparison of Respiration-Correlated and Uncorrelated Cone-Beam CT for Correcting Target-Positioning Errors in Radiotherapy of Thoracic and Abdominal Cancer. Med Phys 2010. [DOI: 10.1118/1.3467994] [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: 11/07/2022] Open
|
49
|
Liu F, Hu Y, Goodman K, Mageras G. SU-GG-I-112: Evaluation of Deformable Registration in CT Images with Limited Feature Visibility. Med Phys 2010. [DOI: 10.1118/1.3468145] [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: 11/07/2022] Open
|
50
|
Goodman K, Hodges LA, Band J, Stevens HN, Weitschies W, Wilson CG. Assessing gastrointestinal motility and disintegration profiles of magnetic tablets by a novel magnetic imaging device and gamma scintigraphy. Eur J Pharm Biopharm 2010; 74:84-92. [DOI: 10.1016/j.ejpb.2009.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 12/09/2008] [Accepted: 01/13/2009] [Indexed: 11/30/2022]
|