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Martin CA, Sarlós K, Logan CV, Thakur RS, Parry DA, Bizard AH, Leitch A, Cleal L, Ali NS, Al-Owain MA, Allen W, Altmüller J, Aza-Carmona M, Barakat BA, Barraza-García J, Begtrup A, Bogliolo M, Cho MT, Cruz-Rojo J, Mundi Dhahrabi HA, Elcioglu NH, GOSgene, Gorman GS, Jobling R, Kesterton I, Kishita Y, Kohda M, Le Quesne Stabej P, Malallah AJ, Nürnberg P, Ohtake A, Okazaki Y, Pujol R, Ramirez MJ, Revah-Politi A, Shimura M, Stevens P, Taylor RW, Turner L, Williams H, Wilson C, Yigit G, Zahavich L, Alkuraya FS, Surralles J, Iglesias A, Murayama K, Wollnik B, Dattani M, Heath KE, Hickson ID, Jackson AP. Mutations in TOP3A Cause a Bloom Syndrome-like Disorder. Am J Hum Genet 2024; 111:996. [PMID: 38701747 PMCID: PMC11080603 DOI: 10.1016/j.ajhg.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
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Turner L, Ball J, Meredith P, Kitson-Reynolds E, Griffiths P. The association between midwifery staffing and reported harmful incidents: a cross-sectional analysis of routinely collected data. BMC Health Serv Res 2024; 24:391. [PMID: 38549131 PMCID: PMC10976845 DOI: 10.1186/s12913-024-10812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/01/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Independent inquiries have identified that appropriate staffing in maternity units is key to enabling quality care and minimising harm, but optimal staffing levels can be difficult to achieve when there is a shortage of midwives. The services provided and how they are staffed (total staffing, skill-mix and deployment) have been changing, and the effects of workforce changes on care quality and outcomes have not been assessed. This study aims to explore the association between daily midwifery staffing levels and the rate of reported harmful incidents affecting mothers and babies. METHODS We conducted a cross-sectional analysis of daily reports of clinical incidents in maternity inpatient areas matched with inpatient staffing levels for three maternity services in England, using data from April 2015 to February 2020. Incidents resulting in harm to mothers or babies was the primary outcome measure. Staffing levels were calculated from daily staffing rosters, quantified in Hours Per Patient Day (HPPD) for midwives and maternity assistants. Understaffing was defined as staffing below the mean for the service. A negative binomial hierarchical model was used to assess the relationship between exposure to low staffing and reported incidents involving harm. RESULTS The sample covered 106,904 maternal admissions over 46 months. The rate of harmful incidents in each of the three services ranged from 2.1 to 3.0 per 100 admissions across the study period. Understaffing by registered midwives was associated with an 11% increase in harmful incidents (adjusted IRR 1.110, 95% CI 1.002,1.229). Understaffing by maternity assistants was not associated with an increase in harmful incidents (adjusted IRR 0.919, 95% 0.813,1.039). Analysis of specific types of incidents showed no statistically significant associations, but most of the point estimates were in the direction of increased incidents when services were understaffed. CONCLUSION When there is understaffing by registered midwives, more harmful incidents are reported but understaffing by maternity assistants is not associated with higher risk of harms. Adequate registered midwife staffing levels are crucial for maintaining safety. Changes in the profile of maternity service workforces need to be carefully scrutinised to prevent mothers and babies being put at risk of avoidable harm.
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Affiliation(s)
| | - Jane Ball
- University of Southampton, Southampton, UK
| | | | | | - Peter Griffiths
- University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Centre (Wessex), Southampton, UK
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Kohut K, Morton K, Turner L, Foster R, Eccles D, Foster C. Codesign of Lynch Choices TM : Using implementation science to create a clinically deliverable patient decision support website to transform cancer genetics care pathways. Psychooncology 2024; 33:e6330. [PMID: 38502032 DOI: 10.1002/pon.6330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Resources including Patient Decision Aids (PtDA) are useful and valued by patients and clinicians to provide information and complement shared decision-making. Despite their promise, few PtDA exist for patients with genetic cancer susceptibility facing difficult decisions about risk management. We aimed to fill this gap, partnering with patients to codesign Lynch ChoicesTM , a PtDA website for families with Lynch Syndrome. In addition to a Patient Reference Panel, we purposively invited an international stakeholder panel including charities, public bodies, clinical and academic experts. Implementation strategies and frameworks were employed to optimise translation of research findings to improve care. METHODS Patient/stakeholder suggestions were incorporated in a transparent Table of Changes and prioritised using the Person-Based Approach throughout planning and codesign of Lynch ChoicesTM . An interactive stakeholder meeting was convened to identify barriers and facilitators to clinical implementation of the PtDA. RESULTS Patient and stakeholder partnerships drove the direction of the research throughout codesign, resulting in several iterative refinements to the PtDA prior to roll out including the addition of illustrations/videos, clearer presentation of cancer risks and increased accessibility for lower literacy. Barriers and facilitators identified from stakeholders were used to create an implementation process map. CONCLUSIONS Creating an effective, engaging PtDA is not enough. Systematic uptake in real world clinical practice, with its resource limitations, is needed to optimise benefit to patients and clinicians. Assessment of speed and breadth of dissemination and usage will be collected to further evidence the benefit of embedding implementation science methods from the outset to translate research findings into clinical practice.
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Affiliation(s)
- Kelly Kohut
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kate Morton
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, UK
| | - Lesley Turner
- Patient and Public Contributor, University of Southampton, Southampton, UK
| | - Rebecca Foster
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, UK
| | - Diana Eccles
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, UK
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Griffiths P, Turner L, Lown J, Sanders J. Evidence on the use of Birthrate Plus® to guide safe staffing in maternity services - A systematic scoping review. Women Birth 2024; 37:317-324. [PMID: 38007331 DOI: 10.1016/j.wombi.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Birthrate Plus® is a widely used tool that informs decisions about the number of midwifery staff needed to provide safe and high quality care in maternity services. Evidence about the effectiveness, validity, reliability, and feasibility of tools such as this is needed. OBJECTIVE To identify, describe and analyse the available evidence supporting the use of Birthrate Plus. METHODS We searched PubMed, Medline, CINAHL, Google Scholar, Scopus, Academic Search, British Library Ethos, Directory of Open Access Journals and Science Direct. Studies were eligible if they reported empirical data relevant to the validity, reliability, or useability of Birthrate Plus or if they measured the impact on staffing levels, outcomes, costs or provided a comparison with other methods. RESULTS 23 sources of evidence were identified and reviewed. We found no prospective intervention studies on the use of Birthrate Plus to demonstrate outcomes for mothers, babies or staff wellbeing. Nor did we find studies comparing the tool to other methods or addressing resource use. Most of the evidence was descriptive, focussing on the use of the tool or the results of Birthrate Plus assessments. There is some evidence of the reliability of application of categories within the tool, the ability of the tool to detect variation in demand and to highlight staff shortages. CONCLUSIONS In terms of traditional hierarchies of evidence, the evidence for Birthrate Plus is weak. There is a need for more independent research or simulation using real world data to understand how the tool performs in the current context of midwifery practice.
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Affiliation(s)
- Peter Griffiths
- School of Health Sciences, University of Southampton, National Institute for Health Research Applied Research Centre (Wessex), Southampton, England, UK
| | - Lesley Turner
- School of Health Sciences, University of Southampton, Southampton, England, UK.
| | - Jenny Lown
- Portsmouth Hospitals University NHS Trust, Portsmouth, England, UK
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Smith J, Essery R, Yardley L, Richardson A, Slodkowska-Barabasz J, Chavlet C, Foster C, Watson E, Grimmett C, Geraghty AWA, Little P, Sharman G, Burford T, Bacon R, Turner L, Bradbury K. Experiences of using a supported digital intervention for cancer survivors in primary care: a qualitative process evaluation. J Cancer Surviv 2024; 18:144-156. [PMID: 37405560 PMCID: PMC10866764 DOI: 10.1007/s11764-023-01412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/24/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Increasing healthy behaviours (e.g. physical activity) can improve cancer survivors' quality of life. Renewed is a digital intervention developed to provide behaviour change advice with brief healthcare practitioner support. A three-arm randomised controlled trial (Renewed, Renewed with support or a control condition) suggested that prostate cancer survivors in the supported arm had slightly greater estimates of improvements in quality of life compared to other cancer survivors. This study explored participants' experiences using Renewed to understand how it might have worked and why it might have provided greater benefit for prostate cancer survivors and those in the supported arm. METHODS Thirty-three semi-structured telephone interviews with cancer survivors' (breast, colorectal, prostate) from the Renewed trial explored their experiences of using Renewed and their perceptions of the intervention. Data were analysed using inductive thematic analysis. RESULTS Some participants only used Renewed modestly but still made behaviour changes. Barriers to using Renewed included low perceived need, joining the study to advance scientific knowledge or 'to give back', or due to perceived availability of support in their existing social networks. Prostate cancer survivors reported less social support outside of Renewed compared to participants with other cancers. CONCLUSION Renewed may support healthy behaviour changes among cancer survivors even with limited use. Interventions targetting individuals who lack social support may be beneficial. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors' experiences may inform the development of digital interventions to better serve this population.
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Affiliation(s)
- Jazzine Smith
- School of Psychology, University of Southampton, Southampton, UK.
| | - Rosie Essery
- School of Psychology, University of Southampton, Southampton, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton, Southampton, UK
| | | | | | - Claire Foster
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Community and Public Health Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Paul Little
- Primary Care Research, University of Southampton, Southampton, UK
| | | | | | - Roger Bacon
- Patient and Public Involvement Team, Southampton, UK
| | - Lesley Turner
- Patient and Public Involvement Team, Southampton, UK
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6
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Kohut K, Speight B, Young J, Way R, Wiggins J, Monje-Garcia L, Eccles DM, Foster C, Turner L, Snape K, Hanson H. Co-design of patient information leaflets for germline predisposition to cancer: recommendations for clinical practice from the UK Cancer Genetics Group (UKCGG), Cancer Research UK (CRUK) funded CanGene-CanVar Programme and the Association of Genetic Nurse Counsellors (AGNC). J Med Genet 2024; 61:142-149. [PMID: 38050080 DOI: 10.1136/jmg-2023-109440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/27/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Testing for germline pathogenic variants (GPVs) in cancer predisposition genes is increasingly offered as part of routine care for patients with cancer. This is often urgent in oncology clinics due to potential implications on treatment and surgical decisions. This also allows identification of family members who should be offered predictive genetic testing. In the UK, it is common practice for healthcare professionals to provide a patient information leaflet (PIL) at point of care for diagnostic genetic testing in patients with cancer, after results disclosure when a GPV is identified, and for predictive testing of at-risk relatives. Services usually create their own PIL, resulting in duplication of effort and wide variability regarding format, content, signposting and patient input in co-design and evaluation. METHODS Representatives from UK Cancer Genetics Group (UKCGG), Cancer Research UK (CRUK) funded CanGene-CanVar programme and Association of Genetic Nurse Counsellors (AGNC) held a 2-day meeting with the aim of making recommendations for clinical practice regarding co-design of PIL for germline cancer susceptibility genetic testing. Lynch syndrome and haematological malignancies were chosen as exemplar conditions. RESULTS Meeting participants included patient representatives including as co-chair, multidisciplinary clinicians and other experts from across the UK. High-level consensus for UK recommendations for clinical practice was reached on several aspects of PIL using digital polling, including that PIL should be offered, accessible, co-designed and evaluated with patients. CONCLUSIONS Recommendations from the meeting are likely to be applicable for PIL co-design for a wide range of germline genetic testing scenarios.
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Affiliation(s)
- Kelly Kohut
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Beverley Speight
- Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Rosalind Way
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Jennifer Wiggins
- Cancer Genetics, The Royal Marsden NHS Foundation Trust, London, UK
| | - Laura Monje-Garcia
- The St Mark's Centre for Familial Intestinal Cancer, London North West University Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Diana M Eccles
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
| | | | - Katie Snape
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| | - Helen Hanson
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
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Iverson R, Taljaard M, Geraghty MT, Pugliese M, Tingley K, Coyle D, Kronick JB, Wilson K, Austin V, Brunel-Guitton C, Buhas D, Butcher NJ, Chan AKJ, Dyack S, Goobie S, Greenberg CR, Jain-Ghai S, Inbar-Feigenberg M, Karp N, Kozenko M, Langley E, Lines M, Little J, MacKenzie J, Maranda B, Mercimek-Andrews S, Mhanni A, Mitchell JJ, Nagy L, Offringa M, Pender A, Potter M, Prasad C, Ratko S, Salvarinova R, Schulze A, Siriwardena K, Sondheimer N, Sparkes R, Stockler-Ipsiroglu S, Tapscott K, Trakadis Y, Turner L, Van Karnebeek C, Vandersteen A, Walia JS, Wilson BJ, Yu AC, Potter BK, Chakraborty P. Assessing the quality and value of metabolic chart data for capturing core outcomes for pediatric medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. BMC Pediatr 2024; 24:37. [PMID: 38216926 PMCID: PMC10787451 DOI: 10.1186/s12887-023-04393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/27/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Generating rigorous evidence to inform care for rare diseases requires reliable, sustainable, and longitudinal measurement of priority outcomes. Having developed a core outcome set for pediatric medium-chain acyl-CoA dehydrogenase (MCAD) deficiency, we aimed to assess the feasibility of prospective measurement of these core outcomes during routine metabolic clinic visits. METHODS We used existing cohort data abstracted from charts of 124 children diagnosed with MCAD deficiency who participated in a Canadian study which collected data from birth to a maximum of 11 years of age to investigate the frequency of clinic visits and quality of metabolic chart data for selected outcomes. We recorded all opportunities to collect outcomes from the medical chart as a function of visit rate to the metabolic clinic, by treatment centre and by child age. We applied a data quality framework to evaluate data based on completeness, conformance, and plausibility for four core MCAD outcomes: emergency department use, fasting time, metabolic decompensation, and death. RESULTS The frequency of metabolic clinic visits decreased with increasing age, from a rate of 2.8 visits per child per year (95% confidence interval, 2.3-3.3) among infants 2 to 6 months, to 1.0 visit per child per year (95% confidence interval, 0.9-1.2) among those ≥ 5 years of age. Rates of emergency department visits followed anticipated trends by child age. Supplemental findings suggested that some emergency visits occur outside of the metabolic care treatment centre but are not captured. Recommended fasting times were updated relatively infrequently in patients' metabolic charts. Episodes of metabolic decompensation were identifiable but required an operational definition based on acute manifestations most commonly recorded in the metabolic chart. Deaths occurred rarely in these patients and quality of mortality data was not evaluated. CONCLUSIONS Opportunities to record core outcomes at the metabolic clinic occur at least annually for children with MCAD deficiency. Methods to comprehensively capture emergency care received at outside institutions are needed. To reduce substantial heterogeneous recording of core outcome across treatment centres, improved documentation standards are required for recording of recommended fasting times and a consensus definition for metabolic decompensations needs to be developed and implemented.
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Affiliation(s)
- Ryan Iverson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Michael T Geraghty
- Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Valerie Austin
- The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | | | | | - Nancy J Butcher
- The Hospital for Sick Children Research Institute/University of Toronto, Toronto, Canada
| | - Alicia K J Chan
- Department of Medical Genetics, University of Alberta/Stollery Children's Hospital, Edmonton, Canada
| | - Sarah Dyack
- IWK Health Centre/Dalhousie University, Halifax, Canada
| | - Sharan Goobie
- IWK Health Centre/Dalhousie University, Halifax, Canada
| | - Cheryl R Greenberg
- Health Sciences Centre Winnipeg/University of Manitoba, Winnipeg, Canada
| | - Shailly Jain-Ghai
- Department of Medical Genetics, University of Alberta/Stollery Children's Hospital, Edmonton, Canada
| | | | - Natalya Karp
- London Health Sciences Centre/Western University, London, Canada
| | | | - Erica Langley
- Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Matthew Lines
- Hamilton Health Sciences Centre/McMaster University, Hamilton, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jennifer MacKenzie
- McMaster Children's Hospital, Hamilton, Canada
- Janeway Children's Hospital/Memorial University, St John's, Canada
| | - Bruno Maranda
- CIUSSSE-CHUS, Université de Sherbrooke, Sherbrooke, Canada, Sherbrooke, Canada
| | | | - Aizeddin Mhanni
- Health Sciences Centre Winnipeg/University of Manitoba, Winnipeg, Canada
| | | | - Laura Nagy
- The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Martin Offringa
- The Hospital for Sick Children Research Institute/University of Toronto, Toronto, Canada
| | - Amy Pender
- McMaster Children's Hospital, Hamilton, Canada
| | | | - Chitra Prasad
- London Health Sciences Centre/Western University, London, Canada
| | - Suzanne Ratko
- London Health Sciences Centre/Western University, London, Canada
| | - Ramona Salvarinova
- BC Children's Hospital/University of British Columbia, Vancouver, Canada
| | - Andreas Schulze
- The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Komudi Siriwardena
- Department of Medical Genetics, University of Alberta/Stollery Children's Hospital, Edmonton, Canada
| | - Neal Sondheimer
- The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Rebecca Sparkes
- Alberta Children's Hospital/University of Calgary, Calgary, Canada
| | | | - Kendra Tapscott
- BC Children's Hospital/University of British Columbia, Vancouver, Canada
| | | | - Lesley Turner
- Janeway Children's Hospital/Memorial University, St John's, Canada
| | - Clara Van Karnebeek
- BC Children's Hospital/University of British Columbia, Vancouver, Canada
- Emma Center for Personalized Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Jagdeep S Walia
- Kingston Health Sciences/Queen's University, Kingston, Canada
| | - Brenda J Wilson
- Janeway Children's Hospital/Memorial University, St John's, Canada
| | - Andrea C Yu
- Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Pranesh Chakraborty
- Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
- Newborn Screening Ontario, Ottawa, Canada.
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8
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Little P, Bradbury K, Stuart B, Barnett J, Krusche A, Steele M, Heber E, Easton S, Smith KA, Slodkowska-Barabasz J, Payne L, Corbett T, Yao G, Pollet S, Smith J, Joseph J, Lawrence M, Bohning D, Cheetham-Blake T, Eccles D, Foster C, Geraghty AWA, Leydon G, Muller A, Neal R, Osborne R, Rathod S, Richardson A, Grimmett C, Sharman G, Bacon R, Turner L, Stephens R, Burford T, Wilde L, Middleton K, Liddiard M, Rogers K, Raftery J, Zhu S, Webley F, Griffiths G, Nutall J, Chalder T, Wilkinson CE, Watson E, Yardley L. A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors. Br J Gen Pract 2023:BJGP.2023.0262. [PMID: 38164562 DOI: 10.3399/bjgp.2023.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Many cancer survivors following primary treatment have prolonged poor quality of life. AIM To determine the effectiveness of a bespoke digital intervention to support cancer survivors. DESIGN Pragmatic parallel open randomised trial. SETTING UK general practices. METHODS People having finished primary treatment (<= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score <85, were randomised by online software to: 1)detailed 'generic' digital NHS support ('LiveWell';n=906), 2) a bespoke complex digital intervention ('Renewed';n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) 'Renewed-with-support' (n=903): 'Renewed' with additional brief email and telephone support. RESULTS Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n's respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified. CONCLUSION Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global health enablement and symptom management, with substantially lower NHS costs.
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Affiliation(s)
- Paul Little
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Katherine Bradbury
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Beth Stuart
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Jane Barnett
- University of Southampton, Southampton, United Kingdom
| | - Adele Krusche
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Mary Steele
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Elena Heber
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Steph Easton
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Kirsten Ailsa Smith
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | | | - Liz Payne
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | | | - Guiqing Yao
- University of Leicester, Department of Health Sciences, Leicester, United Kingdom
| | - Sebastien Pollet
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Jazzine Smith
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Judith Joseph
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Megan Lawrence
- University of Southampton, Clinical Trials Unit, Southampton, United Kingdom
| | - Dankmar Bohning
- University of Southampton School of Mathematical Sciences, Southampton, United Kingdom
| | - Tara Cheetham-Blake
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Diana Eccles
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Claire Foster
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Adam W A Geraghty
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | | | - Andre Muller
- National University of Singapore, Singapore, Singapore
| | | | | | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Alison Richardson
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Chloe Grimmett
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Geoff Sharman
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Roger Bacon
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Lesley Turner
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Richard Stephens
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Tamsin Burford
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Laura Wilde
- Coventry University, Coventry, United Kingdom
| | - Karen Middleton
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Megan Liddiard
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Kirsty Rogers
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - James Raftery
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Shihua Zhu
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Fran Webley
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Gareth Griffiths
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Jaqui Nutall
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Trudie Chalder
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | | | - Eila Watson
- Oxford Brookes University, Oxford, United Kingdom
| | - Lucy Yardley
- Oxford Brookes University, Oxford, United Kingdom
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9
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Griffiths P, Saville C, Ball J, Dall'Ora C, Meredith P, Turner L, Jones J. Costs and cost-effectiveness of improved nurse staffing levels and skill mix in acute hospitals: A systematic review. Int J Nurs Stud 2023; 147:104601. [PMID: 37742413 DOI: 10.1016/j.ijnurstu.2023.104601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals. METHODS We included economic studies exploring the effect of variation in nurse staffing. We searched PubMed, CINAHL, Embase Econlit, Cochrane library, DARE, NHS EED and the INAHTA website. Risk of bias was assessed using a framework based on the NICE guidance for public health reviews and Henrikson's framework for economic evaluations. Inclusion, data extraction and critical appraisal were undertaken by pairs of reviewers with disagreements resolved by the entire review team. Results were synthesised using a hierarchical matrix to summarise findings of economic evaluations. RESULTS We found 23 observational studies conducted in the United States of America (16), Australia, Belgium, China, South Korea, and the United Kingdom (3). Fourteen had high risk of bias and nine moderate. Most studies addressed levels of staffing by RNs and/or licensed practical nurses. Six studies found that increased nurse staffing levels were associated with improved outcomes and reduced or unchanged net costs, but most showed increased costs and outcomes. Studies undertaken outside the USA showed that increased nurse staffing was likely to be cost-effective at a per capita gross domestic product (GDP) threshold or lower. Four studies found that increased skill mix was associated with improved outcomes but increased staff costs. Three studies considering net costs found increased registered nurse skill mix associated with net savings and similar or improved outcomes. CONCLUSION Although more evidence on cost-effectiveness is still needed, increases in absolute or relative numbers of registered nurses in general medical and surgical wards have the potential to be highly cost-effective. The preponderance of the evidence suggests that increasing the proportion of registered nurses is associated with improved outcomes and, potentially, reduced net cost. Conversely, policies that lead to a reduction in the proportion of registered nurses in nursing teams could give worse outcomes at increased costs and there is no evidence that such approaches are cost-effective. In an era of registered nurse scarcity, these results favour investment in registered nurse supply as opposed to using lesser qualified staff as substitutes, especially where baseline nurse staffing and skill mix are low. REGISTRATION PROSPERO (CRD42021281202). TWEETABLE ABSTRACT Increasing registered nurse staffing and skill mix can be a net cost-saving solution to nurse shortages. Contrary to the strong policy push towards a dilution of nursing skill mix, investment in supply of RNs should become the priority.
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Affiliation(s)
- Peter Griffiths
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Christina Saville
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Jane Ball
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Chiara Dall'Ora
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Paul Meredith
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom.
| | - Lesley Turner
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, United Kingdom.
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10
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Barker M, Campbell M, Turner L, Syed ANM, Wei RL, Kabolizadeh P. Assessing Displacement of Plastic Interstitial Catheters in Image-Guided Gynecological HDR Brachytherapy. Int J Radiat Oncol Biol Phys 2023; 117:e642. [PMID: 37785913 DOI: 10.1016/j.ijrobp.2023.06.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Interstitial HDR brachytherapy involves precise, localized delivery to targets with high dose gradients, sparing adjacent organs at risk. Due to the proximity of the rectum and bladder to the target, deviations in the catheters with respect to patient anatomy can change dose to those structures. While utilizing plastic interstitial catheters allows the patient to receive hyperthermia therapy during their course of interstitial treatment, the plastic catheters were observed to show significant deflection when the metal stylets are removed for treatment. The hyperthermia electrodes and the HDR source cable are both wires of approximately the same thickness. The purpose of this study is to assess the magnitude and deflection of the plastic catheters for gynecologic interstitial plans and determine whether using flexible wires for visualization on pre-treatment imaging is suitable for reconstructing the actual treatment received. MATERIALS/METHODS Pre-treatment CT images where the stylets were utilized for catheter visualization were registered to a subsequent CT scan with the metal stylets removed. The original treatment dwell positions were adjusted to the second CT to evaluate 3D catheter displacement and dose distributions calculated for the bladder, rectum, and target. The plans were subsequently reconstructed on a pre-planning CT with flexible 20-gauge wires instead of metal stylets to determine their suitability as a surrogate for stylets. RESULTS Absolute 3D displacement for all patients was 3.5 ± 5.4 mm (n = 3433 catheter dwell positions, mean ± SD, p < 0.001) comparing plans with the stylet in versus out. Absolute catheter deflection for interstitial treatments increased with the removal of the metal stylets with a difference of 0.75 ± 0.49° (n = 313 catheters, mean ± SD, p < 0.01). The plans utilizing flexible wire instead of stylets are observed to correlate with the plans with no stylets with absolute 3D displacement and angular deflection of 1.1 ± 0.6 mm and 0.35° ± 0.3° respectively (n = 39 catheters, mean ± SD, p > 0.2). While the average target EQD2 D90 reduced by 5% ± 5% by planning without the stylets, four patients would have experienced a deviation from the prescription by >10%. There was an overall decrease in bladder D2cc and overall increase in rectal D2cc in the plans with the stylets utilized vs removed. Bladder D2cc, rectal D2cc, and target coverage showed no appreciable difference between utilizing flexible wires and the plans without. The difference in HU between the metal stylets and flexible wires was negligible. CONCLUSION Catheter reconstruction in interstitial gynecological treatments with CT imaging revealed significant changes in catheter positioning with respect to the target volume once the stylets are removed for treatment. Using flexible wires of similar thickness to the source cable allow for more accurate tracking during planning without distorting the patient's anatomy or the treatment images, preserving the integrity of the treatment plan.
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Affiliation(s)
- M Barker
- Memorial Care Medical Center, Long Beach, CA
| | - M Campbell
- Memorial Care Medical Center, Long Beach, CA
| | - L Turner
- Memorial Care Medical Center, Long Beach, CA
| | - A N M Syed
- Memorial Care Medical Center, Long Beach, CA
| | - R L Wei
- Memorial Care Medical Center, Long Beach, CA
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11
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Kohut K, Morton K, Hurley K, Turner L, Dale C, Eastbrook S, Gold R, Henwood K, Patton S, Punjabi R, White H, Young C, Young J, Bancroft E, Barnett L, Cable S, Connolly G, Coad B, Forman A, Hanson H, Kavanaugh G, Sahan K, Snape K, Torr B, Way R, Winchester E, Youngs A, Eccles D, Foster C. 'A good decision is the one that feels right for me': Codesign with patients to inform theoretical underpinning of a decision aid website. Health Expect 2023; 27:e13844. [PMID: 37705192 PMCID: PMC10768874 DOI: 10.1111/hex.13844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Patient decision aids (PtDA) complement shared decision-making with healthcare professionals and improve decision quality. However, PtDA often lack theoretical underpinning. We are codesigning a PtDA to help people with increased genetic cancer risks manage choices. The aim of an innovative workshop described here was to engage with the people who will use the PtDA regarding the theoretical underpinning and logic model outlining our hypothesis of how the PtDA would lead to more informed decision-making. METHODS Short presentations about psychological and behavioural theories by an expert were interspersed with facilitated, small-group discussions led by patients. Patients were asked what is important to them when they make health decisions, what theoretical constructs are most meaningful and how this should be applied to codesign of a PtDA. An artist created a visual summary. Notes from patient discussions and the artwork were analysed using reflexive thematic analysis. RESULTS The overarching theme was: It's personal. Contextual factors important for decision-making were varied and changed over time. There was no one 'best fit' theory to target support needs in a PtDA, suggesting an inductive, flexible framework approach to programme theory would be most effective. The PtDA logic model was revised based on patient feedback. CONCLUSION Meaningful codesign of PtDA including discussions about the theoretical mechanisms through which they support decision-making has the potential to lead to improved patient care through understanding the intricately personal nature of health decisions, and tailoring content and format for holistic care. PATIENT CONTRIBUTION Patients with lived experience were involved in codesign and coproduction of this workshop and analysis as partners and coauthors. Patient discussions were the primary data source. Facilitators provided a semi-structured guide, but they did not influence the patient discussions or provide clinical advice. The premise of this workshop was to prioritise the importance of patient lived experience: to listen, learn, then reflect together to understand and propose ideas to improve patient care through codesign of a PtDA.
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Affiliation(s)
- Kelly Kohut
- School of Health Sciences, Centre for Psychosocial Research in Cancer (CentRIC)University of SouthamptonSouthamptonUK
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Kate Morton
- School of Health Sciences, Centre for Psychosocial Research in Cancer (CentRIC)University of SouthamptonSouthamptonUK
| | - Karen Hurley
- Stanford R. Weiss, MD Center for Hereditary Colorectal NeoplasiaCleveland ClinicClevelandOhioUSA
| | | | | | | | | | | | | | | | | | | | | | | | - Elizabeth Bancroft
- Cancer Genetics Unit and Academic Urology UnitThe Royal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | - Lily Barnett
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Sarah Cable
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Gaya Connolly
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Beth Coad
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Andrea Forman
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Helen Hanson
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Grace Kavanaugh
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Katherine Sahan
- Nuffield Department of Population Health, The Ethox CentreUniversity of OxfordOxfordUK
| | - Katie Snape
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Bethany Torr
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Rosalind Way
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | | | - Alice Youngs
- St George's University Hospitals NHS Foundation TrustLondonUK
| | | | - Diana Eccles
- Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Claire Foster
- School of Health Sciences, Centre for Psychosocial Research in Cancer (CentRIC)University of SouthamptonSouthamptonUK
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12
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Stewart SJF, Slodkowska-Barabasz J, McGeagh L, Moon Z, Brett J, Wells M, Brown MC, Turner M, Horne R, Fenlon D, Rehman F, Cain H, Donnelly P, Harmer V, Turner L, Rose J, Sharp L, Watson E. Development of the HT&Me intervention to support women with breast cancer to adhere to adjuvant endocrine therapy and improve quality of life. Breast 2023; 70:32-40. [PMID: 37300986 PMCID: PMC10382955 DOI: 10.1016/j.breast.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in women worldwide. Approximately 80% of breast cancers are oestrogen receptor positive (ER+). Patients treated surgically are usually recommended adjuvant endocrine therapy (AET) for 5-10 years. AET significantly reduces recurrence, but up to 50% of women do not take it as prescribed. OBJECTIVE To co-design and develop an intervention to support AET adherence and improve health-related quality-of-life (QoL) in women with breast cancer. METHODS Design and development of the HT&Me intervention took a person-based approach and was guided by the Medical Research Council framework for complex interventions, based on evidence and underpinned by theory. Literature reviews, behavioural analysis, and extensive key stakeholder involvement informed 'guiding principles' and the intervention logic model. Using co-design principles, a prototype intervention was developed and refined. RESULTS The blended tailored HT&Me intervention supports women to self-manage their AET. It comprises initial and follow-up consultations with a trained nurse, supported with an animation video, a web-app and ongoing motivational 'nudge' messages. It addresses perceptual (e.g. doubts about necessity, treatment concerns) and practical (e.g. forgetting) barriers to adherence and provides information, support and behaviour change techniques to improve QoL. Iterative patient feedback maximised feasibility, acceptability, and likelihood of maintaining adherence; health professional feedback maximised likelihood of scalability. CONCLUSIONS HT&Me has been systematically and rigorously developed to promote AET adherence and improve QoL, and is complemented with a logic model documenting hypothesized mechanisms of action. An ongoing feasibility trial will inform a future randomised control trial of effectiveness and cost-effectiveness.
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Affiliation(s)
- Sarah-Jane F Stewart
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, UK
| | | | - Lucy McGeagh
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, UK
| | - Zoe Moon
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, UK
| | - Mary Wells
- Imperial College Healthcare NHS Trust, UK
| | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, UK; Newcastle University Centre for Cancer, Newcastle University, UK
| | - Mark Turner
- Research Software Engineering, Newcastle University, UK
| | - Robert Horne
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, UK
| | - Deborah Fenlon
- Faculty of Medicine and Life Science, Swansea University, UK
| | | | - Henry Cain
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | | | | | | | - Jan Rose
- Patient and Public Involvement Representatives, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, UK; Newcastle University Centre for Cancer, Newcastle University, UK
| | - Eila Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, UK.
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13
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Kohut K, Morton K, Turner L, Shepherd J, Fenerty V, Woods L, Grimmett C, Eccles DM, Foster C. Patient decision support resources inform decisions about cancer susceptibility genetic testing and risk management: a systematic review of patient impact and experience. Front Health Serv 2023; 3:1092816. [PMID: 37395995 PMCID: PMC10311450 DOI: 10.3389/frhs.2023.1092816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Abstract
Background Patients with genetic cancer susceptibility are presented with complex management options involving difficult decisions, for example about genetic testing, treatment, screening and risk-reducing surgery/medications. This review sought to explore the experience of patients using decision support resources in this context, and the impact on decision-making outcomes. Methods Systematic review of quantitative, qualitative and mixed-methods studies involving adults with or without cancer who used a decision support resource pre- or post-genetic test for any cancer susceptibility. To gather a broad view of existing resources and gaps for development, digital or paper-based patient resources were included and not limited to decision aids. Narrative synthesis was used to summarise patient impact and experience. Results Thirty-six publications describing 27 resources were included. Heterogeneity of resources and outcome measurements highlighted the multiple modes of resource delivery and personal tailoring acceptable to and valued by patients. Impact on cognitive, emotional, and behavioural outcomes was mixed, but mainly positive. Findings suggested clear potential for quality patient-facing resources to be acceptable and useful. Conclusions Decision support resources about genetic cancer susceptibility are likely useful to support decision-making, but should be co-designed with patients according to evidence-based frameworks. More research is needed to study impact and outcomes, particularly in terms of longer term follow-up to identify whether patients follow through on decisions and whether any increased distress is transient. Innovative, streamlined resources are needed to scale up delivery of genetic cancer susceptibility testing for patients with cancer in mainstream oncology clinics. Tailored patient-facing decision aids should also be made available to patients identified as carriers of a pathogenic gene variant that increases future cancer risks, to complement traditional genetic counselling. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020220460, identifier: CRD42020220460.
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Affiliation(s)
- Kelly Kohut
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kate Morton
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Lesley Turner
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, United Kingdom
| | - Vicky Fenerty
- Engagement Services, University of Southampton Library, University of Southampton, Southampton, United Kingdom
| | - Lois Woods
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, United Kingdom
| | - Chloe Grimmett
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana M. Eccles
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
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14
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Rubbo B, Saville C, Dall'Ora C, Turner L, Jones J, Ball J, Culliford D, Griffiths P. Staffing levels and hospital mortality in England: a national panel study using routinely collected data. BMJ Open 2023; 13:e066702. [PMID: 37197808 DOI: 10.1136/bmjopen-2022-066702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups. DESIGN Retrospective observational study of routinely available data. SETTING AND PARTICIPANTS 138 National Health Service hospital trusts that provided general acute adult services in England between 2015 and 2019. OUTCOME MEASURE Standardised mortality rates were derived from the Summary Hospital level Mortality Indicator data set, with observed deaths as outcome in our models and expected deaths as offset. Staffing levels were calculated as the ratio of occupied beds per staff group. We developed negative binomial random-effects models with trust as random effects. RESULTS Hospitals with lower levels of medical and allied healthcare professional (AHP) staff (e.g, occupational therapy, physiotherapy, radiography, speech and language therapy) had significantly higher mortality rates (rate ratio: 1.04, 95% CI 1.02 to 1.06, and 1.04, 95% CI 1.02 to 1.06, respectively), while those with lower support staff had lower mortality rates (0.85, 95% CI 0.79 to 0.91 for nurse support, and 1.00, 95% CI 0.99 to 1.00 for AHP support). Estimates of the association between staffing levels and mortality were stronger between-hospitals than within-hospitals, which were not statistically significant in a within-between random effects model. CONCLUSIONS In additional to medicine and nursing, AHP staffing levels may influence hospital mortality rates. Considering multiple staff groups simultaneously when examining the association between hospital mortality and clinical staffing levels is crucial. TRIAL REGISTRATION NUMBER NCT04374812.
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Affiliation(s)
- Bruna Rubbo
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
| | - Chiara Dall'Ora
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
| | - Lesley Turner
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - David Culliford
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
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15
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Dall'Ora C, Rubbo B, Saville C, Turner L, Ball J, Ball C, Griffiths P. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. Hum Resour Health 2023; 21:30. [PMID: 37081525 PMCID: PMC10116759 DOI: 10.1186/s12960-023-00817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death. METHODS Systematic review. We searched Embase, Medline, CINAHL, and the Cochrane Library for quantitative or mixed methods studies with a quantitative component exploring the association between multi-disciplinary hospital staffing levels and mortality. RESULTS We included 12 studies. Hospitals with more physicians and registered nurses had lower mortality rates. Higher levels of nursing assistants were associated with higher patient mortality. Only two studies included other health professionals, providing scant evidence about their effect. CONCLUSIONS Pathways for allied health professionals such as physiotherapists, occupational therapists, dietitians, pharmacists, to impact safety and other patient outcomes are plausible and should be explored in future studies.
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Affiliation(s)
- Chiara Dall'Ora
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK.
| | - Bruna Rubbo
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Lesley Turner
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Jane Ball
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Cheska Ball
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
- Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
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16
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Beyltjens T, Boudin E, Revencu N, Boeckx N, Bertrand M, Schütz L, Haack TB, Weber A, Biliouri E, Vinkšel M, Zagožen A, Peterlin B, Pai S, Telegrafi A, Henderson LB, Ells C, Turner L, Wuyts W, Van Hul W, Hendrickx G, Mortier GR. Heterozygous pathogenic variants involving CBFB cause a new skeletal disorder resembling cleidocranial dysplasia. J Med Genet 2022; 60:498-504. [PMID: 36241386 PMCID: PMC10176335 DOI: 10.1136/jmg-2022-108739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cleidocranial dysplasia (CCD) is a rare skeletal dysplasia with significant clinical variability. Patients with CCD typically present with delayed closure of fontanels and cranial sutures, dental anomalies, clavicular hypoplasia or aplasia and short stature. Runt-related transcription factor 2 (RUNX2) is currently the only known disease-causing gene for CCD, but several studies have suggested locus heterogeneity. METHODS The cohort consists of eight subjects from five unrelated families partially identified through GeneMatcher. Exome or genome sequencing was applied and in two subjects the effect of the variant was investigated at RNA level. RESULTS In each subject a heterozygous pathogenic variant in CBFB was detected, whereas no genomic alteration involving RUNX2 was found. Three CBFB variants (one splice site alteration, one nonsense variant, one 2 bp duplication) were shown to result in a premature stop codon. A large intragenic deletion was found to delete exon 4, without affecting CBFB expression. The effect of a second splice site variant could not be determined but most likely results in a shortened or absent protein. Affected individuals showed similarities with RUNX2-related CCD, including dental and clavicular abnormalities. Normal stature and neurocognitive problems were however distinguishing features. CBFB encodes the core-binding factor β subunit, which can interact with all RUNX proteins (RUNX1, RUNX2, RUNX3) to form heterodimeric transcription factors. This may explain the phenotypic differences between CBFB-related and RUNX2-related CCD. CONCLUSION We confirm the previously suggested locus heterogeneity for CCD by identifying five pathogenic variants in CBFB in a cohort of eight individuals with clinical and radiographic features reminiscent of CCD.
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Affiliation(s)
- Tessi Beyltjens
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - Eveline Boudin
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - Nicole Revencu
- Center for Human Genetics, Cliniques universitaires Saint-Luc and University of Louvain, Brussels, Belgium
| | - Nele Boeckx
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - Miriam Bertrand
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Leon Schütz
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Axel Weber
- Institute of Human Genetics, Justus Liebig University, Giessen, Germany
| | - Eleni Biliouri
- Institute of Human Genetics, Justus Liebig University, Giessen, Germany
| | - Mateja Vinkšel
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana Division of Internal Medicine, Ljubljana, Slovenia
| | - Anja Zagožen
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana Division of Internal Medicine, Ljubljana, Slovenia
| | - Borut Peterlin
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana Division of Internal Medicine, Ljubljana, Slovenia
| | - Shashidhar Pai
- Children's Health, Division of Genetics, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - Courtney Ells
- Provincial Medical Genetics Program, Eastern Health, St. John's, Newfoundland, Canada
| | - Lesley Turner
- Provincial Medical Genetics Program, Eastern Health, St. John's, Newfoundland, Canada.,Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Wim Wuyts
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - Wim Van Hul
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - Gretl Hendrickx
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium .,Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Geert R Mortier
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium.,Department of Human Genetics, KU Leuven, Leuven, Belgium.,Center for Human Genetics, University Hospital Leuven, Leuven, Belgium
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Dall'Ora C, Saville C, Rubbo B, Turner L, Jones J, Griffiths P. Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. Int J Nurs Stud 2022; 134:104311. [DOI: 10.1016/j.ijnurstu.2022.104311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 02/08/2023]
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Turner L, Ball J, Culliford D, Kitson-Reynolds E, Griffiths P. Exploring the relationship between women’s experience of postnatal care and reported staffing measures: An observational study. PLoS One 2022; 17:e0266638. [PMID: 35917338 PMCID: PMC9345482 DOI: 10.1371/journal.pone.0266638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Women have reported dissatisfaction with care received on postnatal wards and this area has been highlighted for improvement. Studies have shown an association between midwifery staffing levels and postnatal care experiences, but so far, the influence of registered and support staff deployed in postnatal wards has not been studied. This work is timely as the number of support workers has increased in the workforce and there has been little research on skill mix to date. Methods Cross sectional secondary analysis including 13,264 women from 123 postnatal wards within 93 hospital Trusts. Staffing was measured in each organisation as Full Time Equivalent staff employed per 100 births, and on postnatal wards, using Hours Per Patient Day. Women’s experiences were assessed using four items from the 2019 national maternity survey. Multilevel logistic regression models were used to examine relationships and adjust for maternal age, parity, ethnicity, type of birth, and medical staff. Results Trusts with higher levels of midwifery staffing had higher rates of women reporting positive experiences of postnatal care. However, looking at staffing on postnatal wards, there was no evidence of an association between registered nurses and midwives hours per patient day and patient experience. Wards with higher levels of support worker staffing were associated with higher rates of women reporting they had help when they needed it and were treated with kindness and understanding. Conclusion The relationship between reported registered staffing levels on postnatal wards and women’s experience is uncertain. Further work should be carried out to examine why relationships observed using whole Trust staffing were not replicated closer to the patient, with reported postnatal ward staffing. It is possible that recorded staffing levels on postnatal wards do not actually reflect staff deployment if midwives are floated to cover delivery units. This study highlights the potential contribution of support workers in providing quality care on postnatal wards.
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Affiliation(s)
- Lesley Turner
- School of Health Sciences, University of Southampton, Southampton, England
- * E-mail:
| | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, England
| | - David Culliford
- NIHR Applied Research Collaboration Wessex, School of Health Sciences, University of Southampton, Southampton, England
| | | | - Peter Griffiths
- National Institute for Health Research Applied Research Centre (Wessex), School of Health Sciences, University of Southampton, Southampton, England
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Stephens M, O’Hara A, DeVito I, Turner L, Mozdzierz C, Latif H, Zhou G. Gene Editing/Gene Therapies: HIGH-THROUGHPUT RNA SEQUENCING DIRECTLY FROM CELL LYSATES ENABLES REPRODUCIBLE PHENOTYPIC PROFILING FOR CRISPR TREATMENT AND CELL RESPONSE SCREENING APPLICATIONS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Durkin K, Heetun A, Ewings S, Munday R, Wootton SA, Turner L, Copson ER, Cutress RI. Body composition and chemotherapy toxicity in women with early breast cancer (CANDO-3): protocol for an observational cohort study. BMJ Open 2022; 12:e054412. [PMID: 35193913 PMCID: PMC8867326 DOI: 10.1136/bmjopen-2021-054412] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Systemic anticancer therapy is given to selected patients with early breast cancer (EBC) before or after surgery with the aim of eradicating micrometastatic spread and reducing the risk of cancer recurrence. Chemotherapy treatment is most effective when patients receive the optimum dose, on time and without delays or reductions in their treatment doses. Most chemotherapy drugs are dosed according to body surface area calculated from a patient's height and weight. These calculations were however designed based on data from normal weight patients. This has resulted in uncertainty as to the optimal dosing for patients with different amounts of blood, muscle and fatty tissue (body composition). This study uses segmental bioelectrical impedance analysis (using the Seca mBCA 515) to determine whether differences in the measures of resistance and reactance, and derived estimates of body composition, are predictive of chemotherapy toxicity in the treatment of EBC. METHODS AND ANALYSIS A prospective observational cohort study of women with EBC in whom adjuvant or neoadjuvant chemotherapy is planned. A total of 300 participants will be recruited across nine UK hospital sites. The primary outcome is to determine if higher fat mass index is associated with increased National Cancer Institute Common Terminology Criteria for Adverse Events v5.0 grade 3 (or higher) chemotherapy toxicity. ETHICS AND DISSEMINATION This study has received ethical approval from the South Central Hampshire B Research Ethics Committee, England (19/SC/0596: IRAS: 263666). The chief investigator and coinvestigators will be responsible for publication of the study findings in a peer-reviewed journal, on behalf of all collaborators. TRIAL REGISTRATION NUMBER ISRCTN79577461.
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Affiliation(s)
- Kesta Durkin
- Cancer Sciences Academic Unit, University of Southampton, Southampton, UK
| | - Adam Heetun
- Cancer Sciences Academic Unit, University of Southampton, Southampton, UK
| | - Sean Ewings
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Richard Munday
- Clinical Informatics Research Unit, University of Southampton, Southampton, UK
| | - Stephen A Wootton
- Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | | | - Ellen R Copson
- Cancer Sciences Academic Unit, University of Southampton, Southampton, UK
| | - Ramsey I Cutress
- Cancer Sciences Academic Unit, University of Southampton, Southampton, UK
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21
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Turner L, Culliford D, Ball J, Kitson-Reynolds E, Griffiths P. The association between midwifery staffing levels and the experiences of mothers on postnatal wards: Cross sectional analysis of routine data. Women Birth 2022; 35:e583-e589. [DOI: 10.1016/j.wombi.2022.02.005] [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] [Received: 09/29/2021] [Revised: 01/08/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
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22
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Morton K, Kohut K, Turner L, Smith S, Crosbie EJ, Ryan N, Grimmett C, Eccles DM, Foster C. Person-based co-design of a decision aid template for people with a genetic predisposition to cancer. Front Digit Health 2022; 4:1039701. [PMID: 36518561 PMCID: PMC9743799 DOI: 10.3389/fdgth.2022.1039701] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background People with genetic predispositions to cancer are faced with complex health decisions about managing their risk. Decision aids can support informed, values-based decisions, alongside shared decision-making with a clinician. Whilst diagnoses of genetic predispositions to cancer are increasing, there is no scalable decision aid to support these people. This paper presents an accessible, relevant decision aid template which can be adapted for different predispositions to cancer. Methods The decision aid template was co-developed with 12 patients affected by cancer and informed by empirical and theoretical literature. In addition, consultations were conducted with a further 19 people with Lynch syndrome; a specific genetic predisposition to cancer. Clinical stakeholders were consulted regularly. Coulter's framework for decision aid development guided the process, and these activities were complemented by the International Patient Decision Aid Standards, and the latest evidence on communicating risk in decision aids. Programme theory was developed to hypothesise how the decision aid would support decision-making and contextual factors which could influence the process. Guiding principles co-developed with the patient panel described how the decision aid could effectively engage people. Results The in-depth co-design process led to the identification of five core components of an accessible decision aid template for people with a genetic predisposition to cancer: defining the decision; option grid showing implications of each option; optional further details such as icon arrays to show tailored risk and personal narratives; values clarification activity; and a summary to facilitate discussion with a clinician. Specific guidance was produced describing how to develop each component. The guiding principles identified that the decision aid template needed to promote trust, reduce distress, and be comprehensive, personally relevant and accessible in order to engage people. Conclusion Adopting a co-design process helped ensure that the decision aid components were relevant and accessible to the target population. The template could have widespread application through being adapted for different genetic predispositions. The exact content should be co-designed with people from diverse backgrounds with lived experience of the specific predisposition to ensure it is as useful, engaging and relevant as possible.
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Affiliation(s)
- Kate Morton
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
- Correspondence: Kate Morton
| | - Kelly Kohut
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Lesley Turner
- Patient and Public Contributor, Southampton, United Kingdom
| | - Sian Smith
- Aston University, College of Health and Life Sciences, School of Optometry, Birmingham, United Kingdom
| | - Emma J. Crosbie
- Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cancer Science, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Neil Ryan
- College of Medicine and Veterinary Medicine, University of Edinburgh, United Kingdom
| | - Chloe Grimmett
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana M. Eccles
- Department of Medicine, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
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Turner L, Griffiths P, Kitson-Reynolds E. Midwifery and nurse staffing of inpatient maternity services - A systematic scoping review of associations with outcomes and quality of care. Midwifery 2021; 103:103118. [PMID: 34428733 DOI: 10.1016/j.midw.2021.103118] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/25/2021] [Accepted: 07/29/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To undertake a scoping literature review of studies examining the quantitative association between staffing levels and outcomes for mothers, neonates, and staff. The purpose was to understand the strength of the available evidence, the direction of effects, and to highlight gaps for future research. DATA SOURCES Systematic searches were conducted in Medline (Ovid), Embase (Ovid), CINAHL (EBCSCO), Cochrane Library, TRIP, Web of Science and Scopus. STUDY SELECTION AND REVIEW METHODS To be eligible, staffing levels had to be quantified for in-patient settings, such as ante-natal, labour/delivery or post-natal care. Staff groups included midwives, nurse midwives or equivalent, and assistant staff working under the supervision of professionals. Studies of the quality of care, patient outcomes and staff outcomes were included from all countries. All quantitative designs were included, including controlled trials, time series, cross-sectional, cohort studies and case controlled studies. Data were extracted and sources of bias identified by considering the study design, measurement of exposure and outcomes, and risk adjustment. Studies were grouped by outcome noting the direction and significance of effects. RESULTS The search yielded a total of 3280 records and 21 studies were included in this review originating from ten countries. There were three randomised controlled trials, eleven cohort studies, one case control study and six cross sectional studies. Seventeen were multicentre studies and nine of them had over 30,000 participants. Reduced incidence of epidural use, augmentation, perineal damage at birth, postpartum haemorrhage, maternal readmission, and neonatal resuscitation were associated with increased midwifery staff. Few studies have suggested a negative impact of increasing staffing rates, although a number of studies have found no significant differences in outcomes. Impact on the mode of birth was unclear. Increasing midwifery assistants was not associated with improved patient outcomes. No studies were found on the impact of low staffing levels for the midwifery workforce. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Although there is some evidence that higher midwifery staffing is associated with improved outcomes, current research is insufficient to inform service planning. Studies mainly reported outcomes relating to labour, highlighting a gap in research evidence for the antenatal and postnatal periods. Further studies are needed to assess the costs and consequences of variations in maternity staffing, including the deployment of maternity assistants and other staff groups.
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Affiliation(s)
- Lesley Turner
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ,.
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ and National Institute for Health Research Applied Research Centre (Wessex).
| | - Ellen Kitson-Reynolds
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ,.
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24
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Bhattacharya IS, Haviland JS, Turner L, Stobart H, Balasopoulou A, Stones L, Kirby AM, Kirwan CC, Coles CE, Bliss JM. Can patient decision aids reduce decisional conflict in a de-escalation of breast radiotherapy clinical trial? The PRIMETIME Study Within a Trial implemented using a cluster stepped-wedge trial design. Trials 2021; 22:397. [PMID: 34127033 PMCID: PMC8202048 DOI: 10.1186/s13063-021-05345-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For patients with early breast cancer considered at very-low risk of local relapse, risks of radiotherapy may outweigh the benefits. Decisions regarding treatment omission can lead to patient uncertainty (decisional conflict), which may be lessened with patient decision aids (PDA). PRIMETIME (ISRCTN 41579286) is a UK-led biomarker-directed study evaluating omission of adjuvant radiotherapy in breast cancer; an embedded Study Within A Trial (SWAT) investigated whether PDA reduces decisional conflict using a cluster stepped-wedge trial design. METHODS PDA diagrams and a video explaining risks and benefits of radiotherapy were developed in close collaboration between patient advocates and PRIMETIME trialists. The SWAT used a cluster stepped-wedge trial design, where each cluster represented the radiotherapy centre and referring peripheral centres. All clusters began in the standard information group (patient information and diagrams) and were randomised to cross-over to the enhanced information group (standard information plus video) at 2, 4 or 6 months. Primary endpoint was the decisional conflict scale (0-100, higher scores indicating greater conflict) which was assessed on an individual participant level. Multilevel mixed effects models used a random effect for cluster and a fixed effect for each step to adjust for calendar time and clustering. Robust standard errors were also adjusted for the clustering effect. RESULTS Five hundred twenty-one evaluable questionnaires were returned from 809 eligible patients (64%) in 24 clusters between April 2018 and October 2019. Mean decisional conflict scores in the standard group (N = 184) were 10.88 (SD 11.82) and 8.99 (SD 11.82) in the enhanced group (N = 337), with no statistically significant difference [mean difference - 1.78, 95%CI - 3.82-0.25, p = 0.09]. Compliance with patient information and diagrams was high in both groups although in the enhanced group only 121/337 (36%) reported watching the video. CONCLUSION The low levels of decisional conflict in PRIMETIME are reassuring and may reflect the high-quality information provision, such that not everyone required the video. This reinforces the importance of working with patients as partners in clinical trials especially in the development of patient-centred information and decision aids.
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Affiliation(s)
- Indrani S. Bhattacharya
- The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), London, UK
- Oncology & Radiotherapy, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joanne S. Haviland
- The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), London, UK
| | | | | | - Ada Balasopoulou
- The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), London, UK
| | - Liba Stones
- The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), London, UK
| | - Anna M. Kirby
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Cliona C. Kirwan
- Institute of Cancer Sciences, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Charlotte E. Coles
- Oncology & Radiotherapy, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Judith M. Bliss
- The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), London, UK
| | - on behalf of the PRIMETIME Trialists
- The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), London, UK
- Oncology & Radiotherapy, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Independent Cancer Patients’ Voice, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
- Institute of Cancer Sciences, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
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25
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Moussiliou A, Turner L, Cottrell G, Doritchamou J, Gbédandé K, Fievet N, Luty AJF, Massougbodji A, Theander TG, Deloron P, Lavstsen T, Tuikue Ndam N. Dynamics of PfEMP1 Antibody Profile From Birth to 12 Months of Age in Beninese Infants. J Infect Dis 2021; 221:2010-2017. [PMID: 32002541 DOI: 10.1093/infdis/jiaa043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Plasmodium falciparum-infected erythrocytes bind to specific endothelial cell receptors via members of the PfEMP1 family exported onto the erythrocyte surface. These interactions are mediated by different types of cysteine-rich interdomain region (CIDR) domains found in the N-terminal region of all PfEMP1. CIDRα1 domains bind endothelial protein C receptor (EPCR), CIDRα2-6 domains bind CD36, whereas the receptor specificity of CIDRβ/γ/δ domains is unknown. METHODS In this study, we investigated the level of immunoglobulin (Ig)G targeting the different types of PfEMP1 CIDR during the first year of life. We used plasma collected longitudinally from children of pregnant women who had been followed closely through pregnancy. RESULTS Antibodies to CIDRα1 domains were more frequent in cord blood compared with antibodies to CIDRα2-6 domains. Higher IgG levels to EPCR-binding CIDRα1 variants positively correlated with the timing of first infections. Antibodies to all PfEMP1 types declined at similar rates to the point of disappearance over the first 6 months of life. At 12 months, children had acquired antibody to all types of CIDR domains, mostly in children with documented P falciparum infections. CONCLUSIONS These observations agree with the notion that the timing and phenotype of first P falciparum infections in life are influenced by the immune status of the mother.
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Affiliation(s)
| | - L Turner
- Centre for Medical Parasitology at Department of Immunology and Microbiology (ISIM), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - G Cottrell
- Université de Paris, MERIT, IRD, Paris, France
| | - J Doritchamou
- Institut de Recherche Clinique du Bénin, Université d'Abomey-Calavi, Cotonou, Bénin
| | - K Gbédandé
- Institut de Recherche Clinique du Bénin, Université d'Abomey-Calavi, Cotonou, Bénin
| | - N Fievet
- Université de Paris, MERIT, IRD, Paris, France
| | - A J F Luty
- Université de Paris, MERIT, IRD, Paris, France
| | - A Massougbodji
- Institut de Recherche Clinique du Bénin, Université d'Abomey-Calavi, Cotonou, Bénin
| | - T G Theander
- Centre for Medical Parasitology at Department of Immunology and Microbiology (ISIM), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - P Deloron
- Université de Paris, MERIT, IRD, Paris, France
| | - T Lavstsen
- Centre for Medical Parasitology at Department of Immunology and Microbiology (ISIM), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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Mentasti M, David S, Sands K, Khan S, Davies L, Turner L, Wootton M. Rapid detection and differentiation of mobile colistin resistance (mcr-1 to mcr-10) genes by real-time PCR and melt-curve analysis. J Hosp Infect 2021; 110:148-155. [PMID: 33485969 DOI: 10.1016/j.jhin.2021.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The emergence of multi-drug-resistant (MDR) micro-organisms prompted new interest in older antibiotics, such as colistin, that had been abandoned previously due to limited efficacy or high toxicity. Over the years, several chromosomal-encoded colistin resistance mechanisms have been described; more recently, 10 plasmid-mediated mobile colistin resistance (mcr) genes have been identified. Spread of these genes among MDR Gram-negative bacteria is a matter of serious concern; therefore, reliable and timely mcr detection is paramount. AIM To design and validate a multiplex real-time polymerase chain reaction (PCR) assay for detection and differentiation of mcr genes. METHODS All available mcr alleles were downloaded from the National Center for Biotechnology Information Reference Gene Catalogue, aligned with Clustal Omega and primers designed using Primer-BLAST. Real-time PCR monoplexes were optimized and validated using a panel of 120 characterized Gram-negative strains carrying a wide range of resistance genes, often in combination. Melt-curve analysis was used to confirm positive results. FINDINGS In-silico analysis enabled the design of a 'screening' assay for detection of mcr-1/2/6, mcr-3, mcr-4, mcr-5, mcr-7, mcr-8 and mcr-9/10, paired with an internal control assay to discount inhibition. A 'supplementary' assay was subsequently designed to differentiate mcr-1, mcr-2, mcr-6, mcr-9 and mcr-10. Expected results were obtained for all strains (100% sensitivity and specificity). Melt-curve analysis showed consistent melting temperature results. Inhibition was not observed. CONCLUSIONS The assay is rapid and easy to perform, enabling unequivocal mcr detection and differentiation even when more than one variant is present. Adoption by clinical and veterinary microbiology laboratories would aid the surveillance of mcr genes amongst Gram-negative bacteria.
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Affiliation(s)
- M Mentasti
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK.
| | - S David
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Cambridge, UK
| | - K Sands
- School of Medicine, Cardiff University, Cardiff, UK; Department of Zoology, University of Oxford, Oxford, UK
| | - S Khan
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - L Davies
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - L Turner
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - M Wootton
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
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Lamond A, Buckley D, O'Dea J, Turner L. Variants of SLC18A3 leading to congenital myasthenic syndrome in two children with varying presentations. BMJ Case Rep 2021; 14:14/1/e237799. [PMID: 33462016 PMCID: PMC7813295 DOI: 10.1136/bcr-2020-237799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This report describes the variation in presentation of two unrelated patients found to have a rare form of presynaptic congenital myasthenic syndrome. Both patients presented with hypotonia, ptosis, poor weight gain and apneic episodes. Through whole exome sequencing, our patients were found to have the same likely pathogenic biallelic variants in W315X and I200N of SLC18A3, encoding vesicular acetylcholine transporter (VAChT). These specific variants in SLC18A3 have not been previously described in the literature. We illustrate the variety in clinical presentation and course of children with mutations in SLC18A3, leading to presynaptic congenital myasthenic syndrome through VAChT deficiency.
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Affiliation(s)
- Allison Lamond
- Pediatrics, Memorial University of Newfoundland Faculty of Medicine, St. John's, Newfoundland and Labrador, Canada
| | - David Buckley
- Pediatric Neurology, Memorial University of Newfoundland Faculty of Medicine, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer O'Dea
- Pediatrics, Memorial University of Newfoundland Faculty of Medicine, St. John's, Newfoundland and Labrador, Canada
| | - Lesley Turner
- Genetics, Memorial University of Newfoundland Faculty of Medicine, St. John's, Newfoundland and Labrador, Canada
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Shah K, Woldendorp K, Harris J, Keech A, Morton R, Ng M, Elder D, Seco M, Nguyen M, Turner L, Wu J, Watson D, Doyle M. R29 Hospital Resource Use and Costs of Isolated Aortic Valve Replacement Procedures in Patients with aortic stenosis, by STS risk scores in New South Wales, Australia. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fenlon D, Maishman T, Day L, Nuttall J, May C, Ellis M, Raftery J, Turner L, Fields J, Griffiths G, Hunter MS. Effectiveness of nurse-led group CBT for hot flushes and night sweats in women with breast cancer: Results of the MENOS4 randomised controlled trial. Psychooncology 2020; 29:1514-1523. [PMID: 32458473 PMCID: PMC7590063 DOI: 10.1002/pon.5432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Troublesome hot flushes and night sweats (HFNS) are experienced by many women after treatment for breast cancer, impacting significantly on sleep and quality of life. Cognitive behavioural therapy (CBT) is known to be effective for the alleviation of HFNS. However, it is not known if it can effectively be delivered by specialist nurses. We investigated whether group CBT, delivered by breast care nurses (BCNs), can reduce the impact of HFNS. METHODS We recruited women with primary breast cancer following primary treatment with seven or more HFNS/week (including 4/10 or above on the HFNS problem rating scale), from six UK hospitals to an open, randomised, phase 3 effectiveness trial. Participants were randomised to Group CBT or usual care (UC). The primary endpoint was HFNS problem rating at 26 weeks after randomisation. Secondary outcomes included sleep, depression, anxiety and quality of life. RESULTS Between 2017 and 2018, 130 participants were recruited (CBT:63, control:67). We found a 46% (6.9-3.7) reduction in the mean HFNS problem rating score from randomisation to 26 weeks in the CBT arm and a 15% (6.5-5.5) reduction in the UC arm (adjusted mean difference -1.96, CI -3.68 to -0.23, P = .039). Secondary outcomes, including frequency of HFNS, sleep, anxiety and depression all improved significantly. CONCLUSION Our results suggest that specialist nurses can be trained to deliver CBT effectively to alleviate troublesome menopausal hot flushes in women following breast cancer in the NHS setting.
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Affiliation(s)
- Deborah Fenlon
- Department Nursing, College of Human and Health SciencesSwansea UniversitySwanseaUK
| | - Tom Maishman
- Southampton Clinical Trials UnitUniversity of SouthamptonSouthamptonUK
| | - Laura Day
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | | | - Carl May
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Mary Ellis
- Southampton Clinical Trials UnitUniversity of SouthamptonSouthamptonUK
| | - James Raftery
- Primary Care and Population SciencesUniversity of SouthamptonSouthamptonUK
| | - Lesley Turner
- Southampton Clinical Trials UnitUniversity of SouthamptonSouthamptonUK
| | - Jo Fields
- Ladybird UnitPoole Hospital NHS TrustPooleUK
| | - Gareth Griffiths
- Southampton Clinical Trials UnitUniversity of SouthamptonSouthamptonUK
| | - Myra S. Hunter
- Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
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Mazza D, McCarthy E, Singh N, Carey M, Turner L, Harris M. "There's always something else": Patient perspectives on improving the implementation of obesity guidelines in general practice. Obes Res Clin Pract 2020; 14:437-442. [PMID: 32962956 DOI: 10.1016/j.orcp.2020.09.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The prevalence of obesity in Australia is rising. National guidelines for the management of overweight and obesity exist but our previous work demonstrates poor implementation of key elements in general practice. The aim of this study was to describe patient perspectives on the implementation of obesity guidelines in general practice. METHODS Qualitative study of 40 people living with obesity (PwO) who were recruited through general practices in Melbourne, Australia. PwO had a recorded BMI in the overweight range or above (>25), had attended a consultation in the last 6 months and had a diagnosis of at least one of the following: diabetes, kidney disease, hyperlipidemia, hypertension, or cardiovascular disease. Semi-structured telephone interviews were conducted with patients. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS While a strong general practitioner (GP)-patient relationship enabled conversation to occur about weight management there was uncertainty as to whether patients or GPs should broach the topic of weight. Patients described complacency regarding their weight and often being unprepared to take up GP advice. Other health issues were felt to take precedence, and patients described inconsistent provision of information and resources to assist them in tackling their weight problems. CONCLUSIONS It is imperative to take into account patient perspectives on obesity management in general practice in order to improve health outcomes. This study provides valuable insights into how PwO can be better managed. Interventions should also include strategies to help patients maintain motivation in making lifestyle changes to support healthy weight loss.
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Affiliation(s)
- D Mazza
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - E McCarthy
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - N Singh
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Carey
- School of Medicine and Public Health, University of Newcastle, Australia
| | - L Turner
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Harris
- School of Public Health and Community Medicine, University of New South Wales, Australia
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Murphy JL, Munir F, Davey F, Miller L, Cutress R, White R, Lloyd M, Roe J, Granger C, Burden S, Turner L. The provision of nutritional advice and care for cancer patients: a UK national survey of healthcare professionals. Support Care Cancer 2020; 29:2435-2442. [PMID: 32918612 PMCID: PMC7981321 DOI: 10.1007/s00520-020-05736-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/09/2020] [Accepted: 09/01/2020] [Indexed: 01/21/2023]
Abstract
Purpose People living with and beyond cancer often experience nutrition-related issues and should receive appropriate advice on nutrition that is consistent and evidence based. The aim of this study was to investigate current practice for the provision of nutritional care by healthcare professionals (HCPs) from a UK national survey produced by the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration. Methods An online survey sent to professional groups and networks included questions on discussing nutrition, providing information, awareness of guidelines, confidence in providing nutritional advice, training and strategies for improving nutritional management. Results There were 610 HCPs who responded including nurses (31%), dietitians (25%), doctors (31%) and speech and language therapists (9%). The majority of HCPs discusses nutrition (94%) and provides information on nutrition (77%). However, only 39% of HCPs reported being aware of nutritional guidelines, and just 20% were completely confident in providing nutritional advice. Awareness of guidelines varied between the different professional groups with most but not all dietitians reporting the greatest awareness of guidelines and GPs the least (p = 0.001). Those HCPs with a greater awareness of guidelines had received training (p = 0.001) and were more likely to report complete confidence in providing nutritional advice (p = 0.001). Conclusion Whilst HCPs discuss nutrition with cancer patients and may provide information, many lack an awareness of guidelines and confidence in providing nutritional advice. To ensure consistency of practice and improvements in patient care, there is scope for enhancing the provision of appropriate nutrition education and training.
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Affiliation(s)
- Jane L Murphy
- Faculty of Health & Social Sciences, Bournemouth University, 10 St Paul's Lane, Bournemouth BH8 8AJ, UK.
| | - Fehmidah Munir
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - Fiona Davey
- NIHR Cancer and Nutrition Collaboration, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Laura Miller
- Nutrition and Dietetics Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.,NIHR Nottingham BRC, Nottingham, UK
| | - Ramsey Cutress
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rhys White
- Nutrition and Dietetics, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Megan Lloyd
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Justin Roe
- The Royal Marsden NHS Foundation Trust, London, UK.,Imperial College Healthcare NHS Trust, London, UK.,Imperial College, London, UK
| | | | - Sorrel Burden
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Lesley Turner
- NIHR Cancer and Nutrition Collaboration, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Thomas JMH, Mollart C, Turner L, Heasman P, Fayon P, Trewin A. Artificial Synthesis of Conjugated Microporous Polymers via Sonogashira-Hagihara Coupling. J Phys Chem B 2020; 124:7318-7326. [PMID: 32786713 DOI: 10.1021/acs.jpcb.0c04850] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Amorphous network materials are becoming increasingly important with applications, for example, as supercapacitors, battery anodes, and proton conduction membranes. The design of these materials is hampered by the amorphous nature of the structure and sensitivity to synthetic conditions. Here, we show that through artificial synthesis, fully mimicking the catalytic formation cycle, and full synthetic conditions, we can generate structural models that can fully describe the physical properties of these amorphous network materials. This opens up pathways for the rational design where complex structural influences, such as the solvent and catalyst choice, can be taken into account.
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Affiliation(s)
- J M H Thomas
- Institute of Integrative Biology, University of Liverpool, Liverpool L69 7ZB, U.K
| | - C Mollart
- Department of Chemistry, Lancaster University, Bailrigg, Lancaster LA1 4YB, U.K
| | - L Turner
- Department of Chemistry, Lancaster University, Bailrigg, Lancaster LA1 4YB, U.K
| | - P Heasman
- Department of Chemistry, Lancaster University, Bailrigg, Lancaster LA1 4YB, U.K
| | - P Fayon
- Department of Chemistry, Lancaster University, Bailrigg, Lancaster LA1 4YB, U.K
| | - A Trewin
- Department of Chemistry, Lancaster University, Bailrigg, Lancaster LA1 4YB, U.K
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Clarke A, Beenstock J, Lukacs JN, Turner L, Limmer M. Major risk factors for sexual minority young people's mental and physical health: findings from a county-wide school-based health needs assessment. J Public Health (Oxf) 2020; 41:e274-e282. [PMID: 30252096 DOI: 10.1093/pubmed/fdy167] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/26/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood health is an important adult health predictor. Sexual orientation is increasingly recognized as influential on children and young people's (CYP) mental and physical health. METHODS Data came from a cross-sectional survey of year 9 children attending schools in two local authorities in the north-west of England, including mental and physical health indicators, and demographic characteristics including sexual orientation. The sample of 8058 represented 67.8% of the eligible population. Data were analysed by sexual orientation, sexual majority or sexual minority. RESULTS Children reporting their sexual orientation as sexual minority reported worse mental and physical health outcomes and behaviours than sexual majority peers; had higher odds of being lonely (odds ratios (OR) = 8.24, 95% C.I.: 6.56-10.37), having self-harmed (OR = 7.28, 95% C.I.: 5.78-9.15), being bullied (OR = 4.76, 95% C.I.: 3.74-6.05) or perceiving themselves as overweight (OR = 2.40, 95% C.I.: 1.89-3.06). CONCLUSIONS It is important to identify and support children in a sexual minority. Research is required to understand differences between children within sexual minorities and the impact on outcomes and rights. Health and social policy and services, should respond to the vulnerabilities of sexual minority CYP.
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Affiliation(s)
- A Clarke
- Children and Family Health Service, Lancashire Care NHS Foundation Trust, Preston , UK
| | - J Beenstock
- Lancashire Care NHS Foundation Trust, Preston, UK.,Faculty of Health & Medicine, Lancaster University, UK
| | - J N Lukacs
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - L Turner
- Lancashire LGBT, Preston PR2 8PS, UK
| | - M Limmer
- Division of Health Research, Lancaster University, Lancaster, UK
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Fenlon D, Nuttall J, Day L, Maishman T, Griffiths G, Turner L, May C, Raftery J, Ellis M, Fields J, Hunter M. P013: MENOS4 trial: Nurses can be trained to effectively deliver CBT for menopausal hot flushes in women with breast cancer to reduce hot flush bother and improve quality of life. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.052] [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
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35
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Asada Y, Turner L, Schwartz M, Chriqui JF. "Bridging, brokering, and buffering": a theoretical exploration of school leaders' engagement with local school wellness policy implementation. Implement Sci Commun 2020; 1:44. [PMID: 32885201 PMCID: PMC7427866 DOI: 10.1186/s43058-020-00029-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/25/2020] [Indexed: 11/26/2022] Open
Abstract
Background The Healthy, Hunger-Free Kids Act of 2010 (P.L. 111-296) prompted the expansion of federal requirements for local school wellness policies, which aim to improve health promoting practices across school districts in the USA. This qualitative study examined how school district superintendents—as key school leaders who are often listed as the district accountability figure for wellness policies applicable to kindergarten through 12th grade—engaged with wellness policy implementation. The inquiry was guided by evidence-informed implementation and leadership frameworks, including the Consolidated Framework for Implementation Research (CFIR) and “bridging, buffering, and brokering” strategies from education leadership theory. Methods We conducted focus groups and interviews with superintendents (n = 39) from 23 states. Interviews were recorded and professionally transcribed; transcripts were team-coded in Atlas.ti v8 using an iteratively revised coding guide that was informed by CFIR, pilot testing, and during weekly analyst meetings. Principles of constant comparative analysis were employed to develop themes. Results Most superintendents’ reported positive perspectives and personal motivations to engage with wellness policy implementation. Within the CFIR process domain, superintendents demonstrated adaptive leadership traits and employed a combination of “bridging, buffering, and brokering” strategies to lead implementation activities. Rather than focus on personal traits, an emphasis on specific strategies highlights actions that may be applied. Conclusions The findings offer practical strategies to support superintendents with implementation, as well as a formative contribution to the dearth of theoretical frameworks in school wellness literature, particularly by advancing the specific understanding of leadership roles within a broader implementation framework. The application of education theory allowed for a deeper inquiry into the potential ways that leaders’ strategies and engagement influences implementation more broadly.
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Affiliation(s)
- Y Asada
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W Roosevelt Rd, M/C 275, Chicago, IL 60608 USA
| | - L Turner
- College of Education, Boise State University, 1910 University Drive, Boise, Idaho 83725 USA
| | - M Schwartz
- UConn Rudd Center for Food Policy and Obesity University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT 06103 USA
| | - J F Chriqui
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, 1747 W Roosevelt Rd, M/C 275, Chicago, IL 60608 USA
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36
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Tingley K, Lamoureux M, Pugliese M, Geraghty MT, Kronick JB, Potter BK, Coyle D, Wilson K, Kowalski M, Austin V, Brunel-Guitton C, Buhas D, Chan AKJ, Dyack S, Feigenbaum A, Giezen A, Goobie S, Greenberg CR, Ghai SJ, Inbar-Feigenberg M, Karp N, Kozenko M, Langley E, Lines M, Little J, MacKenzie J, Maranda B, Mercimek-Andrews S, Mohan C, Mhanni A, Mitchell G, Mitchell JJ, Nagy L, Napier M, Pender A, Potter M, Prasad C, Ratko S, Salvarinova R, Schulze A, Siriwardena K, Sondheimer N, Sparkes R, Stockler-Ipsiroglu S, Trakadis Y, Turner L, Van Karnebeek C, Vallance H, Vandersteen A, Walia J, Wilson A, Wilson BJ, Yu AC, Yuskiv N, Chakraborty P. Evaluation of the quality of clinical data collection for a pan-Canadian cohort of children affected by inherited metabolic diseases: lessons learned from the Canadian Inherited Metabolic Diseases Research Network. Orphanet J Rare Dis 2020; 15:89. [PMID: 32276663 PMCID: PMC7149838 DOI: 10.1186/s13023-020-01358-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/17/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Canadian Inherited Metabolic Diseases Research Network (CIMDRN) is a pan-Canadian practice-based research network of 14 Hereditary Metabolic Disease Treatment Centres and over 50 investigators. CIMDRN aims to develop evidence to improve health outcomes for children with inherited metabolic diseases (IMD). We describe the development of our clinical data collection platform, discuss our data quality management plan, and present the findings to date from our data quality assessment, highlighting key lessons that can serve as a resource for future clinical research initiatives relating to rare diseases. METHODS At participating centres, children born from 2006 to 2015 who were diagnosed with one of 31 targeted IMD were eligible to participate in CIMDRN's clinical research stream. For all participants, we collected a minimum data set that includes information about demographics and diagnosis. For children with five prioritized IMD, we collected longitudinal data including interventions, clinical outcomes, and indicators of disease management. The data quality management plan included: design of user-friendly and intuitive clinical data collection forms; validation measures at point of data entry, designed to minimize data entry errors; regular communications with each CIMDRN site; and routine review of aggregate data. RESULTS As of June 2019, CIMDRN has enrolled 798 participants of whom 764 (96%) have complete minimum data set information. Results from our data quality assessment revealed that potential data quality issues were related to interpretation of definitions of some variables, participants who transferred care across institutions, and the organization of information within the patient charts (e.g., neuropsychological test results). Little information was missing regarding disease ascertainment and diagnosis (e.g., ascertainment method - 0% missing). DISCUSSION Using several data quality management strategies, we have established a comprehensive clinical database that provides information about care and outcomes for Canadian children affected by IMD. We describe quality issues and lessons for consideration in future clinical research initiatives for rare diseases, including accurately accommodating different clinic workflows and balancing comprehensiveness of data collection with available resources. Integrating data collection within clinical care, leveraging electronic medical records, and implementing core outcome sets will be essential for achieving sustainability.
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Affiliation(s)
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Michael T Geraghty
- University of Ottawa, Ottawa, Ontario, Canada
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Jonathan B Kronick
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Doug Coyle
- University of Ottawa, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Kowalski
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Valerie Austin
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniela Buhas
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Alicia K J Chan
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Dyack
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annette Feigenbaum
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alette Giezen
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharan Goobie
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheryl R Greenberg
- Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shailly Jain Ghai
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Natalya Karp
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mariya Kozenko
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Erica Langley
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Matthew Lines
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Jennifer MacKenzie
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Bruno Maranda
- Le centre hospitalier universitaire Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Connie Mohan
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Aizeddin Mhanni
- Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Grant Mitchell
- Le centre hospitalier universitaire Ste-Justine, Montreal, Quebec, Canada
| | - John J Mitchell
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Laura Nagy
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Napier
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Amy Pender
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Murray Potter
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Prasad
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Suzanne Ratko
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Ramona Salvarinova
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreas Schulze
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Komudi Siriwardena
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Neal Sondheimer
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Sparkes
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | - Yannis Trakadis
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lesley Turner
- Janeway Children's Hospital, Memorial University, St John's, NL, Canada
| | - Clara Van Karnebeek
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hilary Vallance
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jagdeep Walia
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Ashley Wilson
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Brenda J Wilson
- Janeway Children's Hospital, Memorial University, St John's, NL, Canada
| | - Andrea C Yu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nataliya Yuskiv
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pranesh Chakraborty
- University of Ottawa, Ottawa, Ontario, Canada.
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
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Bhattacharya IS, Haviland J, Balasopoulou A, Stones L, Stobart H, Turner L, Hopwood P, Coles CE, Bliss JM. Abstract P6-12-04: Does the addition of a patient decision aid video reduce decisional conflict in patients considering a de-escalation of radiotherapy trial? Results from the PRIMETIME study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p6-12-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: PRIMETIME is a UK-led prospective biomarker-directed cohort study aiming to identify a group of breast cancer patients who can safely avoid radiotherapy following breast conserving surgery. This group is deemed to be at such a low risk of local relapse that the potential benefits of radiotherapy are unlikely to outweigh the risks. The uncertainty patients face regarding healthcare decisions is known as decisional conflict. Patient decision aids (PDA) are interventions which help patients to weigh up the risks and benefits of treatments. Evidence suggests PDA reduce decisional conflict. A study within a trial (SWAT) concept which enables trialists to conduct research embedded within a larger trial was used to investigate if the introduction of a PDA video reduces decisional conflict within PRIMETIME.
Methods: The PDA video was designed to be used in addition to the standard written information and developed in close collaboration with PRIMETIME patient advocates. The PRIMETIME SWAT was implemented using a cluster stepped-wedge trial design. Each cluster was defined as the radiotherapy centre and peripheral centres referring into that centre. All clusters began in the standard information group (receiving written information) and then crossed over to the enhanced information group (receiving written information and PDA video) at either 2, 4 or 6 months. The primary endpoint was a reduction in decisional conflict following PDA implementation. Decisional conflict was assessed using the validated decisional conflict scale questionnaire (0-100 scale with greater scores indicating more decisional conflict) in the standard and enhanced information groups. The target sample size was 288 patients from 24 clusters, to provide 84% power (alpha 0.05) with an effect size of 0.55 (assuming standard deviation, SD=18) across the 0-1 range of possible intra-class correlation values. For the primary endpoint an estimate of the difference in mean decisional conflict pre- and post-implementation of the PDA video was obtained from a multilevel mixed effects linear regression model.
Results: In an interim analysis conducted on 2nd May 2019, 318 evaluable questionnaires were returned from 463 eligible patients (69%) recruited across 24 clusters; 158 questionnaires from the standard and 160 questionnaires from the enhanced group. 60/130 (53%) patients in the enhanced information group (with available data) reportedly did not watch the PDA video.
The mean decisional conflict score in the standard group [158 patients] was 10.73 (SD=11.63) and 8.43 (10.83) in the enhanced group [160 patients]. There was a reduction in decisional conflict in the enhanced compared with the standard group, however the effect size was small and unlikely to be clinically significant [estimated difference in means = -2.50 (-4.73- -0.28), p=0.03, effect size=0.11]. The final analysis will be conducted after the last cluster has crossed over to the enhanced group in October 2019.
Conclusions: A SWAT using a cluster stepped-wedge trial design testing the implementation of a PDA video on patient’s decisional conflict was conducted across multiple UK centres participating in PRIMETIME. The average decisional conflict scores were low therefore there is less scope for obtaining further reductions, and the difference we observed was not clinically significant. The low baseline scores may reflect the PRIMETIME study population who are at low risk of local recurrence. Almost half of patients reportedly did not watch the video; this may be due to the standard written information being sufficient to fulfil the needs of this patient population.
Citation Format: Indrani Subarna Bhattacharya, Joanne Haviland, Ada Balasopoulou, Liba Stones, Hilary Stobart, Lesley Turner, Penelope Hopwood, Charlotte E Coles, Judith M Bliss. Does the addition of a patient decision aid video reduce decisional conflict in patients considering a de-escalation of radiotherapy trial? Results from the PRIMETIME study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-12-04.
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Affiliation(s)
| | | | | | - Liba Stones
- 1The Institute of Cancer Research, London, United Kingdom
| | - Hilary Stobart
- 2Independent Cancer Patients' Voice, London, United Kingdom
| | - Lesley Turner
- 2Independent Cancer Patients' Voice, London, United Kingdom
| | | | | | - Judith M Bliss
- 1The Institute of Cancer Research, London, United Kingdom
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Bhattacharya IS, Haviland JS, Balasopoulou A, Stones L, Stobart H, Turner L, Hopwood P, Bliss JM, Coles CE. Abstract P6-12-10: Method development for a ‘Study within a Trial’ using a cluster stepped wedge trial design: Evaluating a patient decision aid video on patients’ decisional conflict in the PRIMETIME study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p6-12-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: PRIMETIME is a UK-led prospective biomarker directed cohort study aiming to identify a group of breast cancer patients who can safely avoid radiotherapy following breast conserving surgery. This group is deemed to be at such a low risk of local relapse that the potential benefits of radiotherapy are unlikely to outweigh the risks. The uncertainty patients face regarding healthcare decisions is known as ‘decisional conflict’ which may increase when a component of standard of care is removed. Patient decision aids (PDA) are interventions which help patients to weigh up the risks and benefits of treatments. Evidence suggests PDA reduce decisional conflict. The study within a trial (SWAT) concept enables trialists to conduct research embedded within a larger trial in an economic and efficient manner. A SWAT testing whether the introduction of a PDA video reduces decisional conflict was conducted within the PRIMETIME study. The method development of the PRIMETIME SWAT is described.
Methods: The SWAT was embedded within PRIMETIME after PRIMETIME had opened to recruitment. All eligible patients approached for the PRIMETIME study were eligible for the PRIMETIME SWAT. The SWAT utilised a cluster stepped-wedge trial design. Each cluster consisted of the radiotherapy centre and any peripheral centres referring into that radiotherapy centre. At the outset of the SWAT, all sites utilised the standard written information when discussing the trial with patients as had been envisaged in the original protocol. At pre-specified time-points each cluster “crossed over” to additionally incorporate the PDA video in the information provided to patients eligible for PRIMETIME. Decisional conflict was assessed in clusters prior to and following implementation of the PDA. The PDA was designed in collaboration with PRIMETIME patient advocates to be used in addition to the standard written information, explaining the same risks and benefits of radiotherapy but using an enhanced video format. Access to the PDA was restricted for healthcare professionals as well as patients until the cluster had crossed over to the intervention group to ensure that healthcare professionals did not alter the way in which they presented the study having watched the video. The primary endpoint was reduction in decisional conflict as measured on the decisional conflict scale.
Discussion: The eligible population for the SWAT was greater than the population of the main PRIMETIME study (i.e. including patients who declined PRIMETIME), to try and obtain a SWAT sample representative of the general population. The cluster aspect of the stepped-wedge design ensured all patients in a cluster would receive uniform information which would simplify processes for sites and avoid cross-contamination between patients. The stepped-wedge aspect enabled all clusters to have access to the PDA by the end of the trial. The PDA was designed to complement the standard written information and explain the risks and benefits of radiotherapy in a different format using a video. If PDA are found to reduce decisional conflict within treatment de-escalation trials, this will provide the evidence to increase resources into the development of PDAs in future trials.
Citation Format: Indrani Subarna Bhattacharya, Joanne S Haviland, Ada Balasopoulou, Liba Stones, Hilary Stobart, Lesley Turner, Penelope Hopwood, Judith M Bliss, Charlotte E Coles. Method development for a ‘Study within a Trial’ using a cluster stepped wedge trial design: Evaluating a patient decision aid video on patients’ decisional conflict in the PRIMETIME study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-12-10.
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Affiliation(s)
| | | | | | - Liba Stones
- 1The Institute of Cancer Research, London, United Kingdom
| | - Hilary Stobart
- 2Independent Cancer Patients' Voice, London, United Kingdom
| | - Lesley Turner
- 2Independent Cancer Patients' Voice, London, United Kingdom
| | | | - Judith M Bliss
- 1The Institute of Cancer Research, London, United Kingdom
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Shah K, Elder D, Nguyen M, Turner L, Doyle M, Woldendorp K, Seco M, Law C, Wilson M, Keech A, Ng M, Morton R. 628 Transcatheter Aortic Valve Implantation (TAVI) Versus Surgical Aortic Valve Replacement (SAVR) for Aortic Stenosis: A Cost-Comparison Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.635] [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: 11/28/2022]
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Danson S, Mulvey MR, Turner L, Horsman J, Escott KJ, Coleman RE, Ahmedzai SH, Bennett MI, Andrew D. An exploratory randomized-controlled trial of the efficacy of the Src-kinase inhibitor saracatinib as a novel analgesic for cancer-induced bone pain. J Bone Oncol 2019; 19:100261. [PMID: 31667062 PMCID: PMC6812043 DOI: 10.1016/j.jbo.2019.100261] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 02/04/2023] Open
Abstract
Pain is a major symptom of bone metastases from advanced cancer and represents a clinical challenge to treat effectively. Basic neurobiology in preclinical animal models implicates enhanced sensory processing in the central nervous system, acting through N-methyl-D-aspartate (NMDA) glutamate receptors, as an important mechanism underpinning persistent pain. The non-receptor tyrosine kinase Src is thought to act as a hub for regulating NMDA receptor activity and the orally available Src inhibitor saracatinib has shown promise as a potential analgesic in recent animal studies. Here we tested the efficacy of saracatinib as a novel analgesic in an exploratory phase II randomized controlled trial on cancer patients with painful bone metastases. Twelve patients completed the study, with 6 receiving saracatinib 125 mg/day for 28 days and 6 receiving placebo. Pharmacokinetic measurements confirmed appropriate plasma levels of drug in the saracatinib-treated group and Src inhibition was achieved clinically by a significant reduction in the bone resorption biomarker serum cross-linked C-terminal telopeptide of type I collagen. Differences between the saracatinib and placebo groups self-reported pain scores, measured using the short form of the Brief Pain Inventory, were not clinically significant after 4 weeks of treatment. There was also no change in consumption of maintenance analgesia in the saracatinib-treated group and no improvement in Quality-of-Life scores. The data were insufficient to demonstrate saracatinib has efficacy as analgesic, although it may have a role as an anti-bone resorptive agent.
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Affiliation(s)
- Sarah Danson
- Academic Unit of Clinical Oncology, Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, University of Sheffield, UK
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Lesley Turner
- Academic Unit of Clinical Oncology, Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, University of Sheffield, UK
| | - Janet Horsman
- Academic Unit of Clinical Oncology, Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, University of Sheffield, UK
| | - KJane Escott
- Emerging Innovations Unit, BioPharmaceuticals R & D, AstraZeneca, Cambridge, UK
| | - Robert E Coleman
- Academic Unit of Clinical Oncology, Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, University of Sheffield, UK
| | | | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
| | - David Andrew
- School of Clinical Dentistry, University of Sheffield, UK
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Schmidt MF, Turner L, Bradley M, Shepherd J. 2738 Comparing Postoperative Pain with Laparoscopic Versus Robotic Sacrocolpopexy. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Nicholls SG, Etchegary H, Tessier L, Simmonds C, Potter BK, Brehaut JC, Pullman D, Hayeems RZ, Zelenietz S, Lamoureux M, Milburn J, Turner L, Chakraborty P, Wilson BJ. What is in a Name? Parent, Professional and Policy-Maker Conceptions of Consent-Related Language in the Context of Newborn Screening. Public Health Ethics 2019; 12:158-175. [PMID: 31384304 PMCID: PMC6655345 DOI: 10.1093/phe/phz003] [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] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents (n = 32), healthcare professionals (n = 19) and policy decision makers (n = 17) in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities (including disclosure of information and time to review); parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs.
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Affiliation(s)
- Stuart G Nicholls
- School of Epidemiology and Public Health, University of Ottawa and Ottawa Hospital Research Institute (OHRI)
| | - Holly Etchegary
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador
| | - Laure Tessier
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario
| | - Charlene Simmonds
- Health Research Unit, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa
| | - Jamie C Brehaut
- School of Epidemiology and Public Health, University of Ottawa and Ottawa Hospital Research Institute (OHRI)
| | - Daryl Pullman
- Community Health and Humanities, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador
| | - Robin Z Hayeems
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children and The Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Sari Zelenietz
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario
| | - Jennifer Milburn
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario
| | - Lesley Turner
- Provincial Medical Genetics Program, Eastern Health, St John's, Newfoundland and Labrador
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario and Department of Pediatrics, Faculty of Medicine, University of Ottawa
| | - Brenda J Wilson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland
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Zapata-Aldana E, McMillan HJ, Rupar T, Brunel-Guitton C, Chakraborty P, Mitchell JJ, Roth J, Tarnopolsky MA, Turner L, Campbell C. Muscle problems in juvenile-onset acid maltase deficiency (Pompe disease). Paediatr Child Health 2019; 24:270-271. [PMID: 31239817 PMCID: PMC6587424 DOI: 10.1093/pch/pxy153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/11/2018] [Indexed: 08/22/2023] Open
Affiliation(s)
- Eugenio Zapata-Aldana
- Department of Neurology Paediatrics, Children’s Hospital London Health Science Centre, London, Ontario
| | - Hugh J McMillan
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
| | - Tony Rupar
- Departments of Biochemistry and Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario
| | | | - Pranesh Chakraborty
- Metabolics and Newborn Screening, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario
- Newborn Screening Ontario, Ottawa, Ontario
| | - John J Mitchell
- Department of Pediatrics and Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec
| | - Johannes Roth
- Division of Pediatric Dermatology & Rheumatology, Children’s Hospital of Eastern Ontario, Ottawa
| | - Mark A Tarnopolsky
- Division of Neuromuscular & Neurometabolic Disorders, Departments of Pediatrics and Medicine, McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario
| | - Lesley Turner
- Janeway Children’s Health and Rehabilitation Centre, St. John’s, Newfoundland and Labrador
| | - Craig Campbell
- Department of Neurology Paediatrics, Children’s Hospital London Health Science Centre, London, Ontario
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Zarate YA, Bosanko KA, Caffrey AR, Bernstein JA, Martin DM, Williams MS, Berry-Kravis EM, Mark PR, Manning MA, Bhambhani V, Vargas M, Seeley AH, Estrada-Veras JI, van Dooren MF, Schwab M, Vanderver A, Melis D, Alsadah A, Sadler L, Van Esch H, Callewaert B, Oostra A, Maclean J, Dentici ML, Orlando V, Lipson M, Sparagana SP, Maarup TJ, Alsters SI, Brautbar A, Kovitch E, Naidu S, Lees M, Smith DM, Turner L, Raggio V, Spangenberg L, Garcia-Miñaúr S, Roeder ER, Littlejohn RO, Grange D, Pfotenhauer J, Jones MC, Balasubramanian M, Martinez-Monseny A, Blok LS, Gavrilova R, Fish JL. Mutation update for the SATB2 gene. Hum Mutat 2019; 40:1013-1029. [PMID: 31021519 DOI: 10.1002/humu.23771] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 12/20/2022]
Abstract
SATB2-associated syndrome (SAS) is an autosomal dominant neurodevelopmental disorder caused by alterations in the SATB2 gene. Here we present a review of published pathogenic variants in the SATB2 gene to date and report 38 novel alterations found in 57 additional previously unreported individuals. Overall, we present a compilation of 120 unique variants identified in 155 unrelated families ranging from single nucleotide coding variants to genomic rearrangements distributed throughout the entire coding region of SATB2. Single nucleotide variants predicted to result in the occurrence of a premature stop codon were the most commonly seen (51/120 = 42.5%) followed by missense variants (31/120 = 25.8%). We review the rather limited functional characterization of pathogenic variants and discuss current understanding of the consequences of the different molecular alterations. We present an expansive phenotypic review along with novel genotype-phenotype correlations. Lastly, we discuss current knowledge of animal models and present future prospects. This review should help provide better guidance for the care of individuals diagnosed with SAS.
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Affiliation(s)
- Yuri A Zarate
- Section of Genetics and Metabolism, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Katherine A Bosanko
- Section of Genetics and Metabolism, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Aisling R Caffrey
- Health Outcomes, College of Pharmacy, Department of Pharmacy Practice, University of Rhode Island, Kingston, Rhode Island
| | - Jonathan A Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Donna M Martin
- Departments of Pediatrics and Human Genetics, The University of Michigan, Ann Arbor, Michigan
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Elizabeth M Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, Chicago, Illinois
| | - Paul R Mark
- Division of Medical Genetics, Spectrum Health, Grand Rapids, Michigan
| | - Melanie A Manning
- Departments of Pathology and Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Vikas Bhambhani
- Division of Genetics and Genomic Medicine, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - Marcelo Vargas
- Division of Genetics and Genomic Medicine, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - Andrea H Seeley
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Juvianee I Estrada-Veras
- Murtha Cancer Center Research Program, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Pediatric subspecialty-Medical Genetics Service, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Marieke F van Dooren
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maria Schwab
- Genetics Division, Joseph Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
| | - Adeline Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniela Melis
- Department of Translational Medical Science, Section of Pediatrics, Federico II University, Naples, Italy
| | - Adnan Alsadah
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Laurie Sadler
- Division of Genetics, Oishei Children's Hospital, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, New York
| | - Hilde Van Esch
- Department of Human Genetics, University Hospitals Leuven, KU, Leuven, Belgium
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Ann Oostra
- Department of Pediatric Neurology, Ghent University Hospital, Ghent, Belgium
| | - Jane Maclean
- Pediatric Neurology, Palo Alto Medical Foundation, San Jose, California
| | - Maria Lisa Dentici
- Medical Genetics, Academic Department of Pediatrics, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Valeria Orlando
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mark Lipson
- Department of Genetics, Kaiser Permanente, Sacramento, California
| | - Steven P Sparagana
- Department of Neurology, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Timothy J Maarup
- Department of Genetics, Kaiser Permanente, Los Angeles, California
| | - Suzanne Im Alsters
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ariel Brautbar
- Department of Genetics, Cook Chldren's Medical Center, Fort Worth, Texas
| | | | - Sakkubai Naidu
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Maryland
| | - Melissa Lees
- Department of Clinical Genetics, Great Ormond Street Hospital for Children, London, UK
| | | | - Lesley Turner
- Discipline of Genetics, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Víctor Raggio
- Departamento de Genética, Facultad de Medicina, Montevideo, Uruguay
| | | | - Sixto Garcia-Miñaúr
- Department of Medical Genetics, Hospital Universitario La Paz, Madrid, Spain
| | - Elizabeth R Roeder
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Rebecca O Littlejohn
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Dorothy Grange
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medcine, St Louis, Missouri
| | - Jean Pfotenhauer
- Division of Medical Genetics and Genomic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marilyn C Jones
- Division of Genetics, Department of Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, California
| | - Meena Balasubramanian
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, UK
| | - Antonio Martinez-Monseny
- Genetics and Molecular Medicine Department, Rare Disease Pediatric Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lot Snijders Blok
- Human Genetics Department, Radboud University Medical Center, Nijmegen, The Netherlands.,Language & Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | - Ralitza Gavrilova
- Departments of Neurology and Clinical Genomics, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Fish
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, Massachusetts
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Mazza D, McCarthy E, Carey M, Turner L, Harris M. "90% of the time, it's not just weight": General practitioner and practice staff perspectives regarding the barriers and enablers to obesity guideline implementation. Obes Res Clin Pract 2019; 13:398-403. [PMID: 31109793 DOI: 10.1016/j.orcp.2019.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 11/08/2018] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the views of GPs and general practice staff regarding barriers and enablers to implementation of obesity guideline recommendations in general practice. METHODS Twenty general practitioners (GPs) and 18 practice staff from inner-eastern Melbourne, Australia, participated in semi-structured telephone interviews. The interview schedule was informed by the Theoretical Domains Framework (TDF). Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. RESULTS Participants lacked familiarity with and knowledge of the NHMRC obesity guidelines. Barriers and enablers were predominantly related to five theoretical domains: (1) environmental context and resources, (2) knowledge, (3) emotion, (4) beliefs about consequences, and (5) motivation and goals. Time pressures in consultations, costs for the patient, reluctance to add to patient burden particularly in those with comorbidities such as mental health issues, lack of awareness about services to refer patients to and GPs' fear of embarrassing patients and losing them were significant barriers. Enablers included having a strong doctor-patient relationship and a sense of responsibility to the patient to address weight. CONCLUSIONS Obesity guidelines and policy makers need to better engage with issues of multimorbidity, socioeconomic disadvantage and workforce issues if recommendations are to be widely adopted in general practice. Tasksharing, teamwork and technology are potential solutions to some of the barriers. Patient perspectives and approaches to being able to overcome stigma and legitimise obesity management in primary care consultations could also assist.
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Affiliation(s)
- D Mazza
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - E McCarthy
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Carey
- School of Medicine and Public Health, University of Newcastle, Australia
| | - L Turner
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Harris
- School of Public Health and Community Medicine, University of New South Wales, Australia
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Myles PS, Smith JA, Kasza J, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussières JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S, Forbes A, Myles P, Smith J, Cooper DJ, Silbert B, McNeil J, Marasco S, Esmore D, Krum H, Tonkin A, Buxton B, Heritier S, Merry A, Liew D, McNeil J, Forbes A, Cooper D, Wallace S, Meehan A, Myles P, Wallace S, Galagher W, Farrington C, Ditoro A, Wutzlhofer L, Story D, Peyton P, Baulch S, Sidiropoulos S, Potgieter D, Baker R, Pesudovs B, O'Loughlin J Wells E, Coutts P, Bolsin S, Osborne C, Ives K, Smith J, Hulley A, Christie-Taylor G, Painter T, Lang S, Mackay H, Cokis C, March S, Bannon P, Wong C, Turner L, Scott D, Silbert B, Said S, Corcoran P, Painter T, de Prinse L, Bussières J, Gagné N, Lamy A, Semelhago L, Chan M, Underwood M, Choi G, Fung B, Landoni G, Lembo R, Monaco F, Simeone F, Marianello D, Alvaro G, De Vuono G, van Dijk D, Dieleman J, Numan S, McGuinness S, Parke R, Raudkivi P, Gilder E, Byrne K, Dunning J, Termaat J, Mans G, Jayarajah M, Alderton J, Waugh D, Platt M, Pai A, Sevillano A, Lal A, Sinclair C, Kunst G, Knighton A, Cubas G, Saravanan P, Millner R, Vasudevan V, Patteril M, Lopez E, Basu R, Lu J. Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. J Thorac Cardiovasc Surg 2019; 157:644-652.e9. [DOI: 10.1016/j.jtcvs.2018.09.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
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Shah K, Nguyen M, Seco M, Elder D, Turner L, Wu J, Doyle M, Watson D, Woldendorp K, Keech A, Ng M, Morton R. Comparing Hospital Costs Of Trans-Catheter Aortic Valve Replacement and Isolated Surgical Aortic Valve Replacement in Patients with Aortic Stenosis Treated in New South Wales, Australia. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.463] [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: 11/27/2022]
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Elder D, Ng M, Morton R, Keech A, Seco M, Shah K, Turner L, Nguyen M, Woldendorp K, Doyle M, Wu J, Watson D. A Comparison of the Number and Demographics of Patients Undergoing Either Isolated Surgical or a Trans-Catheter Aortic Valve Replacement Following the Introduction of a TAVI Program. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.459] [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: 10/26/2022]
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Otero MG, Tiongson E, Diaz F, Haude K, Panzer K, Collier A, Kim J, Adams D, Tifft CJ, Cui H, Millian Zamora F, Au MG, Graham JM, Buckley DJ, Lewis R, Toro C, Bai R, Turner L, Mathews KD, Gahl W, Pierson TM. Novel pathogenic COX20 variants causing dysarthria, ataxia, and sensory neuropathy. Ann Clin Transl Neurol 2018; 6:154-160. [PMID: 30656193 PMCID: PMC6331954 DOI: 10.1002/acn3.661] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 01/28/2023] Open
Abstract
COX20/FAM36A encodes a mitochondrial complex IV assembly factor important for COX2 activation. Only one homozygous COX20 missense mutation has been previously described in two separate consanguineous families. We report four subjects with features that include childhood hypotonia, areflexia, ataxia, dysarthria, dystonia, and sensory neuropathy. Exome sequencing in all four subjects identified the same novel COX20 variants. One variant affected the splice donor site of intron‐one (c.41A>G), while the other variant (c.157+3G>C) affected the splice donor site of intron‐two. cDNA and protein analysis indicated that no full‐length cDNA or protein was generated. These subjects expand the phenotype associated with COX20 deficiency.
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Affiliation(s)
- Maria G Otero
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center Los Angeles California
| | - Emmanuelle Tiongson
- Division of Neurology Children's Hospital of Los Angeles Los Angeles California
| | - Frank Diaz
- Department of Neurology Cedars-Sinai Medical Center Los Angeles California
| | | | - Karin Panzer
- Department of Pediatrics University of Iowa Stead Family Children's Hospital Iowa City Iowa
| | - Ashley Collier
- Provincial Medical Genetics Program Eastern Health St. John's Newfoundland and Labrador Canada
| | - Jaemin Kim
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center Los Angeles California
| | - David Adams
- NIH Undiagnosed Diseases Program NIH Office of Rare Diseases Research and NHGRI Bethesda Maryland.,Office of the Clinical Director NHGRI, NIH Bethesda Maryland
| | - Cynthia J Tifft
- NIH Undiagnosed Diseases Program NIH Office of Rare Diseases Research and NHGRI Bethesda Maryland.,Office of the Clinical Director NHGRI, NIH Bethesda Maryland
| | | | | | - Margaret G Au
- Department of Pediatrics Cedars-Sinai Medical Center Los Angeles California
| | - John M Graham
- Department of Pediatrics Cedars-Sinai Medical Center Los Angeles California
| | - David J Buckley
- Department of Pediatrics Janeway Health Centre St. John's Newfoundland and Labrador Canada
| | - Richard Lewis
- Department of Neurology Cedars-Sinai Medical Center Los Angeles California
| | - Camilo Toro
- NIH Undiagnosed Diseases Program NIH Office of Rare Diseases Research and NHGRI Bethesda Maryland.,Office of the Clinical Director NHGRI, NIH Bethesda Maryland
| | | | - Lesley Turner
- Faculty of Medicine Memorial University of Newfoundland St. John's Newfoundland Canada
| | - Katherine D Mathews
- Provincial Medical Genetics Program Eastern Health St. John's Newfoundland and Labrador Canada.,Department of Neurology University of Iowa Stead Family Children's Hospital Iowa City Iowa
| | - William Gahl
- NIH Undiagnosed Diseases Program NIH Office of Rare Diseases Research and NHGRI Bethesda Maryland.,Office of the Clinical Director NHGRI, NIH Bethesda Maryland
| | - Tyler Mark Pierson
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center Los Angeles California.,Department of Neurology Cedars-Sinai Medical Center Los Angeles California.,Department of Pediatrics Cedars-Sinai Medical Center Los Angeles California
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