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Yiannakis C, Hamilton L, Slim M, Kontorinis G. A systematic review and meta-analysis of prophylactic medication of vestibular migraine. J Laryngol Otol 2023; 137:953-961. [PMID: 36200521 DOI: 10.1017/s0022215122001979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Vestibular migraine is in the process of recognition as an individual clinical entity. At present, no guidelines exist for its management. This study aimed to conduct a systematic review and meta-analysis to determine the effectiveness of available prophylactic medication. METHOD A literature search was performed using PubMed, Ovid and Embase databases. Qualitative and quantitative analysis were performed as well as risk of bias analysis. Meta-analysis for the mean differences for pre- and post-treatment impact based on Dizziness Handicap Inventory and Vertigo Symptom Scale were performed. Proportionate transformation meta-analysis for the successful event rate based on complete symptoms control was explored. RESULTS Thirteen publications were identified: 3 were randomised, controlled trials and 10 were non-randomised, controlled trials. Propranolol and venlafaxine improved the Vertigo Symptom Scale score by -13.31 points and -4.16 points, respectively, and the Dizziness Handicap Inventory score by -32.24 and -21.24, respectively. Only propranolol achieved statistically significant impact with 60 per cent of patients achieving complete symptom control. CONCLUSION Propranolol should be offered as the first-line treatment for vestibular migraine followed by venlafaxine. Amitriptyline, flunarizine and cinnarizine showed a trend for symptom improvement, but this was not statistically significant.
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Affiliation(s)
- C Yiannakis
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - L Hamilton
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - M Slim
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - G Kontorinis
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
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Baczynski M, Deekonda V, Hamilton L, Lindsay B, Ye XY, Jain A. Clinical impact of less invasive surfactant administration using video laryngoscopy in extremely preterm infants. Pediatr Res 2023; 93:990-995. [PMID: 35854087 DOI: 10.1038/s41390-022-02197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/13/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Examine the real-world clinical impact of adopting less invasive surfactant administration (LISA) as the primary surfactant administration method in extremely preterm infants. METHODS Single-center pre-post cohort study conducted over a 4-year period comparing outcomes of spontaneously breathing inborn infants 24+0-28+6 weeks gestational age (GA) receiving surfactant via endotracheal tube (pre-cohort, n = 154) or LISA via thin catheter (post-cohort, n = 70). Primary outcome was need for invasive mechanical ventilation (IMV, ≥2 h) ≤72 h of age. Secondary outcomes were a composite of mortality, bronchopulmonary dysplasia, intraventricular hemorrhage ≥grade 3 or necrotizing enterocolitis, and its individual components. Groups were compared using propensity score methods, including covariates: GA, birth weight, sex, small for GA, SNAP II ≥20, premature rupture of membranes, maternal hypertension/diabetes, and C-section. RESULTS GA and birth weight were 27.1 (26, 28.1) weeks and 914 (230) g, and 27.1 (26.1, 28.1) weeks and 920 (236) g for pre- and post-cohorts, respectively. Pre-cohort had higher C-section rates, (67% vs. 51%, p = 0.03). After adjustment for covariates, LISA was associated with reduced IMV exposure [AOR (95% CI) 0.07 (0.04, 0.11)], lower odds of the composite clinical outcome [0.49 (0.33, 0.73)], and most of its individual components. CONCLUSION Real-world experience favors LISA as the primary method in extremely preterm infants with established spontaneous respiration. IMPACT Less invasive surfactant administration (LISA) is associated with a reduction in respiratory morbidity, but real-world data of routine use among extremely preterm infants are limited. LISA is associated with reduced frequency of exposure to and duration of IMV in both ≤72 h after birth and during hospital stay. LISA is associated with a reduction in mortality, and most other major morbidities including bronchopulmonary dysplasia, and interventricular hemorrhage. Data from a large North American center providing real-world clinical outcomes following LISA as the primary method of surfactant administration.
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Affiliation(s)
- Michelle Baczynski
- Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Veena Deekonda
- Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada
| | - Lisa Hamilton
- Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada
| | - Brittany Lindsay
- Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada
| | - Xiang Y Ye
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Amish Jain
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
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Assumpção M, Hamilton L, Díaz Miranda E, Zigo M, Jones A, Rissman J, Taylor J, Schnabel R, Sutovsky P. 167 Role of ADGRA2/TEM5/GPR124 protein during spermatogenesis and fertilisation events. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab167] [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: 12/11/2022] Open
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Zhu J, Stuetz RM, Hamilton L, Power K, Crosbie ND, Tamburic B. Management of biogenic taste and odour: From source water, through treatment processes and distribution systems, to consumers. J Environ Manage 2022; 323:116225. [PMID: 36115245 DOI: 10.1016/j.jenvman.2022.116225] [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] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
Biogenic taste and odour (T&O) have become a global concern for water utilities, due to the increasing frequency of algal blooms and other microbial events arising from the combined effects of climate change and eutrophication. Microbially-produced T&O compounds impact source waters, drinking water treatment plants, and drinking water distribution systems. It is important to manage across the entire biogenic T&O pathway to identify key risk factors and devise strategies that will safeguard the quality of drinking water in a changing world, since the presence of T&O impacts consumer confidence in drinking water safety. This study provides a critical review of current knowledge on T&O-causing microbes and compounds for proactive management, including the identification of abiotic risk factors in source waters, a discussion on the effectiveness of existing T&O barriers in drinking water treatment plants, an analysis of risk factors for biofilm growth in water distribution systems, and an assessment of the impacts of T&O on consumers. The fate of biogenic T&O in drinking water systems is tracked from microbial production pathways, through the release of intracellular T&O by cell lysis, to the treatment of microbial cells and dissolved T&O. Based on current knowledge, five impactful research and management directions across the T&O pathway are recommended.
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Affiliation(s)
- Jin Zhu
- UNSW Water Research Centre, School of Civil and Environmental Engineering, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Richard M Stuetz
- UNSW Water Research Centre, School of Civil and Environmental Engineering, University of New South Wales, Kensington, NSW, 2052, Australia
| | | | - Kaye Power
- Sydney Water Corporation, Parramatta, NSW, 2150, Australia
| | - Nicholas D Crosbie
- UNSW Water Research Centre, School of Civil and Environmental Engineering, University of New South Wales, Kensington, NSW, 2052, Australia; Melbourne Water Corporation, Docklands, VIC, 3008, Australia
| | - Bojan Tamburic
- UNSW Water Research Centre, School of Civil and Environmental Engineering, University of New South Wales, Kensington, NSW, 2052, Australia.
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Xiang L, Fong W, Low A, Leung YY, Gandhi M, Xin X, Uy E, Hamilton L, Thumboo J. POS1411 EARLY IDENTIFICATION OF AXIAL SPONDYLOARTHRITIS IN A MULTI-ETHNIC ASIAN POPULATION. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:To facilitate earlier diagnosis of spondyloarthritis (SpA), we have previously cross-culturally adapted a self-administered screening questionnaire.Objectives:We aimed to improve the sensitivity of this questionnaire as a screening tool by comparing various scoring methods.Methods:Subjects newly referred to a rheumatology clinic self-administered the questionnaire before seeing a rheumatologist. Identification of axial SpA by the questionnaire using original scoring (Method A) and scoring based on Assessment of SpondyloArthritis International Society (ASAS) inflammatory back pain (IBP) criteria (Method B), ASAS referral criteria (Method C), ASAS classification criteria (Method D) and a combination of ASAS referral and classification criteria (Method E) were compared to classification by the ASAS classification criteria and diagnosis by rheumatologist. Since Methods B-E were based on SpA features, we compared self-reported vs rheumatologist-documented features in subjects with axial SpA.Results:Of 1418 subjects (age: 54 ± 14 years, female: 73%), 39 were classified as axial SpA cases by classification criteria. Methods A-E yielded sensitivities of 39%, 72%, 67%, 49% and 85%, respectively, among patients newly referred to the rheumatology clinic (Table 1). Rheumatologist-documented clinical SpA features exceeded self-report for IBP (62 vs 44%) and uveitis (15 vs 5%). The reverse was true for arthritis (21 vs 80%), enthesitis (28 vs 33%), dactylitis (3 vs 18%), good response to NSAIDs (33 vs 41%) and family history for SpA (5 vs 10%).Table 1.Performance of the five scoring methods for the cross-culturally adapted Hamilton axial SpA questionnaire.Scoring methodSensitivity(95% confidence interval)Specificity(95% confidence interval)Positive predictive value(95% confidence interval)Negative predictive value(95% confidence interval)Method A38.5(23.4 – 55.4)93.7(92.3 – 94.9)14.7(8.5 – 23.1)98.2(97.3 – 98.8)Method B71.8(55.1 – 85.0)73.1(70.7 – 75.4)7.0(4.7 – 10.0)98.9(98.1 – 99.5)Method C66.7(49.8 – 80.9)77.8(75.5 – 80.0)7.8(5.2 – 11.3)98.8(98.0 – 99.4)Method D48.7(32.4 – 65.2)74.9(72.5 – 77.2)5.2(3.2 – 8.0)98.1(97.1 – 98.8)Method E84.6(69.5 – 94.1)37.2(34.6 – 39.8)3.7(2.5 – 5.1)98.8(97.5 – 99.6)Method A: the original scoring defined by the questionnaire developers; Method B: a scoring based on the ASAS IBP criteria; Method C: a scoring based on the ASAS referral criteria; Method D: a scoring based on the ASAS classification criteria for axial and peripheral SpA; Method E: a scoring based on a combination of the ASAS referral and classification criteria.Conclusion:A self-administered questionnaire scored based on a combination of ASAS referral and classification criteria achieved high sensitivity in identifying axial SpA in subjects referred to a rheumatology clinic. This supports its evaluation as a screening tool for axial SpA in the general population.References:[1]Xiang L, Teo EPS, Low AHL, Leung YY, Fong W, Xin X, et al. Cross-cultural adaptation of the Hamilton axial spondyloarthritis questionnaire and development of a Chinese version in a multi-ethnic Asian population. Int J Rheum Dis. 2019;22(9):1652-60.[2]Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Annals of the rheumatic diseases. 2009;68 Suppl 2:ii1-44.[3]Poddubnyy D, van Tubergen A, Landewe R, Sieper J, van der Heijde D. Development of an ASAS-endorsed recommendation for the early referral of patients with a suspicion of axial spondyloarthritis. Annals of the rheumatic diseases. 2015;74(8):1483-7.[4]Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Annals of the rheumatic diseases. 2011;70(1):25-31.Acknowledgements:This work was supported by a Health Services Research Grant (HSRG) from the Singapore Ministry of Health National Medical Research Council [grant number: NMRC/HSRG/0075/2017].Disclosure of Interests:None declared
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Lim CSE, Hamilton L, Low S, Toms A, Macgregor A, Gaffney K. POS0035 ONE IN TWENTY INFLAMMATORY BOWEL DISEASE PATIENTS WHO UNDERWENT ABDOMINOPELVIC COMPUTED TOMOGRAPHY HAVE UNDIAGNOSED AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The diagnosis of axial spondyloarthritis (axSpA) is challenging and hindered by delay. There may be an opportunity to identify sacroiliitis for further rheumatology review in inflammatory bowel disease (IBD) patients who undergo Computed Tomography (CT) for non-musculoskeletal (MSK) indications.Objectives:To identify what proportion of IBD patients who underwent abdominopelvic CT for non-MSK indications have axSpA and to explore the role of an imaging strategy for identifying axSpA.Methods:Abdominopelvic CT scans of verified IBD patients were identified retrospectively from eight years of imaging archive. Patients between 18-55 yrs. were selected as having the highest diagnostic yield for axSpA. CT review (using criteria from a validated CT screening tool developed by Chan1) was undertaken by a trained radiology team for presence of CT-defined sacroiliitis (CTSI). All CTSI patients were sent a screening questionnaire. Those with self-reported chronic back pain (CBP), duration > 3 months, onset < 45 years were invited for rheumatology review. This included a medical interview, physical examination (joint count, MASES, dactylitis count, BASMI), patient reported outcomes (BASDAI, BASFI, BASGI, Harvey-Bradshaw-Index, Partial-Mayo-Index), relevant laboratory tests (CRP, ESR, HLA-B27), axSpA protocol MRI, and remote review by a panel of experienced rheumatologists with a special interest in axSpA.Results:CTSI was identified in 60 of 301 patients. Thirty-two (53%) responded to the invitation to participate and 27 (84%) were enrolled. Of these, eight had a pre-existing axSpA diagnosis and five did not report chronic back pain. Fourteen patients underwent rheumatological assessment; three of 14 (21.4% [95% CI: 4.7%, 50.8%]) had undiagnosed axSpA. In total, 11 of 27 (40.7% [95% CI: 22.4%, 61.2%]) patients had a rheumatologist verified diagnosis of axSpA.Conclusion:One in five patients (60/301) with IBD who underwent abdominopelvic CT for non-MSK indications have CTSI and at least one in five (11/60) have axSpA. Five percent (3/60) were previously undiagnosed. This highlights a hidden disease burden and a potential strategy for identifying new cases.References:[1]Chan J, Sari I, Salonen D, Inman RD, Haroon N. Development of a Screening Tool for the Identification of Sacroiliitis in Computed Tomography Scans of the Abdomen. J Rheumatol 2016; 43(9); 1687-94.Acknowledgements:We are indebted to Baljeet Dhillon and Shin Azegami for their assistance in the scoring of the CTSI.Disclosure of Interests:Chong Seng Edwin Lim Grant/research support from: AbbVie, Louise Hamilton: None declared, Samantha Low: None declared, Andoni Toms: None declared, Alex MacGregor: None declared, Karl Gaffney Speakers bureau: AbbVie, Eli Lilly, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, UCB Pharma, Grant/research support from: AbbVie, Gilead, Eli Lilly, Novartis, UCB Pharma.
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Drerup B, Espenschied J, Wiedemer J, Hamilton L. Reduced No-Show Rates and Sustained Patient Satisfaction of Telehealth During the COVID-19 Pandemic. Telemed J E Health 2021; 27:1409-1415. [PMID: 33661708 DOI: 10.1089/tmj.2021.0002] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The unprecedented COVID-19 pandemic has thrust telehealth into the center stage of health care, leading to a dramatic increase in utilization of telehealth services. The impact of telehealth on patient satisfaction during the current pandemic is yet to be fully understood. Objective: This study aimed to identify patient perspectives and behaviors toward virtual primary care appointments at a telehealth-naïve institution during the COVID-19 pandemic and establish the rate of missed appointments to help guide future implementation of telehealth services. Methods: Patients at a primary and specialty care clinic, seen between March and May 2020, completed a survey analyzing nine commonly used satisfaction metrics. The rate of missed appointments was recorded and compared with analogous cohorts of in-person office visits. Results: The no-show rate of telehealth visits during the COVID-19 pandemic was 7.5% (14/186), lower than both the no-show rate of 36.1% for in-office visits (56/155) (p < 0.0001) and a pre-pandemic in-office no-show rate of 29.8% (129/433) (p < 0.0001). Surveyed patients who experienced telehealth visits (n = 65) had similar satisfaction compared with those surveyed who attended in-office visits (n = 36) in seven of nine metrics. No statistically significant differences were identified in the satisfaction metrics with telehealth visits performed on video (n = 26) versus the phone-only format (n = 38). Patients aged 65 years or over were less likely to have a video component to their virtual visit (1/12, 8.3%) than those under age 65 (25/44, 56.8%) (p = 0.0031). Discussion/Conclusions: Telehealth offers significant benefits for both patients and providers, strongly supporting its widespread utilization both during and following the COVID-19 pandemic.
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Affiliation(s)
- Brenden Drerup
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | | | - Joseph Wiedemer
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Lisa Hamilton
- Department of Internal Medicine, Mount Carmel Health System, Columbus, Ohio, USA
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Cox J, Hamilton L, Doucette S, Foster G, Thabane L, Parkash R, Xie F, MacKillop J, Ciaccia A, Choudhri S, Nemis-White J. The effect of computer decision support on optimizing appropriate dosing of novel oral anticoagulant therapy in the IMPACT-AF study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines favour use of the non-vitamin K oral anticoagulants (NOACs) over vitamin-K antagonists for stroke prevention in atrial fibrillation (AF). However, studies have shown these agents are being under-dosed relative to the doses recommended in the product labels.
Purpose
To assess the ability of a CDS tool, employed to support management of patients with AF in primary care, to optimize NOAC prescribing.
Methods
The Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) study was a cluster randomized controlled trial that assessed the ability of a CDS tool to optimize care of community-based AF patients. Between September 2014 and December 2016, 203 primary care providers (104 randomized to CDS use, 99 to usual care [UC]) and 1133 of their patients (n=597 CDS, n=548 UC) were enrolled. Among other functions, 9 CDS program rules provided recommendations on NOAC prescribing based upon a given patient's clinical profile, as per product labels. Appropriate NOAC prescribing within the IMPACT-AF study population was compared between patients managed with the CDS versus UC at baseline and 12-months.
Results
Of those patients prescribed a NOAC, a high proportion (approximately 70%) were managed as per NOAC prescribing recommendations at baseline (Fig. 1). At 12 months, this proportion did not appreciably change in the UC arm (Fig. 1). In the CDS arm, an 8.2% absolute/11.8% relative improvement in appropriate NOAC prescribing over baseline was seen at 12-months (Fig. 1).
A comparison of patients at baseline and 12-months within each arm revealed a non-significant decline in the level of appropriate NOAC prescribing in the UC group (p=0.53). In the CDS arm, a significant improvement was observed in appropriate NOAC prescribing over time (p<0.001).
Conclusion
Even prior to any quality improvement efforts, appropriate NOAC prescribing was higher than anticipated in this contemporary cohort of community-based AF patients. At 12-months, significant further improvements were seen in the CDS but not the UC arm. These findings suggest that physician decision support can help enhance appropriate NOAC prescribing in the primary care setting.
Figure 1. Appropriate NOAC prescribing
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Inc.
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Affiliation(s)
- J Cox
- Dalhousie University, Professor of Medicine, Halifax, Canada
| | - L Hamilton
- Nova Scotia Health Authority, Halifax, Canada
| | - S Doucette
- Nova Scotia Health Authority, Halifax, Canada
| | - G Foster
- McMaster University, Health Research Methods, Evidence and Impact, Hamilton, Canada
| | - L Thabane
- McMaster University, Health Research Methods, Evidence and Impact, Hamilton, Canada
| | - R Parkash
- Dalhousie University, Professor of Medicine, Halifax, Canada
| | - F Xie
- McMaster University, Health Research Methods, Evidence and Impact, Hamilton, Canada
| | - J MacKillop
- Nova Scotia Health Authority, Halifax, Canada
| | | | | | - J Nemis-White
- Strive Health Management Consulting Ltd., Halifax, Canada
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Sicker K, Habash D, Hamilton L, Nelson NG, Robertson-Boyd L, Shaikhkhalil AK. Implementing Culinary Medicine Training: Collaboratively Learning the Way Forward. J Nutr Educ Behav 2020; 52:742-746. [PMID: 31932229 DOI: 10.1016/j.jneb.2019.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 06/10/2023]
Abstract
There is a documented substantial gap between the level of nutrition education for medical trainees and the need to provide nutrition counseling. Culinary medicine offers a solution, but there are multiple barriers and no guides to implementation. This article identifies core components and strategies to overcome barriers on the basis of experiences of multiple institutions. The outline forms a foundation to be built upon by future collaborators to empower more widespread implementation of culinary medicine education and improve medical nutrition education and ultimately, patient outcomes.
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Affiliation(s)
- Kelsey Sicker
- Department of Family Medicine, Riverside Methodist Hospitals (OhioHealth) Program, Columbus, OH
| | - Diane Habash
- The Ohio State University College of Medicine, Columbus, OH
| | | | | | | | - Ala K Shaikhkhalil
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
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Lim CSE, Tremelling M, Hamilton L, Macgregor A, Gaffney K. SAT0380 ENHANCING RHEUMATOLOGY REFERRALS AMONG INFLAMMATORY BOWEL DISEASE PATIENTS WITH SUSPECTED AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Axial spondyloarthritis (axSpA) is associated with inflammatory bowel disease (IBD). In IBD patients, the clinical probability of axSpA increases in those with chronic back pain (CBP) whose symptoms started before the age of forty-five years old. In practice, this should trigger a rheumatology review especially if accompanied by other symptoms suspicious of inflammatory disease. However, in any health system, the goal of identifying all possible cases need to be balanced with the practical realisation of the finite resources available.Objectives:The study aimed to define the clinical characteristics of a subgroup of IBD patients who are routinely managed in secondary care who have an increased clinical probability for axSpA. Identification of these characteristics may help improve the quality and specificity of referrals to Rheumatology from Gastroenterology clinics.Methods:An analytical cross-sectional study was undertaken. Consecutive IBD patients attending routine Gastroenterology clinics were sent a modified validated back pain questionnaire. The questionnaire included the presence or absence of a previous diagnosis of axSpA; components of validated inflammatory back pain criteria; diagrams to indicate the location of back pain and other musculoskeletal pain; personal and family history of known axSpA manifestations; and details of their IBD course, activity and treatment.IBD patients, with back pain duration > 3 months with onset before 45 years were considered to have a medium diagnostic probability (MDP) for axSpA. MDP-positive IBD patients were compared with MDP-negative IBD patients and logistic regression was used to model the association with clinical features.Results:Four hundred and seventy consecutive IBD patients (mean age 54 years; 46% male) were surveyed. Two hundred and nine patients (59%) replied, of whom 191 patients (69%) consented to participate. One hundred and seventy-three (91%) of those who consented had a valid completed questionnaire and were included for data analysis. Of these, 74% had Ulcerative Colitis and 26% had Crohn’s disease. Their mean age was 58 years, 39% male. Mean age at IBD diagnosis was 39 years, mean IBD disease duration 19 yrs. CBP (back pain greater than three months) was reported by 76%. Inflammatory back pain fulfilling Calin, Berlin, ASAS criteria was seen in 23%, 29%, and 15% respectively. In addition, 80% reported peripheral musculoskeletal pain. Self-reported personal history of enthesitis, reactive arthritis (ReA), acute anterior uveitis (AAU), skin psoriasis (PSO) and dactylitis were 50%, 30%, 24%, 15% and 0% respectively. Self-reported family history of IBD, ReA, PSO, axSpA and AAU were 60%, 36%, 22%, 11%, and 1% respectively.Ninety-one (53%) patients were MDP-positive and 82 (47%) patients were MDP-negative. The clinical characteristics associated with MDP (adjusted for age at invitation) were: the presence of inflammatory back pain using ASAS criteria [OR 8.84 (1.61,48.67); p=0.01], longer interval between symptom onset and gastroenterologist diagnosis of IBD [OR 1.09 (1.03,1.16); p=0.005], and use of rectal topical 5-aminosalicylic acid [OR 3.27 (1.11,9.68); p=0.03].Conclusion:Chronic back pain and peripheral musculoskeletal pain are common in a secondary care IBD population. In IBD patients, with back pain duration > 3 months and onset before 45 years, the presence of inflammatory back pain, longer diagnostic delay of IBD and the use of rectal topical 5-aminosalicylic acid were associated with a higher clinical probability of axSpA. The identification of these clinical features may not only improve the quality and specificity of Rheumatology referrals from Gastroenterology in this subgroup of patients but also lends real world evidence to current ASAS-endorsed recommendations for early referral of patients with a suspicion of axial spondyloarthritis.Disclosure of Interests:Chong Seng Edwin Lim Grant/research support from: AbbVie - Research support/grant but NOT for this study., Mark Tremelling: None declared, Louise Hamilton: None declared, Alexander Macgregor: None declared, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma
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Morley J, Moayyeri A, Ali L, Taylor A, Feudjo-Tepie M, Hamilton L, Bayly J. Persistence and compliance with osteoporosis therapies among postmenopausal women in the UK Clinical Practice Research Datalink. Osteoporos Int 2020; 31:533-545. [PMID: 31758206 PMCID: PMC7076063 DOI: 10.1007/s00198-019-05228-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 11/06/2019] [Indexed: 12/16/2022]
Abstract
UNLABELLED Gaining full benefits from osteoporosis medications requires long-term treatment. Investigating the real-world persistence of women receiving osteoporosis medications in the UK, we found that most patients stop treatment within a year. To prevent osteoporotic fragility fractures, long-term treatment persistence must be improved. INTRODUCTION Persistence with osteoporosis therapies has historically been poor. To treat this chronic and progressive disease, it is essential that patients receive the full benefit of these medications. We estimated persistence and compliance with osteoporosis therapies in a large sample of postmenopausal women in the UK. METHODS Data were obtained from the Clinical Practice Research Datalink for all women aged 50 years and over or women with early menopause, who received at least one prescription in primary care for any licensed osteoporosis therapy between January 1, 2010 and December 31, 2015. Persistence and compliance at 24 months (primary objective) and at 5 years (exploratory objective) were estimated in three patient cohorts: "All Patients," "Naïve Patients," and "Drug-Specific." RESULTS The All Patients cohort included 72,256 women. Persistence with any therapy was 56.1%, 43.6%, 36.4%, and 31.0% at 6, 12, 18, and 24 months, respectively, and 23.2% and 13.1% at 3 years and 5 years, respectively. Patients were generally more persistent and compliant if evaluated from their first exposure to osteoporosis therapy (Naïve Patients cohort). In the drug-specific analysis, 64% of patients receiving denosumab (administered subcutaneously every 6 months) were persistent at 24 months compared with 28% and 23% of those taking oral bisphosphonates and intravenous bisphosphonates, respectively. CONCLUSIONS Only about one in three patients who received osteoporosis therapy continued to be on treatment after 2 years. There is a need to improve persistence with osteoporosis therapy, especially for high-risk patients.
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Affiliation(s)
| | | | | | | | | | | | - J Bayly
- University of Derby, Derby, UK
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Hamilton L, Farrell M, Mielke B, Solano M, Silva S, Calvo I. The natural history of canine occult Grade II medial patellar luxation: an observational study. J Small Anim Pract 2020; 61:241-246. [PMID: 32003012 DOI: 10.1111/jsap.13093] [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] [Received: 11/12/2018] [Revised: 10/08/2019] [Accepted: 11/07/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the risk of lameness and the rate of subsequent medial patellar luxation surgery in dogs that present with occult Grade II medial patellar luxation. MATERIALS AND METHODS Retrospective owner survey and review of clinical records of adult dogs diagnosed with Grade II medial patellar luxation that were initially asymptomatic and managed non-surgically that had a minimum of 4-year follow-up. Clinical notes and owner questionnaires identified dogs that subsequently developed lameness and required surgery on the previously asymptomatic stifle. RESULTS Thirty-eight dogs were included with an average follow-up of 51 months. Seventeen dogs re-presented for unscheduled contralateral medial patellar luxation surgery at an average of 15 months after initial presentation. A further two dogs had chronic contralateral limb lameness after an average of 33 months after initial surgery and may have been potential surgical candidates. CLINICAL SIGNIFICANCE Fifty percent of adult dogs presenting with occult Grade II medial patellar luxation subsequently developed chronic lameness or required surgery.
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Affiliation(s)
- L Hamilton
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, SG53HR, UK
| | - M Farrell
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, SG53HR, UK
| | - B Mielke
- Department of Orthopaedic Surgery, Royal Veterinary College, Hertfordshire, UKAL97TA, UK
| | - M Solano
- Department of Orthopaedic Surgery, Fitzpatrick Referrals, Surrey, GU72Q, UK
| | - S Silva
- Department of Orthopaedic Surgery, Fitzpatrick Referrals, Surrey, GU72Q, UK
| | - I Calvo
- Department of Orthopaedic Surgery, Royal Veterinary College, Hertfordshire, UKAL97TA, UK
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Scovil CY, Delparte JJ, Walia S, Flett HM, Guy SD, Wallace M, Burns AS, Wolfe DL, Wolfe D, Kras-Dupuis A, Walia S, Guy S, Askes H, Casalino A, Fraser C, Paiva M, Miles S, Gagliardi J, Orenczuk S, Sommerdyk J, Genereaux M, Jarvis D, Wesenger J, Bloetjes L, Flett H, Burns A, Scovil C, Delparte J, Leber D, McMillan L, Domingo T, Wallace M, Stoesz B, Aguillon G, Koning C, Mumme L, Cwiklewich M, Bayless K, Crouse L, Crocker J, Erickson G, Mark M, Charbonneau R, Lloyd A, Van Doesburg C, Knox J, Wright P, Mouneimne M, Parmar R, Isaacs T, Reader J, Oga C, Birchall N, McKenzie N, Nicol S, Joly C, Laramée M, Robidoux I, Casimir M, Côté S, Lubin C, Lemay J, Beaulieu J, Truchon C, Noreau L, Lemay V, Vachon J, Bélanger D, Proteau F, O'Connell C, Savoie J, McCullum S, Brown J, Duda M, Bassett-Spiers K, Riopelle R, Hsieh J, Reinhart-McMillan W, Joshi P, Noonan V, Humphreys S, Hamilton L, MacIsaac G. Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network. Arch Phys Med Rehabil 2019; 100:327-335. [DOI: 10.1016/j.apmr.2018.07.444] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022]
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Lee E, Gibbs JP, Emery MG, Block G, Wasserman SM, Hamilton L, Kasichayanula S, Hanafin P, Somaratne R, Egbuna O. Influence of Renal Function on Evolocumab Exposure, Pharmacodynamics, and Safety. Clin Pharmacol Drug Dev 2019; 8:281-289. [PMID: 30676701 PMCID: PMC6590207 DOI: 10.1002/cpdd.650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/03/2018] [Indexed: 12/31/2022]
Abstract
We evaluated the pharmacokinetics, pharmacodynamics, and safety of evolocumab, a fully human monoclonal antibody against proprotein convertase subtilisin kexin type 9 (PCSK9), in an open‐label, parallel‐design study in participants with normal renal function (n = 6), severe renal impairment (RI; n = 6), or end‐stage renal disease (ESRD) receiving hemodialysis (n = 6) who received a single 140‐mg dose of evolocumab. The effects of evolocumab treatment on low‐density lipoprotein cholesterol (LDL‐C) lowering and unbound PCSK9 concentrations were similar in the normal renal function group and the renally impaired groups. Geometric mean Cmax and AUClast values in the severe RI and ESRD hemodialysis groups compared with the normal renal function group were lower but within 37% of the normal renal function group (Jonckheere‐Terpstra trend test; Cmax, P = .23; AUClast, P = .22) and within 26% after adjusting for body weight (mean body weight was approximately 9% higher in the renally impaired groups compared with the normal renal function group). No correlations were observed between exposure and baseline creatinine clearance. No adverse event was determined by the investigators to be related to evolocumab, and there were no trends indicative of clinically important effects on laboratory variables or vital signs. Overall, there were no meaningful differences in evolocumab exposure, as assessed by Cmax and AUClast, in patients with severe RI and ESRD hemodialysis compared with patients with normal renal function, and LDL‐C‐lowering effects were similar across groups. These results support the use of evolocumab without dose adjustment in patients who have severe RI or ESRD.
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Hamilton L, Allard E. INVESTIGATING HOW THE AGING BODY IMPACTS EMOTION-COGNITION ACROSS ADULTHOOD. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Růžičková O, Killinger Z, Kasalický P, Hamilton L, Tyl R, Tomková S, Kalouche-Khalil L. Real-world Management of Women with Postmenopausal Osteoporosis Treated with Denosumab: A Prospective Observational Study in the Czech Republic and Slovakia. Adv Ther 2018; 35:1713-1728. [PMID: 30191465 PMCID: PMC6182647 DOI: 10.1007/s12325-018-0779-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Indexed: 12/14/2022]
Abstract
Introduction Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fracture. In randomized controlled trials, denosumab has been shown to significantly reduce the fracture risk in women with osteoporosis. However, little is known about the real-world management of women who are prescribed denosumab. Methods This multicenter, prospective, observational real-world study in the Czech Republic and Slovakia evaluated the baseline characteristics and clinical management of women with postmenopausal osteoporosis prescribed denosumab for 24 months. Results A total of 600 women were included (300 in each country). In the Czech Republic and Slovakia, respectively, mean age at enrollment was 69.0 and 64.3 years, 67.7% and 30.0% of patients had a previous osteoporotic fracture, and 85.0% and 48.7% had previously received osteoporosis medication. In both countries, ‘low BMD T score’ and ‘a history of osteoporotic fracture’ were the main reasons for prescribing denosumab. Most patients received all four post-baseline denosumab injections (Czech Republic, 82.0%; Slovakia, 81.0%), and more than 98% of patients in both countries received all injections at the prescribing center. At 24 months, most patients experienced an increase in BMD T score for the lumbar spine, total hip, or femoral neck (Czech Republic, 69.7–91.7%; Slovakia, 67.1–92.9%). Adverse drug reactions were consistent with the known safety profile of denosumab. Conclusion Baseline characteristics of patients receiving denosumab in the Czech Republic and Slovakia reflect the reimbursement criteria for this agent in each country. The findings of our study in patients who are at high risk for fracture are consistent with the growing body of evidence demonstrating the effectiveness of denosumab in real-world clinical practice. Trial Registration ClinicalTrials.gov identifier, NCT01652690. Funding Amgen Inc. Electronic supplementary material The online version of this article (10.1007/s12325-018-0779-9) contains supplementary material, which is available to authorized users.
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Krassioukov A, Holmgren T, Lee A, Shea H, Hamilton L, Sandholdt N, Hellsing I, Elliott S, Claes H. Breastfeeding and motherhood after spinal cord injury: Barriers and challenges. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.555] [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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18
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de Hoon J, Van Hecken A, Vandermeulen C, Yan L, Smith B, Chen JS, Bautista E, Hamilton L, Waksman J, Vu T, Vargas G. Phase I, Randomized, Double-blind, Placebo-controlled, Single-dose, and Multiple-dose Studies of Erenumab in Healthy Subjects and Patients With Migraine. Clin Pharmacol Ther 2017; 103:815-825. [PMID: 28736918 DOI: 10.1002/cpt.799] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 12/22/2022]
Abstract
Monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) signaling are being explored as prophylactic treatments for migraine. Erenumab (AMG 334) is the first potent, selective, and competitive human mAb antagonist of the CGRP receptor. We report the data from two phase I studies assessing the safety, pharmacokinetics (PK), and pharmacodynamics of single and multiple administrations of erenumab in healthy subjects and patients with migraine. The results indicate that the PK profile of erenumab is nonlinear from 1 mg to 70 mg and the linear portion of the clearance from 70 mg to 210 mg is consistent with other human immunoglobulin G2 antibodies. Single doses of erenumab resulted in >75% inhibition of capsaicin-induced dermal blood flow, with no apparent dose-dependency for erenumab ≥21 mg. Erenumab was generally well tolerated, with an acceptable safety profile, supporting further clinical development of erenumab for migraine prevention.
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Affiliation(s)
- Jan de Hoon
- Center for Clinical Pharmacology, University Hospitals of Leuven, Leuven, Belgium
| | - Anne Van Hecken
- Center for Clinical Pharmacology, University Hospitals of Leuven, Leuven, Belgium
| | - Corinne Vandermeulen
- Center for Clinical Pharmacology, University Hospitals of Leuven, Leuven, Belgium
| | - Lucy Yan
- Early Development, Amgen, Thousand Oaks, California, USA
| | - Brian Smith
- Early Development, Amgen, Thousand Oaks, California, USA
| | | | - Edgar Bautista
- Early Development, Amgen, Thousand Oaks, California, USA
| | - Lisa Hamilton
- Global Biostatistical Science, Amgen Ltd., Uxbridge, UK
| | | | - Thuy Vu
- Early Development, Amgen, Thousand Oaks, California, USA
| | - Gabriel Vargas
- Early Development, Amgen, Thousand Oaks, California, USA
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Oliver-Welsh L, Hamilton L, Slater N. A novel cabling technique. Ann R Coll Surg Engl 2017; 100:417-418. [PMID: 29046097 DOI: 10.1308/rcsann.2017.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- L Oliver-Welsh
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital , Pembury, Tunbridge Wells , UK
| | - L Hamilton
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital , Pembury, Tunbridge Wells , UK
| | - N Slater
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital , Pembury, Tunbridge Wells , UK
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Vu T, Ma P, Chen JS, de Hoon J, Van Hecken A, Yan L, Wu LS, Hamilton L, Vargas G. Pharmacokinetic-Pharmacodynamic Relationship of Erenumab (AMG 334) and Capsaicin-Induced Dermal Blood Flow in Healthy and Migraine Subjects. Pharm Res 2017; 34:1784-1795. [PMID: 28593473 PMCID: PMC5533838 DOI: 10.1007/s11095-017-2183-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/15/2017] [Indexed: 01/16/2023]
Abstract
Purpose Capsaicin-induced dermal blood flow (CIDBF) is a validated biomarker used to evaluate the target engagement of potential calcitonin gene-related peptide-blocking therapeutics for migraine. To characterize the pharmacokinetics (PK) and quantify the inhibitory effects of erenumab (AMG 334) on CIDBF, CIDBF data were pooled from a single- and a multiple-dose study in healthy and migraine subjects. Methods Repeated capsaicin challenges and DBF measurements were performed and serum erenumab concentrations determined. A population analysis was conducted using a nonlinear mixed-effects modeling approach. Effects of body weight, gender, and age on model parameters were evaluated. Results Two-compartment target-mediated drug disposition (TMDD) model assuming binding of erenumab in the central compartment best described the nonlinear PK of erenumab. Subcutaneous absorption half-life was 1.6 days and bioavailability was 74%. Erenumab produced a maximum inhibition of 89% (95% confidence interval: 87–91%). Erenumab concentrations required for 50% and 99% of maximum inhibition were 255 ng/mL and 1134 ng/mL, respectively. Increased body weight was associated with increased erenumab clearance but had no effect on the inhibitory effect on CIDBF. Conclusions Our results show that erenumab pharmacokinetics was best characterized by a TMDD model and resulted in potent inhibition of CIDBF. Electronic supplementary material The online version of this article (doi:10.1007/s11095-017-2183-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thuy Vu
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, 91320-1799, USA.
| | - Peiming Ma
- Clinical Pharmacology, GSK R&D, Shanghai, China
| | | | - Jan de Hoon
- Center for Clinical Pharmacology, University Hospitals of Leuven, Leuven, Belgium
| | - Anne Van Hecken
- Center for Clinical Pharmacology, University Hospitals of Leuven, Leuven, Belgium
| | - Lucy Yan
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, 91320-1799, USA
| | - Liviawati Sutjandra Wu
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, 91320-1799, USA
| | - Lisa Hamilton
- Global Biostatistical Sciences, Amgen Limited, Uxbridge, England, UK
| | - Gabriel Vargas
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, 91320-1799, USA
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Abstract
Abstract
Skin wounds are a common presentation in small animal practice. These wounds may be acute or chronic with a complicated healing process. An important aspect of the healing of wounds is debridement which may be carried out by surgical, autolytic, mechanical or enzymatic methods. The debridement method is chosen according to the individual skin defect and influenced by factors such as wound size and location, the age of the wound, and the presence of infection or exudate. Enzymatic debridement is a method that is not commonly used in veterinary practice, and involves the use of enzyme preparations to remove necrotic tissue from a wound. The aim of this study was to investigate the effects of the enzymatic ointment collagenase as a method of debridement, and its effect on the macroscopic appearance of chronic skin wounds in cats and dogs. We observed that the application of Iruxol Mono directly to the wound changes the progress of the healing process, with no obvious adverse effects. The time of healing of chronic wounds was decreased and healthy granulation tissue was developed within a couple of days after application of the ointment. Enzymatic debridement appears to be a promising method of debridement for use in chronic wounds, and should be considered in cases where more conventional methods of debridement are ineffective or unsuitable.
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Affiliation(s)
- L. Hamilton
- University of Veterinary Medicine and Pharmacy, Komenského 73, 04181 Košice, Slovakia
| | - M. Kožár
- University of Veterinary Medicine and Pharmacy, Komenského 73, 04181 Košice, Slovakia
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Gibbs JP, Slatter JG, Egbuna O, Geller M, Hamilton L, Dias CS, Xu RY, Johnson J, Wasserman SM, Emery MG. Evaluation of Evolocumab (AMG 145), a Fully Human Anti-PCSK9 IgG2 Monoclonal Antibody, in Subjects With Hepatic Impairment. J Clin Pharmacol 2016; 57:513-523. [PMID: 27667740 PMCID: PMC5363371 DOI: 10.1002/jcph.832] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 07/27/2016] [Accepted: 09/22/2016] [Indexed: 11/11/2022]
Abstract
Evolocumab binds PCSK9, increasing low-density lipoprotein cholesterol (LDL-C) receptors and lowering LDL-C. Target-mediated evolocumab elimination is attributable to PCSK9 binding. As circulating PCSK9 and LDL-C levels are primarily regulated by the liver, we compared evolocumab pharmacokinetics, pharmacodynamics, and safety in individuals with and without hepatic impairment. An open-label, parallel-group study evaluated the pharmacokinetics of evolocumab in hepatic-impaired (Child-Pugh Class A or B) or healthy adults. Participants were classified as having no, mild, or moderate hepatic impairment (n = 8/group) and received a single 140-mg evolocumab dose. Assessments of unbound evolocumab and PCSK9 were made predose and postdose. Adverse events were monitored throughout the study. No significant association was observed between baseline PCSK9 and increasing level of hepatic impairment. No difference in extent and time course of PCSK9 or LDL-C reduction was observed despite an apparent decrease in mean unbound evolocumab exposure with increasing hepatic impairment (Jonckheere-Terpstra trend test; maximum serum concentration P = .18; area under the curve P = .09). Maximum reductions were observed in moderately impaired subjects vs healthy individuals: mean maximum serum concentration -34%; mean area under the concentration-time curve (AUC) -47%. On average, unbound PCSK9 serum concentrations fell by >80% at 4 hours after a single evolocumab dose. Mean (95% confidence interval) maximum LDL-C reductions in the healthy, mild, and moderate groups were -57% (-64% to -48%), -70% (-75% to -63%), and -53% (-61% to -43%), respectively. No safety risks were identified. These results support evolocumab use without dose adjustment in patients with active liver disease and mild or moderate hepatic impairment.
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Affiliation(s)
- John P Gibbs
- Medical Sciences, Amgen, Inc., Thousand Oaks, CA, USA.,AbbVie, North Chicago, IL, USA
| | - J Greg Slatter
- Medical Sciences, Amgen, Inc., Thousand Oaks, CA, USA.,Acerta Pharma, Bellevue, WA, USA
| | - Ogo Egbuna
- Medical Sciences, Amgen, Inc., Thousand Oaks, CA, USA
| | | | - Lisa Hamilton
- Biostatistics-Internationals, Amgen, Inc., Uxbridge, UK
| | - Clapton S Dias
- Medical Sciences, Amgen, Inc., Thousand Oaks, CA, USA.,BioMarin Pharmaceutical Inc., San Rafael, CA, USA
| | - Ren Y Xu
- Medical Sciences, Amgen, Inc., Thousand Oaks, CA, USA.,Gilead Science Inc., Foster City, CA, USA
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Peach M, Xu R, Fitzpatrick D, Hamilton L, Somaratne R, Scott R, Wasserman SM, Djedjos CS. Effect of evolocumab on cholesterol synthesis and absorption. J Lipid Res 2016; 57:2217-2224. [PMID: 27707817 DOI: 10.1194/jlr.p071704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/25/2016] [Revised: 09/28/2016] [Indexed: 11/20/2022] Open
Abstract
The effects of cholesterol-lowering drugs, including those that reduce cholesterol synthesis (statins) and those that reduce cholesterol absorption (ezetimibe), on cholesterol absorption and synthesis are well understood. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a novel class of cholesterol-lowering drugs that robustly reduce LDL-cholesterol (LDL-C), but little is known about their effects on cholesterol absorption and synthesis. We evaluated how treatment with evolocumab, a fully human monoclonal IgG2 antibody to PCSK9, affects markers of cholesterol synthesis and absorption by measuring these markers in patients from an evolocumab clinical trial. At 2 weeks, changes in β-sitosterol/total cholesterol (TC) from baseline were 4% for placebo, 10% for evolocumab 140 mg (nonsignificant vs. placebo), and 26% for evolocumab 420 mg (P < 0.001 vs. placebo). Changes in campesterol/TC at week 2, relative to baseline between placebo and evolocumab, were all nonsignificant. Evolocumab had a modest effect on markers of cholesterol synthesis. At 2 weeks, changes in desmosterol/TC were 1% for placebo, 7% for evolocumab 140 mg (nonsignificant vs. placebo), and 15% for evolocumab 420 mg (P < 0.01 vs. placebo). Changes from baseline in lathosterol/TC at week 2 between placebo and evolocumab were nonsignificant. These results suggest that evolocumab has a modest effect on cholesterol synthesis and absorption despite significant LDL-C lowering.
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Affiliation(s)
| | - Ren Xu
- Amgen Inc., Thousand Oaks, CA
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Sykes M, Hamilton L, Jones C, Gaffney K. FRI0427 The Prevalence of Axial Spondyloarthritis in Patients Presenting with Acute Anterior Uveitis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3739] [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: 11/04/2022]
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25
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Hamilton L. Psychiatric input into the assessment and management of chronic pelvic pain. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.373] [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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Tennant S, Cornford E, James J, Burrell H, Hamilton L, Chen Y. Contrast-enhanced spectral mammography: what is the 'added value' in a symptomatic setting? Initial findings from a UK centre. Breast Cancer Res 2015. [PMCID: PMC4670140 DOI: 10.1186/bcr3776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Flaten HK, Kim HS, Campbell J, Hamilton L, Monte AA. CYP2C19 drug-drug and drug-gene interactions in ED patients. Am J Emerg Med 2015; 34:245-9. [PMID: 26639454 DOI: 10.1016/j.ajem.2015.10.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/24/2015] [Accepted: 10/30/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND CYP450 polymorphisms result in variable rates of drug metabolism. CYP drug-drug interactions can contribute to altered drug effectiveness and safety. STUDY OBJECTIVES The primary objective was to determine the percentage of emergency department (ED) patients with cytochrome 2C19 (CYP2C19) drug-drug interactions. The secondary objective was to determine the prevalence of CYP2C19 polymorphisms in a US ED population. METHODS We conducted a prospective observational study in an urban academic ED with 72,000 annual visits. Drug ingestion histories for the 48 hours preceding ED visit were obtained; each drug was coded as CYP2C19 substrate, inhibitor, inducer, or not CYP2C19 dependent. Ten percent of patients were randomized to undergo CYP2C19 genotyping using the Roche Amplichip. RESULTS A total of 502 patients were included; 61% were female, 65% were white, and median age was 39 years (interquartile range, 22-53). One hundred thirty-one (26.1%) patients had taken at least 1 CYP2C19-dependent home drug. Eighteen (13.7%) patients who were already taking a CYP2C19-dependent drug were given or prescribed a CYP2C19-dependent drug while in the ED. Among the 53 patients genotyped, 52 (98%) were extensive metabolizers and 1 was a poor metabolizer. CONCLUSIONS In a population of ED patients, more than a quarter had taken a CYP2C19-dependent drug in the preceding 48 hours, but few were given or prescribed another CYP2C19-dependent drug in the ED. On genotyping analysis, CYP2C19 polymorphisms were uncommon in our cohort. We conclude that changing prescribing practice due to CYP2C19 drug-drug interaction or genotype is unlikely to be useful in most US ED populations.
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Affiliation(s)
- Hanna K Flaten
- University of Colorado Department of Emergency Medicine, 12401 E 17th Ave, Aurora, CO, 80045
| | - Howard S Kim
- Denver Health Residency in Emergency Medicine, 770 Bannock St, Denver, CO, 80204
| | - Jenny Campbell
- University of Colorado Department of Emergency Medicine, 12401 E 17th Ave, Aurora, CO, 80045
| | - Lisa Hamilton
- University of Colorado School of Medicine, 12401 E 17th Ave, Aurora, CO, 80045
| | - Andrew A Monte
- University of Colorado Department of Emergency Medicine, 12401 E 17th Ave, Aurora, CO, 80045; Denver Health Residency in Emergency Medicine, 770 Bannock St, Denver, CO, 80204; University of Colorado School of Medicine, 12401 E 17th Ave, Aurora, CO, 80045; Skaggs School of Pharmacy and Pharmaceutical Sciences, 12401 E 17th Ave, Aurora, CO, 80045; Rocky Mountain Poison & Drug Center, 990 Bannock St, Denver, CO, 80204.
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Hamilton L, Nguyen D, Heneghan S, Oceguera S. Provider Prediction of Success After Bariatric Surgery. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.080] [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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Hamilton L, Keh S, Spielmann PM, Hussain SSM. How we do it: locating the posterior semicircular canal in occlusion surgery for refractory benign paroxysmal positional vertigo: a cadaveric temporal bone study. Clin Otolaryngol 2015; 41:190-3. [PMID: 26095673 DOI: 10.1111/coa.12479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Affiliation(s)
- L Hamilton
- Temporal Bone Laboratory, Department of Otolaryngology, University of Dundee School of Medicine & Ninewells Hospital, Dundee, UK
| | - S Keh
- Temporal Bone Laboratory, Department of Otolaryngology, University of Dundee School of Medicine & Ninewells Hospital, Dundee, UK
| | - P M Spielmann
- Temporal Bone Laboratory, Department of Otolaryngology, University of Dundee School of Medicine & Ninewells Hospital, Dundee, UK
| | - S S M Hussain
- Temporal Bone Laboratory, Department of Otolaryngology, University of Dundee School of Medicine & Ninewells Hospital, Dundee, UK
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Armstrong C, Hamilton L, Shenkin SD. 26 * FACTORS PREDICTIVE OF NURSING HOME ADMISSION DIRECTLY FROM HOSPITAL: A SYSTEMATIC REVIEW. Age Ageing 2015. [DOI: 10.1093/ageing/afv029.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Xu R, Dias C, Peach M, Gao B, Hamilton L, Smith B, Cooke B, Jackson S, Shaywitz A, Fitzpatrick D, Scott R, Wasserman S. EFFECTS OF EVOLOCUMAB ON LIPOPROTEIN PARTICLES AND SUBCLASSES IN HYPERCHOLESTEROLEMIC AND HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA SUBJECTS ON STATIN THERAPY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61378-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jang G, Kaufman A, Lee E, Hamilton L, Hutton S, Egbuna O, Padhi D. A clinical therapeutic protein drug-drug interaction study: coadministration of denosumab and midazolam in postmenopausal women with osteoporosis. Pharmacol Res Perspect 2014; 2:e00033. [PMID: 25505582 PMCID: PMC4184705 DOI: 10.1002/prp2.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 01/10/2023] Open
Abstract
Drug–disease interactions involving therapeutic proteins that target cytokines and potentially impact cytochrome P450 (CYP) enzymes have been of increased interest to drug regulatory agencies and industry sponsors in recent years. This parallel-group open-label study evaluated the effects of the monoclonal antibody denosumab, an inhibitor of the cytokine RANKL, on the pharmacokinetics of the probe CYP3A4 substrate midazolam in postmenopausal women with osteoporosis. The pharmacokinetics of a 2 mg oral dose of midazolam was evaluated on days 1 and 16. Subjects in Group A received a 60 mg subcutaneous dose of denosumab on day 2, 2 weeks before the second midazolam dose, while subjects in Group B did not. For Group A (n = 17), point estimates for the ratio of least square means for midazolam exposures based on maximum observed plasma concentration (Cmax) and areas under the plasma concentration–time curve (AUCs) on day 16 versus day 1 ranged from 1.02 to 1.04 and 90% confidence intervals were within 0.80–1.25. No period effect was observed for Group B (n = 8). Midazolam and denosumab coadministration was safe and well tolerated. Inhibition of the cytokine RANKL by denosumab does not affect CYP3A4 in postmenopausal women with osteoporosis and will not alter the pharmacokinetics of drugs metabolized by this enzyme. These results are consistent with data suggesting that RANKL does not impact markers of inflammation and represent the first clinical data demonstrating a lack of effect on CYP3A4 of a therapeutic protein that is a cytokine modulator.
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Affiliation(s)
- Graham Jang
- Medical Sciences, Amgen Inc. Thousand Oaks, California
| | | | - Edward Lee
- Medical Sciences, Amgen Inc. Thousand Oaks, California
| | | | - Shauna Hutton
- Pharmacokinetics and Drug Metabolism, Amgen Inc. Thousand Oaks, California
| | - Ogo Egbuna
- Medical Sciences, Amgen Inc. Thousand Oaks, California
| | - Desmond Padhi
- Medical Sciences, Amgen Inc. Thousand Oaks, California
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Yang JC, Simon C, Schneider A, Seritan AL, Hamilton L, Hagerman PJ, Hagerman RJ, Olichney JM. Abnormal semantic processing in females with fragile X-associated tremor/ataxia syndrome. Genes Brain Behav 2013; 13:152-62. [PMID: 24299169 DOI: 10.1111/gbb.12114] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/12/2013] [Accepted: 11/28/2013] [Indexed: 11/29/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disorder, affects fragile X (FMR1) gene premutation carriers in late life. Studies have shown cognitive impairments in FXTAS including executive dysfunction, working memory and visuospatial deficits. However, less is known about cognition in females with FXTAS. Thus, we examined semantic processing and verbal memory in female FXTAS patients with event-related potentials (ERPs) and neuropsychological testing. Sixty-one females (34 FXTAS, Mage = 62.7; 27 controls, Mage = 60.4) were studied with 32-channel ERPs during a category judgment task in which semantically congruous (50%) and incongruous items were repeated approximately 10-140 seconds later. N400 and P600 amplitude data were submitted to analysis of covariance. Neuropsychological testing demonstrated lower performance in verbal learning and executive function in females with FXTAS. Event-related potential analyses showed a significant reduction of the N400 congruity effect (incongruous - congruous) in the FXTAS group. The N400 congruity effect reduction in females with FXTAS was mainly due to increased N400 amplitude to congruous new words. No significant abnormalities of the N400 repetition effect or the P600 repetition effect were found, indicating preserved implicit memory and verbal memory, respectively, in females with FXTAS. The decreased N400 congruity effect suggests abnormal semantic expectancy and/or semantic network disorganization in female FXTAS patients. The enhanced N400 amplitude to congruous new words may reflect decreased cognitive flexibility among FXTAS women, making access to less typical category exemplar words more difficult.
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Affiliation(s)
- J-C Yang
- Department of Neurology, University of California Davis School of Medicine, Sacramento; Center for Mind and Brain, University of California Davis, Davis
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Hamilton L, Macgregor A, Warmington V, Pinch E, Gaffney K. The prevalence of inflammatory back pain in a UK primary care population. Rheumatology (Oxford) 2013; 53:161-4. [DOI: 10.1093/rheumatology/ket344] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rakha EA, Shaaban AM, Haider SA, Jenkins J, Menon S, Johnson C, Yamaguchi R, Murphy A, Liston J, Cornford E, Hamilton L, James J, Ellis IO, Lee AHS. Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology 2013; 62:894-8. [DOI: 10.1111/his.12081] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/04/2012] [Accepted: 12/04/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Emad A Rakha
- Department of Histopathology; Nottingham University; Nottingham; UK
| | - Abeer M Shaaban
- Department of Histopathology and Molecular Pathology; St James's University Hospital; Leeds; UK
| | - Syeda Asma Haider
- Department of Histopathology; Leicester University Hospitals NHS Trust; Leicester; UK
| | - Jacquie Jenkins
- East Midlands Breast Screening Programme Quality Assurance Reference Centre; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Sindhu Menon
- Department of Histopathology; Derby Hospitals NHS Foundation Trust; Derby; UK
| | - Christopher Johnson
- Department of Histopathology; Leicester University Hospitals NHS Trust; Leicester; UK
| | - Rin Yamaguchi
- Department of Pathology; Kurume University Medical Centre; Kurume; Japan
| | - Alison Murphy
- East Midlands Breast Screening Programme Quality Assurance Reference Centre; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Joyce Liston
- Leeds/Wakefield Breast Screening Service; Leeds; UK
| | - Eleanor Cornford
- Breast Unit; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Lisa Hamilton
- Breast Unit; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Jonathan James
- Breast Unit; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Ian O Ellis
- Department of Histopathology; Nottingham University; Nottingham; UK
| | - Andrew H S Lee
- Department of Histopathology; Nottingham University; Nottingham; UK
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Ranasinghe A, Clark S, Corris P, Fisher A, Gould K, Hamilton L, Lordan J, Meachery G, Morley K, Parry G, Perry A, Pillay T, Schueler S, Tocewicz K, Dark J. Improving Outcomes in Lung Transplantation for Cystic Fibrosis – A Unified Approach. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.542] [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: 12/01/2022] Open
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Harris C, Remedios D, Aptowitzer T, Keat A, Hamilton L, Guile G, Belkhiri A, Newman D, Toms A, Macgregor A, Gaffney K, Morton L, Jones GT, MacDonald AG, Downham C, Macfarlane GJ, Tillett W, Jadon D, Wallis D, Costa L, Waldron N, Griffith N, Cavill C, Korendowych E, de Vries C, McHugh N, Iaremenko O, Fedkov D, Emery P, Baeten D, Sieper J, Braun J, van der Heijde D, McInnes I, Van Laar J, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Paramarta I, Bertolino A, Wright AM, Hueber W, Sofat N, Smee C, Hermansson M, Wajed J, Sanyal K, Kiely P, Howard M, Howe FA, Barrick TR, Abraham AM, Pearce MS, Mann KD, Francis RM, Birrell F, Carr A, Macleod I, Ng WF, Kavanaugh A, van der Heijde D, Chattopadhyay C, Gladman D, Mease P, McInnes I, Krueger G, Xu W, Goldstein N, Beutler A, Van Laar J, Baraliakos X, Braun J, Laurent DD, Baeten D, van der Heijde D, Sieper J, Emery P, McInnes I, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Wright AM, Gsteiger S, Hueber W, Conaghan PG, Peterfy CG, DiCarlo J, Olech E, Alberts AR, Alper JA, Devenport J, Anisfeld AM, Troum OM, Cooper P, Gimpel M, Deakin G, Jameson K, Godtschailk M, Gadola S, Stokes M, Cooper C, Gordon C, Kalunian K, Petri M, Strand V, Kilgallen B, Barry A, Wallace D, Flurey CA, Morris M, Pollock J, Hughes R, Richards P, Hewlett S. Oral abstracts 1: Spondyloarthropathies * O1. Detecting axial spondyloarthritis amongst primary care back pain referrals. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gregory P, Woollard M, Lighton D, Munro G, Jenkinson E, Newcombe RG, O'Meara P, Hamilton L. Comparison of malleable stylet and reusable and disposable bougies by paramedics in a simulated difficult intubation. Anaesthesia 2012; 67:371-6. [PMID: 22288931 DOI: 10.1111/j.1365-2044.2011.06999.x] [Citation(s) in RCA: 9] [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: 11/29/2022]
Abstract
In a randomised crossover study, 60 ambulance paramedics attempted tracheal intubation of a manikin model of a Cormack and Lehane grade 3/4 view using a Portex stylet, Portex and Frova single-use bougies, and a Portex reusable bougie. Tracheal intubation within 30 s was achieved by 34/60 (57%) using the stylet, 18/60 (30%) using a Portex single-use bougie, 16/60 (27%) using a Frova single-use bougie and 5/60 (8%) using a Portex reusable bougie. The proportion intubating within 30 s was significantly higher with the stylet compared with any bougie (p < 0.001), but significantly lower with a Portex reusable bougie than any other device (p < 0.004). Participants rated the Portex reusable bougie as significantly more difficult to use than the other devices (p < 0.001). There was no evidence of a relationship between previous experience and success rate for any device.
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Jeffery ND, Hamilton L, Granger N. Designing clinical trials in canine spinal cord injury as a model to translate successful laboratory interventions into clinical practice. Vet Rec 2011; 168:102-7. [PMID: 21493470 DOI: 10.1136/vr.d475] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Many interventions have been shown to improve outcome after experimental spinal cord injury in laboratory animals. The challenge now is to determine whether any of these can be translated to become an efficacious therapy for clinical lesions - a process that is often difficult and frequently fails. Here, we discuss the steps that are required to make this transition and the need for rigorous clinical trials. A key component is an outcome measure that is amenable to statistical analysis; we describe methods that we have developed to accurately measure function after spinal cord injury in dogs. The general methodology may have parallels in the development of veterinary models to test putative therapies for other diseases of humans and animals.
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Affiliation(s)
- N D Jeffery
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1600 South 16th Street, Ames, IA 50011, USA.
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Castillo-Gallego C, de Miguel Mendieta E, Garcia-Arias M, Plasencia-Rodriguez C, Lojo-Oliveira L, Martin-Mola E, Tillett W, Cavill C, Korendowych E, McHugh N, Coates L, Bhalla AK, Creamer P, Packham J, Hailwood S, Taylor G, Hamilton L, Brooksby A, Leeder J, Gaffney K, Malipeddi AS, Neame R, Francis J, Hassan W, Mease P, Olds M, Kary S, Kupper H, Bell C, Peffers G, Rees F, Lanyon P, Obrenovic K, Sandhu R, Packham J, Erb N, Coates LC, Conaghan P, Emery P, Green M, Ibrahim G, MakIver H, Helliwell P, Giles JL, McHugh K, DiGleria K, Shaw J, Kollnberger S, Maenaka K, Marroquin O, Renner C, Bowness P, Landewe R, Ritchlin C, Olds M, Guerette B, Lavie F, Kavanaugh A, McInnes I, Krueger GG, Gladman D, Zrubek J, Goldstein N, Xu S, Mudivarthy S, Mack M, Prevosto C, McDonald S, De Riva A, Goodman R, Key T, Hill Gaston JS, Deery MJ, Busch R, Fischer R, Wright C, Kessler B, Bowness P, Sheehy C, Jois RN, Leeder J, Kerrigan N, Mills KS, Somerville M, Scott DG, Gaffney K, Kavanaugh A, van der Heijde D, Chattopadhyay C, Gladman D, Mease P, McInnes I, Krueger GG, Xu W, Rahman MU, Zrubek J, Baratelle A, Beutler A, Stober CB, Benham HJ, Goodall JC, Hill Gaston JS, Sanyal K, Walker-Bone K, Coates LC, Conaghan P, Emery P, Green M, Ibrahim G, MakIver H, Helliwell PS, Vastesaeger N, Wang Y, Inman R, Deodhar A, Hsu B, Rahman MU, Dijkmans B, Braun J, Geusens P, Sieper J, van der Heijde D, El Miedany Y, Palmer D, McHugh K, Giles JL, Shaw J, Kollnberger S, Payeli S, Utriainen L, Milling S, Renner C, Bowness P. Spondylarthropathies (including psoriatic arthritis): 244. Validity of Colour Doppler and Spectral Doppler Ultrasound of Sacroilicac Joints Againts Physical Examination as Gold Standard. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Haioun C, Salar A, Pettengell R, Johnsen HE, Duehrsen U, Rossi FG, Verhoef G, Schwenkglenks M, Jaeger U, Hamilton L, Pujol B, Lugtenburg PJ. Anemia and erythropoiesis-stimulating agent administration in patients with non-Hodgkin lymphoma treated with cyclophosphamide, doxorubicin, vincristine, and prednisolone ± rituximab chemotherapy: results from an observational study. Leuk Lymphoma 2011; 52:796-803. [PMID: 21338278 DOI: 10.3109/10428194.2011.557166] [Citation(s) in RCA: 10] [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: 01/23/2023]
Abstract
CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) ± rituximab [(± R)CHOP] is the current standard of care for aggressive non-Hodgkin lymphoma (NHL). Anemia resulting from chemotherapy can be treated with erythropoiesis-stimulating agents (ESAs). As part of the observational IMPACT NHL study, data were collected on ESA use and anemia-related outcomes in 1829 adults receiving (± R)CHOP-14 or (± R)CHOP-21. Overall, 33% of patients were anemic during chemotherapy. Older age, lower baseline hemoglobin (Hb), worse performance status, more advanced disease stage, and use of CHOP-14 were significant predictors of transfusion and anemia in logistic regression models. ESAs were received by 404 patients, usually in response to low or declining Hb levels. Most patients (65%) had Hb 9-11 g/dL at ESA initiation, and 89% (Kaplan-Meier percentage) achieved Hb 10-12 g/dL. In conclusion, two-thirds of anemic patients with NHL receiving (± R)CHOP initiated ESA treatment at Hb 9-11 g/dL, and most achieved target Hb levels (10-12 g/dL).
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Affiliation(s)
- Corinne Haioun
- Hematology Department, Henri Mondor Hospital, Creteil, France.
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Rennerfelt K, Zhang Q, Hamilton L, Styf J. Patient pain drawing in diagnosing the cause of exercise-induced leg pain. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2010.081554.51] [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: 11/03/2022]
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Van Belle S, Dalivoust P, Reinthaller A, Tzanninis D, Urbanski K, Hamilton L, Pujol B. P92 Current practice use of darbepoetin alfa in the management of chemotherapy-induced anaemia in patients < 65 and ≥65 years: interim data from CHOICE, an international, observational study. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70130-1] [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: 10/20/2022] Open
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Woollard M, Lighton D, Gregory P, Munro G, Jenkinson E, Hamilton L, Newcombe R, O'Meara P. Malleable stylet vs re-useable and disposable bougies in a model of difficult intubation: a randomised cross-over trial. Emerg Med J 2009. [DOI: 10.1136/emj.2009.075416l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vansteenkiste J, Hedenus M, Gascon P, Bokemeyer C, Ludwig H, Vermorken J, Hamilton L, Bridges K, Pujol B. Darbepoetin alfa for treating chemotherapy-induced anemia in patients with a baseline hemoglobin level < 10 g/dL versus > or = 10 g/dL: an exploratory analysis from a randomized, double-blind, active-controlled trial. BMC Cancer 2009; 9:311. [PMID: 19728887 PMCID: PMC2744706 DOI: 10.1186/1471-2407-9-311] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: 02/25/2009] [Accepted: 09/03/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have shown that darbepoetin alfa, an erythropoiesis-stimulating agent (ESA), can reduce transfusions and increase hemoglobin (Hb) levels in patients with chemotherapy-induced anemia (CIA). Recent safety concerns, however, have prompted changes to ESA product information. In the European Union and United States, ESA therapy initiation for CIA is now recommended at a Hb level < or = 10 g/dL. The present exploratory analysis examined how ESA initiation at this Hb level may impact patient care. METHODS Data from a phase 3 randomized trial were retrospectively reanalyzed. CIA patients with nonmyeloid malignancies were randomized 1:1 to 500 mcg darbepoetin alfa every three weeks (Q3W) or 2.25 mcg/kg darbepoetin alfa weekly (QW) for 15 weeks. A previously published report from this trial showed Q3W dosing was non-inferior to QW dosing for reducing transfusions from week 5 to end-of-the-treatment period (EOTP). In the present analysis, outcomes were reanalyzed by baseline Hb <10 g/dL and > or = 10 g/dL. Endpoints included transfusion rates, Hb outcomes, and safety profiles. RESULTS This study reanalyzed 351 and 354 patients who initiated ESA therapy at a baseline Hb of <10 g/dL or > or = 10 g/dL, respectively. From week 5 to EOTP, the estimated Kaplan-Meier transfusion incidence (Q3W vs QW) was lower in the > or = 10 g/dL baseline-Hb group (14% vs 21%) compared with the <10 g/dL baseline-Hb group (36% vs 41%). By week 5, the > or = 10 g/dL baseline-Hb group, but not the <10 g/dL baseline-Hb group, achieved a mean Hb > or = 11 g/dL. The Kaplan-Meier estimate of percentage of patients (Q3W vs QW) who achieved Hb > or = 11 g/dL from week 1 to EOTP was 90% vs 85% in the > or = 10 g/dL baseline-Hb group and 54% vs 57% in the <10 g/dL baseline-Hb group. Both baseline-Hb groups maintained mean Hb levels <12 g/dL and had similar safety profiles, though more patients in the > or = 10 g/dL baseline-Hb group reached the threshold Hb of > or = 13 g/dL. CONCLUSION In this exploratory analysis, darbepoetin alfa Q3W and QW raised Hb levels and maintained mean Hb at <12 g/dL in both baseline-Hb groups. The > or = 10 g/dL baseline-Hb group had fewer transfusions and faster anemia correction. Additional studies should prospectively evaluate the relationship between Hb levels at ESA initiation and outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT00118638.
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Affiliation(s)
- Johan Vansteenkiste
- Respiratory Oncology Unit (Pulmonology), University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
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Hamilton L, Fay S, Rockwood K. Misplacing objects in mild to moderate Alzheimer's disease: a descriptive analysis from the VISTA clinical trial. J Neurol Neurosurg Psychiatry 2009; 80:960-5. [PMID: 19293172 DOI: 10.1136/jnnp.2008.166801] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Misplacing objects is a commonly reported symptom of Alzheimer's disease (AD) but it is little described systematically and conflicting characterisations (losing/forgetting the location of objects versus inappropriate placement) of this "warning sign" of dementia currently exist. Patient and carer descriptions of misplacing in clinical interviews are reported here. METHODS This was a secondary qualitative analysis of video recorded, open ended and semistructured clinical interviews with 130 community dwelling patients with mild to moderate AD (mean age 77 (7.7) years; 63% women; 67% mild AD) and their carers who participated in the Video Imaging Synthesis of Treating Alzheimer's Disease (VISTA) study, a 4 month, randomised, placebo controlled trial of galantamine. Employing a framework analysis approach, we summarised descriptive accounts of misplacing with relevant proportions. RESULTS Recurrent incidents of misplacing were described for 96/130 (74%) study patients, 45 of whom established treatment goals to track this problem. For most (78/96, 81%), misplacing was the inability to recall where an item had been set down or put away. Fewer patients (25/96, including 18 with recall misplacing) put objects in unusual or incorrect places. Patients were commonly aware of their misplacing (56/96, 58%) and were distressed by it (31/56). Patients who misplaced also displayed tendencies towards delusions/hallucinations (51/96, but only directly related to misplacing in 17 cases) and hiding items (15%) CONCLUSION Misplacing is a common phenomenon in mild to moderate AD. Here, misplacing was usually described as an inability to recall where an item was set down, more so than the inappropriate placement of items.
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Affiliation(s)
- L Hamilton
- Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
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Hamilton L, Evans A, Cornford E, James J, Burrell H. Ultrasound diagnosis of fibroadenoma — is biopsy always necessary? Clin Radiol 2008; 63:1070-1. [DOI: 10.1016/j.crad.2008.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 05/09/2008] [Indexed: 11/24/2022]
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Bristow AR, Agrawal A, Evans AJ, Burrell HC, Cornford EJ, James JJ, Hamilton L, Robertson JFR, Chan SY, Lawton PA, Cheung KL. Can computerised tomography replace bone scintigraphy in detecting bone metastases from breast cancer? A prospective study. Breast 2008; 17:98-103. [PMID: 17890090 DOI: 10.1016/j.breast.2007.07.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Revised: 07/24/2007] [Accepted: 07/25/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The aim of this study was to determine whether bone scans (BS) can be avoided if pelvis was included in CT thorax and abdomen to detect bony metastases from breast cancer. MATERIALS AND METHODS Results of 77 pairs of CT (thorax, abdomen, and pelvis) and BS in newly diagnosed patients with metastatic breast cancer (MBC) were compared prospectively for 12 months. Both scans were blindly assessed by experienced radiologists and discussed at multidisciplinary team meetings regarding the diagnosis of bone metastases. RESULTS CT detected metastatic bone lesions in 43 (98%) of 44 patients with bone metastases. The remaining patient had a solitary, asymptomatic bony metastasis in shaft of femur. BS was positive in all patients with bone metastases. There were 11 cases of false positive findings on BS. CONCLUSION Our findings suggest routine BS of patients presenting with MBC is not required if CT (thorax, abdomen, and pelvis) is performed.
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Affiliation(s)
- A R Bristow
- Division of Breast Surgery, University of Nottingham, UK
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Botha P, Chaudhari M, Wrightson N, Parry G, Griselli M, Hamilton L, Dark J, Hasan A. 494: Cardiac Transplantation for the Failing Fontan Circulation. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.507] [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: 10/22/2022] Open
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