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Ghanbarian S, Wong GWK, Bunka M, Edwards L, Cressman S, Conte T, Peterson S, Vijh R, Price M, Schuetz C, Erickson D, Riches L, Landry G, McGrail K, Austin J, Bryan S. A Canadian Simulation Model for Major Depressive Disorder: Study Protocol. Pharmacoecon Open 2024; 8:493-505. [PMID: 38528312 PMCID: PMC11058136 DOI: 10.1007/s41669-024-00481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is a common, often recurrent condition and a significant driver of healthcare costs. People with MDD often receive pharmacological therapy as the first-line treatment, but the majority of people require more than one medication trial to find one that relieves symptoms without causing intolerable side effects. There is an acute need for more effective interventions to improve patients' remission and quality of life and reduce the condition's economic burden on the healthcare system. Pharmacogenomic (PGx) testing could deliver these objectives, using genomic information to guide prescribing decisions. With an already complex and multifaceted care pathway for MDD, future evaluations of new treatment options require a flexible analytic infrastructure encompassing the entire care pathway. Individual-level simulation models are ideally suited for this purpose. We sought to develop an economic simulation model to assess the effectiveness and cost effectiveness of PGx testing for individuals with major depression. Additionally, the model serves as an analytic infrastructure, simulating the entire patient pathway for those with MDD. METHODS AND ANALYSIS Key stakeholders, including patient partners, clinical experts, researchers, and modelers, designed and developed a discrete-time microsimulation model of the clinical pathways of adults with MDD in British Columbia (BC), including all publicly-funded treatment options and multiple treatment steps. The Simulation Model of Major Depression (SiMMDep) was coded with a modular approach to enhance flexibility. The model was populated using multiple original data analyses conducted with BC administrative data, a systematic review, and an expert panel. The model accommodates newly diagnosed and prevalent adult patients with MDD in BC, with and without PGx-guided treatment. SiMMDep comprises over 1500 parameters in eight modules: entry cohort, demographics, disease progression, treatment, adverse events, hospitalization, costs and quality-adjusted life-years (payoff), and mortality. The model predicts health outcomes and estimates costs from a health system perspective. In addition, the model can incorporate interactive decision nodes to address different implementation strategies for PGx testing (or other interventions) along the clinical pathway. We conducted various forms of model validation (face, internal, and cross-validity) to ensure the correct functioning and expected results of SiMMDep. CONCLUSION SiMMDep is Canada's first medication-specific, discrete-time microsimulation model for the treatment of MDD. With patient partner collaboration guiding its development, it incorporates realistic care journeys. SiMMDep synthesizes existing information and incorporates provincially-specific data to predict the benefits and costs associated with PGx testing. These predictions estimate the effectiveness, cost-effectiveness, resource utilization, and health gains of PGx testing compared with the current standard of care. However, the flexible analytic infrastructure can be adapted to support other policy questions and facilitate the rapid synthesis of new data for a broader search for efficiency improvements in the clinical field of depression.
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Affiliation(s)
- Shahzad Ghanbarian
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Gavin W K Wong
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Mary Bunka
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Louisa Edwards
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Sonya Cressman
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Tania Conte
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Vijh
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Morgan Price
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Christian Schuetz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - David Erickson
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Psychology Department, Fraser Health, Vancouver, BC, Canada
| | | | | | - Kim McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Stirling Bryan
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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Millington PM, Snaith B, Edwards L, Carus CA. Factors that influence the quality of the clinical supervision experience in a first contact physiotherapy (FCP) role - The perspectives of supervisors and supervisees - A qualitative analysis. Musculoskelet Sci Pract 2024; 70:102921. [PMID: 38354619 DOI: 10.1016/j.msksp.2024.102921] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/08/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE First contact practitioner (FCP) roles have been developed to supplement the primary care workforce in managing the burden of musculoskeletal conditions. In order to quality assure and standardise capability of these clinicians an educational framework was developed by NHS England. The Roadmap to Practice (2020) was the curriculum designed to support and develop capability for FCP roles. This secondary analysis of a broader research project aimed to understand the factors affecting the supervisory experience from both a supervisor and supervisee perspective. METHODS A qualitative design using group interviews and an online survey was utilised to examine the experiences of these clinicians on their journey navigating and supporting the Roadmap to Practice portfolio process. FINDINGS Three principal themes were identified that affected the supervisory process; preparation of both supervisors and supervisee; the person (supervisor) and the practicalities associated with supervision. CONCLUSION There were numerous factors influencing the quality of clinical supervision. Adequate preparation of the supervisor and supervisee is critical to success. The attributes of the supervisor were important in the enhancing the quality of supervisory process. Time afforded to undertake supervision and access to appropriate supervisors need to be adequate and accounted for in workforce planning. A paradigm shift in workplace culture is required so clinical supervision is seen as an integral component in maintaining quality and assuring patient safety.
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Affiliation(s)
- P M Millington
- School of Allied Health Professions & Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK.
| | - B Snaith
- School of Allied Health Professions & Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK; The Mid Yorkshire Teaching NHS Trust, Wakefield, UK
| | - L Edwards
- School of Allied Health Professions & Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - C A Carus
- School of Allied Health Professions & Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK
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Wiles MD, Benson I, Edwards L, Miller R, Tait F, Wynn-Hebden A. Management of acute cervical spinal cord injury in the non-specialist intensive care unit: a narrative review of current evidence. Anaesthesia 2024; 79:193-202. [PMID: 38088443 DOI: 10.1111/anae.16198] [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] [Accepted: 11/23/2023] [Indexed: 01/11/2024]
Abstract
Each year approximately one million people suffer spinal cord injury, which has significant physical, psychosocial and economic impacts on patients and their families. Spinal cord rehabilitation centres are a well-established part of the care pathway for patients with spinal cord injury and facilitate improvements in functional independence and reductions in healthcare costs. Within the UK, however, there are a limited number of spinal cord injury centres, which delays admission. Patients and their families often perceive that they are not receiving specialist care while being treated in non-specialist units. This review aimed to provide clinicians who work in non-specialist spinal injury centres with a summary of contemporary studies relevant to the critical care management of patients with cervical spinal cord injury. We undertook a targeted literature review including guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials published in English between 1 June 2017 and 1 June 2023. Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also included. We then summarised the key management themes: acute critical care management approaches (including ventilation strategies, blood pressure management and tracheostomy insertion); respiratory weaning techniques; management of pain and autonomic dysreflexia; and rehabilitation.
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Affiliation(s)
- M D Wiles
- Academic Department of Anaesthesia and Peri-operative Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Centre for Applied Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - I Benson
- National Spinal Injuries Centre, Buckinghamshire Hospitals NHS Trust, Stoke Mandeville, UK
| | - L Edwards
- University of Nottingham, Nottingham, UK
| | - R Miller
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - F Tait
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - A Wynn-Hebden
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
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Cressman S, Ghanbarian S, Edwards L, Peterson S, Bunka M, Hoens AM, Riches L, Austin J, Vijh R, McGrail K, Bryan S. Costs of major depression covered / not covered in British Columbia, Canada. BMC Health Serv Res 2023; 23:1446. [PMID: 38124043 PMCID: PMC10734183 DOI: 10.1186/s12913-023-10474-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the world's leading causes of disability. Our purpose was to characterize the total costs of MDD and evaluate the degree to which the British Columbia provincial health system meets its objective to protect people from the financial impact of illness. METHODS We performed a population-based cohort study of adults newly diagnosed with MDD between 2015 and 2020 and followed their health system costs over two years. The expenditure proportion of MDD-related, patient paid costs relative to non-subsistence income was estimated, incidences of financial hardship were identified and the slope index of inequality (SII) between the highest and lowest income groups compared across regions. RESULTS There were 250,855 individuals diagnosed with MDD in British Columbia over the observation period. Costs to the health system totalled >$1.5 billion (2020 CDN), averaging $138/week for the first 12 weeks following a new diagnosis and $65/week to week 52 and $55/week for weeks 53-104 unless MDD was refractory to treatment ($125/week between week 12-52 and $101/week over weeks 53-104). The proportion of MDD-attributable costs not covered by the health system was 2-15x greater than costs covered by the health system, exceeding $700/week for patients with severe MDD or MDD that was refractory to treatment. Population members in lower-income groups and urban homeowners had disadvantages in the distribution of financial protection received by the health system (SII reached - 8.47 and 15.25, respectively); however, financial hardship and inequities were mitigated province-wide if MDD went into remission (SII - 0.07 to 0.6). CONCLUSIONS MDD-attributable costs to health systems and patients are highest in the first 12 weeks after a new diagnosis. During this time, lower income groups and homeowners in urban areas run the risk of financial hardship.
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Affiliation(s)
- Sonya Cressman
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Shahzad Ghanbarian
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Louisa Edwards
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Mary Bunka
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Linda Riches
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Patient Partner, University of British Columbia, Vancouver, BC, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Vijh
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
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Ghanbarian S, Wong GWK, Bunka M, Edwards L, Cressman S, Conte T, Price M, Schuetz C, Riches L, Landry G, Erickson D, McGrail K, Peterson S, Vijh R, Hoens AM, Austin J, Bryan S. Cost-effectiveness of pharmacogenomic-guided treatment for major depression. CMAJ 2023; 195:E1499-E1508. [PMID: 37963621 DOI: 10.1503/cmaj.221785] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Pharmacogenomic testing to identify variations in genes that influence metabolism of antidepressant medications can enhance efficacy and reduce adverse effects of pharmacotherapy for major depressive disorder. We sought to establish the cost-effectiveness of implementing pharmacogenomic testing to guide prescription of antidepressants. METHODS We developed a discrete-time microsimulation model of care pathways for major depressive disorder in British Columbia, Canada, to evaluate the effectiveness and cost-effectiveness of pharmacogenomic testing from the public payer's perspective over 20 years. The model included unique patient characteristics (e.g., metabolizer phenotypes) and used estimates derived from systematic reviews, analyses of administrative data (2015-2020) and expert judgment. We estimated incremental costs, life-years and quality-adjusted life-years (QALYs) for a representative cohort of patients with major depressive disorder in BC. RESULTS Pharmacogenomic testing, if implemented in BC for adult patients with moderate-severe major depressive disorder, was predicted to save the health system $956 million ($4926 per patient) and bring health gains of 0.064 life-years and 0.381 QALYs per patient (12 436 life-years and 74 023 QALYs overall over 20 yr). These savings were mainly driven by slowing or avoiding the transition to refractory (treatment-resistant) depression. Pharmacogenomic-guided care was associated with 37% fewer patients with refractory depression over 20 years. Sensitivity analyses estimated that costs of pharmacogenomic testing would be offset within about 2 years of implementation. INTERPRETATION Pharmacogenomic testing to guide antidepressant use was estimated to yield population health gains while substantially reducing health system costs. These findings suggest that pharmacogenomic testing offers health systems an opportunity for a major value-promoting investment.
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Affiliation(s)
- Shahzad Ghanbarian
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Gavin W K Wong
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Mary Bunka
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Louisa Edwards
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Sonya Cressman
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Tania Conte
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Morgan Price
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Christian Schuetz
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Linda Riches
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Ginny Landry
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - David Erickson
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Kim McGrail
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Sandra Peterson
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Rohit Vijh
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Alison M Hoens
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Jehannine Austin
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Stirling Bryan
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
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Young E, Edwards L, Singh R. The Role of Artificial Intelligence in Colorectal Cancer Screening: Lesion Detection and Lesion Characterization. Cancers (Basel) 2023; 15:5126. [PMID: 37958301 PMCID: PMC10647850 DOI: 10.3390/cancers15215126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/14/2023] [Indexed: 11/15/2023] Open
Abstract
Colorectal cancer remains a leading cause of cancer-related morbidity and mortality worldwide, despite the widespread uptake of population surveillance strategies. This is in part due to the persistent development of 'interval colorectal cancers', where patients develop colorectal cancer despite appropriate surveillance intervals, implying pre-malignant polyps were not resected at a prior colonoscopy. Multiple techniques have been developed to improve the sensitivity and accuracy of lesion detection and characterisation in an effort to improve the efficacy of colorectal cancer screening, thereby reducing the incidence of interval colorectal cancers. This article presents a comprehensive review of the transformative role of artificial intelligence (AI), which has recently emerged as one such solution for improving the quality of screening and surveillance colonoscopy. Firstly, AI-driven algorithms demonstrate remarkable potential in addressing the challenge of overlooked polyps, particularly polyp subtypes infamous for escaping human detection because of their inconspicuous appearance. Secondly, AI empowers gastroenterologists without exhaustive training in advanced mucosal imaging to characterise polyps with accuracy similar to that of expert interventionalists, reducing the dependence on pathologic evaluation and guiding appropriate resection techniques or referrals for more complex resections. AI in colonoscopy holds the potential to advance the detection and characterisation of polyps, addressing current limitations and improving patient outcomes. The integration of AI technologies into routine colonoscopy represents a promising step towards more effective colorectal cancer screening and prevention.
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Affiliation(s)
- Edward Young
- Faculty of Health and Medical Sciences, University of Adelaide, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Australia
| | - Louisa Edwards
- Faculty of Health and Medical Sciences, University of Adelaide, Queen Elizabeth Hospital, Port Rd, Woodville South, SA 5011, Australia
| | - Rajvinder Singh
- Faculty of Health and Medical Sciences, University of Adelaide, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Australia
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Edwards L, Bentley C, Burgess M, Sapir-Pichhadze R, Hartell D, Keown P, Bryan S. Adding epitope compatibility to deceased donor kidney allocation criteria: recommendations from a pan-Canadian online public deliberation. BMC Nephrol 2023; 24:165. [PMID: 37296384 PMCID: PMC10255937 DOI: 10.1186/s12882-023-03224-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The widening supply-demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly. METHODS Invitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November-December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed. RESULTS Thirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes. CONCLUSIONS Participants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria.
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Affiliation(s)
- Louisa Edwards
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.
| | | | - Michael Burgess
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- W. Maurice Young Centre for Applied Ethics, UBC, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Vancouver, Canada
| | | | - Paul Keown
- Department of Medicine, UBC, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Slomp C, Edwards L, Burgess M, Sapir-Pichhadze R, Keown P, Bryan S. Public values and guiding principles for implementing epitope compatibility in kidney transplantation allocation criteria: results from a Canadian online public deliberation. BMC Public Health 2023; 23:844. [PMID: 37165330 PMCID: PMC10170053 DOI: 10.1186/s12889-023-15790-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/30/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Epitope compatibility in deceased donor kidney allocation is an emerging area of precision medicine (PM), seeking to improve compatibility between donor kidneys to transplant candidates in the hope of avoiding kidney rejection. Though the potential benefits of using epitope compatibility are promising, the implied modification of deceased organ allocation criteria requires consideration of significant clinical and ethical trade-offs. As a matter of public policy, these trade-offs should consider public values and preferences. We invited members of the Canadian public to participate in a deliberation about epitope compatibility in deceased donor kidney transplantation; to identify what is important to them and to provide recommendations to policymakers. METHODS An online public deliberation was conducted with members of the Canadian public, in which participants were asked to construct recommendations for policymakers regarding the introduction of epitope compatibility to kidney allocation criteria. In the present paper, a qualitative analysis was conducted to identify the values reflected in participants' recommendations. All virtual sessions were recorded, transcribed, and analyzed using NVivo 12 software. RESULTS Thirty-two participants constructed nine recommendations regarding the adoption of epitope compatibility into deceased donor kidney allocation. Five values were identified that drove participants' recommendations: Health Maximization, Protection/Mitigation of Negative Impacts, Fairness, Science/Evidence-based Healthcare, and Responsibility to Maintain Trust. Conflicts between these values were discussed in terms of operational principles that were required for epitope compatibility to be implemented in an acceptable manner: the needs for Flexibility, Accountability, Transparent Communication and a Transition Plan. All nine recommendations were informed by these four principles. Participant deliberations were often dominated by the conflict between Health Maximization and Fairness or Protection/Mitigation of Negative Impacts, which was discussed as the need for Flexibility. Two additional values (Efficient Use of Resources and Logic/Rationality) were also discussed and were reasons for some participants voting against some recommendations. CONCLUSIONS Public recommendations indicate support for using epitope compatibility in deceased donor kidney allocation. A flexible approach to organ allocation decision-making may allow for the balancing of Health Maximization against maintaining Fairness and Mitigating Negative Impacts. Flexibility is particularly important in the context of epitope compatibility and other PM initiatives where evidence is still emerging.
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Affiliation(s)
- Caitlin Slomp
- BC Children's Hospital Research Institute, 938 W 28th Ave, BC, V5Z 4H4, Vancouver, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Louisa Edwards
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Michael Burgess
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Paul Keown
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Riches L, Ridgway L, Edwards L. Co-learning commentary: a patient partner perspective in mental health care research. Res Involv Engagem 2023; 9:24. [PMID: 37072880 PMCID: PMC10114418 DOI: 10.1186/s40900-023-00435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Although including patients as full, active members of research teams is becoming more common, there are few accounts about how to do so successfully, and almost none of these are written by patient partners themselves. Three patient partners contributed their lived experience to a three-year, multi-component mental health research project in British Columbia, Canada. As patient partners, we contributed to innovative co-learning in this project, resulting in mutual respect and wide-ranging benefits. To guide future patient partners and researchers seeking patient engagement, we outline the processes that helped our research team 'get it right'. MAIN BODY From the outset, we were integrated into components of the project that we chose: thematically coding a rapid review, developing questions and engagement processes for focus groups, and shaping an economic model. Our level of engagement in each component was determined by us. Additionally, we catalyzed the use of surveys to evaluate our engagement and the perceptions of patient engagement from the wider team. At our request, we had a standing place on each monthly meeting agenda. Importantly, we broke new ground when we moved the team from using previously accepted psychiatric terminology that no longer fit the reality of patients' experiences. We worked diligently with the team to represent the reality that was appropriate for all parties. The approach taken in this project led to meaningful and successfully integrated patient experiences, fostered a shared understanding, which positively impacted team development and cohesion. The resulting 'lessons learned' included engaging early, often, and with respect; carving out and creating a safe place, free from stigma; building trust within the research team; drawing on lived experience; co-creating acceptable terminology; and cultivating inclusivity throughout the entire study. CONCLUSION We believe that lived experience can and should go hand-in-hand with research, to ensure study outcomes reflect the knowledge of patients themselves. We were willing to share the truth of our lived experience. We were treated as co-researchers. Successful engagement came from the 'lessons learned' that can be used by other teams who wish to engage patient partners in health research.
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Affiliation(s)
- Linda Riches
- Patient Partner, Prince George, Canada.
- Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, 717-828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada.
| | | | - Louisa Edwards
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, 717-828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
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Bunka M, Wong G, Kim D, Edwards L, Austin J, Doyle-Waters MM, Gaedigk A, Bryan S. Evaluating treatment outcomes in pharmacogenomic-guided care for major depression: A rapid review and meta-analysis. Psychiatry Res 2023; 321:115102. [PMID: 36780865 DOI: 10.1016/j.psychres.2023.115102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Abstract
Pharmacogenomic (PGx) testing may increase the probability of remission and response in patients with major depressive disorder (MDD) undergoing pharmacotherapy. Given the potential implications of these outcomes and recent proliferation of PGx studies, we conducted a systematic review to evaluate the effectiveness of PGx testing on clinical outcomes in patients with MDD as compared to treatment as usual (TAU). MEDLINE, Embase, PsycInfo, and CENTRAL were searched for English-language articles from 2000 to 2021 for randomized controlled trials (RCTs) comparing PGx-guided treatment vs. TAU in patients with MDD. Meta-analyses were conducted in R. Ten RCTs were included: eight reported remission and seven reported response. The best available evidence suggests that PGx-guided care for moderate-to-severe adult depression is more likely to result in remission and response than TAU (both risk ratios significant). However, there are limitations in the evidence base, including high risk of bias and inconsistency between trials. Despite the consequent very low certainty in the magnitude of effect, there is confidence in the direction. Though modest, the beneficial effects of PGx for adults with moderate-severe MDD could - as a result of the scope and scale of the condition and its impacts - have important ramifications for patients and the health system.
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Affiliation(s)
- Mary Bunka
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Gavin Wong
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Dan Kim
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Louisa Edwards
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Jehannine Austin
- BC Mental Health and Substance Use Services Research Institute, UBC, Vancouver, BC, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Yaghoubi M, Cressman S, Edwards L, Shechter S, Doyle-Waters MM, Keown P, Sapir-Pichhadze R, Bryan S. A Systematic Review of Kidney Transplantation Decision Modelling Studies. Appl Health Econ Health Policy 2023; 21:39-51. [PMID: 35945483 DOI: 10.1007/s40258-022-00744-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Genome-based precision medicine strategies promise to minimize premature graft loss after renal transplantation, through precision approaches to immune compatibility matching between kidney donors and recipients. The potential adoption of this technology calls for important changes to clinical management processes and allocation policy. Such potential policy change decisions may be supported by decision models from health economics, comparative effectiveness research and operations management. OBJECTIVE We used a systematic approach to identify and extract information about models published in the kidney transplantation literature and provide an overview of the status of our collective model-based knowledge about the kidney transplant process. METHODS Database searches were conducted in MEDLINE, Embase, Web of Science and other sources, for reviews and primary studies. We reviewed all English-language papers that presented a model that could be a tool to support decision making in kidney transplantation. Data were extracted on the clinical context and modelling methods used. RESULTS A total of 144 studies were included, most of which focused on a single component of the transplantation process, such as immunosuppressive therapy or donor-recipient matching and organ allocation policies. Pre- and post-transplant processes have rarely been modelled together. CONCLUSION A whole-disease modelling approach is preferred to inform precision medicine policy, given its potential upstream implementation in the treatment pathway. This requires consideration of pre- and post-transplant natural history, risk factors for allograft dysfunction and failure, and other post-transplant outcomes. Our call is for greater collaboration across disciplines and whole-disease modelling approaches to more accurately simulate complex policy decisions about the integration of precision medicine tools in kidney transplantation.
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Affiliation(s)
- Mohsen Yaghoubi
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, USA
| | - Sonya Cressman
- Faculty of Health Sciences, Simon Fraser University, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Louisa Edwards
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada
| | - Steven Shechter
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Paul Keown
- Department of Medicine, Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada.
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Edwards L, Osayimwen O, McCubbin J, Hill C. Evaluation of the novel Situational Sleepiness Scale for children with Narcolepsy. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.528] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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14
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Slomp C, Morris E, Edwards L, Hoens AM, Landry G, Riches L, Ridgway L, Bryan S, Austin J. Pharmacogenomic Testing for Major Depression: A Qualitative Study of the Perceptions of People with Lived Experience and Professional Stakeholders. Can J Psychiatry 2022:7067437221140383. [PMID: 36437757 DOI: 10.1177/07067437221140383] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES With increasing evidence for the clinical utility of pharmacogenomic (PGx) testing for depression, there is a growing need to consider issues related to the clinical implementation of this testing. The perspectives of key stakeholders (both people with lived experience [PWLE] and providers) are critical, but not frequently explored. The purpose of this study was to understand how PWLE and healthcare providers/policy experts (P/HCPs) perceive PGx testing for depression, to inform the consideration of clinical implementation within the healthcare system in British Columbia (BC), Canada. METHODS We recruited two cohorts of participants to complete individual 1-h, semi-structured interviews: (a) PWLE, recruited from patient and research engagement networks and organizations and (b) P/HCPs, recruited via targeted invitation. Interviews were audiotaped, transcribed verbatim, de-identified, and analysed using interpretive description. RESULTS Seventeen interviews were completed with PWLE (7 with experience of PGx testing for depression; 10 without); 15 interviews were completed with P/HCPs (family physicians, psychiatrists, nurses, pharmacists, genetic counsellors, medical geneticists, lab technologists, program directors, and insurers). Visual models of PWLE's and P/HCP's perceptions of and attitudes towards PGx testing were developed separately, but both were heavily influenced by participants' prior professional and/or personal experiences with depression and/or PGx testing. Both groups expressed a need for evidence and numerous considerations for the implementation of PGx testing in BC, including the requirement for conclusive economic analyses, patient and provider education, technological and clinical support, local testing facilities, and measures to ensure equitable access to testing. CONCLUSIONS While hopeful about the potential for therapeutic benefit from PGx testing, PWLE and P/HCPs see the need for robust evidence of utility, and BC-wide infrastructure and policies to ensure equitable and effective access to PGx testing. Further research into the accessibility, effectiveness, and cost-effectiveness of various implementation strategies is needed to inform PGx testing use in BC.
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Affiliation(s)
- Caitlin Slomp
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Emily Morris
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Louisa Edwards
- School of Population & Public Health, 8166University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Alison M Hoens
- Department of Physical Therapy, 8166University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | | | | | | | - Stirling Bryan
- School of Population & Public Health, 8166University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Jehannine Austin
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
- Department of Medical Genetics, 8166University of British Columbia, Vancouver, Canada
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Bunka M, Ghanbarian S, Riches L, Landry G, Edwards L, Hoens AM, Bryan S. Collaborating with Patient Partners to Model Clinical Care Pathways in Major Depressive Disorder: The Benefits of Mixing Evidence and Lived Experience. Pharmacoeconomics 2022; 40:971-977. [PMID: 35877043 PMCID: PMC9522760 DOI: 10.1007/s40273-022-01175-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Partnering with patients can enrich the design and development of models of clinical care pathways, yet the practice is not commonplace. Guidelines or "best practices" for patient involvement in modeling are scarce. OBJECTIVES In this paper, we outline the steps we took to form an effective partnership with patients to design a robust microsimulation Markov model of major depressive disorder care pathways in British Columbia, Canada, with the aim of encouraging other teams to partner with patients in healthcare modeling endeavors. METHODS We describe three unique phases of our collaborative process: uncertainty, mapping, and structured collaboration. We then explore the unique contributions the patient partners made, not only to the model itself, but to our process. Key perspectives are shared from both the modeler and the patient partners in their own words. RESULTS The patient partners made distinct contributions by challenging and verifying modeling assumptions, noting limitations of the model, and suggesting areas for future research. Both the patient partners and the modelers saw great value in the partnership and agreed that the model was strengthened by the diversity of the team. CONCLUSIONS We present our learning and key recommendations for future modeling teams in the absence of tested frameworks. We encourage more widespread adoption of patient involvement in modeling and the development of guidelines for such work to increase the democracy of scientific decision making.
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Affiliation(s)
- Mary Bunka
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 712 - 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Shahzad Ghanbarian
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 712 - 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | | | | | - Louisa Edwards
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 712 - 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada
| | - Stirling Bryan
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 712 - 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
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Shivaram A, Chavez Y, Anderson E, Fritz A, Jackson R, Edwards L, Powers S, Libertus M, Hespos S. Brief Interventions Influence the Quantity and Quality of Caregiver-Child Conversations in an Everyday Context. Front Psychol 2021; 12:645788. [PMID: 34220615 PMCID: PMC8242245 DOI: 10.3389/fpsyg.2021.645788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Reading and arithmetic are difficult cognitive feats for children to master and youth from low-income communities are often less “school ready” in terms of letter and number recognition skills (Lee and Burkam, 2002). One way to prepare children for school is by encouraging caregivers to engage children in conversations about academically-relevant concepts by using numbers, recognizing shapes, and naming colors (Levine et al., 2010; Fisher et al., 2013). Previous research shows that caregiver-child conversations about these topics rarely take place in everyday contexts (Hassinger-Das et al., 2018), but interventions designed to encourage such conversations, like displaying signs in a grocery store, have resulted in significant increases in caregiver-child conversations (Ridge et al., 2015; Hanner et al., 2019). We investigated whether a similar brief intervention could change caregiver-child conversations in an everyday context. We observed 212 families in a volunteer-run facility where people who are food-insecure can select food from available donations. Volunteers greet all the clients as they pass through the aisles, offer food, and restock the shelves as needed. About 25% of the clients have children with them and our data consist of observations of the caregiver-child conversations with 2- to 10-year-old children. Half of the observation days consisted of a baseline condition in which the quantity and quality of caregiver-child conversation was observed as the client went through aisles where no signs were displayed, and volunteers merely greeted the clients. The other half of the observation days consisted of a brief intervention where signs were displayed (signs-up condition), where, volunteers greeted the clients and pointed out that there were signs displayed to entertain the children if they were interested. In addition, there was a within-subject manipulation for the intervention condition where each family interacted with two different categories of signs. Half of the signs had academically-relevant content and the other half had non-academically-relevant content. The results demonstrate that the brief intervention used in the signs-up condition increases the quantity of conversation between a caregiver and child. In addition, signs with academically-relevant content increases the quality of the conversation. These findings provide further evidence that brief interventions in an everyday context can change the caregiver-child conversation. Specifically, signs with academically-relevant content may promote school readiness.
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Affiliation(s)
- Apoorva Shivaram
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Yaritza Chavez
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Erin Anderson
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Autumn Fritz
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Ryleigh Jackson
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Louisa Edwards
- Department of Applied Statistics, University of Virginia, Charlottesville, VA, United States
| | - Shelley Powers
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Melissa Libertus
- Department of Psychology, Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Susan Hespos
- Department of Psychology, Northwestern University, Evanston, IL, United States
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Banerjee I, Edwards L, Halvey P, Alioto S, Cluckley D, Mitchell C, Cox C, Lurier E, Cianci M, Bengeri S, Borthakur S, Kis-Toth K, Higginson-Scott N, Viney J, Otipoby KL. AB0034 PD-1 AGONISM INHIBITS ACTIVATION OF PLASMACYTOID DENDRITIC CELLS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2682] [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:T cell function is regulated by complex signaling networks of interconnected activators and inhibitors. Blockade of inhibitory receptors such as programmed death-1 (PD-1) has emerged as a novel treatment for multiple forms of cancer. One of the most common adverse events associated with blockade of the endogenous PD-1/PD-L1 pathway is the induction of autoimmune pathology in multiple tissues, demonstrating that PD-1 activation is necessary for normal immune homeostasis in humans (Kostine, et al., 2018). Given this body of clinical data, we sought to develop a PD-1 agonist antibody as a therapeutic approach to restore immune homeostasis in patients living with autoimmune diseases. PD-1 expression and function has been primarily described on T cells (Ishida, et al., 1992), with additional data available from several other immune cell populations (Ohaegbulam, et al., 2015).Objectives:To study the effect of PD-1 agonism on plasmacytoid dendritic cell (pDC) function.Methods:Human PBMCs stimulated with or without toll-like receptor (TLR)-9 agonist, CpG were analyzed by flow cytometry for PD-1 expression on immune cell subsets. To assess the impact of PD-1 agonist on pDC function human PBMCs were activated by CpG in the presence or absence of PD-1 agonist. Type-I interferon (IFN) levels were quantified using ELISA from culture supernatants. The expression of interferon stimulated genes was analyzed by qPCR as a measure of type-I IFN activation.Results:We have discovered that TLR9 activation can induce PD-1 expression on plasmacytoid dendritic cells, which has not been previously reported. Further, we have demonstrated that PD-1 agonism inhibits TLR9-mediated activation and the effector functions of plasmacytoid dendritic cells.Conclusion:These data suggest the potential of PD-1 as a target for regulating diseases with pathology generated by type-I IFN.References:[1]Ishida, Y., Agata, Y., Shihibahara, K., & Honjo, T. (1992). Induced expression of PD-1, a novel member of the immunoglobulin gene superfamily, upon programmed cell death. EMBO J., 11(11):3887-95.[2]Kostine, M., Rouxel, L., Barnetche, T., Veillon, R., Martin, F., Dutriaux, C., . . . Schaeverbeke, T. (2018). Rheumatic disorders associated with immune checkpoint inhibitors in patients with cancer-clinical aspects and relationship with tumour response: a single-centre prospective cohort study. Annual Rheumatic Disease, 77(3):393-398.[3]Ohaegbulam, K. C., Assal, A., Lazar-Molnar, E., Yao, Y., & Zang, X. (2015). Human cancer immunotherapy with antibodies to the PD-1 and PD-L1 pathway. Trends in Molecular Medicine, 21(1); 24-33.Disclosure of Interests:Ishita Banerjee Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Lindsay Edwards Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Patrick Halvey Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Salvatore Alioto Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, David Cluckley Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Caitlin Mitchell Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Christopher Cox Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Emily Lurier Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Michael Cianci Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Soumya Bengeri Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Susmita Borthakur Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Katalin Kis-Toth Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Nathan Higginson-Scott Shareholder of: Pandion Therapeutics, Consultant of: Biotech Companies, Employee of: Pandion Therapeutics, Jo Viney Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Kevin L. Otipoby Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics
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18
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Edwards L, Schlundt D, Bonnet K, Chren M. 346 Ensuring the content validity of a quality-of-life measure for patients with chronic itch. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Wheless L, Edwards L, Hanlon A, Chren M. 303 No difference in skin cancer rates by transplanted organ type after the initial skin cancer. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Miles LF, Chuen J, Edwards L, Hohmann JD, Williams R, Peyton P, Grayden DB. The design and manufacture of 3D-printed adjuncts for powered air-purifying respirators. Anaesth Rep 2020; 8:e12055. [PMID: 32705085 PMCID: PMC7369400 DOI: 10.1002/anr3.12055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/21/2022] Open
Abstract
Spurred in part by literature published in the immediate aftermath of the severe acute respiratory syndrome epidemic in 2003, powered air‐purifying respirators have seen increased use worldwide during the COVID‐19 pandemic. Whereas these devices provide excellent protection of the user, there is an added element of risk during doffing and cleaning of the device. An additional layer of barrier protection, in the form of a polypropylene gown, to be worn over the hood and motor belt, can be used to minimise this risk. However, the device entrains air perpendicular to the lie of the gown, resulting in the impermeable material being sucked into the air intake, and partial occlusion of flow. In this report, we describe a clinical‐academic partnership whereby a bespoke filter guard was designed to disrupt airflow and prevent gown entrainment, thereby enabling full barrier protection of both the device and user. This intervention was simple, cheap, scalable and able to be mass produced.
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Affiliation(s)
- L F Miles
- Department of Anaesthesia Austin Health Melbourne Vic Australia
| | - J Chuen
- 3DMedLab Austin Health Melbourne Vic Australia
| | - L Edwards
- MSD Robotics Lab Melbourne School of Design Melbourne Vic Australia
| | - J D Hohmann
- Technician NExT Lab Melbourne School of Design Melbourne Vic Australia
| | - R Williams
- Melbourne Brain Centre Imaging Unit Melbourne Vic Australia
| | - P Peyton
- Department of Anaesthesia Austin Health Melbourne Vic Australia
| | - D B Grayden
- Department of Biomedical Engineering The University of Melbourne Vic Australia
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21
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Nur A, Boerner S, Edwards L, Ryan K, James P. A275 REVISITING THE DIAGNOSTIC YIELD OF ERCP BRUSH CYTOLOGY FOR INDETERMINATE BILIARY STRICTURES. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.274] [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
Endoscopic Retrograde Cholangiopancreatography (ERCP) brush cytology is the most frequently used tool for sampling indeterminate biliary strictures. Previous studies have demonstrated that the diagnostic yield of brush cytology for malignant biliary strictures is 60%. With improved diagnostic tools, sampling techniques and specimen processing, the yield of ERCP brush cytology may be higher.
Aims
To assess the diagnostic yield of ERCP brush cytology in patients with indeterminate biliary strictures and to determine factors associated with positive diagnosis.
Methods
This is a retrospective study of all patients who underwent ERCP with brush cytology at University Health Network (UHN) from October 2016 to September 2019. The cytological samples were taken as follows: the cytology brush is introduced into the stricture ten times under direct fluoroscopy guidance. The brush was cut and placed into a methanol based buffered solution (CytoLyt®). Residual sample was then flushed out of the catheter with the solution and into the sample container. Patient demographic, clinical, procedural and pathological data was collected by chart review. All patients were followed for a minimum of three months after their index ERCP. Post-ERCP sampling via repeat ERCP brushings, endoscopic ultrasound fine needle biopsy, percutaneous biopsy or surgical resection was recorded.
Results
A total of 97 patients underwent ERCP with brush cytology during the study period (43 females, median age 69 years). Fifty-nine patients (84%) were diagnosed with malignancy via ERCP brush cytology. Using follow up sampling, surgical resection and clinical follow up as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 84%, 100%, 100%, and 71% respectively. Patient demographics, degree of cholestasis or stricture location had no significant impact on these outcomes.
Conclusions
This study shows a high diagnostic yield for ERCP with brush cytology for patients with indeterminate biliary strictures. Large prospective studies using updated tools, techniques and specimen handling processes are needed to confirm our observations.
Funding Agencies
None
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Affiliation(s)
- A Nur
- University Health Network, Toronto, ON, Canada
| | - S Boerner
- University Health Network, Toronto, ON, Canada
| | - L Edwards
- University Health Network, Toronto, ON, Canada
| | - K Ryan
- University Health Network, Toronto, ON, Canada
| | - P James
- University Health Network, Toronto, ON, Canada
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Knight T, Edwards L, Rajasekaran A, Clare S, Lasserson D. Point-of-care lung ultrasound in the assessment of suspected COVID-19: a retrospective service evaluation with a severity score. Acute Med 2020; 19:192-200. [PMID: 33215172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Point-of-care lung ultrasound (POCUS) has been advocated as a tool to assess the severity of COVID19 and thereby aid risk stratification. METHODS We conducted a retrospective service evaluation between the 3rd March and the 5th May 2020 to describe and characterise the use of POCUS within an acute care pathway designed specifically for the assessment of suspected or confirmed COVID-19. A novel POCUS severity scale was formulated by assessing pleural and interstitial abnormalities within six anatomical zones (three for each lung). An aggregated score was calculated for each patient and evaluated as a marker of disease severity using standard metrics of discriminatory performance. RESULTS POCUS was performed in the assessment of 100 patients presenting with suspected COVID-19. POCUS was consistent with COVID-19 infection in 92% (n = 92) of the patients assessed. Severity, as assessed by POCUS, showed good discriminatory performance to predict all-cause inpatient mortality, death or critical care admission, and escalated oxygen requirements (AUC .80, .80, 82). The risk of all-cause mortality in patients with scores in lowest quartile was 2.5% (95%CI 0.12- 12.95) compared with 42.9% (95CI 15.8 - 75.0%) in the highest quartile. POCUS assessed severity correlated with length of stay and duration of supplemental oxygen therapy. CONCLUSION A simple aggregated score formed by the summating the degree of pleural and interstitial change within six anatomical lung zones showed good discriminatory performance in predicting a range of adverse outcomes in patients with suspected COVID-19.
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Affiliation(s)
- T Knight
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
| | - L Edwards
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
| | - A Rajasekaran
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
| | - S Clare
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
| | - D Lasserson
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
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Ridd MJ, Wells S, Edwards L, Santer M, MacNeill S, Sanderson E, Sutton E, Shaw ARG, Banks J, Garfield K, Roberts A, Barrett TJ, Baxter H, Taylor J, Lane JA, Hay AD, Williams HC, Thomas KS. Best emollients for eczema (BEE) - comparing four types of emollients in children with eczema: protocol for randomised trial and nested qualitative study. BMJ Open 2019; 9:e033387. [PMID: 31699751 PMCID: PMC6858146 DOI: 10.1136/bmjopen-2019-033387] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Atopic dermatitis/eczema affects around 20% of children and is characterised by inflamed, dry, itchy skin. Guidelines recommend 'leave-on' emollients that are applied directly to the skin to add or trap moisture and used regularly, they can soothe, enhance the skin barrier and may prevent disease 'flares'. However, the suitability of the many different emollients varies between people and there is little evidence to help prescribers and parents and carers decide which type to try first. METHODS AND ANALYSIS Design: pragmatic, multicentre, individually randomised, parallel group superiority trial of four types of emollient (lotions, creams, gel or ointments). SETTING general practitioner surgeries in England. PARTICIPANTS children aged over 6 months and less than 12 years with mild-to-severe eczema and no known sensitivity to study emollients. INTERVENTIONS study-approved lotion, cream, gel or ointment as the only leave-on emollient for 16 weeks, with directions to apply twice daily and as required. Other treatments, such as topical corticosteroids, used as standard care. FOLLOW-UP 52 weeks. PRIMARY OUTCOME validated patient-orientated eczema measure measured weekly for 16 weeks. SECONDARY OUTCOMES eczema signs (Eczema Area Severity Index) by masked researcher, treatment use, parent satisfaction, adverse events, child and family quality of life (Atopic Dermatitis Quality of Life, Child Health Utility 9D and Dermatitis Family Impact). SAMPLE SIZE 520 participants (130 per group). ANALYSIS intention-to-treat using linear mixed models for repeated measures.Nested qualitative study: audio-recording of sample of baseline appointments and up to 60 interviews with participants at 4 and 16 weeks, interviews to be transcribed and analysed thematically. ETHICS AND DISSEMINATION Ethics approval granted by the NHS REC (South West - Central Bristol Research Ethics Committee 17/SW/0089). Findings will be presented at conferences, published in open-access peer-reviewed journals and the study website; and summaries shared with key stakeholders. TRIAL REGISTRATION NUMBER ISRCTN84540529.
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Affiliation(s)
- Matthew J Ridd
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Wells
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louisa Edwards
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Stephanie MacNeill
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Emily Sanderson
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Eileen Sutton
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison R G Shaw
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan Banks
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kirsty Garfield
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Tiffany J Barrett
- South West Medicines Information & Training, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Helen Baxter
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jodi Taylor
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - J Athene Lane
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hywel C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
| | - Kim Suzanne Thomas
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
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Edwards L, Monro M, Butterfield Y, Johl R, Loftsgard KC, Pelletier H, McGavin C, Lavergne MR. What matters most to patients about primary healthcare: mixed-methods patient priority setting exercises within the PREFeR (PRioritiEs For Research) project. BMJ Open 2019; 9:e025954. [PMID: 31292175 PMCID: PMC6624027 DOI: 10.1136/bmjopen-2018-025954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/09/2018] [Revised: 04/05/2019] [Accepted: 06/03/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify patient-generated priority topics for future primary care research in British Columbia (BC), Canada within a diverse patient population. DESIGN Mixed-methods priority setting exercises framed by the dialogue model, using the nominal group technique (rank-ordered scoring) and province-wide online surveys capturing importance ratings of the top 10 primary healthcare topics from patients and primary care providers. SETTING BC, Canada. PARTICIPANTS Topic identification was completed by 10 patient partners (7 female, 3 male) from the BC Primary Health Care Research Network Patient Advisory; online surveys were completed by 464 patients and 173 primary care providers. RESULTS The 10 members recruited to the patient advisory provided over 80 experiences of what stood out for them in BC primary care, which were grouped thematically into 18 topics, 10 of which were retained in province-wide surveys. Top-rated survey topics for both patients (n=464) and providers (n=173) included being unable to find a regular family doctor/other primary healthcare provider, support for living with chronic conditions, mental health resources and information sharing, including electronic medical records. However, all 10 topics were rated important, on average, by both groups. CONCLUSIONS The current project activities demonstrate the feasibility of including patients in priority setting exercises for primary healthcare in general, rather than focusing on a condition-specific population or disease area. There was considerable overlap between patient-generated topics and topics previously identified by other stakeholders, but patients identified two additional topics (mental health resources, improve and strengthen patient-provider communication). More similarities than differences in topic importance between patients and providers emerged in the online surveys. The project activities that follow (rapid literature reviews, multistakeholder dialogue) will highlight under-researched topics and inform the development of specific research questions.
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Affiliation(s)
- Louisa Edwards
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Melody Monro
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Yaron Butterfield
- BC Primary Health Care Research Network Patient Advisory, Vancouver, British Columbia, Canada
| | - Ravin Johl
- BC Primary Health Care Research Network Patient Advisory, Vancouver, British Columbia, Canada
| | - Kent Cadogan Loftsgard
- BC Primary Health Care Research Network Patient Advisory, Vancouver, British Columbia, Canada
| | - Hayley Pelletier
- BC Primary Health Care Research Network Patient Advisory, Vancouver, British Columbia, Canada
| | | | - M Ruth Lavergne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Ridd MJ, Edwards L, Santer M, Chalmers JR, Waddell L, Marriage D, Muller I, Roberts K, Garfield K, Coast J, Selman L, Clement C, Shaw ARG, Angier E, Blair PS, Turner NL, Taylor J, Kai J, Boyle RJ. TEST (Trial of Eczema allergy Screening Tests): protocol for feasibility randomised controlled trial of allergy tests in children with eczema, including economic scoping and nested qualitative study. BMJ Open 2019; 9:e028428. [PMID: 31076476 PMCID: PMC6527983 DOI: 10.1136/bmjopen-2018-028428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Early onset eczema is associated with food allergy, and allergic reactions to foods can cause acute exacerbations of eczema. Parents often pursue dietary restrictions as a way of managing eczema and seek allergy testing for their children to guide dietary management. However, it is unclear whether test-guided dietary management improves eczema symptoms, and whether the practice causes harm through reduced use of conventional eczema treatment or unnecessary dietary restrictions. The aim of the Trial of Eczema allergy Screening Tests Study is to determine the feasibility of conducting a trial comparing food allergy testing and dietary advice versus usual care, for the management of eczema in children. METHODS AND ANALYSIS Design: A single centre, two-group, individually randomised, feasibility randomised controlled trial (RCT) with economic scoping and a nested qualitative study. SETTING General Practioner (GP) surgeries in the west of England. PARTICIPANTS children aged over 3 months and less than 5 years with mild to severe eczema. INTERVENTIONS allergy testing (structured allergy history and skin prick tests) or usual care. Sample size and outcome measures: we aim to recruit 80 participants and follow them up using 4-weekly questionnaires for 24 weeks. Nested qualitative study: We will conduct ~20 interviews with parents of participating children, 5-8 interviews with parents who decline or withdraw from the trial and ~10 interviews with participating GPs. Economic scoping: We will gather data on key costs and outcomes to assess the feasibility of carrying out a cost-effectiveness analysis in a future definitive trial. ETHICS AND DISSEMINATION The study has been reviewed by the Health Research Authority and given a favourable opinion by the NHS REC (West Midlands - South Birmingham Research Ethics Committee, Reference Number 18/WM/0124). Findings will be submitted for presentation at conferences and written up for publication in peer-reviewed journals, which may include mixed-method triangulation and integration of the quantitative and qualitative findings. TRIAL REGISTRATION ISRCTN15397185; Pre-results.
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Affiliation(s)
| | - Louisa Edwards
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Joanne R Chalmers
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | | | - Ingrid Muller
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Kirsty Garfield
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Joanna Coast
- Health Economics at Bristol, University of Bristol, Bristol, UK
| | - Lucy Selman
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | | | - Elizabeth Angier
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Peter S Blair
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | - Jodi Taylor
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Joe Kai
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Wheless L, Wang L, Edwards L, Anand N, Birdwell K, Hanlon A, Chren M. 280 Validation of algorithms to identify transplant recipients from the electronic health record. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.356] [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: 10/27/2022]
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27
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Edwards L, Phillips S. Improving the patient experience by modifying computed tomography (CT) colon pre-procedure information within an advanced practice radiography role. Clin Radiol 2018. [DOI: 10.1016/j.crad.2018.07.183] [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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28
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Stanton TR, Gilpin HR, Edwards L, Moseley GL, Newport R. Illusory resizing of the painful knee is analgesic in symptomatic knee osteoarthritis. PeerJ 2018; 6:e5206. [PMID: 30038863 PMCID: PMC6054060 DOI: 10.7717/peerj.5206] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/20/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Experimental and clinical evidence support a link between body representations and pain. This proof-of-concept study in people with painful knee osteoarthritis (OA) aimed to determine if: (i) visuotactile illusions that manipulate perceived knee size are analgesic; (ii) cumulative analgesic effects occur with sustained or repeated illusions. METHODS Participants with knee OA underwent eight conditions (order randomised): stretch and shrink visuotactile (congruent) illusions and corresponding visual, tactile and incongruent control conditions. Knee pain intensity (0-100 numerical rating scale; 0 = no pain at all and 100 = worst pain imaginable) was assessed pre- and post-condition. Condition (visuotactile illusion vs control) × Time (pre-/post-condition) repeated measure ANOVAs evaluated the effect on pain. In each participant, the most beneficial illusion was sustained for 3 min and was repeated 10 times (each during two sessions); paired t-tests compared pain at time 0 and 180s (sustained) and between illusion 1 and illusion 10 (repeated). RESULTS Visuotactile illusions decreased pain by an average of 7.8 points (95% CI [2.0-13.5]) which corresponds to a 25% reduction in pain, but the tactile only and visual only control conditions did not (Condition × Time interaction: p = 0.028). Visuotactile illusions did not differ from incongruent control conditions where the same visual manipulation occurred, but did differ when only the same tactile input was applied. Sustained illusions prolonged analgesia, but did not increase it. Repeated illusions increased the analgesic effect with an average pain decrease of 20 points (95% CI [6.9-33.1])-corresponding to a 40% pain reduction. DISCUSSION Visuotactile illusions are analgesic in people with knee OA. Our results suggest that visual input plays a critical role in pain relief, but that analgesia requires multisensory input. That visual and tactile input is needed for analgesia, supports multisensory modulation processes as a possible explanatory mechanism. Further research exploring the neural underpinnings of these visuotactile illusions is needed. For potential clinical applications, future research using a greater dosage in larger samples is warranted.
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Affiliation(s)
- Tasha R. Stanton
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Helen R. Gilpin
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Louisa Edwards
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - G. Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Roger Newport
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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29
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Edwards L, Farrington R. 2.11-P7Exploring the healthcare concerns of pregnant women and new mothers seeking asylum in the United Kingdom. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.079] [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: 11/15/2022] Open
Affiliation(s)
- L Edwards
- The University of Manchester, United Kingdom
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30
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Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, Donovan JL. Cat-PROM5: a brief psychometrically robust self-report questionnaire instrument for cataract surgery. Eye (Lond) 2018. [PMID: 29521952 PMCID: PMC5898878 DOI: 10.1038/eye.2018.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose To develop a short, psychometrically robust and responsive cataract patient reported outcome measure suitable for use in high-volume surgical environments. Methods A prospective study in which participants completed development versions of questionnaires exploring the quality of their eyesight using items harvested from two existing United Kingdom developed parent questionnaires. Participants were 822 patients awaiting cataract surgery recruited from 4 cataract surgical centres based in the UK. Exclusion criteria were other visually significant comorbidities and age <50 years. An iterative multi-stage process of evaluation using Rasch and factor analyses with sequential item reduction was undertaken. Results A definitive item set of just five items delivered performance in accordance with the requirements of the Rasch model: no threshold disordering, no misfitting items, Rasch-based reliability 0.90, person separation 2.98, Cronbach’s α 0.89, good targeting of questions to patients with cataract with pre-operative item mean −0.41 logits and absence of significant floor or ceiling effects, minor deviations of item invariance, and confirmed unidimensionality. The test–re-test repeatability intra-class correlation coefficient was 0.89 with excellent responsiveness to surgery, Cohen’s d −1.45 SD. Rasch calibration values are provided for Cat-PROM5 users. Conclusions A psychometrically robust and highly responsive five-item cataract surgery patient reported outcome measure has been developed, which is suitable for use in high-volume cataract surgical services.
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Affiliation(s)
- J M Sparrow
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M T Grzeda
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - N A Frost
- Torbay Hospital, Lawes Bridge, Torquay, UK
| | - R L Johnston
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - C S C Liu
- Sussex Eye Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - L Edwards
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK
| | - A Loose
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK
| | - J L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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31
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Jones PA, Pittam MR, Moxon RA, Edwards L. Double-ended Pigtail Polyethylene Stents in Management of Benign and Malignant Ureteric Obstruction. J R Soc Med 2018; 76:458-62. [PMID: 6864718 PMCID: PMC1439223 DOI: 10.1177/014107688307600605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surgical urinary diversion for incurable pelvic malignancy has a high morbidity and mortality, and external drainage provides less than ideal palliation. Six patients with ureteric obstruction caused by cancer have been managed by operative or endoscopic insertion of self-retaining polyethylene tubes. These techniques also have applications in non-malignant disease, and the treatment of two patients with benign ureteric stricture is described.
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32
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Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, Elliott D, Donovan JL. Cataract surgery patient-reported outcome measures: a head-to-head comparison of the psychometric performance and patient acceptability of the Cat-PROM5 and Catquest-9SF self-report questionnaires. Eye (Lond) 2018; 32:788-795. [PMID: 29386619 PMCID: PMC5898871 DOI: 10.1038/eye.2017.297] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background Cataract surgery is the most frequently undertaken NHS surgical procedure. Visual acuity (VA) provides a poor indication of visual difficulty in a complex visual world. In the absence of a suitable outcome metric, recent efforts have been directed towards the development of a cataract patient-reported outcome measure (PROM) of sufficient brevity, precision, and responsiveness to be implementable in routine high volume clinical services. Aim To compare and contrast the two most promising candidate PROMs for routine cataract surgery. Method The psychometric performance and patient acceptability of the recently UK developed five-item Cat-PROM5 questionnaire was compared with the English translation of the Swedish nine-item Catquest-9SF using Rasch-based performance metrics and qualitative semistructured interviews. Results Rasch-based performance was assessed in 822 typical NHS cataract surgery patients across four centres in England. Both questionnaires demonstrated good to excellent performance for all metrics assessed, including Person Reliability Indices of 0.90 (Cat-PROM5) and 0.88 (Catquest-9SF), responsiveness to surgery (Cohen’s standardized effect size) of 1.45 SD (Cat-PROM5) and 1.47 SD (Catquest-9SF) and they were highly correlated with each other (R=0.85). Qualitative assessments confirmed that both questionnaires were acceptable to patients, including in the presence of ocular comorbidities. Preferences were expressed for the shorter Cat-PROM5, which allowed patients to map their own issues to the questions as opposed to the more restrictive specific scenarios of Catquest-9SF. Conclusion The recently UK developed Cat-PROM5 cataract surgery questionnaire is shorter, with performance and patient acceptability at least as good or better than the previous ‘best of class’ Catquest-9SF instrument.
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Affiliation(s)
- J M Sparrow
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M T Grzeda
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - N A Frost
- Torbay Hospital, Lawes Bridge, Torquay, UK
| | - R L Johnston
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - C S C Liu
- Sussex Eye Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - L Edwards
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Trust, Bristol, UK
| | - A Loose
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - D Elliott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Trust, Bristol, UK
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Bernhardt A, Hakmi S, Levin A, Stehlik J, Edwards L, Wagner F, Benden C, Reichenspurner H. “Old-for-Old” in Lung Transplantation? Insights from the ISHLT Database. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627952] [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: 10/28/2022]
Affiliation(s)
- A. Bernhardt
- Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Hakmi
- Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Levin
- Columbia University, New York City, United States
| | - J. Stehlik
- University of Utah, Salt Lake City, United States
| | - L. Edwards
- United Networks of Organ Sharing, Richmond, United States
| | - F. Wagner
- Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Benden
- Universitätsspital Zürich, Zürich, Switzerland
| | - H. Reichenspurner
- Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
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Vallis M, Lee-Baggley D, Sampalli T, Ryer A, Ryan-Carson S, Kumanan K, Edwards L. Equipping providers with principles, knowledge and skills to successfully integrate behaviour change counselling into practice: a primary healthcare framework. Public Health 2017; 154:70-78. [PMID: 29216495 DOI: 10.1016/j.puhe.2017.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/06/2017] [Accepted: 10/25/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There is an urgent need for healthcare providers and healthcare systems to support productive interactions with patients that promote sustained health behaviour change in order to improve patient and population health outcomes. Behaviour change theories and interventions have been developed and evaluated in experimental contexts; however, most healthcare providers have little training, and therefore low confidence in, behaviour change counselling. Particularly important is how to integrate theory and method to support healthcare providers to engage in behaviour change counselling competently. In this article, we describe a general training model developed from theory, evidence, experience and stakeholder engagement. This model will set the stage for future evaluation research on training needed to achieve competency, sustainability of competency, as well as effectiveness/cost-effectiveness of training in supporting behaviour change. DESIGN AND METHODS A framework to support competency based training in behaviour change counselling is described in this article. This framework is designed to be integrative, sustainable, scalable and capable of being evaluated in follow-up studies. RESULTS AND DISCUSSION Effective training in behaviour change counselling is critical to meet the current and future healthcare needs of patients living with, or at risk of, chronic diseases. Increasing competency in establishing change-based relationships, assessing and promoting readiness to change, implementing behaviour modification and addressing psychosocial issues will be value added to the healthcare system.
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Affiliation(s)
- M Vallis
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada.
| | - D Lee-Baggley
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - T Sampalli
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - A Ryer
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - S Ryan-Carson
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - K Kumanan
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - L Edwards
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
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Asfari A, Ahmed M, Edwards L, Irby K, Agarwal A, Pasala S, Prodhan P, Frazier B, Sanders R. Survival from Septic Shock Secondary to Disseminated Group A Streptococcal Infection after Central Extracorporeal Membrane Oxygenation. JCS 2017. [DOI: 10.1055/s-0037-1607312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective The objective of this study was to describe a case of severe life-threatening acute respiratory distress syndrome (ARDS) and septic shock in a child who responded to a prolonged extracorporeal membrane oxygenation (ECMO) support course utilizing different cannulation techniques depending on the physiological derangement until he recovered.
Design This is a case report.
Setting This study was done at the medical–surgical pediatric intensive care unit in an academic freestanding children's hospital.
Patient A previously healthy 4-year-old boy was presented with respiratory distress and fever. He was diagnosed with respiratory syncytial viral upper respiratory tract infection and group A β-hemolytic Streptococcus septic shock.
Interventions The patient was referred to peripheral ECMO for hemodynamic, ventilatory, and oxygenation support; conversion to central ECMO to augment blood flow; and transition to extracorporeal carbon dioxide removal before successful wean off extracorporeal support.
Measurements and Main Results Patient experienced severe pediatric ARDS and septic shock that were refractory to maximal medical therapy. Patient was able to be decannulated after 75 days of extracorporeal support. He was weaned completely off of mechanical ventilation and oxygen after 6 months. The only neurological deficit he exhibited was poor fine motor skills of his hands for which he continued to receive physical therapy.
Conclusion Central ECMO may benefit children with pediatric ARDS and septic shock who require higher flows than what can be provided from peripheral ECMO. Extracorporeal membrane carbon dioxide removal may be an effective option in children who do not respond to mechanical ventilation alone.
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Affiliation(s)
- A. Asfari
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - M. Ahmed
- Section of Critical Care, Department of Pediatrics, Texas Children's Hospital, Houston, Texas, United States
| | - L. Edwards
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - K. Irby
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - A. Agarwal
- Section of Pulmonology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - S. Pasala
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - P. Prodhan
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Section of Cardiology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - B. Frazier
- Department of Extracorporeal Membrane Oxygenation, Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - R. Sanders
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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Edwards L, Meyers B, Heydinger E, Navarre H, Josiah K, Belton A, Riojas L, Knackstedt A, Brewer L. A Quick and Effective Approach to Nutrition Education and Health Literacy in Primary Care. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jimenez-Liñan LM, Edwards L, Abhishek A, Doherty M. Adequacy of Online Patient Information Resources on Gout and Potentially Curative Urate-Lowering Treatment. Arthritis Care Res (Hoboken) 2017; 69:748-752. [PMID: 27390083 DOI: 10.1002/acr.22981] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/03/2016] [Accepted: 06/28/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the content and readability of online patient information resources against the current understanding of gout. METHODS An online survey was undertaken using Google UK, USA, Australia, and Canada. Information was assessed for content and accuracy on 19 key points regarding core content for gout patient information resources. Readability was assessed using the Flesch-Kincaid Reading Ease score. Fifteen randomly selected websites were reviewed by a blinded second observer. RESULTS A total of 85 websites were selected. More than 50% of the websites provided no information or had inaccuracies regarding the pathogenesis of gout. Most websites contained information on dietary and lifestyle modifications for treating gout and did not emphasize urate-lowering therapy (ULT) and its potential for cure. Over 75% of the websites had no/inaccurate information on the role of ULT or prophylaxis for preventing gout attacks on starting ULT. The majority of websites were difficult to read, with information in 68% of the websites rated at least fairly difficult. CONCLUSION Only a few web-based patient information resources provide accurate and easy-to-read information on gout. This study will help physicians direct patients to currently reliable resources, but there is a need to improve many web-based patient information resources, which at present act as barriers to care.
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Affiliation(s)
- L M Jimenez-Liñan
- University of Nottingham and Nottingham City Hospital, Nottingham, UK
| | - L Edwards
- University of Nottingham and Nottingham City Hospital, Nottingham, and Royal Derby Hospital, Derby, UK
| | - A Abhishek
- University of Nottingham and Nottingham City Hospital, Nottingham, UK
| | - Michael Doherty
- University of Nottingham and Nottingham City Hospital, Nottingham, UK
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Gleeson M, Peckitt C, To Y, Edwards L, Chau I, Johnson P, Ardeshna K, Wotherspoon A, Attygalle A, Begum R, Chua S, Zerizer I, Hawkes E, Macheta M, Collins G, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Cunningham D. CHOP VERSUS GEM-P IN THE FIRST-LINE TREATMENT OF T-CELL LYMPHOMA (PTCL): INITIAL RESULTS OF THE UK NRCI PHASE II RANDOMISED CHEMO-T TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- M. Gleeson
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - C. Peckitt
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - Y.M. To
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - L. Edwards
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Chau
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - K.M. Ardeshna
- Department of Haematology; University College Hospital; London UK
| | - A. Wotherspoon
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - A. Attygalle
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - R. Begum
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - S. Chua
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - I. Zerizer
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - E.A. Hawkes
- Department of Oncology Research; Eastern Health; Melbourne Australia
| | - M.P. Macheta
- Department of Haematology; Blackpool Victoria Hospital; Blackpool UK
| | - G.P. Collins
- Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - J.A. Radford
- Manchester Academic Health Science Centre; University of Manchester and the Christie NHS Foundation Trust; Manchester UK
| | - A. Forbes
- Department of Haematology; Royal Cornwall Hospital; Truro UK
| | - A. Hart
- Department of Haematology; New Victoria Hospital; Glasgow UK
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. McKay
- Department of Haematology; The Beatson West of Scotland Cancer Centre; Glasgow UK
| | - K. Benstead
- Department of Oncology; Gloucestershire Hospitals NHS Foundation Trust; Gloucester UK
| | - N. Morley
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - N. Kalakonda
- Department of Haematology; Royal Liverpool University Hospital; Liverpool UK
| | - Y. Hasan
- Department of Haematology; Sandwell and West Birmingham Hospitals NHS Trust; West Bromwich UK
| | - D. Turner
- Department of Haematology; Torbay Hospital; Torquay UK
| | - D. Cunningham
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
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Gleeson M, Peckitt C, Cunningham D, To Y, Edwards L, Chau I, Johnson P, Ardeshna K, Wotherspoon A, Attygalle A, Begum R, Zerizer I, Hawkes E, Macheta M, Collins G, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Chua S. THE ROLE OF 18F FDG-PET/CT IN PERIPHERAL T-CELL LYMPHOMA (PTCL): INITIAL RESULTS OF THE UK NCRI MULTICENTRE PHASE II RANDOMISED CHEMO-T TRIAL PET/CT SUBSTUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_108] [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: 11/06/2022]
Affiliation(s)
- M. Gleeson
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - C. Peckitt
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - D. Cunningham
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - Y.M. To
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - L. Edwards
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Chau
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - K.M. Ardeshna
- Department of Haematology; University College Hospital; London UK
| | - A. Wotherspoon
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - A. Attygalle
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - R. Begum
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Zerizer
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - E.A. Hawkes
- Department of Oncology; Eastern Health; Melbourne Australia
| | - M.P. Macheta
- Department of Haematology; Blackpool Teaching Hospitals; Blackpool UK
| | - G.P. Collins
- Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - J.A. Radford
- Manchester Academic Health Science Centre; University of Manchester and the Christie NHS Foundation Trust; Manchester UK
| | - A. Forbes
- Department of Haematology; Royal Cornwall Hospital; Truro UK
| | - A. Hart
- Department of Haematology; New Victoria Hospital; Glasgow UK
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. McKay
- Department of Haematology; Beatson West of Scotland Cancer Centre; Glasgow UK
| | - K. Benstead
- Department of Oncology, Gloucestershire Hospitals NHS Foundation Trust; Gloucester UK
| | - N. Morley
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - N. Kalakonda
- Department of Haematology; Royal Liverpool University Hospital; Liverpool UK
| | - Y. Hasan
- Department of Haematology, Sandwell and West Birmingham Hospitals NHS Trust; West Bromwich UK
| | - D. Turner
- Department of Haematology; Torbay Hospital; Torquay UK
| | - S. Chua
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
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Kuhnl A, Shaikh R, Cunningham D, Counsell N, Barrans S, Burton C, Bentley M, Gleeson M, Edwards L, Ulrich L, Smith P, Clifton-Hadley L, Schofield O, Lawrie A, Linch D, Hubank M, Kaiser M. DNMT3A-2
EXPRESSION LEVELS CHARACTERISE DIFFUSE LARGE B-CELL LYMPHOMA WITH DISTINCT METHYLATION PATTERNS AND OUTCOME. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_7] [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: 11/07/2022]
Affiliation(s)
- A. Kuhnl
- Department of Medicine; Royal Marsden Hospital; London UK
| | - R. Shaikh
- Centre for Molecular Pathology; Royal Marsden Hospital; London UK
| | - D. Cunningham
- Department of Medicine; Royal Marsden Hospital; London UK
| | - N. Counsell
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - S. Barrans
- HMDS St James's Institute of Oncology; St James's University Hospital; Leeds UK
| | - C. Burton
- HMDS St James's Institute of Oncology; St James's University Hospital; Leeds UK
| | - M. Bentley
- HMDS St James's Institute of Oncology; St James's University Hospital; Leeds UK
| | - M. Gleeson
- Department of Medicine; Royal Marsden Hospital; London UK
| | - L. Edwards
- Department of Medicine; Royal Marsden Hospital; London UK
| | - L. Ulrich
- Department of Medicine; Royal Marsden Hospital; London UK
| | - P. Smith
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - L. Clifton-Hadley
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - O. Schofield
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - A. Lawrie
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - D. Linch
- Department of Hematology; University College London; London UK
| | - M. Hubank
- Centre for Molecular Pathology; Royal Marsden Hospital; London UK
| | - M. Kaiser
- Division of Molecular Pathology; The Institute of Cancer Research; Sutton UK
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Lewis S, Edwards L, Glasbey J, Johansen A. 9MEASURING HEALTH-RELATED QUALITY OF LIFE IN HIP FRACTURE - A PILOT STUDY. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bernhardt A, Levin A, Stehlik J, Benden C, Edwards L, Wagner F, Reichenspurner H. Is There a Rationale for an “Old-for-Old” Program in Lung Transplantation? A Comparative Study Using the International Society of Heart and Lung Transplantation Database. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Loor G, Camp P, D'Ovidio F, Edwards L, Erasmus M, Glanville A, Hertz M, Hopkins P, Keshavjee S, Levvey B, McCurry K, Musk M, Patterson G, Snell G, Stehlik J, Urban R, Van Raemdonck D. Comparison of Long-Term Survival Outcomes in Recipients of Lungs from Donation After Circulatory Death (DCD) and Donation After Brain Death (DBD). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Bernhardt A, Levin A, Stehlik J, Benden C, Edwards L, Wagner F, Reichenspurner H. The Impact of Donor Age on Post–Lung Transplant Survival: How Far Can We Go? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598767] [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: 10/20/2022]
Affiliation(s)
- A. Bernhardt
- Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
| | - A.P. Levin
- Columbia University Medical Center, New York City, United States
| | - J. Stehlik
- University of Utah, Salt Lake City, United States
| | - C. Benden
- UniversitätsSpital Zürich, Zürich, Switzerland
| | - L. Edwards
- United Network for Organ Sharing, Richmond, United States
| | - F.M. Wagner
- Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
| | - H. Reichenspurner
- Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
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Stone J, Waern S, Khabra K, Wharram B, Middleton A, Edwards L, Kuhlthau K, Crouch C, Marshall L, Zacharoulis S, Vaidya S, Powell K, Saran F, Yock T, Mandeville H. Impact of toxicities and neurocognitive impairment on the health related quality of life (HR-QoL) for survivors of medulloblastoma. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30631-7] [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: 11/26/2022]
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Salisbury C, O’Cathain A, Thomas C, Edwards L, Montgomery AA, Hollinghurst S, Large S, Nicholl J, Pope C, Rogers A, Lewis G, Fahey T, Yardley L, Brownsell S, Dixon P, Drabble S, Esmonde L, Foster A, Garner K, Gaunt D, Horspool K, Man MS, Rowsell A, Segar J. An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk. Programme Grants Appl Res 2017. [DOI: 10.3310/pgfar05010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Clare Thomas
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Louisa Edwards
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Simon Brownsell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Padraig Dixon
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Drabble
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Lisa Esmonde
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alexis Foster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Garner
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kim Horspool
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mei-See Man
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Rowsell
- Centre for Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | - Julia Segar
- Centre for Primary Care, University of Manchester, Manchester, UK
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Martin HJ, Turner MA, Bandelow S, Edwards L, Riazanskaia S, Thomas CLP. Volatile organic compound markers of psychological stress in skin: a pilot study. J Breath Res 2016; 10:046012. [DOI: 10.1088/1752-7155/10/4/046012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Herring K, Ganesan R, Rao A, Edwards L, Pascoe J, Williams S. Ovarian granulosa cell tumours: hormone receptor positivity and response to aromatase inhibitors. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dixon P, Hollinghurst S, Ara R, Edwards L, Foster A, Salisbury C. Cost-effectiveness modelling of telehealth for patients with raised cardiovascular disease risk: evidence from a cohort simulation conducted alongside the Healthlines randomised controlled trial. BMJ Open 2016; 6:e012355. [PMID: 27670521 PMCID: PMC5051382 DOI: 10.1136/bmjopen-2016-012355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To investigate the long-term cost-effectiveness (measured as the ratio of incremental NHS cost to incremental quality-adjusted life years) of a telehealth intervention for patients with raised cardiovascular disease (CVD) risk. DESIGN A cohort simulation model developed as part of the economic evaluation conducted alongside the Healthlines randomised controlled trial. SETTING Patients recruited through primary care, and intervention delivered via telehealth service. PARTICIPANTS Participants with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, and with at least 1 modifiable risk factor, individually randomised from 42 general practices in England. INTERVENTION A telehealth service delivered over a 12-month period. The intervention involved a series of responsive, theory-led encounters between patients and trained health information advisors who provided access to information resources and supported medication adherence and coordination of care. PRIMARY AND SECONDARY OUTCOME MEASURES Cost-effectiveness measured by net monetary benefit over the simulated lifetime of trial participants from a UK National Health Service perspective. RESULTS The probability that the intervention was cost-effective depended on the duration of the effect of the intervention. The intervention was cost-effective with high probability if effects persisted over the lifetime of intervention recipients. The probability of cost-effectiveness was lower for shorter durations of effect. CONCLUSIONS The intervention was likely to be cost-effective under a lifetime perspective. TRIAL REGISTRATION NUMBER ISRCTN27508731; Results.
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Affiliation(s)
- Padraig Dixon
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Roberta Ara
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Louisa Edwards
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Isaacs T, Hunt D, Ward D, Rooshenas L, Edwards L. The Inclusion of Ethnic Minority Patients and the Role of Language in Telehealth Trials for Type 2 Diabetes: A Systematic Review. J Med Internet Res 2016; 18:e256. [PMID: 27670360 PMCID: PMC5057063 DOI: 10.2196/jmir.6374] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a serious, pervasive metabolic condition that disproportionately affects ethnic minority patients. Telehealth interventions can facilitate type 2 diabetes monitoring and prevent secondary complications. However, trials designed to test the effectiveness of telehealth interventions may underrecruit or exclude ethnic minority patients, with language a potential barrier to recruitment. The underrepresentation of minorities in trials limits the external validity of the findings for this key patient demographic. OBJECTIVE This systematic review examines (1) the research reporting practices and prevalence of ethnic minority patients included in telehealth randomized controlled trials (RCTs) targeting type 2 diabetes and the trial characteristics associated with recruiting a high proportion of minority patients, and (2) the proportion of included RCTs that report using English language proficiency as a patient screening criterion and how and why they do so. METHODS Telehealth RCTs published in refereed journals targeting type 2 diabetes as a primary condition for adults in Western majority English-speaking countries were included. Ethnically targeted RCTs were excluded from the main review, but were included in a post hoc subgroup analysis. Abstract and full-text screening, risk of bias assessment, and data extraction were independently conducted by two reviewers. RESULTS Of 3358 records identified in the search, 79 articles comprising 58 RCTs were included. Nearly two-thirds of the RCTs (38/58) reported on the ethnic composition of participants, with a median proportion of 23.5% patients (range 0%-97.7%). Fourteen studies (24%) that included at least 30% minority patients were all US-based, predominantly recruited from urban areas, and described the target population as underserved, financially deprived, or uninsured. Eight of these 14 studies (57%) offered intervention materials in a language other than English or employed bilingual staff. Half of all identified RCTs (29/58) included language proficiency as a participant-screening criterion. Language proficiency was operationalized using nonstandardized measures (eg, having sufficient "verbal fluency"), with only three studies providing reasons for excluding patients on language grounds. CONCLUSIONS There was considerable variability across studies in the inclusion of ethnic minority patients in RCTs, with higher participation rates in countries with legislation to mandate their inclusion (eg, United States) than in those without such legislation (eg, United Kingdom). Less than 25% of the RCTs recruited a sizeable proportion of ethnic minorities, which raises concerns about external validity. The lack of objective measures or common procedures for assessing language proficiency across trials implies that language-related eligibility decisions are often based on trial recruiters' impressionistic judgments, which could be subject to bias. The variability and inconsistent reporting on ethnicity and other socioeconomic factors in descriptions of research participants could be more specifically emphasized in trial reporting guidelines to promote best practice. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews: CRD42015024899; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024899 (Archived by WebCite at http://www.webcitation.org/6kQmI2bdF).
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Affiliation(s)
- Talia Isaacs
- University of Bristol, Graduate School of Education, Bristol, United Kingdom.
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