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Ziauddeen N, Pantelic M, O'Hara ME, Hastie C, Alwan NA. Impact of long COVID-19 on work: a co-produced survey. Lancet 2023; 402 Suppl 1:S98. [PMID: 37997145 DOI: 10.1016/s0140-6736(23)02157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND A proportion of people infected with SARS-CoV-2 develop post-COVID-19 condition (also known as long COVID), a predominantly multisystem condition resulting in varying degrees of functional disability limiting day-to-day activities. We aimed to describe the impact of long COVID on work. METHODS We co-produced baseline and follow-up online surveys with people with lived experience of long COVID (including three of the co-authors). Respondents were aged 18 years and older with self-reported long COVID following confirmed or suspected COVID-19 infection who were not hospitalised in the first 2 weeks of illness. The baseline survey was administered in November, 2020, using convenience non-probability sampling through social media. Following informed consent, participants completed a follow-up survey at 1 year (November, 2021). Ethics approval was granted by the University of Southampton. FINDINGS Of 2210 invited, 1153 (52%) participants responded to the survey (mean age of 47·7 years [SD 10·6], 965 [84%] female, 1096 [95%] White, and 892 [78%] holding a university degree). 54 participants (4·7%) reported recovery at follow-up. Median duration of illness was 19·8 months (IQR 19·3-20·1) at follow-up. An equal proportion reported being unable to work at baseline (20·4%, n=235) and follow-up (20·6%, n=237). However, a higher proportion reported being made redundant or taking early retirement at follow-up (8·9%, n=102) than at baseline (2·2%, n=25). 209 (18·1%) reported losing or resigning or leaving their job due to long COVID at follow-up compared with 170 (14·8%) participants at baseline. 307 (26·6%) participants reported not taking time off-sick due to long COVID at baseline, decreasing to 122 (10·6%) at follow-up. Of the 656 individuals reporting length of time off-sick, 354 (54%) were off-sick for more than 3 months, with 113 (17·2%) off-sick for more than 12 months. Nearly half (47%, n=538) reported a loss in income. INTERPRETATION The convenience non-probability sampling limits generalisability. Research is needed in a representative population sample to characterise the effect on working patterns in people with long COVID, particularly in those with less flexible and more physically demanding occupations who may be less able to take time off to recover. FUNDING None.
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Affiliation(s)
- Nida Ziauddeen
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Applied Research Collaboration Wessex, Southampton, UK.
| | - Marija Pantelic
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | | | | | - Nisreen A Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Applied Research Collaboration Wessex, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Pantelic M, Ziauddeen N, Boyes M, O'Hara ME, Hastie C, Alwan NA. The prevalence of stigma in a UK community survey of people with lived experience of long COVID. Lancet 2022; 400 Suppl 1:S84. [PMID: 36930033 DOI: 10.1016/s0140-6736(22)02294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stigma can be experienced as perceived or actual disqualification from social and institutional acceptance on the basis of one or more physical, health-related, behavioural, or other attributes deemed to be undesirable. Long COVID is a predominantly multisystem condition that occurs in people with a history of SARS-CoV-2 infection, often resulting in functional disability, which limits day-to-day activities. We aimed to quantify the burden of stigma experienced in a community-based sample of people with lived experience of long COVID. METHODS Data from the follow-up of a long COVID longitudinal online survey was used. The survey was coproduced with people living with long COVID. 13 questions on stigma were included to develop a Long COVID Stigma Scale capturing three domains: enacted (overt experiences of discrimination due to long COVID), internalised (internalising negative associations with long COVID and accepting them as self-applicable), and anticipated (expectation of bias or poor treatment by others) stigma. Data were collected through a social media survey with convenience non-probability sampling. FINDINGS 966 (47·9%) of 2016 participants from the UK completed the follow-up survey and 888 responded to the questions on stigma. The mean age of respondents was 48·3 years (SD 10·7), and 84·6% identified as female. Roughly half (n=460, 50·4%) reported having a formal, clinical, long COVID diagnosis, and of these, 440 responded to the questions on stigma. The prevalence of people experiencing overall stigma at least sometimes was 95·4% (n=847), prevalence of enacted stigma was 62·7% (n=557), internalised stigma was 86·4% (n=767), and anticipated stigma was 90·8% (n=806). Prevalence of stigma was higher in respondents with a formal diagnosis of long COVID (97·5%; n=429) than in those without (93·2%; n=413). INTERPRETATION This study highlights widespread and multilayered stigmas experienced by people living with long COVID in the UK, which presents a serious public health concern. The broader literature on stigmatised health conditions consistently suggests that stigma drives people away from health services, contributes to psychological distress, and compromises long-term physical outcomes. The higher proportion experiencing stigma in those with clinical diagnosis of long COVID might be indicative of stigma within the health-care system. Findings from this study should be taken into consideration within clinical practice and health care, social care, employment, and education policies. FUNDING None.
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Affiliation(s)
- Marija Pantelic
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Nida Ziauddeen
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Applied Research Collaboration Wessex, Southampton, UK.
| | - Mark Boyes
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | | | | | - Nisreen A Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Applied Research Collaboration Wessex, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Munblit D, O'Hara ME, Akrami A, Perego E, Olliaro P, Needham DM. Long COVID: aiming for a consensus. The Lancet Respiratory Medicine 2022; 10:632-634. [PMID: 35525253 PMCID: PMC9067938 DOI: 10.1016/s2213-2600(22)00135-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia; Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London W2 1PG, UK.
| | | | - Athena Akrami
- Sainsbury Wellcome Centre, University College London, London, UK; Patient-Led Research Collaborative, Washington, DC, USA
| | - Elisa Perego
- Institute of Archaeology, University College London, London, UK
| | - Piero Olliaro
- ISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Dale M Needham
- Pulmonary and Critical Care Medicine, Department of Medicine, and Department of Physical Medicine and Rehabilitation, School of Medicine, and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
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Affiliation(s)
- Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Margaret E O'Hara
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Munblit D, Nicholson TR, Needham DM, Seylanova N, Parr C, Chen J, Kokorina A, Sigfrid L, Buonsenso D, Bhatnagar S, Thiruvengadam R, Parker AM, Preller J, Avdeev S, Klok FA, Tong A, Diaz JV, Groote WD, Schiess N, Akrami A, Simpson F, Olliaro P, Apfelbacher C, Rosa RG, Chevinsky JR, Saydah S, Schmitt J, Guekht A, Gorst SL, Genuneit J, Reyes LF, Asmanov A, O'Hara ME, Scott JT, Michelen M, Stavropoulou C, Warner JO, Herridge M, Williamson PR. Studying the post-COVID-19 condition: research challenges, strategies, and importance of Core Outcome Set development. BMC Med 2022; 20:50. [PMID: 35114994 PMCID: PMC8813480 DOI: 10.1186/s12916-021-02222-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A substantial portion of people with COVID-19 subsequently experience lasting symptoms including fatigue, shortness of breath, and neurological complaints such as cognitive dysfunction many months after acute infection. Emerging evidence suggests that this condition, commonly referred to as long COVID but also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or post-COVID-19 condition, could become a significant global health burden. MAIN TEXT While the number of studies investigating the post-COVID-19 condition is increasing, there is no agreement on how this new disease should be defined and diagnosed in clinical practice and what relevant outcomes to measure. There is an urgent need to optimise and standardise outcome measures for this important patient group both for clinical services and for research and to allow comparing and pooling of data. CONCLUSIONS A Core Outcome Set for post-COVID-19 condition should be developed in the shortest time frame possible, for improvement in data quality, harmonisation, and comparability between different geographical locations. We call for a global initiative, involving all relevant partners, including, but not limited to, healthcare professionals, researchers, methodologists, patients, and caregivers. We urge coordinated actions aiming to develop a Core Outcome Set (COS) for post-COVID-19 condition in both the adult and paediatric populations.
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Affiliation(s)
- Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. .,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK. .,Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.,Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nina Seylanova
- Sechenov Biomedical Science and Technology Park, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Callum Parr
- Faculty of Medicine, Imperial College London, London, UK
| | - Jessica Chen
- Faculty of Medicine, Imperial College London, London, UK
| | - Alisa Kokorina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Shinjini Bhatnagar
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Delhi, National Capital Region, India
| | - Ramachandran Thiruvengadam
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Delhi, National Capital Region, India
| | - Ann M Parker
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.,Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sergey Avdeev
- Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Janet V Diaz
- NCD Department, Rehabilitation Programme, WHO, Geneva, Switzerland
| | - Wouter De Groote
- NCD Department, Rehabilitation Programme, WHO, Geneva, Switzerland
| | | | - Athena Akrami
- Sainsbury Wellcome Centre, UCL, London, UK.,Patient-Led Research Collaborative, Washington, DC, USA
| | | | - Piero Olliaro
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Regis Goulart Rosa
- Critical Care Department, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
| | - Jennifer R Chevinsky
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharon Saydah
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Respiratory Viruses Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Alla Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - Sarah L Gorst
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Jon Genuneit
- Paediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Luis Felipe Reyes
- Universidad de La Sabana, Chía, Colombia.,Clínica Universidad de La Sabana, Chía, Colombia
| | - Alan Asmanov
- The Research and Clinical Institute for Pediatrics named after Academician Yuri Veltischev of the Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Janet T Scott
- MRC-University of Glasgow, Centre for Virus Research, Glasgow, UK
| | - Melina Michelen
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,School of Health Sciences, City, University of London, London, UK
| | | | - John O Warner
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - Margaret Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Paula R Williamson
- MRC/NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
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Routen A, O'Mahoney L, Ayoubkhani D, Banerjee A, Brightling C, Calvert M, Chaturvedi N, Diamond I, Eggo R, Elliott P, Evans RA, Haroon S, Herret E, O'Hara ME, Shafran R, Stanborough J, Stephenson T, Sterne J, Ward H, Khunti K. Understanding and tracking the impact of long COVID in the United Kingdom. Nat Med 2022; 28:11-15. [PMID: 34811549 DOI: 10.1038/s41591-021-01591-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Ash Routen
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Lauren O'Mahoney
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | | | - Amitava Banerjee
- Faculty of Population Health Sciences, Institute of Health Informatics, University College London, London, UK
| | - Chris Brightling
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,National Institute for Health Research Applied Research Centre West Midlands, Birmingham, UK.,National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Nishi Chaturvedi
- Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Ian Diamond
- Office for National Statistics, Government Buildings, Newport, UK
| | - Rosalind Eggo
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Elliott
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emily Herret
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Roz Shafran
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Terence Stephenson
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jonathan Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Helen Ward
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
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Robson S, McParlin C, Mossop H, Lie M, Fernandez-Garcia C, Howel D, Graham R, Ternent L, Steel A, Goudie N, Nadeem A, Phillipson J, Shehmar M, Simpson N, Tuffnell D, Campbell I, Williams R, O'Hara ME, McColl E, Nelson-Piercy C. Ondansetron and metoclopramide as second-line antiemetics in women with nausea and vomiting in pregnancy: the EMPOWER pilot factorial RCT. Health Technol Assess 2021; 25:1-116. [PMID: 34782054 DOI: 10.3310/hta25630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Around one-third of pregnant women suffer from moderate to severe nausea and vomiting, causing physical and emotional distress and reducing their quality of life. There is no cure for nausea and vomiting in pregnancy. Management focuses on relieving symptoms and preventing morbidity, and often requires antiemetic therapy. National guidelines make recommendations about first-, second- and third-line antiemetic therapies, although care varies in different hospitals and women report feeling unsupported, dissatisfied and depressed. OBJECTIVES To determine whether or not, in addition to intravenous rehydration, ondansetron compared with no ondansetron and metoclopramide compared with no metoclopramide reduced the rate of treatment failure up to 10 days after drug initiation; improved symptom severity at 2, 5 and 10 days after drug initiation; improved quality of life at 10 days after drug initiation; and had an acceptable side effect and safety profile. To estimate the incremental cost per treatment failure avoided and the net monetary benefits from the perspectives of the NHS and women. DESIGN This was a multicentre, double-dummy, randomised, double-blinded, dummy-controlled 2 × 2 factorial trial (with an internal pilot phase), with qualitative and health economic evaluations. PARTICIPANTS Thirty-three patients (who were < 17 weeks pregnant and who attended hospital with nausea and vomiting after little or no improvement with first-line antiemetic medication) who attended 12 secondary care NHS trusts in England, 22 health-care professionals and 21 women participated in the qualitative evaluation. INTERVENTIONS Participants were randomly allocated to one of four treatment groups (1 : 1 : 1: 1 ratio): (1) metoclopramide and dummy ondansetron; (2) ondansetron and dummy metoclopramide; (3) metoclopramide and ondansetron; or (4) double dummy. Trial medication was initially given intravenously and then continued orally once women were able to tolerate oral fluids for a maximum of 10 days of treatment. MAIN OUTCOME MEASURES The primary end point was the number of participants who experienced treatment failure, which was defined as the need for further treatment because symptoms had worsened between 12 hours and 10 days post treatment. The main economic outcomes were incremental cost per additional successful treatment and incremental net benefit. RESULTS Of the 592 patients screened, 122 were considered eligible and 33 were recruited into the internal pilot (metoclopramide and dummy ondansetron, n = 8; ondansetron and dummy metoclopramide, n = 8; metoclopramide and ondansetron, n = 8; double dummy, n = 9). Owing to slow recruitment, the trial did not progress beyond the pilot. Fifteen out of 30 evaluable participants experienced treatment failure. No statistical analyses were performed. The main reason for ineligibility was prior treatment with trial drugs, reflecting an unpredicted change in prescribing practice at several points along the care pathway. The qualitative evaluation identified the requirements of the study protocol, in relation to guidelines on anti-sickness drugs, and the diversity of pathways to care as key hurdles to recruitment while the role of research staff was a key enabler. No important adverse events or side effects were reported. LIMITATIONS The pilot trial failed to achieve the recruitment target owing to unforeseen changes in the provision of care. CONCLUSIONS The trial was unable to provide evidence to support clinician decisions about the best choice of second-line antiemetic for nausea and vomiting in pregnancy. TRIAL REGISTRATION Current Controlled Trials ISRCTN16924692 and EudraCT 2017-001651-31. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 63. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephen Robson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine McParlin
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Helen Mossop
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mabel Lie
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Cristina Fernandez-Garcia
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth Graham
- School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Ternent
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alison Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Goudie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Afnan Nadeem
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Julia Phillipson
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Manjeet Shehmar
- Gynaecology Secretaries Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Nigel Simpson
- Leeds Institute of Medical Research, Department of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, UK
| | - Derek Tuffnell
- Department of Obstetrics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ian Campbell
- Pharmacy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Elaine McColl
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Boddy L, Allen R, Parker R, O'Hara ME, Gosling AV. PANDA: A case-study examining a successful Audiology and Otology Patient and Public Involvement and Engagement research group. Patient Experience Journal 2020. [DOI: 10.35680/2372-0247.1431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Breath samples were taken from 31 patients with liver disease and 30 controls in a clinical setting and proton transfer reaction quadrupole mass spectrometry (PTR-Quad-MS) used to measure the concentration of volatile organic compounds (VOCs). All patients had cirrhosis of various etiologies, with some also suffering from hepatocellular cancer (HCC) and/or hepatic encephalopathy (HE). Breath limonene was higher in patients with No-HCC than with HCC, median (lower/upper quartile) 14.2 (7.2/60.1) versus 3.6 (2.0/13.7) and 1.5 (1.1/2.3) nmol mol-1 in controls. This may reflect disease severity, as those with No-HCC had significantly higher UKELD (United Kingdom model for End stage Liver Disease) scores. Patients with HE were categorized as having HE symptoms presently, having a history but no current symptoms and having neither history nor current symptoms. Breath limonene in these groups was median (lower/upper quartile) 46.0 (14.0/103), 4.2 (2.6/6.4) and 7.2 (2.0/19.1) nmol mol-1, respectively. The higher concentration of limonene in those with current symptoms of HE than with a history but no current symptoms cannot be explained by disease severity as their UKELD scores were not significantly different. Longitudinal data from two patients admitted to hospital with HE show a large intra-subject variation in breath limonene, median (range) 18 (10-44) and 42 (32-58) nmol mol-1.
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Affiliation(s)
- M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK. Author to whom any correspondence should be addressed
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Fernández Del Río R, O'Hara ME, Pemberton P, Whitehouse T, Mayhew CA. Elimination characteristics of post-operative isoflurane levels in alveolar exhaled breath via PTR-MS analysis. J Breath Res 2016; 10:046006. [PMID: 27732571 PMCID: PMC6050519 DOI: 10.1088/1752-7155/10/4/046006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/24/2023]
Abstract
Isoflurane (1-chloro-2,2,2-trifluoroethyl difluoromethyl ether), C3H2ClF5O, is a commonly used inhalation anaesthetic. Using a proton transfer reaction mass spectrometer (PTR-MS) we have detected isoflurane in the breath of patients several weeks following major surgery. That isoflurane is detected in the breath of patients so long after being anaesthetised raises questions about when cognitive function has fully returned to a patient. Temporal profiles of isoflurane concentrations in breath are presented for five patients (F/M 3/2, mean age 50 years, min-max 36-58 years) who had undergone liver transplant surgery. In addition, results from a headspace analysis of isoflurane are presented so that the product ions resulting from the reactions of H3O+ with isoflurane in PTR-MS could be easily identified in the absence of the complex chemical environment of breath. Six product ions were identified. In order of increasing m/z (using the 35Cl isotope where appropriate) these are [Formula: see text] (m/z 51), CHFCl+ (m/z 67), CF3CHCl+ (m/z 117), C3F4OCl+ (m/z 163), C3H2F4OCl+ (m/z 165), and C3F4OCl+ H2O (m/z 183). No protonated parent was detected. For the headspace study both clean air and CO2 enriched clean air (4% CO2) were used as buffer gases in the drift tube of the PTR-MS. The CO2 enriched air was used to determine if exhaled breath would affect the product ion branching ratios. Importantly no significant differences were observed, and therefore for isoflurane the product ion distributions determined in a normal air mixture can be used for breath analysis. Given that PTR-MS can be operated under different reduced electric fields (E/N), the dependence of the product ion branching percentages for isoflurane on E/N (96-138 Td) are reported.
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Affiliation(s)
- R Fernández Del Río
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
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Fernández Del Río R, O'Hara ME, Holt A, Pemberton P, Shah T, Whitehouse T, Mayhew CA. Volatile Biomarkers in Breath Associated With Liver Cirrhosis - Comparisons of Pre- and Post-liver Transplant Breath Samples. EBioMedicine 2015; 2:1243-50. [PMID: 26501124 PMCID: PMC4588000 DOI: 10.1016/j.ebiom.2015.07.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background The burden of liver disease in the UK has risen dramatically and there is a need for improved diagnostics. Aims To determine which breath volatiles are associated with the cirrhotic liver and hence diagnostically useful. Methods A two-stage biomarker discovery procedure was used. Alveolar breath samples of 31 patients with cirrhosis and 30 healthy controls were mass spectrometrically analysed and compared (stage 1). 12 of these patients had their breath analysed after liver transplant (stage 2). Five patients were followed longitudinally as in-patients in the post-transplant period. Results Seven volatiles were elevated in the breath of patients versus controls. Of these, five showed statistically significant decrease post-transplant: limonene, methanol, 2-pentanone, 2-butanone and carbon disulfide. On an individual basis limonene has the best diagnostic capability (the area under a receiver operating characteristic curve (AUROC) is 0.91), but this is improved by combining methanol, 2-pentanone and limonene (AUROC curve 0.95). Following transplant, limonene shows wash-out characteristics. Conclusions Limonene, methanol and 2-pentanone are breath markers for a cirrhotic liver. This study raises the potential to investigate these volatiles as markers for early-stage liver disease. By monitoring the wash-out of limonene following transplant, graft liver function can be non-invasively assessed. Breath volatiles were compared for cirrhotic patients and controls and pre- and post-liver transplant. Three volatiles (limonene, methanol, 2-pentanone) have been found to have excellent diagnostic capabilities. Limonene shows washout characteristics following transplant supporting a hypothesis that it accumulates in fat.
There are numerous previous studies investigating breath volatiles in patients with liver disease but with conflicting results. It is impossible to tell which volatiles from previous studies may be false discoveries, and which are actually associated with the disease. We measured breath samples in patients and controls and in patients after transplant. Methanol, 2-pentanone and limonene show differences not only between patients and controls but also in cases pre- and post-transplant and have excellent diagnostic capabilities. We show evidence that limonene accumulates in the body, probably because the cirrhotic liver fails to metabolise dietary limonene.
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Key Words
- AID, autoimmune liver disease
- ALD, alcoholic liver disease
- AUROC, area under receiver operator curve
- BMI, body mass index
- Breath analysis
- CD, cryptogenic disease
- Cirrhosis
- Diagnosis limonene
- GC, gas chromatography
- HBV, hepatitis B virus
- HCC, hepatocellular cancer
- HCV, hepatitis C virus
- ITU, intensive treatment unit
- LQ, lower quartile
- Liver transplant
- MS, mass spectrometry
- OPU, out-patient clinic
- PBC, primary biliary cirrhosis
- PSC, primary sclerosing cholangitis
- PTR-MS
- PTR-MS, proton transfer reaction mass spectrometry
- ROC, Receiver operating characteristics
- TAC, transplant assessment clinic
- TE, transient elastography
- UKELD, United Kingdom model for end-stage liver disease
- UQ, upper quartile
- VMR, volume mixing ratio
- VOC, volatile organic compounds
- Volatile organic compounds
- ppbv, parts per billion by volume
- ppmv, parts per million by volume
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Affiliation(s)
- R Fernández Del Río
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
| | - M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
| | - A Holt
- Department of Hepatology, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - P Pemberton
- Critical Care and Anaesthesia, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - T Shah
- Department of Hepatology, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - T Whitehouse
- Critical Care and Anaesthesia, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - C A Mayhew
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
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O'Hara ME, Clutton-Brock TH, Green S, Mayhew CA. Endogenous volatile organic compounds in breath and blood of healthy volunteers: examining breath analysis as a surrogate for blood measurements. J Breath Res 2009; 3:027005. [PMID: 21383460 DOI: 10.1088/1752-7155/3/2/027005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To investigate the premise that levels of endogenous volatile organic compounds (VOC) in breath reflect those in blood, the concentration of acetone and isoprene were measured in radial arterial blood, peripheral venous blood and breath samples from ten healthy volunteers. Coefficients of repeatability as a percentage of mean are less than 30% in breath but greater than 70% in blood. The volunteer-mean ratios of arterial to venous blood concentration are 1.4 (0.9-2.1) for acetone and 0.55 (0.3-1.0) for isoprene. Concentration in breath showed a significant inter-subject correlation with concentration in arterial blood (CAB) for acetone but not for isoprene. Arterial blood/breath ratios are 580 (280-1060) for acetone and 0.47 (0.22-0.77) for isoprene. The sample-mean blood/breath ratio was used to calculate an estimate of CAB and the standard deviation of this estimate was lower than that of arterial blood measured directly. For most subjects, estimated CAB was within uncertainty limits of the actual CAB. Owing to the poor repeatability of VOC concentrations from consecutive blood samples, and the capacitive effects of the lung, this study suggests that breath VOC measurements may provide a more consistent measure than blood measurements for investigating underlying physiological function or pathology within individuals.
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Affiliation(s)
- M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Birmingham, B15 2TT, UK
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O'Hara ME, O'Hehir S, Green S, Mayhew CA. Development of a protocol to measure volatile organic compounds in human breath: a comparison of rebreathing and on-line single exhalations using proton transfer reaction mass spectrometry. Physiol Meas 2008; 29:309-30. [PMID: 18367807 DOI: 10.1088/0967-3334/29/3/003] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Analysis of volatile organic compounds (VOCs) on human breath has great potential as a non-invasive diagnostic technique. It is, therefore, surprising that no single, standard procedure has evolved for breath sampling. Here we present a novel repeated-cycle isothermal rebreathing method, where one cycle comprises five rebreaths, which could be adopted for breath analysis of VOCs. For demonstration purposes, we present measurements of three common breath VOCs: isoprene, acetone and methanol. Their concentrations measured in breath are shown to increase with number of rebreaths until a plateau value is reached by at least 20 rebreaths. The average ratio of plateau concentration to single mixed expired breath concentration was found to be 1.92 +/- 0.57 for isoprene, 1.25 +/- 0.13 for acetone and 1.12 +/- 0.12 for methanol (mean +/- standard deviation). Measurements from on-line single exhalations are presented which demonstrate a positive slope in the time-dependent expirograms of isoprene and acetone. The slope of the isoprene expirogram is persistently linear and the end-expired concentration of isoprene is highly variable in the same subject depending on the duration of exhalation. End-expired values of acetone are not as sensitive to the length of exhalation, and are the same to within measurement uncertainty for any duration of exhalation for any subject. It is concluded that uncontrolled single on-line exhalations are not suitable for the reliable measurement of isoprene in the breath and that rebreathing can be the basis of an easily tolerated protocol for the reliable collection of breath samples.
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Affiliation(s)
- M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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