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Bashir K, Beintaris I, Sharp L, Newton J, Elliott K, Rees J, Rogers P, Rutter M. Colonoscopic cancer detection rate: a new performance measure - is it FIT for purpose? Frontline Gastroenterol 2024; 15:198-202. [PMID: 38668994 PMCID: PMC11042456 DOI: 10.1136/flgastro-2023-102555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 04/28/2024] Open
Abstract
Introduction Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate identification of target populations for colonoscopy; then to use CDR to assess the impact of implementing an FIT-based referral pathway locally. Methods NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames. Results 1, 123, 624 NED diagnostic colonoscopies were analysed. Locally, there was a significant increase in CDR between 2019 and 2021, from 3.01% (2.45%-3.47%) to 4.32% (3.69%-4.95%), p=0.003. The CDR increase was due to both a 10% increase in the number of CRCs detected and a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a smaller, but significant, increase in CDR from 2.02% (1.99%-2.07%) to 2.33% (2.29%-2.37%), p<0.001. The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared with nationally. Conclusion Our study indicates that the introduction of a robustly vetted FIT-based algorithm to determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically calculated through NED, enabling monitoring of the quality of referral and vetting pathways.
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Affiliation(s)
- Khalid Bashir
- University Hospital of North Tees, Stockton-on-Tees, UK
| | - Iosif Beintaris
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Julia Newton
- Academic Health Science Network for the North East and North Cumbria, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Elliott
- Northern Cancer Alliance and GP Spring Terrace North Shields, North Shields, UK
| | - Jon Rees
- School of Psychology Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | | | - Matt Rutter
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
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2
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Khanna R, Ma C, Hogan M, Zou G, Bessissow T, Bressler B, Colombel JF, Danese S, Daperno M, East JE, Hookey L, Loftus EV, McDonald JWD, Panaccione R, Peyrin-Biroulet L, Rutter M, Sands BE, Vermeire S, Rémillard J, McFarlane SC, Sandborn WJ, D'Haens GR, Feagan BG, Jairath V. Standardizing Scoring Conventions for Crohn's Disease Endoscopy: An International RAND/UCLA Appropriateness Study. Clin Gastroenterol Hepatol 2023; 21:2938-2950.e6. [PMID: 37308036 DOI: 10.1016/j.cgh.2023.05.029] [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: 03/27/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIMS Endoscopic assessment of disease activity is integral for evaluating treatment response in patients with Crohn's disease (CD). We aimed to define appropriate items for evaluating endoscopic activity and conventions for consistent endoscopic scoring rules in CD. METHODS A 2-round modified RAND/University of California at Los Angeles Appropriateness Method study was conducted. A panel of 15 gastroenterologists used a 9-point Likert scale to rate the appropriateness of statements pertaining to the Simple Endoscopic Score for CD, Crohn's Disease Endoscopic Index of Severity, and additional items relevant to endoscopy scoring in CD. Each statement was voted as appropriate, uncertain, or inappropriate based on the median panel rating and presence of disagreement. RESULTS Panelists voted that it is appropriate for all ulcers to contribute to endoscopic scoring in CD, including aphthous ulcers, ulcerations at a surgical anastomosis, and anal canal ulcers (scored in the rectum). Endoscopic healing should reflect an absence of ulcers. Narrowing should be defined as a clear decrease in luminal diameter; stenosis should be defined by an impassable narrowing, and if occurring at the junction of 2 segments, scored in the distal segment. Scarring and inflammatory polyps were considered inappropriate for including in the affected area score. The optimal method for defining ulcer depth remains uncertain. CONCLUSIONS We outlined scoring conventions for the Simple Endoscopic Score for CD and Crohn's Disease Endoscopic Index of Severity, noting that both scores have limitations. Therefore, we identified priorities for future research and steps for developing and validating a more representative endoscopic index in CD.
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Affiliation(s)
- Reena Khanna
- Department of Medicine, Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alimentiv Inc, London, Ontario, Canada
| | | | - Guangyong Zou
- Alimentiv Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brian Bressler
- Division of Gastroenterology, Department of Medicine, University of British Colombia, Vancouver, British Colombia, Canada; Division of Gastroenterology, Department of Medicine, St. Paul's Hospital, Vancouver, British Colombia
| | - Jean-Frédéric Colombel
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Silvio Danese
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Daperno
- Division of Gastroenterology, Ospedale Mauriziano Umberto I, Torino, Italy
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, United Kingdom
| | - Lawrence Hookey
- Department of Medicine, Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laurent Peyrin-Biroulet
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly-sur-Seine, France; Nutrition-Genetics and Environmental Risk Exposure, INSERM, Université de Lorraine, Nancy, France
| | - Matt Rutter
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, United Kingdom; Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Catholic University Leuven, Leuven, Belgium
| | | | | | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Geert R D'Haens
- Alimentiv Inc, London, Ontario, Canada; Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
| | - Brian G Feagan
- Department of Medicine, Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada; Alimentiv Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada; Alimentiv Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
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3
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Kamran U, Abbasi A, Umar N, Tahir I, Brookes MJ, Rutter M, McCord M, Adderley NJ, Dretzke J, Trudgill N. Umbrella systematic review of potential quality indicators for the detection of dysplasia and cancer at upper gastrointestinal endoscopy. Endosc Int Open 2023; 11:E835-E848. [PMID: 37719799 PMCID: PMC10504040 DOI: 10.1055/a-2117-8621] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/13/2023] [Indexed: 09/19/2023] Open
Abstract
Background and study aims Upper gastrointestinal (UGI) endoscopy lacks established quality indicators. We conducted an umbrella systematic review of potential quality indicators for the detection of UGI cancer and dysplasia. Methods Bibliographic databases were searched up to December 2021 for systematic reviews and primary studies. Studies reporting diagnostic accuracy, detection rates or the association of endoscopy or endoscopist-related factors with UGI cancer or dysplasia detection were included. AMSTAR2 and JBI checklists were used to assess systematic review and primary study quality. Clinical heterogeneity precluded meta-analysis and findings are summarized narratively. Results Eight systematic reviews and nine primary studies were included. Image enhancement, especially narrow band imaging, had high diagnostic accuracy for dysplasia and early gastric cancer (pooled sensitivity 0.87 (95% CI 0.84-0.89) and specificity 0.97 (0.97-0.98)). Higher detection rates with longer endoscopy examination times were reported in three studies, but no difference was observed in one study. Endoscopist biopsy rate was associated with increased gastric cancer detection (odds ratio 2.5; 95% confidence interval [CI] 2.1-2.9). Early esophageal cancer (0.17% vs 0.14%, P =0.04) and gastric cancer (0.16% vs 0.12%, P =0.02) detection rates were higher with propofol sedation compared to no sedation. Endoscopies performed by trained endoscopists on dedicated Barrett's surveillance lists had higher detection rates (8% vs 3%, P <0.001). The neoplasia detection rate during diagnostic endoscopies for Barrett's esophagus was 7% (95% CI 4%-10%). Conclusions Image enhancement use, longer examination times, biopsy rate and propofol sedation are potential quality indicators for UGI endoscopy. Neoplasia detection rate and dedicated endoscopy lists are additional potential quality indicators for Barrett's esophagus.
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Affiliation(s)
- Umair Kamran
- Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Abdullah Abbasi
- Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Nosheen Umar
- Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Imran Tahir
- Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Matthew J Brookes
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
- Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
| | - Matt Rutter
- Gastroenterology, University Hospital of North Tees, Stockton on Tees, United Kingdom of Great Britain and Northern Ireland
- Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Mimi McCord
- Heartburn Cancer, Hampshire, United Kingdom of Great Britain and Northern
Ireland
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Janine Dretzke
- University of Birmingham, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Nigel Trudgill
- Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
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4
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Ravindran S, Matharoo M, Marshall S, Robinson E, Bano M, Bassett P, Coleman M, Rutter M, Ashrafian H, Darzi A, Healey C, Thomas-Gibson S. Development, validation, and results of a national endoscopy safety attitudes questionnaire (Endo-SAQ). Endosc Int Open 2023; 11:E679-E689. [PMID: 37502673 PMCID: PMC10370487 DOI: 10.1055/a-2112-5105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/13/2023] [Indexed: 07/29/2023] Open
Abstract
Background and study aims Safety attitudes are linked to patient outcomes. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) identifies the need to improve our understanding of safety culture in endoscopy. We describe the development and validation of the Endo-SAQ (endoscopy safety attitudes questionnaire) and the results of a national survey of staff attitudes. Methods Questions from the original SAQ were adapted to reflect endoscopy-specific content. This was refined by an expert group, followed by a pilot study to assess acceptability. The refined Endo-SAQ (comprising 35 questions across six domains) was disseminated to endoscopy staff across the UK and Ireland. Outcomes were domain scores and the percentage of positive responses (score ≥75/100) per domain. Descriptive and comparative analyses were performed. Binary logistic regression identified staff and service factors associated with positive scores. Validity and reliability of Endo-SAQ were assessed through psychometric analysis. Results After expert review, four questions in the preliminary Endo-SAQ were adjusted. Sixty-one participants undertook the pilot study with good acceptability. A total of 453 participants completed the refined Endo-SAQ. There were positive responses in teamwork, safety climate, job satisfaction, and working conditions domains. Endoscopists had significantly more positive responses to stress recognition and working conditions than nursing staff. JAG accreditation was associated with positive scores in safety climate and job satisfaction domains. Endo-SAQ met thresholds of construct validity and reliability. Conclusions Endoscopy staff had largely positive safety attitudes scores but there were significant differences across domains and staff. There is evidence for the validity and reliability of Endo-SAQ. Endo-SAQ could complement current measures of patient safety in endoscopy and be used in evaluation and research.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Manmeet Matharoo
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
| | - Sarah Marshall
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
| | - Emma Robinson
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
| | - Madeline Bano
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
| | - Paul Bassett
- Statistics, Statsconsultancy Ltd, Amersham, United Kingdom of Great Britain and Northern Ireland
| | - Mark Coleman
- Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom of Great Britain and Northern Ireland
| | - Matt Rutter
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom of Great Britain and Northern Ireland
| | - Hutan Ashrafian
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ara Darzi
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Chris Healey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, United Kingdom of Great Britain and Northern Ireland
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
- Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
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5
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Beaton D, Rutter M, Sharp L, Oppong KW, Awadelkarim B, Everett SM, Mitra V. UK ERCP sedation practices, patient comfort and endoscopist characteristics: National Endoscopy Database (NED) analysis on behalf of the JAG and BSG. Frontline Gastroenterol 2023; 14:384-391. [PMID: 37581181 PMCID: PMC10423606 DOI: 10.1136/flgastro-2023-102424] [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: 03/15/2023] [Accepted: 04/19/2023] [Indexed: 08/16/2023] Open
Abstract
Objectives This analysis assessed current endoscopic retrograde cholangiopancreatography (ERCP) practice within the UK, including use of sedation and patient comfort. Methods ERCPs conducted over 1 year (1 July 2021-30 June 2022) and uploaded to the National Endoscopy Database (NED) were analysed. The endoscopist workforce was classified by gender and specialty, use of sedation was analysed. Logistic regression was used to assess associations between patient age, gender and procedure indications on moderate to severe discomfort risk. Results 27 812 ERCPs were performed by 491 endoscopists in 175 sites and uploaded to NED, an estimated 50% of total UK activity. 13% were training procedures, 94% of the endoscopists were male, with 72% being gastroenterologists. Most ERCPs were performed under conscious sedation (89%). The discomfort rate among patients aged 60-90 undergoing ERCP under conscious sedation was 4.2% (95% CI 3.9% to 4.5%), with only 5.5% (95% CI 5.2% to 5.9%) receiving greater than 5 mg midazolam or 100 µg fentanyl.Younger patients (<30 years) had a higher discomfort risk during conscious sedation ERCPs than those aged 70-79 (OR 3.0, 95% CI 2.2 to 4.3, p<0.05), while male patients had a lower discomfort risk compared with females (OR 0.9, 95% CI 0.8 to 1.0, p=0.05).Enhanced sedation (propofol or general anaesthetic) was associated with lower frequency of discomfort (0.3%, 95% CI 0.1 to 0.6) compared with conscious sedation (5.1%, 95% CI 4.9% to 5.4%, p<0.05). Conclusions Conscious sedation is well tolerated for most patients and prescribing practices have improved. However, triage of more patients, particularly young females, to enhanced sedation lists should be considered to reduce discomfort rates in future.
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Affiliation(s)
- David Beaton
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - Matt Rutter
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Newcastle University, Newcastle upon Tyne, UK
| | - Kofi W Oppong
- Hepatobiliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Simon M Everett
- Gastroenterology, St James's University Hospital NHS Trust, Leeds, UK
| | - Vikramjit Mitra
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
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6
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Tolan D, Rutter M, Plumb A. CT colonography and lower gastrointestinal cancer pathways: planning for the next decade. Clin Radiol 2023:S0009-9260(23)00049-1. [PMID: 37087315 DOI: 10.1016/j.crad.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/17/2023]
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7
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Wagener M, van Heemst D, Kooijman S, Willems van Dijk K, Redline S, Tan X, Lawlor D, Rutter M, Noordam R. Dissecting insomnia from sleep duration in relation to coronary artery disease: evidence from multivariable-adjusted and factorial Mendelian Randomization analyses. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.317] [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: 11/29/2022]
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Beaton D, Sharp L, Trudgill NJ, Thoufeeq M, Nicholson BD, Rogers P, Docherty J, Penman ID, Rutter M. UK endoscopy workload and workforce patterns: is there potential to increase capacity? A BSG analysis of the National Endoscopy Database. Frontline Gastroenterol 2022; 14:103-110. [PMID: 36818791 PMCID: PMC9933584 DOI: 10.1136/flgastro-2022-102145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/31/2022] [Indexed: 02/24/2023] Open
Abstract
Background The lack of comprehensive national data on endoscopy activity and workforce hampers strategic planning. The National Endoscopy Database (NED) provides a unique opportunity to address this in the UK. We evaluated NED to inform service planning, exploring opportunities to expand capacity to meet service demands. Design Data on all procedures between 1 March 2019 and 29 February 2020 were extracted from NED. Endoscopy activity and endoscopist workforce were analysed. Results 1 639 640 procedures were analysed (oesophagogastroduodenoscopy (OGD) 693 663, colonoscopy 586 464, flexible sigmoidoscopy 335 439 and endoscopic retrograde cholangiopancreatography 23 074) from 407 sites by 4990 endoscopists. 89% of procedures were performed in NHS sites. 17% took place each weekday, 10% on Saturdays and 6% on Sundays. Training procedures accounted for 6% of total activity, over 99% of which took place in NHS sites. Median patient age was younger in the independent sector (IS) (51 vs 60 years, p<0.001). 74% of endoscopists were male. Gastroenterologists and surgeons each comprised one-third of the endoscopist workforce; non-medical endoscopists (NMEs) comprised 12% yet undertook 23% of procedures. Approximately half of endoscopists performing OGD (52%) or colonoscopies (48%) did not meet minimum annual procedure numbers. Conclusion This comprehensive analysis reveals endoscopy workload and workforce patterns for the first time across both the NHS and the IS in all four UK nations. Half of all endoscopists perform fewer than the recommended minimum annual procedure numbers: a national strategy to address this, along with expansion of the NME workforce, would increase endoscopy capacity, which could be used to exploit latent weekend capacity.
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Affiliation(s)
- David Beaton
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Ian D Penman
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matt Rutter
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Abstract
Big data is defined as being large, varied or frequently updated, and usually generated from real-world interaction. With the unprecedented availability of big data, comes an obligation to maximise its potential for healthcare improvements in treatment effectiveness, disease prevention and healthcare delivery. We review the opportunities and challenges that big data brings to gastroenterology. We review its sources for healthcare improvement in gastroenterology, including electronic medical records, patient registries and patient-generated data. Big data can complement traditional research methods in hypothesis generation, supporting studies and disseminating findings; and in some cases holds distinct advantages where traditional trials are unfeasible. There is great potential power in patient-level linkage of datasets to help quantify inequalities, identify best practice and improve patient outcomes. We exemplify this with the UK colorectal cancer repository and the potential of linkage using the National Endoscopy Database, the inflammatory bowel disease registry and the National Health Service bowel cancer screening programme. Artificial intelligence and machine learning are increasingly being used to improve diagnostics in gastroenterology, with image analysis entering clinical practice, and the potential of machine learning to improve outcome prediction and diagnostics in other clinical areas. Big data brings issues with large sample sizes, real-world biases, data curation, keeping clinical context at analysis and General Data Protection Regulation compliance. There is a tension between our obligation to use data for the common good and protecting individual patient's data. We emphasise the importance of engaging with our patients to enable them to understand their data usage as fully as they wish.
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Affiliation(s)
- Jamie Catlow
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Benjamin Bray
- Medical Director & Head of Epidemiology, EMEA Data Science, IQVIA Europe, Reading, UK
- Medicine Clinical Academic Group, King's College London, London, UK
| | - Eva Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Matt Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
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Wong B, Summer S, Horn P, Rutter M, Tian C, Rybalsky I, Shellenbarger K, Kalkwarf H. DMD – CLINICAL CARE. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Godsave C, Chakravorty M, Rutter M, Lanyon P, Aston J, Bythell M, Stevens S, Pearce F. POS1412 IDENTIFYING HIGH-COST DRUGS FOR RARE RHEUMATIC DISEASES IN ROUTINELY COLLECTED NHS DATA. RESULTS FROM A PILOT STUDY OF RITUXIMAB USE IN VASCULITIS USING DATA FROM THE NATIONAL DISEASE REGISTRATION SERVICE AND THE REGISTRATION OF COMPLEX RARE DISEASES-EXEMPLARS IN RHEUMATOLOGY (RECORDER) PROJECT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Understanding real-world usage of high-cost drugs is crucial to support planning, adoption of innovation and reduce unwarranted variation in treatment. Hospital Episode Statistics (HES) contain diagnoses (coded by ICD-10) and procedures/treatments (coded by OPCS) for all daycase or inpatient care in England. However, OPCS codes are not specific for individual drugs, for example X921 (cytokine inhibitors band 1) includes rituximab (RTX) and 15 other drugs.Objectives:We aimed to validate the accurate identification of patients treated with RTX for ANCA-associated vasculitis (AAV) using HES data.Methods:We used data from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) at Public Health England and their legal permissions (CAG 10-02(d)/2015). We extracted records from HES of all patients treated at two hospitals during financial year 2018/19 who ever had a coded diagnosis of granulomatosis with polyangiitis (GPA, M313), eosinophilic granulomatosis with polyangiitis (EGPA, M301), microscopic polyangiitis (MPA, M317), polyarteritis nodosa (PAN, M300) or arteritis unspecified (I776). Where people had multiple diagnoses of vasculitis, the most specific was considered their diagnosis. Enabled by data sharing agreements, we reviewed hospital records of those patients to validate diagnoses and whether X921 reliably identified RTX. We report the positive predictive value and sensitivity of the coding for X921 and GPA/EGPA/MPA for identifying people with AAV who are treated with RTX.Results:At Trust 1 records ever coded with GPA/EGPA/MPA identified 74 people, 69 of whom had AAV confirmed in their medical notes. Among these 74 patients there were 59 episodes coded with X921 procedure codes, of which 56 correctly identified a RTX infusion given for AAV. A total of 64 RTX infusions were given to people with AAV – 3 missed infusions were X921 procedures in patients who had coded diagnoses of PAN or I776 but never GPA/EGPA/MPA and 5 infusions were not coded as X921.The same analysis at Trust 2 identified 46 people, 44 of whom had AAV confirmed in their medical notes. Among patients identified with AAV there were 17 episodes coded as X921, of which 15 correctly identified a RTX infusion. A total of 23 infusions were given to people with AAV: 4 infusions were X921 procedures in patients who had coded diagnoses of PAN or I776 but never GPA/EGPA/MPA, and 4 infusions were not coded as X921.Table 1. Summary of Positive Predictive Values (PPV) applying our algorithm to identify AAV diagnoses and RTX useTrust 1Trust 2CombinedDiagnosis of AAV and coded as AAV6944113AAV coded7446120Diagnosis of AAV under any code7355128PPV AAV ascertainment (95% CI)93.2% (84.9-97.8)95.7% (85.2-99.5)94.2% (88.4-97.6)Sensitivity of AAV ascertainment (95% CI)94.5% (86.8-98.5)80.0% (67.0-89.6)88.3% (81.4-93.3)RTX given in people coded as AAV561571RTX coded in people coded as AAV591776RTX given for AAV under any diagnostic or procedure code642387PPV RTX ascertainment (95% CI)94.9% (85.9-98.9)88.2% (63.6-98.5)93.4% (85.3-97.8)Sensitivity of RTX ascertainment (95% CI)87.5% (76.8-94.4)65.2% (42.7-83.6)81.6% (71.9-89.1)Conclusion:HES data identified patients treated with RTX for AAV with a PPV of 93.4% (85.3-97.8) and sensitivity of 81.6% (71.9-89.1). This demonstrates the utility of national data to identify people receiving RTX for AAV. The RECORDER project, within the National Disease Registration Service plans to conduct real-world studies of the high-cost drug RTX, given for AAV, across the whole of England, and assess whether geography, demographics or socioeconomic factors influence frequency of prescription of this, and potentially other, high-cost drugs in line with the NHS long term plan.References:[1]Ward-Platt M, Stevens S, Miller N. I18 The national congenital anomaly and rare disease registration service (NCARDRS): The first yearAcknowledgements:I have no acknowledgements to declare.Disclosure of Interests:Cattleya Godsave: None declared, Mithun Chakravorty: None declared, Megan Rutter: None declared, Peter Lanyon Grant/research support from: P.C.L. is a recipients of a grant from Vifor Pharma. Vifor Pharma had no influence on the design, conduct or interpretation of this study., Jeanette Aston: None declared, Mary Bythell: None declared, Sarah Stevens: None declared, Fiona Pearce Grant/research support from: I have received a research grant from Vifor Pharma
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Catlow J, Sharp L, Kasim A, Lu L, Brookes M, Lee T, McCarthy S, Gray J, Sniehotta F, Deane J, Rutter M. The National Endoscopy Database (NED) Automated Performance Reports to Improve Quality Outcomes Trial (APRIQOT) randomized controlled trial design. Endosc Int Open 2020; 8:E1545-E1552. [PMID: 33140009 PMCID: PMC7584467 DOI: 10.1055/a-1261-3151] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background and study aims Colonoscopists with low polyp detection have higher post colonoscopy colorectal cancer incidence and mortality rates. The United Kingdom's National Endoscopy Database (NED) automatically captures patient level data in real time and provides endoscopy key performance indicators (KPI) at a national, endoscopy center, and individual level. Using an electronic behavior change intervention, the primary objective of this study is to assess if automated feedback of endoscopist and endoscopy center-level optimal procedure-adjusted detection KPI (opadKPI) improves polyp detection performance. Methods This multicenter, prospective, cluster-randomized controlled trial is randomizing NHS endoscopy centres to either intervention or control. The intervention is targeted at independent colonoscopists and each center's endoscopy lead. The intervention reports are evidence-based from endoscopist qualitative interviews and informed by psychological theories of behavior. NED automatically creates monthly reports providing an opadKPI, using mean number of polyps, and an action plan. The primary outcome is opadKPI comparing endoscopists in intervention and control centers at 9 months. Secondary outcomes include other KPI and proximal detection measures at 9 and 12 months. A nested histological validation study will correlate opadKPI to adenoma detection rate at the center level. A cost-effectiveness and budget impact analysis will be undertaken. Conclusion If the intervention is efficacious and cost-effective, we will showcase the potential of this learning health system, which can be implemented at local and national levels to improve colonoscopy quality, and demonstrate that an automated system that collects, analyses, and disseminates real-time clinical data can deliver evidence- and theory-informed feedback.
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Affiliation(s)
- Jamie Catlow
- Newcastle University Centre for Cancer – Populations Health Sciences Institute, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland,North Tees and Hartlepool NHL Foundation Trust – Gastroenterology, Stockton on Tees, United Kingdom of Great Britain and Northern Ireland
| | - Linda Sharp
- Newcastle University Centre for Cancer – Populations Health Sciences Institute, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Adetayo Kasim
- Durham University, Wolfson Research Institute of Health and Wellbeing, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Liya Lu
- Newcastle University Centre for Cancer – Populations Health Sciences Institute, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Matthew Brookes
- Royal Wolverhampton Hospitals NHS Trust, Gastroenterology, Wolverhamptonm
| | - Tom Lee
- Northumbria Healthcare NHS Foundation Trust, Gastroenterology, North Shields, Tyne and Wear, United Kingdom of Great Britain and Northern Ireland
| | - Stephen McCarthy
- Northumbria University, Department of Nursing, Midwifery & Health, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Joanne Gray
- Northumbria University, Department of Nursing, Midwifery & Health, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Falko Sniehotta
- Newcastle University, Population and Health Sciences Institute, Newcastle Upon Tyne, Tyne and Wear, United Kingdom of Great Britain and Northern Ireland
| | - Jill Deane
- North Tees and Hartlepool NHL Foundation Trust – Gastroenterology, Stockton on Tees, United Kingdom of Great Britain and Northern Ireland
| | - Matt Rutter
- North Tees and Hartlepool NHL Foundation Trust – Gastroenterology, Stockton on Tees, United Kingdom of Great Britain and Northern Ireland,Newcastle University, Centre for Cancer, Newcastle Upon Tyne, Tyne and Wear, United Kingdom of Great Britain and Northern Ireland
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Catlow J, Beaton D, Beintaris I, Shaw T, Broughton R, Healey C, Penman I, Coleman M, Rutter M. JAG/BSG national survey of UK endoscopy services: impact of the COVID-19 pandemic and early restoration of endoscopy services. Frontline Gastroenterol 2020; 12:272-278. [PMID: 34249311 PMCID: PMC8231419 DOI: 10.1136/flgastro-2020-101582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 07/19/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has profoundly affected UK endoscopy workload. The Joint Advisory Group on GI endoscopy and British Society of Gastroenterology issued guidelines on endoscopy service delivery changes and restoration. We surveyed UK endoscopy clinical leads to gain insights into service restoration. METHODS A Google Forms-designed survey, assessing endoscopy provision, Covid minimisation and referral pathways was circulated to all UK endoscopy leads. The survey was open between 19 and 24 May 2020. RESULTS 97 endoscopy leads completed the survey, with all UK nations and regions represented. Analysis showed 20% of endoscopy services were not providing endoscopy. Workload limitations were due to enforced interprocedural downtime (92%; with some services enforcing >1-hour downtime between procedures), social distancing (88%) and working in personal protective equipment (PPE) (87%). 91% of services reported a referral backlog (urgent median 2 months, routine median 6 months). 96% of services reported no current problems accessing PPE. Level 1/2 PPE use in colonoscopy was not uniform. 63% of services routinely swab patients for COVID-19 before endoscopy, 88% of services do not routinely swab asymptomatic staff. Comments addressed reducing endoscopy demand through vetting and changing referral criteria, the mostly commonly cited strategy being increased faecal immunochemical testing in symptomatic patients (70% of services). CONCLUSION This survey demonstrates the pandemic's profound impact on UK endoscopy. Challenges include standardising Covid-minimisation strategies and recovering staffing levels. To improve endoscopy services, there is a need to refine referral pathways, improve vetting and clarify guidance on downtime and PPE within endoscopy.
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Affiliation(s)
- Jamie Catlow
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, UK
| | - David Beaton
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, UK
| | - Iosif Beintaris
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, UK
| | - Tim Shaw
- Joint Advisory Group on GI Endoscopy, Royal College of Physicians, London, London, UK
| | - Raphael Broughton
- Joint Advisory Group on GI Endoscopy, Royal College of Physicians, London, London, UK
| | - Chris Healey
- Gastroenterology and Hepatology Services, Airedale General Hospital, Keighley, West Yorkshire, UK
| | - Ian Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark Coleman
- Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, Plymouth, UK
| | - Matt Rutter
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, UK
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Tanner E, Munro APS, Gray J, Green H, Rutter M, Jones CE, Faust SN, Alderton M, Patel SV. Improving paediatric antimicrobial stewardship in hospital-based settings: why, where and how? JAC Antimicrob Resist 2020; 2:dlaa011. [PMID: 34222969 PMCID: PMC8210213 DOI: 10.1093/jacamr/dlaa011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is being recognized as a priority by healthcare organizations across the world. However, many children are managed on IV antimicrobials in hospital with very little consideration of antimicrobial stewardship issues. Objectives A nurse-led paediatric ambulatory outpatient parenteral antimicrobial therapy (OPAT) service, managing children with common infections being ambulated on short courses of IV antimicrobials, was introduced within Southampton Children’s Hospital in January 2018. We evaluated the impact of this service in terms of the quality of antimicrobial prescribing and timing of ambulation in children presenting with common infections. Methods All cases managed within the service were reviewed in two separate 2 month time periods: prior to introduction of the service (September–October 2016) and then prospectively after its introduction (September–October 2018). Results A total of 96% of IV antibiotic management decisions at 48 h were deemed appropriate in 2018, compared with 75% in 2016. A total of 64% of patients were ambulated on IV antibiotics at some point during their treatment course in 2018, compared with 19% in 2016. However, a significant proportion of antimicrobial decisions made at the point of presentation to hospital remained suboptimal in 2018. Conclusions Children are commonly managed with IV antibiotics in hospital. We demonstrate marked improvements in appropriate antimicrobial use through the introduction of a nurse-led ambulatory OPAT service. In addition, such a service can promote a greater proportion of children being ambulated from hospital, freeing up valuable inpatient beds and potentially delivering cost savings that can be used to fund such services.
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Affiliation(s)
- E Tanner
- University of Southampton Medical School, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A P S Munro
- Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Gray
- Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H Green
- Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Rutter
- Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C E Jones
- Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - S N Faust
- Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - M Alderton
- Department of Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S V Patel
- Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Wang H, Lane J, Jones S, Dashti H, Ollila H, Wood A, van Hees V, Brumpton B, Winsvold B, Kantojärvi K, Palviainen T, Cade B, Sofer T, Song Y, Patel K, Anderson S, Bechtold D, Bowden J, Emsley R, Kyle S, Little M, Loudon A, Scheer F, Purcell S, Richmond R, Spiegelhalder K, Tyrrell J, Zhu X, Hublin C, Kaprio J, Kristiansson K, Sulkava S, Paunio T, Hveem K, Nielsen J, Willer C, Zwart JA, Strand L, Frayling T, Ray D, Lawlor D, Rutter M, Weedon M, Redline S, Saxena R. Genome-wide association analysis of self-reported daytime sleepiness identifies 42 loci that suggest biological subtypes. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hassan C, Rutter M, Repici A. En Bloc Resection for 10-20 mm Polyps to Reduce Post Colonoscopy Cancer and Surveillance. Clin Gastroenterol Hepatol 2019; 17:2173-2175. [PMID: 30995528 DOI: 10.1016/j.cgh.2019.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Matt Rutter
- Northern Institute for Cancer Research, Newcastle University, Newcastle; Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, United Kingdom
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Wong B, Summer S, Horn P, Rutter M, Rybalsky I, Tian C, Shellenbarger K, Hu S, Bange J, Kalkwarf H. P.260Lean muscle mass changes in patients with Duchenne and Becker muscular dystrophies. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.374] [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: 11/30/2022]
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Repici A, Wallace MB, East JE, Sharma P, Ramirez FC, Bruining DH, Young M, Gatof D, Irene Mimi Canto M, Marcon N, Cannizzaro R, Kiesslich R, Rutter M, Dekker E, Siersema PD, Spaander M, Kupcinskas L, Jonaitis L, Bisschops R, Radaelli F, Bhandari P, Wilson A, Early D, Gupta N, Vieth M, Lauwers GY, Rossini M, Hassan C. Efficacy of Per-oral Methylene Blue Formulation for Screening Colonoscopy. Gastroenterology 2019; 156:2198-2207.e1. [PMID: 30742834 DOI: 10.1053/j.gastro.2019.02.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Topically applied methylene blue dye chromoendoscopy is effective in improving detection of colorectal neoplasia. When combined with a pH- and time-dependent multimatrix structure, a per-oral methylene blue formulation (MB-MMX) can be delivered directly to the colorectal mucosa. METHODS We performed a phase 3 study of 1205 patients scheduled for colorectal cancer screening or surveillance colonoscopies (50-75 years old) at 20 sites in Europe and the United States, from December 2013 through October 2016. Patients were randomly assigned to groups given 200 mg MB-MMX, placebo, or 100 mg MB-MMX (ratio of 2:2:1). The 100-mg MB-MMX group was included for masking purposes. MB-MMX and placebo tablets were administered with a 4-L polyethylene glycol-based bowel preparation. The patients then underwent colonoscopy by an experienced endoscopist with centralized double-reading. The primary endpoint was the proportion of patients with 1 adenoma or carcinoma (adenoma detection rate [ADR]). We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for differences in detection between the 200-mg MB-MMX and placebo groups. False-positive (resection rate for non-neoplastic polyps) and adverse events were assessed as secondary endpoints. RESULTS The ADR was higher for the MB-MMX group (273 of 485 patients, 56.29%) than the placebo group (229 of 479 patients, 47.81%) (OR 1.46; 95% CI 1.09-1.96). The proportion of patients with nonpolypoid lesions was higher in the MB-MMX group (213 of 485 patients, 43.92%) than the placebo group (168 of 479 patients, 35.07%) (OR 1.66; 95% CI 1.21-2.26). The proportion of patients with adenomas ≤5 mm was higher in the MB-MMX group (180 of 485 patients, 37.11%) than the placebo group (148 of 479 patients, 30.90%) (OR 1.36; 95% CI 1.01-1.83), but there was no difference between groups in detection of polypoid or larger lesions. The false-positive rate did not differ significantly between groups (83 [23.31%] of 356 patients with non-neoplastic lesions in the MB-MMX vs 97 [29.75%] of 326 patients with non-neoplastic lesions in the placebo group). Overall, 0.7% of patients had severe adverse events but there was no significant difference between groups. CONCLUSIONS In a phase 3 trial of patients undergoing screening or surveillance colonoscopies, we found MB-MMX led to an absolute 8.5% increase in ADR, compared with placebo, without increasing the removal of non-neoplastic lesions. Clinicaltrials.gov no: NCT01694966.
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Affiliation(s)
| | | | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Prateek Sharma
- Kansas City Veterans Affairs Hospital, Kansas City, Missouri
| | | | | | | | - David Gatof
- Clinical Research of the Rockies, Lafayette, Colorado
| | | | | | | | - Ralf Kiesslich
- St. Marienkrankenhaus, Frankfurt, Germany; Horst Schmidt Kliniken GmbH, Wiesbaden, Germany
| | - Matt Rutter
- University Hospital of North Tees, Stockton-on-Tees, United Kingdom
| | | | | | | | | | | | | | | | - Pradeep Bhandari
- Solent Centre for Digestive Diseases, Portsmouth, United Kingdom
| | - Ana Wilson
- St. Mark's Hospital, London, United Kingdom
| | - Dayna Early
- Washington University School of Medicine, St. Louis, Missouri
| | - Neil Gupta
- Loyola University Medical Center, Maywood, Illinois
| | - Michael Vieth
- Institut für Pathologie Klinikum Bayreuth GmbH, Bayreuth, Germany
| | | | | | - Cesare Hassan
- Ospedale Nuovo Regina, Margherita, Gastroenterology Unit, Roma, Italy
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Affiliation(s)
- M Rutter
- MRC Child Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF
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Abstract
The main focus is on the assessment of the effects of early institutional care and compares three longitudinal studies from Romania, Greece and Hong Kong/China. The findings have been strikingly contrasting. The review asks if the risks are dependent on whether or not the institutional rearing is accompanied by gross pervasive deprivation (as it was in Romania) and investigates the methodological issues to explore the causal influence of the outcomes. Evidence is considered on changing institutional practices and the benefits of doing so. Comparison is made between institutions with major deprivation and those without global deprivation. A small number of studies are discussed that look at direct comparisons between institutional and community care. The empirical and conceptual implications of the findings are discussed.
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Affiliation(s)
- S Woodhouse
- MRC Social,Genetic and Developmental Psychiatry Centre,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
| | - A Miah
- MRC Social,Genetic and Developmental Psychiatry Centre,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
| | - M Rutter
- MRC Social,Genetic and Developmental Psychiatry Centre,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
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Bisschops R, Bessissow T, Dekker E, East JE, Para-Blanco A, Ragunath K, Bhandari P, Rutter M, Schoon E, Wilson A, John JM, Van Steen K, Baert F, Ferrante M. Pit pattern analysis with high-definition chromoendoscopy and narrow-band imaging for optical diagnosis of dysplasia in patients with ulcerative colitis. Gastrointest Endosc 2017; 86:1100-1106.e1. [PMID: 28986266 DOI: 10.1016/j.gie.2017.09.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/22/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with longstanding ulcerative colitis (UC) are at increased risk of developing colorectal neoplasia. Chromoendoscopy (CE) increases detection of lesions, and Kudo pit pattern classification I and II have been suggested to be predictive of benign polyps in UC. Little is known on the use of this classification in nonmagnified high-definition (HD) (virtual) CE and narrow-band Imaging (NBI) or on the interobserver agreement. The aim of this pilot study was to assess the diagnostic accuracy and the interobserver agreement of the Kudo pit pattern classification in UC patients undergoing surveillance with methylene blue CE or NBI in a multicenter study. METHODS Fifty images of lesions identified in 27 UC patients (13 neoplastic) either with classical CE (methylene blue .1%; n = 24) or NBI (n = 26) were selected by an independent investigator. Images were selected from a randomized controlled trial to compare CE and NBI. All nonmagnified images were obtained with a processor and mounted in a PowerPoint file in a standardized way (same size; black background). Ten endoscopists with extensive experience in NBI/CE were asked to assess the lesions for the predominant Kudo pit pattern (I, II, IIIL, IIIS, IV, and V) to indicate if they believed the lesion was neoplastic and how confident they were about the diagnosis. Histology was used as the criterion standard. RESULTS Median sensitivity, specificity, negative predictive value, and positive predictive value for diagnosing neoplasia based on the presence of pit pattern other than I or II was 77%, 68%, 88%, and 46%, respectively. Diagnostic accuracy was significantly higher when a diagnosis was made with a high level of confidence (77% vs 21%, P < .001). The overall interobserver agreement for any pit pattern was only fair (κ = .282), with CE being significantly better than NBI (.322 vs .224, P < .001). From a clinical viewpoint the difference between neoplastic and non-neoplastic lesions is important. The agreement for differentiation between non-neoplastic patterns (I, II) and neoplastic patterns (IIIL, IIIS, IV, or V) was moderate (κ = .587) and even significantly better for NBI in comparison with CE (κ = .653 vs .495, P < .001). CONCLUSIONS Differentiation between non-neoplastic and neoplastic pit patterns in UC lesions shows a moderate to substantial agreement among expert endoscopists. The agreement for differentiating neoplastic from non-neoplastic lesions is significantly better for NBI in comparison with HD CE. The assessment of pit pattern I or II with nonmagnified HD CE or NBI has a high negative predictive value to rule out neoplasia. (Clinical trial registration number: NCT01882205.).
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Affiliation(s)
- Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Talat Bessissow
- Division of Gastroenterology, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Adolfo Para-Blanco
- NIHR Nottingham Digestive Diseases Biomedical Research Unit City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Pradeep Bhandari
- Department of Gastroenterology, Spire Portsmouth Hospital, Portsmouth, United Kingdom
| | - Matt Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, United Kingdom, and School of Medicine, Durham University, Durham, United Kingdom
| | - Erik Schoon
- Department of Gastroenterology, Catherina Hospital, Eindhoven, The Netherlands
| | - Ana Wilson
- Wolfson Unit for Endoscopy, St. Mark's Hospital, London, United Kingdom
| | | | - Kristel Van Steen
- Medical Genomics Unit, BIO3, GIGA-R, University of Liège, Liège, Belgium
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
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Abstract
BACKGROUND AND STUDY AIMS There is very little literature defining characteristics of expert endoscopists. It is hypothesised that previously undetermined human factors may correlate with high performance in screening colonoscopists. The aim of this study was to determine factors contributing towards expertise in screening colonoscopy. MATERIALS AND METHODS A focus group was used to hypothesise skills considered to be relevant to high performance in colonoscopy. The skills were then ranked in order of importance by an independent group of screening colonoscopists for both diagnostic and therapeutic colonoscopy. Twenty screening colonoscopists subsequently participated in individual semi-structured interviews to explore participants' views of expertise and the factors contributing to it. Data extracted from the interview transcripts were used to identify the thematic framework associated with expertise. RESULTS The 5 initial highest-ranked themes were low complication rates, high adenoma detection rates, interpersonal skills with staff, communication skills, and manner with patients. Interviewees considered technical skills (20/20), previous experience of colonoscopy (19/20), judgment/decision-making (18/20), communication (18/20), teamwork (15/20), resources (11/20) and leadership (8/20) to be the most important themes related to expertise. CONCLUSIONS Both technical and non-technical abilities are considered essential components of expertise by experienced colonoscopists. Further research into targeted interventions to improve the rate of acquisition of these skills in training endoscopists may be useful in improving performance.
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Affiliation(s)
- Kinesh Patel
- Wolfson Unit for Endoscopy, St. Mark’s Hospital, London, United Kingdom of Great Britain and Northern Ireland
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Anna Pinto
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Omar Faiz
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Matt Rutter
- University Hospital of North Tees, Stockport, United Kingdom of Great Britain and Northern Ireland
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St. Mark’s Hospital, London, United Kingdom of Great Britain and Northern Ireland
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
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Kyle SD, Sexton C, Feige B, Rutter M, Spiegelhalder K. 0323 SLEEP AND COGNITIVE PERFORMANCE: CROSS-SECTIONAL ASSOCIATIONS FROM THE UK BIOBANK (N=477,966). Sleep 2017. [DOI: 10.1093/sleepj/zsx050.322] [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: 11/13/2022] Open
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Lane JM, Kyle S, Spiegelhalder K, Vlasac I, Redline S, Ray D, Rutter M, Saxena R. 0027 A GENETIC LINK BETWEEN SLEEP AND PSYCHIATRIC TRAITS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.026] [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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25
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Lane JM, Vlasac I, Redline S, Ray D, Rutter M, Saxena R. 0004 GENOME-WIDE ASSOCIATION STUDY FOR SNORING IDENTIFIES NOVEL GENETIC FACTORS AND BIOLOGICAL LINKS TO SLEEP APNEA AND OBESITY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.003] [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: 11/13/2022] Open
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26
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Patel K, Faiz O, Rutter M, Dunckley P, Thomas-Gibson S. The impact of the introduction of formalised polypectomy assessment on training in the UK. Frontline Gastroenterol 2017; 8:104-109. [PMID: 28250907 PMCID: PMC5318649 DOI: 10.1136/flgastro-2016-100718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/12/2016] [Accepted: 06/27/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim was to describe the impact on polypectomy experience by the mandatory introduction of the Directly Observed Polypectomy Skills tool (DOPyS) and electronic portfolio as part of the formal colonoscopy certification process. DESIGN Applications for colonoscopy certification in the UK in the year prior to the introduction of DOPyS were analysed retrospectively and compared with data collected prospectively for those in the following year. SETTING UK National Health Service. PATIENTS None. INTERVENTIONS None. MAIN OUTCOME MEASURES The outcomes studied included whether evidence of exposure to polypectomy, endoscopic mucosal resection (EMR) and colonoscopy changed over the 2-year period. The nature of the polyps removed by trainees was also studied. RESULTS Thirty two per cent of candidates in the first year had evidence of any observed polypectomy with 7% of candidates referring to training in EMR. The median number of formative colonoscopy assessments was 3 (range 0-16). All of these candidates in the second year had evidence of polypectomy assessment, with a median number of DOPyS of 7 (range 3-27). Eighty nine per cent of applicants had evidence of assessed EMR. The median number of formative colonoscopy assessments in this cohort was 32 (range 9-199). There was a significant increase in the number of logged polypectomy assessments (p<0.001), experience of EMR (p<0.001) and formative colonoscopy assessments (p<0.001). There was no significant difference in the total number of colonoscopy procedures performed. CONCLUSIONS Structured polypectomy assessment improves trainees' documented exposure to therapeutic endoscopy as well as providing formal evidence of skills acquisition. As polypectomy plays an increasing role globally in colorectal cancer prevention, the DOPyS provides an effective means of assessing and certifying polypectomy.
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Affiliation(s)
- Kinesh Patel
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK
| | - Omar Faiz
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK
| | - Matt Rutter
- University Hospital of North Tees, Stockport, UK
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Monahan KJ, Alsina D, Bach S, Buchanan J, Burn J, Clark S, Dawson P, De Souza B, Din FVN, Dolwani S, Dunlop MG, East J, Evans DG, Fearnhead N, Frayling IM, Glynne-Jones R, Hill J, Houlston R, Hull M, Lalloo F, Latchford A, Lishman S, Quirke P, Rees C, Rutter M, Sasieni P, Senapati A, Speake D, Thomas H, Tomlinson I. Urgent improvements needed to diagnose and manage Lynch syndrome. BMJ 2017; 356:j1388. [PMID: 28320700 DOI: 10.1136/bmj.j1388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kevin J Monahan
- Family History of Bowel Cancer Clinic, West Middlesex University Hospital, Chelsea and Westminster Hospitals NHS Trust; Imperial College London, London, UK
| | | | | | | | | | | | - Peter Dawson
- Association of Coloproctology for Great Britain and Ireland
| | | | | | - Sunil Dolwani
- Cardiff University and Welsh Association of Gastroenterology and Endoscopy
| | - Malcolm G Dunlop
- Colon Cancer Genetics Group and Academic Coloproctology, Institute of Genetics and Molecular Medicine
| | | | | | - Nicola Fearnhead
- Cambridge University Hospitals NHS Foundation Trust and Association of Coloproctology of Great Britain and Ireland
| | | | | | | | | | - Mark Hull
- University of Leeds and Leeds Teaching Hospitals NHS Trust
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - Huw Thomas
- St Mark's Hospital, Imperial College London
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Beintaris I, Rutter M. Advanced imaging in colonoscopy: contemporary approach to dysplasia surveillance in inflammatory bowel disease. Frontline Gastroenterol 2016; 7:308-315. [PMID: 28839872 PMCID: PMC5369495 DOI: 10.1136/flgastro-2016-100735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/10/2016] [Accepted: 07/19/2016] [Indexed: 02/04/2023] Open
Abstract
Inflammatory bowel disease (IBD) (ulcerative colitis (UC) and Crohn's disease (CD)) is a chronic relapsing/remitting condition characterised by intestinal inflammation. One of the main concerns in patients with longstanding ulcerative and Crohn's colitis is development of colonic dysplasia and colorectal cancer (CRC), a risk higher than that of the general population. Colonoscopy surveillance programmes have been developed by major societies worldwide to improve early dysplasia detection and treatment, thus preventing progression to colorectal cancer. Colonoscopy is an imperfect tool as lesions can be missed, an issue even more relevant to colitic patients, where mucosal inspection and lesion recognition may prove challenging. Extensive research has been undertaken on performance improvement in this area while technical advances in optical imaging, such as high-definition, have made their way into modern endoscopy units. Techniques and technologies available to enhance optical diagnosis of dysplasia in inflammatory bowel disease are reviewed in this paper, focusing on those that are realistic, widely available and feasible for everyday practice.
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Affiliation(s)
| | - Matt Rutter
- University Hospital of North Tees, Cleveland, UK
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30
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Affiliation(s)
- M Rutter
- Institute of Psychiatry, Maudsley Hospital, London
| | - P Graham
- Institute of Psychiatry, Maudsley Hospital, London
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31
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Affiliation(s)
- M Rutter
- Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF
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Kumsta R, Marzi SJ, Viana J, Dempster EL, Crawford B, Rutter M, Mill J, Sonuga-Barke EJS. Severe psychosocial deprivation in early childhood is associated with increased DNA methylation across a region spanning the transcription start site of CYP2E1. Transl Psychiatry 2016; 6:e830. [PMID: 27271856 PMCID: PMC4931613 DOI: 10.1038/tp.2016.95] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/22/2016] [Accepted: 03/31/2016] [Indexed: 01/09/2023] Open
Abstract
Exposure to adverse rearing environments including institutional deprivation and severe childhood abuse is associated with an increased risk for mental and physical health problems across the lifespan. Although the mechanisms mediating these effects are not known, recent work in rodent models suggests that epigenetic processes may be involved. We studied the impact of severe early-life adversity on epigenetic variation in a sample of adolescents adopted from the severely depriving orphanages of the Romanian communist era in the 1980s. We quantified buccal cell DNA methylation at ~400 000 sites across the genome in Romanian adoptees exposed to either extended (6-43 months; n=16) or limited duration (<6 months; n=17) of severe early-life deprivation, in addition to a matched sample of UK adoptees (n=16) not exposed to severe deprivation. Although no probe-wise differences remained significant after controlling for the number of probes tested, we identified an exposure-associated differentially methylated region (DMR) spanning nine sequential CpG sites in the promoter-regulatory region of the cytochrome P450 2E1 gene (CYP2E1) on chromosome 10 (corrected P=2.98 × 10(-5)). Elevated DNA methylation across this region was also associated with deprivation-related clinical markers of impaired social cognition. Our data suggest that environmental insults of sufficient biological impact during early development are associated with long-lasting epigenetic changes, potentially reflecting a biological mechanism linking the effects of early-life adversity to cognitive and neurobiological phenotypes.
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Affiliation(s)
- R Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - S J Marzi
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Viana
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - E L Dempster
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - B Crawford
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - M Rutter
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Mill
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,University of Exeter Medical School, University of Exeter, Exeter, UK
| | - E J S Sonuga-Barke
- Department of Psychology, Institute for Disorders of Impulse and Attention, Developmental Brain-Behavior Laboratory, University of Southampton, Southampton, UK,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium,Department of Psychology, Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, University of Southampton, Building 44, Highfield Campus, Southampton SO17 1BJ, UK. E-mail:
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Affiliation(s)
| | - Matt Rutter
- University Hospital of North Tees, Stockton-on-Tees, UK
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Tian C, Rutter M, Hornung L, Khoury J, Miller L, Bange J, Wong B. P.2.18 Bone mineral density and bone mineral content as measures of bone health in ambulatory boys with Duchenne Muscular Dystrophy. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rembacken B, Hassan C, Riemann JF, Chilton A, Rutter M, Dumonceau JM, Omar M, Ponchon T. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2012; 44:957-68. [PMID: 22987217 DOI: 10.1055/s-0032-1325686] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- B Rembacken
- Centre for Digestive Diseases, Department of Gastroenterology, The General Infirmary at Leeds, Leeds, United Kingdom.
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Raake J, Johnson B, Seger B, Manning PB, Eghtesady P, Boesch P, Rutter M, Woodard A, Chima RS. Extracorporeal Membrane Oxygenation, Extubation, and Lung-Recruitment Maneuvers as Rescue Therapy in a Patient With Tracheal Dehiscence Following Slide Tracheoplasty. Respir Care 2011; 56:1198-202. [DOI: 10.4187/respcare.00948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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38
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Liu Y, Soran H, Charlton-Menys V, Bhatnagar D, Rutter M, Kwok S, France M, Durrington P. 625 HIGH-DOSE ATORVASTATIN REDUCES APOLIPOPROTEIN E CONCENTRATION SIGNIFICANTLY AND THIS IS INFLUENCED BY THE APOLIPOPROTEIN E GENOTYPE. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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39
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Gupta S, Anderson J, Bhandari P, McKaig B, Rupert P, Rembacken B, Riley S, Rutter M, Valori R, Vance M, van der Vleuten CPM, Saunders BP, Thomas-Gibson S. Development and validation of a novel method for assessing competency in polypectomy: direct observation of polypectomy skills. Gastrointest Endosc 2011; 73:1232-9.e2. [PMID: 21628015 DOI: 10.1016/j.gie.2011.01.069] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 01/29/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite its ubiquitous use over the past 4 decades, there is no structured, formal method with which to assess polypectomy. OBJECTIVE To develop and validate a new method with which to assess competency in polypectomy. DESIGN Polypectomy underwent task deconstruction, and a structured checklist and global assessment scale were developed (direct observation of polypectomy skills [DOPyS]). Sixty bowel cancer screening polypectomy videos were randomly chosen for analysis and were scored independently by 7 expert assessors by using DOPyS. Each parameter and the global rating were scored from 1 to 4 (scores ≥3 = competency). The scores were analyzed by using generalizability theory (G theory). SETTING Multicenter. RESULTS Fifty-nine of the 60 videos were assessable and scored. The majority of the assessors agreed across the pass/fail divide for the global assessment scale in 58 of 59 (98%) polyps. For G-theory analysis, 47 of the 60 videos were analyzed. G-theory analysis suggested that DOPyS is a reliable assessment tool, provided that it is used by 2 assessors to score 5 polypectomy videos all performed by 1 endoscopist. DOPyS scores obtained in this format would reflect the endoscopist's competence. LIMITATIONS Small sample and polyp size. CONCLUSIONS This study is the first attempt to develop and validate a tool designed specifically for the assessment of technical skills in performing polypectomy. G-theory analysis suggests that DOPyS could reliably reflect an endoscopist's competence in performing polypectomy provided a requisite number of assessors and cases were used.
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Affiliation(s)
- Sachin Gupta
- Wolfson Unit for Endoscopy, St. Mark's Hospital and Imperial College London HA1 3UJ., United Kingdom
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Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011; 60:571-607. [PMID: 21464096 DOI: 10.1136/gut.2010.224154] [Citation(s) in RCA: 893] [Impact Index Per Article: 68.7] [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: 12/12/2022]
Abstract
The management of inflammatory bowel disease represents a key component of clinical practice for members of the British Society of Gastroenterology (BSG). There has been considerable progress in management strategies affecting all aspects of clinical care since the publication of previous BSG guidelines in 2004, necessitating the present revision. Key components of the present document worthy of attention as having been subject to re-assessment, and revision, and having direct impact on practice include: The data generated by the nationwide audits of inflammatory bowel disease (IBD) management in the UK in 2006, and 2008. The publication of 'Quality Care: service standards for the healthcare of people with IBD' in 2009. The introduction of the Montreal classification for Crohn's disease and ulcerative colitis. The revision of recommendations for the use of immunosuppressive therapy. The detailed analysis, guidelines and recommendations for the safe and appropriate use of biological therapies in Crohn's disease and ulcerative colitis. The reassessment of the role of surgery in disease management, with emphasis on the importance of multi-disciplinary decision-making in complex cases. The availablity of new data on the role of reconstructive surgery in ulcerative colitis. The cross-referencing to revised guidelines for colonoscopic surveillance, for the management of metabolic bone disease, and for the care of children with inflammatory bowel disease. Use of the BSG discussion forum available on the BSG website to enable ongoing feedback on the published document http://www.bsg.org.uk/forum (accessed Oct 2010). The present document is intended primarily for the use of clinicians in the United Kingdom, and serves to replace the previous BSG guidelines in IBD, while complementing recent consensus statements published by the European Crohn's and Colitis Organisation (ECCO) https://www.ecco-ibd.eu/index.php (accessed Oct 2010).
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Affiliation(s)
- Craig Mowat
- Gastrointestinal Unit, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.
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Tierney S, Deaton C, Mamas M, Rutter M, Gibson M, Neyses L. P89 Understanding barriers and enablers of physical activity among patients with heart failure: a systematic review of qualitative studies. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-5151(11)60102-3] [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: 10/18/2022]
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Tierney S, Deaton C, Elwers H, Sange C, Mamas M, Rutter M, Gibson M, Neyses L. 21 Physical activity as heart failure therapy: patient perspectives. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-5151(11)60095-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tierney S, Deaton C, Mamas M, Rutter M, Gibson M, Neyses L. P89 Poster Understanding Barriers and Enablers of Physical Activity among Patients with Heart Failure: A Systematic Review of Qualitative Studies. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-51511160102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S. Tierney
- University of Manchester, Manchester, United Kingdom
| | - C. Deaton
- University of Manchester, Manchester, United Kingdom
| | - M. Mamas
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M. Rutter
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M. Gibson
- University of Manchester, Manchester, United Kingdom
| | - L. Neyses
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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44
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Tierney S, Deaton C, Elwers H, Sange C, Mamas M, Rutter M, Gibson M, Neyses L. 21 Oral Physical activity as heart failure therapy: patient perspectives. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-51511160095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S. Tierney
- University of Manchester, Manchester, United Kingdom
| | - C. Deaton
- University of Manchester, Manchester, United Kingdom
| | - H. Elwers
- University Hospitals of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - C. Sange
- University of Manchester, Manchester, United Kingdom
| | - M. Mamas
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M. Rutter
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M. Gibson
- University of Manchester, Manchester, United Kingdom
| | - L. Neyses
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Abstract
BACKGROUND Data from a representative community sample were used to explore predictors of lifetime suicidality and to examine associations between distal adolescent and more proximal adult risks. METHOD Data are from a midlife follow-up of the Isle of Wight study, an epidemiological sample of adolescents assessed in 1968. Ratings of psychiatric symptoms and disorder, relationships and family functioning and adversity were made in adolescence; adult assessments included lifetime psychiatric history and suicidality, neuroticism and retrospective reports of childhood sexual abuse and harsh parenting. RESULTS A wide range of measures of childhood psychopathology, adverse experiences and interpersonal difficulties were associated with adult suicidality; associations were particularly strong for adolescent irritability, worry and depression. In multivariate analyses, substantial proportions of these effects could be explained by their association with adult psychopathology and neuroticism, but additional effects remained for adolescent irritability and worry. CONCLUSIONS Factors of importance for long-term suicidality risk are evident in adolescence. These include family and experiential adversities as well as psychopathology. In particular, markers of adolescent worry and irritability appeared both potent risks and ones with additional effects beyond associations with adult disorder and adult neuroticism.
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Affiliation(s)
- A Pickles
- Biostatistics, Health Methodology Research Group, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK.
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46
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Rutter M. Commentary: Fact and artefact in the secular increase in the rate of autism. Int J Epidemiol 2009; 38:1238-9; author reply 1243-4. [DOI: 10.1093/ije/dyp257] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Maughan B, Messer J, Collishaw S, Pickles A, Snowling M, Yule W, Rutter M. Persistence of literacy problems: spelling in adolescence and at mid-life. J Child Psychol Psychiatry 2009; 50:893-901. [PMID: 19490310 DOI: 10.1111/j.1469-7610.2009.02079.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [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: 11/30/2022]
Abstract
BACKGROUND Developmental reading problems show strong persistence across the school years; less is known about poor readers' later progress in literacy skills. METHOD Poor (n = 42) and normally developing readers (n = 86) tested in adolescence (ages 14/15 years) in the Isle of Wight epidemiological studies were re-contacted at mid-life (ages 44/45 years). Participants completed a spelling test, and reported on educational qualifications, perceived adult spelling competence, and problems in day-to-day literacy tasks. RESULTS Individual differences in spelling were highly persistent across this 30-year follow-up, with correlations between spelling at ages 14 and 44 years of r = .91 (p < .001) for poor readers and r = .89 (p < .001) for normally developing readers. Poor readers' spelling remained markedly impaired at mid-life, with some evidence that they had fallen further behind over the follow-up period. Taking account of adolescent spelling levels, continued exposure to reading and literacy demands in adolescence and early adulthood was independently predictive of adult spelling in both samples; family social background added further to prediction among normally developing readers only. CONCLUSIONS By adolescence, individual differences in spelling and its related sub-skills are highly stable. Encouraging young people with reading disabilities to maintain their exposure to reading and writing may be advantageous in the longer term.
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Affiliation(s)
- B Maughan
- MRC Social, Genetic & Developmental Psychiatry Centre, King's College London Institute of Psychiatry, London, UK.
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Abstract
There have been numerous exhortations for more 'translational research'. A selective review of historical examples of research leading to health benefits is used to consider the various forms of successful interplay between basic science and clinical applications. This is followed by a consideration of key neuroscience findings that might be relevant for translation, and then by a discussion of the challenges and opportunities in relation to mental disorders. The time-frame for the pathway from science findings to health benefits is usually long, and generally requires an interactive interplay among different scientific strategies. There is a false dichotomy between so-called basic and applied research and translation needs to proceed from the bedside to the laboratory as well as in the opposite direction. There is a key need for bridging research of the hypothesis-testing experimental medicine variety. Health benefits may involve either public health considerations or the treatment of individual patients, or both. There are now some opportunities for direct translational research but there is a much greater need for hypothesis-based bridging studies that occupy a crucial mid-phase in the pathway from science findings to health benefits.
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Affiliation(s)
- M Rutter
- Institute of Psychiatry, King's College London, London, UK.
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Milne B, Caspi A, Crump R, Poulton R, Rutter M, Sears M, Moffitt T. The validity of the family history screen for assessing family history of mental disorders. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:41-9. [PMID: 18449865 PMCID: PMC3750954 DOI: 10.1002/ajmg.b.30764] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is a need to collect psychiatric family history information quickly and economically (e.g., for genome-wide studies and primary care practice). We sought to evaluate the validity of family history reports using a brief screening instrument, the Family History Screen (FHS). We assessed the validity of parents' reports of seven psychiatric disorders in their adult children probands from the Dunedin Study (n = 959, 52% male), using the proband's diagnosis as the criterion outcome. We also investigated whether there were informant characteristics that enhanced accuracy of reporting or were associated with reporting biases. Using reports from multiple informants, we obtained sensitivities ranging from 31.7% (alcohol dependence) to 60.0% (conduct disorder) and specificities ranging from 76.0% (major depressive episode) to 97.1% (suicide attempt). There was little evidence that any informant characteristics enhanced accuracy of reporting. However, three reporting biases were found: the probability of reporting disorder in the proband was greater for informants with versus without a disorder, for female versus male informants, and for younger versus older informants. We conclude that the FHS is as valid as other family history instruments (e.g., the FH-RDC, FISC), and its brief administration time makes it a cost-effective method for collecting family history data. To avoid biasing results, researchers who aim to compare groups in terms of their family history should ensure that the informants reporting on these groups do not differ in terms of age, sex or personal history of disorder.
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Affiliation(s)
- B.J. Milne
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK,Correspondence to: B.J. Milne, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, P080, De Crespigny Park, London SE5 8AF, UK.,
| | - A. Caspi
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK,Departments of Psychology and Neuroscience, and Psychiatry and Behavioral Sciences, Institute for Genome Sciences and Policy, Duke University, Durham, North Carolina
| | - R. Crump
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - R. Poulton
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - M. Rutter
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK
| | - M.R. Sears
- Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - T.E. Moffitt
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK,Departments of Psychology and Neuroscience, and Psychiatry and Behavioral Sciences, Institute for Genome Sciences and Policy, Duke University, Durham, North Carolina
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Milne BJ, Moffitt TE, Crump R, Poulton R, Rutter M, Sears MR, Taylor A, Caspi A. How should we construct psychiatric family history scores? A comparison of alternative approaches from the Dunedin Family Health History Study. Psychol Med 2008; 38:1793-1802. [PMID: 18366822 PMCID: PMC3752774 DOI: 10.1017/s0033291708003115] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is increased interest in assessing the family history of psychiatric disorders for both genetic research and public health screening. It is unclear how best to combine family history reports into an overall score. We compare the predictive validity of different family history scores. METHOD Probands from the Dunedin Study (n=981, 51% male) had their family history assessed for nine different conditions. We computed four family history scores for each disorder: (1) a simple dichotomous categorization of whether or not probands had any disordered first-degree relatives; (2) the observed number of disordered first-degree relatives; (3) the proportion of first-degree relatives who are disordered; and (4) Reed's score, which expressed the observed number of disordered first-degree relatives in terms of the number expected given the age and sex of each relative. We compared the strength of association between each family history score and probands' disorder outcome. RESULTS Each score produced significant family history associations for all disorders. The scores that took account of the number of disordered relatives within families (i.e. the observed, proportion, and Reed's scores) produced significantly stronger associations than the dichotomous score for conduct disorder, alcohol dependence and smoking. Taking account of family size (i.e. using the proportion or Reed's score) produced stronger family history associations depending on the prevalence of the disorder among family members. CONCLUSIONS Dichotomous family history scores can be improved upon by considering the number of disordered relatives in a family and the population prevalence of the disorder.
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Affiliation(s)
- B J Milne
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.
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