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Poynton M, Gilmour-Hamilton C, Dale-Harris I, Clarke E, Stanworth S, Murphy M, Roy N. The future of myelodysplastic syndrome-patient priorities and outcomes that matter. Front Med (Lausanne) 2023; 10:1267139. [PMID: 38164222 PMCID: PMC10757956 DOI: 10.3389/fmed.2023.1267139] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background Without a definitive curative option available to many patients, learning to live with myelodysplastic syndrome (MDS) and manage symptoms effectively becomes a priority in their care. Anaemia is an almost universal feature of MDS. Individuals suffer differently and better individualisation of care is needed. Most MDS patient information offers scant appreciation for disease heterogeneity, variable response to treatment and each patient's likely trajectory. Methods We undertook a two-part, online workshop to discuss what matters most to people living with MDS. Patients generated questions about their condition which they felt should be addressed by research or change how their care is delivered. Patients voted on the importance of each topic, creating a "prioritised" list of issues. Results Fourteen participants of varying age and experience took part raising 56 unique questions under the themes of: prognosis; end of life; treatment; supportive care; medical staff training; diagnosis and communication. These reflect the symptoms of MDS, improving quality of life (QoL) and communication. Discussion Although haemoglobin (Hb) levels have correlation to QoL, it is widely reported that other factors are important in determining QoL and need for transfusions varies despite stable Hb levels. We showed that Hb level and the need for transfusions is not comparable between different patients and even non-comparable over time meaning that the maximal benefit and timing of transfusions cannot be determined from Hb alone. This workshop highlighted patient dissatisfaction with the "numbers-led" approach and the need for an alternative method to determine when to transfuse.
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Affiliation(s)
- Matthew Poynton
- Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | | | - Isabella Dale-Harris
- Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Evelyn Clarke
- Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Simon Stanworth
- NHS Blood and Transplant, Radcliffe Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Mike Murphy
- NHS Blood and Transplant, Radcliffe Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Noémi Roy
- Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Mo A, Poynton M, Wood E, Shortt J, Brunskill SJ, Doree C, Sandercock J, Saadah N, Luk E, Stanworth SJ, McQuilten Z. Do anemia treatments improve quality of life and physical function in patients with myelodysplastic syndromes (MDS)? A systematic review. Blood Rev 2023; 61:101114. [PMID: 37479599 DOI: 10.1016/j.blre.2023.101114] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
Anemia is common in Myelodysplastic Syndromes (MDS). Different anemia treatments have been tested in clinical studies, but the full impact on patients' health-related quality of life (HRQoL) and physical function is unknown. The main aim of this review was to assess whether improvements in anemia are associated with changes in HRQoL/physical function. Twenty-six full-text publications were identified, enrolling 2211 patients: nine randomized trials (RCTs), fourteen non-randomized studies of interventions and three cross-sectional studies. Interventions included: growth factors/erythropoiesis-stimulating agents (n = 14), red cell transfusion (n = 9), erythroid maturation agents (n = 1), or a combination (n = 2). Five RCTs reported no changes in HRQoL despite erythroid response to the intervention, raising the question of whether anemia treatment alone can effectively improve HRQoL. Many studies were considered at high risk of bias for assessing HRQoL. There is a pressing need for future clinical trials to better define the nature of the relationship between anemia and HRQoL/functional outcomes.
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Affiliation(s)
- Allison Mo
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia; Department of Haematology, Monash Health, Clayton, Australia; Austin Pathology & Department of Haematology, Heidelberg, Australia
| | - Matthew Poynton
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Erica Wood
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia; Department of Haematology, Monash Health, Clayton, Australia
| | - Jake Shortt
- Department of Haematology, Monash Health, Clayton, Australia; School of Clinical Sciences, Monash University, Australia
| | - Susan J Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | - Josie Sandercock
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | - Nicholas Saadah
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
| | - Edwin Luk
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia
| | - Simon J Stanworth
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; NHS Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom; Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia; Department of Haematology, Monash Health, Clayton, Australia.
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Rowan B, Narus S, Smith M, Hastings T, Poynton M, Nebeker J, Hales J, Evans RS, Olola CHO. Implementation of an Emergency Medical Card and a Continuity of Care. Methods Inf Med 2018; 48:519-30. [DOI: 10.3414/me09-01-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 05/02/2009] [Indexed: 11/09/2022]
Abstract
Summary
Objectives: To describe the design and implementation procedures for an emergency medical card (EMC) and a continuity of care (CoC) report using the continuity of care record (CCR) standard. We also describe studies to evaluate the effectiveness of these documents in Co C.
Methods: We convened weekly planning, design, development, implementation, and evaluation meetings, involving 25 outpatient clinics at Intermountain Healthcare. The CCR standard schema and documentation from American Society for Testing and Materials were used to develop the data model. An outside consultant provided further advice on committee-approved designs. We then developed a functional design document for the CCR application implementation. Healthcare professionals (medical doctors and physician assistants) and fourth-year medical students will simulate the will simulate the EMC and CoC report use and assess their usefulness in Co C. The reviewers will review three randomly selected patient cases, using patient information in the electronic medical record, EMC and CoC report. A structured questionnaire with Likert scale will assess the reviewers’ perceptions of the documents’ usefulness in medical decision making. Other studies will compare patient- and HCP-entered data to evaluate the effect of patient-entered data on the quality of HCP-entered data and assess user-satisfaction with the documents’ usefulness in Co C.
Results: An automated CCR application compliant with the CCR standard was developed and integrated in an already implemented patient portal at the Intermountain Healthcare clinics. Patients use the application to view, add, modify their information and use the data plus EMR data to create EMC and CoC report.
Conclusions: The CCR standard can be used to implement an application to enable patients to not only view but add or modify personal health records, and create, print and share paper EMC and CoC report with HCPs. The documents can be created using HCP-maintained EMR data, in addition to patient-entered data as is currently the norm.
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Abstract
BACKGROUND Implementing community water fluoridation involves costs, but these need to be considered against the likely benefits. We aimed to assess the cost-benefit and cost-effectiveness of water fluoridation in New Zealand (NZ) in terms of expenditure and quality-adjusted life years. METHODS Based on published studies, we determined the risk reduction effects of fluoridation, we quantified its health benefits using standardised dental indexes, and we calculated financial savings from averted treatment. We analysed NZ water supplies to estimate the financial costs of fluoridation. We devised a method to represent dental caries experience in quality-adjusted life years. RESULTS Over 20 years, the net discounted saving from adding fluoride to reticulated water supplies supplying populations over 500 would be NZ$1401 million, a nine times pay-off. Between 8800 and 13,700 quality-adjusted life years would be gained. While fluoridating reticulated water supplies for large communities is cost-effective, it is unlikely to be so with populations smaller than 500. CONCLUSIONS Community water fluoridation remains highly cost-effective for all but very small communities. The health benefits-while (on average) small per person-add up to a substantial reduction in the national disease burden across all ethnic and socioeconomic groups.
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Affiliation(s)
- David Moore
- Sapere Research Group Limited, PO Box 587, Wellington, New Zealand
| | - Matthew Poynton
- Sapere Research Group Limited, PO Box 587, Wellington, New Zealand
| | - Jonathan M. Broadbent
- Sir John Walsh Research Institute, School of Dentistry, The University of Otago, PO Box 56, Dunedin, New Zealand
| | - W. Murray Thomson
- Sir John Walsh Research Institute, School of Dentistry, The University of Otago, PO Box 56, Dunedin, New Zealand
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Moodie P, Metcalfe S, Poynton M. Do pharmaceutical score cards give us the answers we seek? N Z Med J 2011; 124:69-74. [PMID: 22143855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Few countries can afford to fund all pharmaceuticals for all of their people all of the time, and the current international economic climate brings this into clearer focus. Various agencies have tried to solve the problem in different ways, varying from funding a restricted list that applies to the whole population, to funding most medicines but with a significant part charge, or as in the United States, funding for only selected groups and leaving others to fend for themselves other than in an emergency. For countries like New Zealand and Australia who have universal health coverage but restricted (and different) lists of funded pharmaceuticals, comparisons of those lists can occur, but are problematic. Comparisons need to be interpreted with caution as systems and policies vary between countries. That one country funds more new medicines than the other is one thing, but the more important questions are whether one country gets more health gains and more value for precious health dollars than the other.
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Affiliation(s)
- Peter Moodie
- PHARMAC, PO Box 10-254, Wellington, New Zealand.
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Olola CHO, Narus S, Poynton M, Nebeker J, Hales J, Rowan B, Smith M, Evans RS. Patient-perceived usefulness of an emergency medical card and a continuity-of-care report in enhancing the quality of care. Int J Qual Health Care 2010; 23:60-7. [PMID: 21163777 DOI: 10.1093/intqhc/mzq073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the patients' opinion on the usefulness of the electronic medical card (EMC) and continuity-of-care report in enhancing quality of care, and to assess the effects of the patient-entered data on the quality of data in the electronic medical record (EMR). DESIGN A structured survey assessed patients' opinion on the usefulness of the EMC and continuity-of-care report. The accuracy of EMR data involved comparing the patient-entered data in the continuity-of-care report with the healthcare-provider-entered data in the EMR. The analysis assessed whether the EMR information was consistent with the patient-entered data. A data completeness evaluation compared data entries in the EMR collected before and after the use of continuity-of-care record application. RESULTS One hundred and thirty-three patients used the application, of which 76% who had actually used the EMC and continuity-of-care report to seek medical care and/or update EMR information were surveyed. Age was associated with the reported usefulness of the documents. Few users (16%) printed the continuity-of-care reports to take to their healthcare providers for data updates and fewer (9%) to correct errors in the EMR. Overall, 68% of patients found the documents to be useful. CONCLUSIONS Patients reported that the EMC and continuity-of-care report were useful in enhancing quality of care. They were able to identify missing or erroneous data in the EMR data, making them an important source of quality control for their information in the healthcare-provider-maintained EMR.
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Affiliation(s)
- C H O Olola
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah 84112, USA.
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Dry LJ, Poynton M, Thompson ME, Warren FL. 947. The alkaloids of the amaryllidaceae. Part IV. The alkaloids of brunsvigia cooperi baker. ACTA ACUST UNITED AC 1958. [DOI: 10.1039/jr9580004701] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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