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Mangiola S, Milton M, Ranathunga N, Li-Wai-Suen C, Odainic A, Yang E, Hutchison W, Garnham A, Iskander J, Pal B, Yadav V, Rossello J, Carey VJ, Morgan M, Bedoui S, Kallies A, Papenfuss AT. A multi-organ map of the human immune system across age, sex and ethnicity. bioRxiv 2024:2023.06.08.542671. [PMID: 38746418 PMCID: PMC11092463 DOI: 10.1101/2023.06.08.542671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Understanding tissue biology's heterogeneity is crucial for advancing precision medicine. Despite the centrality of the immune system in tissue homeostasis, a detailed and comprehensive map of immune cell distribution and interactions across human tissues and demographics remains elusive. To fill this gap, we harmonised data from 12,981 single-cell RNA sequencing samples and curated 29 million cells from 45 anatomical sites to create a comprehensive compositional and transcriptional healthy map of the healthy immune system. We used this resource and a novel multilevel modelling approach to track immune ageing and test differences across sex and ethnicity. We uncovered conserved and tissue-specific immune-ageing programs, resolved sex-dependent differential ageing and identified ethnic diversity in clinically critical immune checkpoints. This study provides a quantitative baseline of the immune system, facilitating advances in precision medicine. By sharing our immune map, we hope to catalyse further breakthroughs in cancer, infectious disease, immunology and precision medicine.
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Noble AJ, Morris B, Dixon P, Mathieson A, Ridsdale L, Morgan M, Dickson J, Goodacre S, Jackson M, Hughes D, Marson A, Holmes E. Service users' preferences and feasibility - which alternative care pathway for adult ambulance users achieves the optimal balance? Workshops for the COLLABORATE project. Seizure 2024; 118:17-27. [PMID: 38613878 DOI: 10.1016/j.seizure.2024.04.010] [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] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Adults presenting to the ambulance service for diagnosed epilepsy are often transported to emergency departments (EDs) despite no clinical need. An alternative care pathway (CP) could allow paramedics to divert them from ED and instigate ambulatory care improvements. To identify the most promising CP configuration for subsequent testing, the COLLABORATE project surveyed people with epilepsy and family/friends who had recently used the English ambulance service to elicit preferences for 288 CP configurations for different seizures. This allowed CPs to be ranked according to alignment with service users' preferences. However, as well as being acceptable to users, a CP must be feasible. We thus engaged with paramedics, epilepsy specialists and commissioners to identify the optimal configuration. METHODS Three Knowledge Exchange workshops completed. Participants considered COLLABORATE's evidence on service users' preferences for the different configurations. Nominal group techniques elicited views on the feasibility of users' preferences according to APEASE criteria. Workshop groups specified the configuration/s considered optimum. Qualitative data was analysed thematically. Utility to users of the specified CP configurations estimated using the COLLABORATE preference survey data. RESULTS Twenty-seven participants found service users' preferences broadly feasible and outlined delivery recommendations. They identified enough commonality in preferences for different seizures to propose a single CP. Its configuration comprised: 1) patients staying where they were; 2) paramedics having access to medical records; 3) care episodes lasting <6 h; 4) paramedics receiving specialist advice on the day; 5) patient's GP being notified; and 6) a follow-up appointment being arranged with an epilepsy specialist. Preference data indicated higher utility for this configuration compared to current care. DISCUSSION Stakeholders are of the view that the CP configuration favoured by service users could be NHS feasible. It should be developed and evaluated.
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Affiliation(s)
- Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Beth Morris
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Pete Dixon
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK; Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, UK
| | - Jon Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Dyfrig Hughes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Emily Holmes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
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Holmes E, Dixon P, Mathieson A, Ridsdale L, Morgan M, McKinlay A, Dickson J, Goodacre S, Jackson M, Foster D, Hardman K, Bell S, Marson A, Hughes D, Noble AJ. Developing an alternative care pathway for emergency ambulance responses for adults with epilepsy: A Discrete Choice Experiment to understand which configuration service users prefer. Part of the COLLABORATE project. Seizure 2024; 118:28-37. [PMID: 38615478 DOI: 10.1016/j.seizure.2024.04.008] [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] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION To identify service users' preferences for an alternative care pathway for adults with epilepsy presenting to the ambulance service. METHODS Extensive formative work (qualitative, survey and knowledge exchange) informed the design of a stated preference discrete choice experiment (DCE). This hypothetical survey was hosted online and consisted of 12 binary choices of alternative care pathways described in terms of: the paramedic's access to medical records/ 'care plan', what happens next (described in terms of conveyance), time, availability of epilepsy specialists today, general practitioner (GP) notification and future contact with epilepsy specialists. DCE scenarios were described as: (i) typical seizure at home. (ii) typical seizure in public, (iii) atypical seizure. Respondents were recruited by a regional English ambulance service and by national public adverts. Participants were randomised to complete 2 of the 3 DCEs. RESULTS People with epilepsy (PWE; n = 427) and friends/family (n = 167) who completed the survey were representative of the target population. PWE preferred paramedics to have access to medical records, non-conveyance, to avoid lengthy episodes of care, availability of epilepsy specialists today, GP notification, and contact with epilepsy specialists within 2-3 weeks. Significant others (close family members or friends) preferred PWE experiencing an atypical seizure to be conveyed to an Urgent Treatment Centre and preferred shorter times. Optimal configuration of services from service users' perspective far out ranked current practice (rank 230/288 possible configurations). DISCUSSION Preferences differ to current practice but have minimal variation by seizure type or stakeholder. Further work on feasibility of these pathways in England, and potentially beyond, is required.
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Affiliation(s)
- Emily Holmes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Pete Dixon
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK; Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, UK
| | - Alison McKinlay
- Department of Basic and Clinical Neuroscience, King's College London, London, UK; Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Jon Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | | | | | - Steve Bell
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
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Merrick R, McKerr C, Song J, Donnelly K, Gerrard R, Morgan M, Williams C, Craine N. Transferring inpatients between wards drives large nosocomial COVID-19 outbreaks, Wales, 2020-22: a matched case-control study using routine and enhanced surveillance data. J Hosp Infect 2024; 145:1-10. [PMID: 38081454 DOI: 10.1016/j.jhin.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND The role of the hospital environment in the spread of COVID-19 is unclear. AIM To measure associations between ward characteristics and outbreak size to inform mitigations. METHODS Wards with large (case wards) and small (control wards) outbreaks in three acute hospitals were compared. Cases were healthcare-associated COVID-19 inpatients (positive polymerase chain reaction test ≥8 days post admission). Case wards were adult medical/surgical wards with ≥10 cases within rolling 14-day periods, between April 1st, 2020 and April 30th, 2022. Control wards were equivalents with 2-9 cases. Demographic and laboratory data were extracted from routine surveillance systems. Continuous data were aggregated fortnightly and analysed as binary variables according to median values. Each case ward was compared with two control wards matched on outbreak start date (±14 days) to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) using univariable and conditional multivariable logistic regression. FINDINGS From 170 outbreaks (median: 5 cases; interquartile range: 2-9), 35 case wards were identified. Community admissions were lower in case wards vs control wards (5 vs 10 median admissions; P<0.01, respectively), whereas transfers between wards within the same hospital were higher (58 vs 29 median transfers; P<0.01, respectively). Wards with more transfers in the preceding fortnight were significantly more likely to experience a large outbreak (≥35 vs <35 transfers; adjusted OR: 9.08; 95% CI: 2.5-33). CONCLUSION We recommend safely minimizing patient movements, such as by asking clinicians to record the rationale for transfer, to reduce the likelihood of disease transmission.
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Affiliation(s)
- R Merrick
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency, UK; Public Health Wales, UK
| | | | | | | | | | - M Morgan
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency, UK; Public Health Wales, UK
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Dickson SP, Haaland B, Mallinckrodt CH, Dubois B, O'Keefe P, Morgan M, Peters O, Fernández Santana Iii A, Harrison J, Schneeberger A, Hendrix S. "Time Saved" Calculations to Improve Decision-Making in Progressive Disease Studies. J Prev Alzheimers Dis 2024; 11:529-536. [PMID: 38706269 PMCID: PMC11060991 DOI: 10.14283/jpad.2024.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/11/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Disease modifying therapies (DMTs) may be most beneficial in early disease, when progression is slow and changes small, with clinical relevance difficult to interpret. OBJECTIVES Time component tests (TCTs) translate differences between treatments from mean change, vertical distance between longitudinal trajectories, into intuitively understood time saved, horizontal distance between trajectories, which can be readily combined across endpoints in a global TCT (gTCT). DESIGN The value of composites, time savings estimates, and combination scores to optimize measurement and interpretation of DMTs are demonstrated, along with construction details and simulation studies. SETTING TCT methods were applied to a randomized phase II clinical trial. PARTICIPANTS Patients with early Alzheimer's disease (N=332). INTERVENTION Three treatment groups with AFFITOPE® AD02 and two control groups with aluminum oxyhydroxide, AD04. MEASUREMENTS The co-primary efficacy outcomes were an adapted ADAS-Cog (aADAS) and adapted ADCS-ADL (aADL), which were optimized composite scales specific to cognitive and functional domains. A composite based on these two scores was the study's prespecified primary outcome. The CDR-sb and standard non-adapted ADCS-ADL and ADAS-Cog scales were prespecified secondary outcomes. RESULTS The AD04 2 mg group showed some statistically significant effects compared with other study arms. It is unclear whether the observed 3.8-point difference on the composite is clinically meaningful. TCT results show a time savings of 11 months in an 18-month study with AD04 2 mg. CONCLUSION The relevance of 11 months saved is more universally understood than a mean difference of 3.8 points in the composite outcome. These results suggest that a combination of a composite approach and a time savings interpretation offers a powerful approach for detecting and interpreting disease modifying effects.
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Affiliation(s)
- S P Dickson
- Achim Schneeberger, Advantage Therapeutics, 195 NW 40th St, Miami, FL 33127 United States, , +43 69911098989
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Rubeshkumar P, Beer J, McClure V, Morgan M. Mortality amongst hospitalized COVID-19 cases by acquisition and pandemic wave in Wales, UK, February 2020-March 2022. J Hosp Infect 2024; 143:48-52. [PMID: 37852537 DOI: 10.1016/j.jhin.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Hospital populations are vulnerable to COVID-19, but the relative severity of hospital acquisition compared to community is unknown. We investigated differences in mortality between hospital and community acquired cases in Wales. METHODS Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction tests from February 2020 to March 2022 were linked with hospital admissions to identify likely hospital-acquired cases. All-cause mortality within 28 days of a positive SARS-CoV-2 were measured by source of acquisition. Multi-variable logistic regression was used to compare mortality by source of acquisition, adjusting for confounders, computing adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS There were 25,263 hospital-acquired cases of COVID-19 and 5490 (22%) deaths in the study period. Although significant on univariate analysis, adjustment for confounding showed no association with increased mortality for hospital-acquired cases compared with cases admitted with COVID-19 (aOR 0.8, 95% CI 0.7-0.8). Vaccination (aOR 0.6, 95% CI 0.5-0.7) and infection in later pandemic waves (aOR 0.5, 95% CI 0.4-0.6) were associated with lower mortality; older age (≥85 vs <25 years: aOR 76.4, 95% CI 41.8-160.5) and male sex (aOR 1.5, 95% CI 1.4-1.6) were associated with higher mortality. CONCLUSION One in five hospitalised COVID-19 cases died within a month of infection. Mortality in nosocomial cases was not worse than those admitted with COVID-19, possibly reflecting early identification of nosocomial cases through screening.
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Affiliation(s)
- P Rubeshkumar
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK.
| | - J Beer
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK
| | - V McClure
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK
| | - M Morgan
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK
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Walburn J, Foster L, Araújo-Soares V, Sarkany R, Weinman J, Sainsbury K, Morgan M. Acceptability and influence of a complex personalized intervention on changes in photoprotection behaviours among people with xeroderma pigmentosum. Br J Health Psychol 2023; 28:1113-1131. [PMID: 37414737 DOI: 10.1111/bjhp.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES Rigorous photoprotection is the only means to prevent skin cancer in people with the rare condition of xeroderma pigmentosum (XP). We conducted a qualitative process evaluation of patient experiences and responses to a highly personalized, multi-component intervention, 'XPAND', designed to influence the psychosocial determinants of inadequate photoprotection among adults with XP. DESIGN Qualitative study of 15 patients following participation in a RCT. METHODS Semi-structured interviews explored acceptability, changes in photoprotection and attributions for behavioural changes. Analysis followed a framework approach. RESULTS Participants were overwhelmingly positive in their views of the quality and range of components of XPAND and the relevance to their personal photoprotection barriers. All participants reported improved adherence to at least one photoprotection activity and nearly two-thirds of participants noted improvements across multiple activities. Participants believed improvements in their photoprotection behaviours were influenced by different change mechanisms. Sunscreen application, was mainly facilitated by habit formation, prompted by text messages, whereas the wearing of a photoprotective face buff was influenced by strategies, learnt during one-to-one sessions, to overcome worry about looking different. Enhancement of general self-confidence and perceived support from XPAND described by participants facilitated change more broadly. CONCLUSIONS Exploration of responses to XPAND is required in the international XP population, followed by adaptation and evaluation to see if it could benefit other patient groups at higher risk of skin cancer. Implications for approaches to behaviour change include the acceptability of complex multidimensional interventions, the importance of dynamic personalization and the interactive nature of behaviour change mechanisms.
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Affiliation(s)
- Jessica Walburn
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Lesley Foster
- National Xeroderma Pigmentosum Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Vera Araújo-Soares
- Division of Prevention, Center for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Robert Sarkany
- National Xeroderma Pigmentosum Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - John Weinman
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Kirby Sainsbury
- Faculty of Medical Sciences, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Myfanwy Morgan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Sharp O, Johal KS, Morgan M, Ramakrishnan VV. Primary lipofilling as an adjunct in transverse upper gracilis flap breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 86:1-7. [PMID: 37634487 DOI: 10.1016/j.bjps.2023.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023]
Abstract
In many centres, the myocutaneous transverse upper gracilis (TUG) flap represents an alternative choice in autologous breast reconstruction when abdominal tissue is unavailable. However, a single TUG flap may be volume deficient, particularly in the upper pole. We describe the application of simultaneous lipofilling to the pectoralis major muscle at the index procedure and present our decision-making algorithm, technique and outcomes. A retrospective review of all TUG flaps between January 2011 and May 2021 was conducted. Patient demographics, volume of primary and any subsequent fat grafting and complications were recorded. A total of 183 patients (242 TUG flaps) were included in this study. Of these; 130 patients were reconstructed with single TUG flaps, 16 patients received a single TUG flap with immediate lipofilling, and 37 patients underwent stacked, double TUG flap reconstructions. Of the 242 flaps, there were 2 flap losses (<1%), neither of which occurred in the immediate lipofilling cohort. Among the 130 single TUG patients, 28 (21.5%) required a cumulative total of 40, and a mean of 1.4, secondary lipofilling procedures. The immediate lipofilling patients were injected with a mean of 42 ml fat (range: 20-80 ml). In this group, only 2 of 16 patients required secondary lipofilling. The mean follow-up was 67 months (17-141). Primary lipofilling may reduce the need for secondary revisional procedures and appears safe at the index operation, adds little operative time and has negligible donor site morbidity. In patients where a second (stacked) flap would add unnecessary volume and complexity, it can be considered a useful adjunct.
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Affiliation(s)
- O Sharp
- St Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom.
| | - K S Johal
- St Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom
| | - M Morgan
- St Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom
| | - V V Ramakrishnan
- St Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom
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Morgan M. Intensive care 2.0. Anaesthesia 2023; 78:413-415. [PMID: 36629760 DOI: 10.1111/anae.15954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Affiliation(s)
- M Morgan
- Curtin University, Perth, WA, Australia.,The Royal Perth Hospital, Perth, WA, Australia
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Morgan M, Salih H. Resident review: assessing the impact of new homes on people’s health and wellbeing. Perspect Public Health 2023; 143:71-72. [PMID: 37002669 DOI: 10.1177/17579139231157530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Affiliation(s)
- M Morgan
- Quality of Life Foundation, London, UK
| | - H Salih
- Quality of Life Foundation, London, UK
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Morgan M, Monroe K. ATV provider education and documentation. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00194-5] [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: 01/28/2023]
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O'Connell L, Asad H, Hall G, Jones T, Walters J, Manchipp-Taylor L, Barry J, Keighan D, Jones H, Williams C, Cronin M, Hughes H, Morgan M, Connor TR, Healy B. Detailed analysis of in-hospital transmission of SARS-CoV-2 using whole genome sequencing. J Hosp Infect 2023; 131:23-33. [PMID: 36240955 PMCID: PMC9554319 DOI: 10.1016/j.jhin.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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Affiliation(s)
- L O'Connell
- Public Health Wales and Swansea Bay University Health Board, Swansea, UK. lorcan.o'
| | - H Asad
- Health Protection Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Swansea, UK
| | - G Hall
- Swansea Bay University Health Board, Swansea, UK
| | - T Jones
- Swansea Bay University Health Board, Swansea, UK
| | - J Walters
- Quality Improvement Infection Prevention & Control, Infection Prevention & Control Team, Swansea Bay University Health Board, Swansea, UK
| | | | - J Barry
- Swansea Bay University Health Board, Swansea, UK
| | - D Keighan
- Estates, Swansea Bay University Health Board, Swansea, UK
| | - H Jones
- Health Protection CDSC, Public Health Wales, Carmarthen, UK
| | - C Williams
- Health Protection CDSC, Public Health Wales, Carmarthen, UK
| | - M Cronin
- Health Protection CDSC, Public Health Wales, Cardiff, UK
| | - H Hughes
- Public Health Wales and Cardiff University Health Board, Cardiff, UK
| | - M Morgan
- Healthcare Associated Infection, Antimicrobial Resistance & Prescribing Programme, Public Health Wales, Cardiff, UK
| | - T R Connor
- Public Health Wales and Cardiff University, Cardiff, UK
| | - B Healy
- Public Health Wales and Swansea Bay University Health Board, Swansea, UK
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Fujiwara K, Kristeleit R, Ghamande S, Lim MC, Parkinson C, Morgan M, Wilson M, Oaknin A, Buscema J, Bessette P, Lorusso D, Ueland F, Safra T, Barlin J, Marmé F, Herzog T, McNeish I, Goble S, Hume S, Monk B. 178O Rucaparib maintenance treatment in patients (pts) with newly diagnosed ovarian cancer (OC): Defining benefit according to disease risk subgroups within the phase III ATHENA–MONO study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Bowen H, Morgan M, Shapiro L. POS1557-HPR PATIENT-CENTRIC INTERPROFESSIONAL EDUCATION AS A MEANS TO INCREASE HEALTH PROFESSIONAL STUDENTS’ AWARENESS AND UNDERSTANDING OF SCLERODERMA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1909] [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
BackgroundIncorporating a complex chronic disease into an interprofessional education (IPE) event is an appropriate method to increase knowledge and awareness of diseases that require multiple disciplines to manage. Scleroderma is one example of a rheumatic condition that requires an interprofessional (IP) team management approach. In practice, the rheumatologist must rely heavily on other healthcare professionals to provide optimal care to a scleroderma patient. Core competencies such as teamwork, leadership, and accomplishing common patient care aims are promoted by IPE1. The foundation of the patient-centric approach is seldom learned in a classroom setting while IPE can promote the observation of the patient-lived experience, the value of patients as a knowledge resource, and the emphasis of patient diversity2.ObjectivesAt each event we aim to increase awareness and understanding of scleroderma among health care professional students and enable patients to draw on their health histories to act as lead educators. Based on the success to date, we hope to promote replication of this model at other scleroderma centers.MethodsOver four years, approximately 800 students from Russell Sage College, Albany College of Pharmacy and Health Sciences, and most recently The State University of New York at Albany, have participated in an IPE event which included individuals living with scleroderma and/or caregivers. For the first three years the event was held in person and the most recent was hosted virtually following the same structure as years prior. The event includes introductions of the moderators and words from a patient advocate followed by guidance on active listening and patient interview techniques. Eight to ten students enrolled in health-related programs including nutrition, psychology, occupational therapy, physical therapy, pharmacy, nursing and public health are assigned into small IP teams. Each team joins a round table or breakout room with one patient and/or caregiver. Students ask discipline specific questions which allows the patient and/or caregiver to share their narrative(s), enabling students to cultivate active listening skills and elicit the perspective of the patient. As the disease presentation and symptoms vary, the student IP teams will then interview another patient and/or caregiver. During the event students also hear best practices through a facilitated patient interview. An expert panel reflective of the disciplines represented on the student IP teams who have experience working with those diagnosed with scleroderma and other chronic conditions answer student questions. All attendees are asked to complete an anonymous pre and post event survey.Figure 1.ResultsIncluding patients with scleroderma as educators is effective in increasing student awareness and knowledge of the disease. The implementation of this model into IPE also allows students to practice IP collaboration specific to the needs of an individual living with scleroderma, as it would occur in the health care setting.ConclusionThis patient-centric IPE enables patients to share their medical journey as lead educators in increasing future health care professionals’ awareness and knowledge of scleroderma. Replication of this pilot model at other scleroderma centers worldwide could promote the collaboration needed from healthcare professionals to assure the best quality of care for those living with scleroderma.References[1]Buring, S. et al. Interprofessional education: definitions, student competencies, and guidelines for implementation. American Journal of Pharmaceutical Education. 2009; 73(4): 59[2]Towle A, Godolphin W. Patients as educators: interprofessional learning for patient-centred care. Med Teach. 2013; 35(3): 219-225AcknowledgementsSteffens Scleroderma Foundation, Russell Sage College, Albany College of Pharmacy and Health SciencesDisclosure of InterestsHannah Bowen: None declared, Michelle Morgan: None declared, Lee Shapiro Consultant of: Actelion 2020
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MD Yusof MY, Robinson J, Davies V, Wild D, Morgan M, Taylor J, El-Sherbiny Y, Morris D, Liu L, Rawstron A, Buch MH, Plant D, Cordell H, Isaacs J, Bruce IN, Emery P, Barton A, Vyse T, Barrett J, Vital E, Morgan A. OP0190 COMPREHENSIVE GENETIC AND FUNCTIONAL ANALYSES OF Fc GAMMA RECEPTORS EXPLAIN RESPONSE TO RITUXIMAB THERAPY FOR AUTOIMMUNE RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRituximab is widely used to treat rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) but clinical response varies. Efficacy is determined by the efficiency of depletion, which may depend on a variety of Fc gamma receptor (FcγR)-dependent mechanisms. Previous research was limited by complexity of the FCGR locus, not integrating copy number variation with functional SNP, and small sample size.ObjectivesThe study objectives were to assess the effect of the full range of FcγRs variants on depletion, clinical response and functional effect on NK-cell-mediated killing in two rheumatic diseases with a view to personalised B-cell depleting therapies.MethodsA prospective longitudinal cohort study was conducted in 873 patients [RA=611; SLE=262] from four cohorts (BSRBR-RA and BILAG-BR registries, Leeds RA and Leeds SLE Biologics). For RA, the outcome measures were 3C-DAS28CRP and 2C-DAS28CRP at 6 (+/-3) months post-rituximab (adjusted for baseline DAS28). For SLE, major clinical response (MCR) was defined as improvement of active BILAG-2004 domains to grade C/better at 6 months. B-cell depletion was evaluated by highly-sensitive flow cytometry. Qualitative and quantitative polymorphisms for five major FcγRs were measured using a commercial multiplex ligation-dependent probe amplification. Median NK cell FcγRIIIa expression (CD3-CD56+CD16+) and NK-cell degranulation (CD107a) in the presence of rituximab-coated Daudi/Raji B-cell lines were assessed using flow cytometry.ResultsIn RA, for FCGR3A, carriage of V allele (coefficient -0.25 (SE 0.11); p=0.02) and increased copies of V allele (-0.20 (0.09); p=0.02) were associated with greater 2C-DAS28 response. Irrespective of FCGR3A genotype, increased gene copies were associated with a better response. In SLE, 177/262 (67.6%) achieved BILAG response [MCR=34.4%; Partial=33.2%]. MCR was associated with increased copies of FCGR3A-158V allele, OR 1.64 (95% CI 1.12-2.41) and FCGR2C-ORF allele 1.93 (1.09-3.40). Of patients with B-cells data in the combined cohort, 236/413 (57%) achieved complete depletion post-rituximab. Only homozygosity for FCGR3A-158V and increased FCGR3A-158V copy number were associated with increased odds of complete depletion. Patients with complete depletion had higher NK cell FcγRIIIa expression at rituximab initiation than those with incomplete depletion (p=0.04) and this higher expression was associated with improved EULAR response in RA. Moreover, for FCGR3A, degranulation activity was increased in V allele carriers vs FF genotype in the combined cohort; p=0.02.ConclusionFcγRIIIa is the major low affinity FcγR and increased copies of the FCGR3A-158V allele, encoding the allotype with a higher affinity for IgG1, was associated with clinical and biological responses to rituximab in two autoimmune diseases. This was supported by functional data on NK cell-mediated cytotoxicity. In SLE, increased copies of the FCGR2C-ORF allele was also associated with improved response. Our findings indicate that enhancing FcγR-effector functions could improve the next generation of CD20-depleting therapies and genotyping could stratify patients for optimal treatment protocols.ReferencesNoneAcknowledgementsThis research was funded/supported by the joint funding from the Medical Research Council (MRC) and Versus Arthritis of MATURA (grant codes 36661 and MR/K015346/1). MASTERPLANS was funded by the MRC (grant code MR/M01665X/1). The Leeds Biologics Cohort was part funded by programme grants from Versus Arthritis (grant codes 18475 and 18387), the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC) and Diagnostic Evaluation Co-operative and the Ann Wilks Charitable Foundation. The BILAG-BR has received funding support from Lupus UK, and unrestricted grants from Roche and GSK.The functional studies were in part supported through a NIHR/HEFCE Clinical Senior Lectureship and a Versus Arthritis Foundation Fellowship (grant code 19764) to AWM, the Wellcome Trust Institutional Strategic Support Fund to JIR and MYMY (204825/Z/16/Z), NIHR Doctoral Research Fellowship to MYMY (DRF-2014-07-155) and NIHR Clinician Scientist to EMV (CS-2013-13-032). . AWM, INB, JDI and PE were supported by NIHR Senior Investigator awards. Work in JDI’s laboratory is supported by the NIHR Newcastle BRC, the Research Into Inflammatory Arthritis Centre Versus Arthritis, and Rheuma Tolerance for Cure (European Union Innovative Medicines Initiative 2, grant number 777357). INB is funded by the NIHR Manchester BRC.This article/paper/report presents independent research funded/supported by the NIHR Leeds BRC and the NIHR Guy’s and St Thomas’ BRC. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.Disclosure of InterestsMd Yuzaiful Md Yusof: None declared, James Robinson: None declared, Vinny Davies: None declared, Dawn Wild: None declared, Michael Morgan: None declared, John Taylor: None declared, Yasser El-Sherbiny: None declared, David Morris: None declared, Lu Liu: None declared, Andrew Rawstron: None declared, Maya H Buch: None declared, Darren Plant: None declared, Heather Cordell: None declared, John Isaacs: None declared, Ian N. Bruce: None declared, Paul Emery Speakers bureau: Roche, Consultant of: Roche, Grant/research support from: Roche, Anne Barton: None declared, Timothy Vyse: None declared, Jennifer Barrett: None declared, Edward Vital Consultant of: Roche, Grant/research support from: Roche, Ann Morgan Speakers bureau: Roche/Chugai, Consultant of: GSK, Roche, Chugai, AstraZeneka, Regeneron, Sanofi, Vifor, Grant/research support from: Roche, Kiniksa Pharmaceuticals
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Symvoulakis EK, Linardakis M, Kamekis A, Morgan M, Klinis S. The Personal Sociability and Connections Scale (PeSCS): Development and initial assessment at a primary care facility. Int J Soc Psychiatry 2022; 68:639-648. [PMID: 33570018 DOI: 10.1177/0020764021993510] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE An individual's lack of social connections and social isolation is often associated with feelings of loneliness which is regarded as having a negative effect on health. This paper describes the development and assessment of a 10 item 'Personal Sociability and Connections Scale' (PeSCS) to measure individual's disposition and accompanying skills to seek out companionship and engage in interpersonal relations. METHODS The study was conducted at a rural primary care unit in Northern Greece. A total of 199 attenders were recruited over a 6-week period in 2020 and questionnaires completed. This informed the 10-items PeSCS that comprises Social, Behavioral, and Emotional components focusing on the expression of social comfort, willingness to share experiences, stories and concepts, and feelings of similarity at first contact. Reliability of the PeSC scale was assessed and the relationship with scale scores examined as an indicator of convergent validity. A multivariate linear regression analysis was performed to examine the relationship of PeSC scale score with the characteristics of participants. RESULTS Assessment of reliability of PeSC scale produced a Cronbach's alpha of 0.809. The relationship between components and the total PeSCS scores identified significant correlations (p < .001). At a multivariate level, male gender was the sample characteristic with a significant association with scale levels (p < .05) and higher annual income with Social component (p < .05). Otherwise the distribution of sociability dispositions was similar across population groups. CONCLUSION The 10-item PeSC scale forms a simple and quick to complete measure whose overall reliability was rated as 'meritorious'. The PeSC instrument may be a useful tool for assessing the causes and appropriate responses to the negative health effects of loneliness and social isolation.
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Affiliation(s)
- Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, Faculty of Medicine University of Crete, Heraklion, Crete, Greece
| | - Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Myfanwy Morgan
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, UK
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Sarkany R, Norton S, Canfield M, Morgan M, Foster L, Sainsbury K, Araujo-Soares V, Wulf HC, Weinman J, Walburn J. Identifying the psychosocial predictors of ultraviolet exposure to the face in patients with xeroderma pigmentosum: a study of the behavioural factors affecting clinical outcomes in this genetic disease. J Med Genet 2022; 59:1095-1103. [PMID: 35393336 PMCID: PMC9613853 DOI: 10.1136/jmedgenet-2021-108323] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/14/2022] [Indexed: 01/24/2023]
Abstract
Background For patients with xeroderma pigmentosum (XP), the main means of preventing skin and eye cancers is extreme protection against ultraviolet radiation (UVR), particularly for the face. We have recently developed a methodology for objectively measuring photoprotection behaviour (‘UVR dose to facial skin’) and have found that the degree of photoprotection varies greatly between patients with XP. We have previously identified factors affecting photoprotection behaviour in XP using a subjective measure of photoprotection. Here, we have used this objective methodology to identify the factors which determine photoprotection behaviour in XP. Methods We studied 29 psychological, social, demographic and clinical variables in 36 patients with XP. We have previously objectively measured UVR protection (by measuring the dose of UVR reaching the skin of the face over a 3-week period) in these patients. Here, we use linear mixed-effects model analysis to identify the factors which lead to the differences in degree of photoprotection observed in these patients. Results Psychosocial factors accounted for as much of the interindividual variation in photoprotection behaviour (29%) as demographic and clinical factors (24%). Psychosocial factors significantly associated with worse UVR protection included: automaticity of the behaviours, and a group of beliefs and perceptions about XP and photoprotection known to associate with poor treatment adherence in other diseases. Conclusions We have identified factors contributing to poor photoprotection in XP. Identifying these potentially reversible psychosocial features has enabled us to design an intervention to improve photoprotection in patients with XP, aiming to prevent skin and eye cancers in these patients.
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Affiliation(s)
- Robert Sarkany
- Xeroderma Pigmentosum Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Martha Canfield
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Myfanwy Morgan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Lesley Foster
- Xeroderma Pigmentosum Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kirby Sainsbury
- Population Health Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Vera Araujo-Soares
- Population Health Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - John Weinman
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jessica Walburn
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Pitt L, Morgan M, Moffatt M, Edwards P, Davies R, Peach C, Littlewood C. Rehabilitation following shoulder arthroplasty: A survey of protocols. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.073] [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: 11/26/2022]
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Molina-Pérez A, Delgado J, Frunza M, Morgan M, Randhawa G, de Wijdeven JRV, Schicktanz S, Schiks E, Wöhlke S, Rodríguez-Arias D. Should the family have a role in deceased organ donation decision-making? A systematic review of public knowledge and attitudes towards organ procurement policies in Europe. Transplant Rev (Orlando) 2021; 36:100673. [PMID: 34864448 DOI: 10.1016/j.trre.2021.100673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
GOAL To assess public knowledge and attitudes towards the family's role in deceased organ donation in Europe. METHODS A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection were performed by two or more independent reviewers for each record. RESULTS Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. CONCLUSIONS Public views on the authority of the family in organ donation decision-making requiere further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation.
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Affiliation(s)
- Alberto Molina-Pérez
- Institute for Advanced Social Studies, Spanish National Research Council, Cordoba, Spain; Public Issues working group, ELPAT-ESOT, Padova, Italy.
| | - Janet Delgado
- Public Issues working group, ELPAT-ESOT, Padova, Italy; Department of Philosophy 1, University of Granada, Granada, Spain
| | - Mihaela Frunza
- Department of Philosophy, Faculty of History and Philosophy, Babes-Bolyai University of Cluj, Cluj, Romania
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, United Kingdom
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, England, United Kingdom
| | | | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Eline Schiks
- Department of Policy, Dutch Transplant Foundation, Leiden, the Netherlands
| | - Sabine Wöhlke
- Department of Health Sciences, HAW-Hamburg, Hamburg, Germany
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Evans CJ, Bone AE, Yi D, Morgan M, Maddocks M, Wright J, Lindsay F, Higginson IJ. Response to Zhou (2021) "Comment on Evans et al. (2021) 'Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care'". Int J Nurs Stud 2021; 125:104119. [PMID: 34782149 DOI: 10.1016/j.ijnurstu.2021.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton BN2 3EW, United Kingdom.
| | - Anna E Bone
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, United Kingdom
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation
| | - Juliet Wright
- University of Sussex, Brighton and Sussex Medical School, Falmer, Brighton BN1 9RH, United Kingdom
| | - Fiona Lindsay
- Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, United Kingdom
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation
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Sarkany RPE, Canfield M, Morgan M, Foster L, Johnstone K, Sainsbury K, Araujo-Soares V, Wulf HC, Weinman J, Walburn J, Norton S. Ultraviolet exposure to the face in patients with xeroderma pigmentosum and healthy controls: applying a novel methodology to define photoprotection behaviour. Br J Dermatol 2021; 186:713-720. [PMID: 34783007 PMCID: PMC9306996 DOI: 10.1111/bjd.20899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Xeroderma Pigmentosum (XP), the main means of preventing skin and eye cancers is extreme protection against ultraviolet radiation (UVR). Protection is most important for the face. OBJECTIVES We aimed to assess how well patients with XP adhere to medical advice to protect against UVR by objectively estimating the mean daily dose of UVR to the face. METHODS We objectively estimated the UVR dose to the face in 36 XP patients and 25 healthy individuals over 3 weeks in the summer. We used a new methodology which combined UVR dose measurements from a wrist-worn dosimeter with an activity diary record of face photoprotection behaviour for each 15 minute period spent outside. A protection factor was associated with each behaviour, and the data analysed using a negative binomial mixed-effects model. RESULTS The mean daily UVR dose (weighted for DNA damage capacity) to the face in the XP patients was 0.13 Standard Erythemal Doses (SED) (mean in healthy individuals = 0.51 SED). There was wide variation between patients (range <0.01 - 0.48 SED/day). Self-caring adult patients had a very similar UV dose to the face to cared-for patients (0.13 vs 0.12 SED/day) despite photoprotecting much more poorly when outside, because the self-caring adults were outside in daylight much less. CONCLUSIONS Photoprotection behaviour varies widely within the XP group indicating that non-adherence to photoprotection advice is a significant issue. Timing and duration of going outside are as important as photoprotective measures taken when outside, to determine the UVR exposure to the face. This new methodology will be of value in identifying the sources of UVR exposure in other conditions where facial UV exposure is a key outcome, particularly in patients with multiple non-melanoma skin cancers.
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Affiliation(s)
- R P E Sarkany
- Xeroderma Pigmentosum Unit, Guys and St Thomas' NHS Foundation Trust, UK
| | - M Canfield
- Health Psychology Section, Institute of Psychiatry, King's College London, Psychology & Neuroscience, UK
| | - M Morgan
- School of Cancer and Pharmaceutical Sciences, King's College London, UK
| | - L Foster
- Xeroderma Pigmentosum Unit, Guys and St Thomas' NHS Foundation Trust, UK
| | - K Johnstone
- School of Cancer and Pharmaceutical Sciences, King's College London, UK
| | - K Sainsbury
- Population Health Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - V Araujo-Soares
- Population Health Institute, Faculty of Medical Sciences, Newcastle University, UK.,Health Technology and Services Research, Technical Medical Centre, University of Twente, The Netherlands
| | - H C Wulf
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - J Weinman
- School of Cancer and Pharmaceutical Sciences, King's College London, UK
| | - J Walburn
- School of Cancer and Pharmaceutical Sciences, King's College London, UK
| | - S Norton
- Health Psychology Section, Institute of Psychiatry, King's College London, Psychology & Neuroscience, UK
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23
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Mariño R, Glenister K, Bourke L, Morgan M, Atala-Acevedo C, Simmons D. Patterns of use of oral health care services in Australian rural adults: the Crossroads-II Dental sub-study. Aust Dent J 2021; 66:397-405. [PMID: 34152019 DOI: 10.1111/adj.12865] [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] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND As part of a larger study, the Crossroads-II Dental sub-study determined the patterns of, and barriers to, oral health care service utilization in a rural area of Victoria. METHODS In this cross-sectional sub-study predisposing, enabling, needs-related, and oral health variables were considered in association with patterns of oral health care utilization. A logistic regression was performed to explain the use of oral health care services. RESULTS Overall, 574 adults participated, with 50.9% reporting having visited an oral health care service in the previous 12 months. Age, number of chronic health conditions and holding a health card; were associated with increased visit to a dentist (OR = 1.01; 95% CI: 1.00-1.03; OR = 1.08; 95% CI: 1.01-1.16; OR = 2.06; 95% CI: 1.26-3.36, respectively). Perceived barriers to care and number of missing teeth decreased the odds of using services (OR = 0.46; 95% CI: 0.36-0.58; OR = 0.95; 95% CI: 0.92-0.98, respectively). CONCLUSIONS Results suggest that use of oral health care services is associated with a range of financial, educational, health and structural barriers. Increasing the use of oral health care services in rural populations requires additional efforts beyond the reduction of financial barriers.
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Affiliation(s)
- R Mariño
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - K Glenister
- Department of Rural Health, The University of Melbourne, Melbourne, Australia
| | - L Bourke
- Department of Rural Health, The University of Melbourne, Melbourne, Australia
| | - M Morgan
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - C Atala-Acevedo
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia.,Centre for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - D Simmons
- Department of Rural Health, The University of Melbourne, Melbourne, Australia.,Macarthur Clinical School, Western Sydney University, Sydney, Australia
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Evans CJ, Bone AE, Yi D, Gao W, Morgan M, Taherzadeh S, Maddocks M, Wright J, Lindsay F, Bruni C, Harding R, Sleeman KE, Gomes B, Higginson IJ. Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: A randomised controlled single-blind mixed method trial. Int J Nurs Stud 2021; 120:103978. [PMID: 34146843 DOI: 10.1016/j.ijnurstu.2021.103978] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/18/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Globally, a rising number of people live into advanced age and die with multimorbidity and frailty. Palliative care is advocated as a person-centred approach to reduce health-related suffering and promote quality of life. However, no evidence-based interventions exist to deliver community-based palliative care for this population. AIM To evaluate the impact of the short-term integrated palliative and supportive care intervention for older people living with chronic noncancer conditions and frailty on clinical and economic outcomes and perceptions of care. DESIGN Single-blind trial with random block assignment to usual care or the intervention and usual care. The intervention comprised integrated person-centred palliative care delivered by multidisciplinary palliative care teams working with general practitioners and community nurses. Main outcome was change in five key palliative care symptoms from baseline to 12-weeks. Data analysis used intention to treat and complete cases to examine the mean difference in change scores and effect size between the trial arms. Economic evaluation used cost-effectiveness planes and qualitative interviews explored perceptions of the intervention. SETTING/PARTICIPANTS Four National Health Service general practices in England with recruitment of patients aged ≥75 years, with moderate to severe frailty, chronic noncancer condition(s) and ≥2 symptoms or concerns, and family caregivers when available. RESULTS 50 patients were randomly assigned to receive usual care (n = 26, mean age 86.0 years) or the intervention and usual care (n = 24, mean age 85.3 years), and 26 caregivers (control n = 16, mean age 77.0 years; intervention n = 10, mean age 77.3 years). Participants lived at home (n = 48) or care home (n = 2). Complete case analysis (n = 48) on the main outcome showed reduced symptom distress between the intervention compared with usual care (mean difference -1.20, 95% confidence interval -2.37 to -0.027) and medium effect size (omega squared = 0.071). Symptom distress reduced with decreased costs from the intervention compared with usual care, demonstrating cost-effectiveness. Patient (n = 19) and caregiver (n = 9) interviews generated themes about the intervention of 'Little things make a big difference' with optimal management of symptoms and 'Care beyond medicines' of psychosocial support to accommodate decline and maintain independence. CONCLUSIONS This palliative and supportive care intervention is an effective and cost-effective approach to reduce symptom distress for older people severely affected by chronic noncancer conditions. It is a clinically effective way to integrate specialist palliative care with primary and community care for older people with chronic conditions. Further research is indicated to examine its implementation more widely for people at home and in care homes. TRIAL REGISTRATION Controlled-Trials.com ISRCTN 45837097 Tweetable abstract: Specialist palliative care integrated with district nurses and GPs is cost-effective to reduce symptom distress for older people severely affected by chronic conditions.
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Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England; Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Anna E Bone
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, England.
| | - Shamim Taherzadeh
- Northbourne Medical Centre, 193A Upper Shoreham Road, Shoreham-by-Sea, BN43 6BT, England.
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Juliet Wright
- University of Sussex, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9RH, England.
| | - Fiona Lindsay
- Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Carla Bruni
- Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Richard Harding
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Katherine E Sleeman
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Barbara Gomes
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
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25
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Whelan K, Murrells T, Morgan M, Cummings F, Stansfield C, Todd A, Sebastian S, Lobo A, Lomer MCE, Lindsay JO, Czuber-Dochan W. Food-related quality of life is impaired in inflammatory bowel disease and associated with reduced intake of key nutrients. Am J Clin Nutr 2021; 113:832-844. [PMID: 33677550 DOI: 10.1093/ajcn/nqaa395] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) may impact the extent to which food, eating, and drinking bring satisfaction and enjoyment to peoples' lives, and this may impact dietary intake. The prevalence of an impaired food-related quality of life (FR-QoL), its associated factors, and its impact on diet have not been explored. OBJECTIVES To measure the prevalence and nature of the burden of impaired FR-QoL in people with IBD, the factors associated with these, and their associations with nutrient intake. METHODS We recruited 1576 outpatients with IBD (≥16 years old) in person from 7 IBD centers across the United Kingdom. Patients completed validated questionnaires to measure their FR-QoL, quality of life (QoL), distress, fatigue, anxiety, and depression. Dietary intake was recorded using the European Prospective Investigation into Cancer FFQ. A health professional recorded disease activity, Montreal classification, blood results, BMI, and malnutrition risk. FR-QoL was regressed onto explanatory variables using univariable and multivariable analyses. RESULTS Data from 1221 patients were available (77.4% response; Crohn's disease, 65%; ulcerative colitis, 35%). The FR-QoL mean (± SD) score was 80.8 ± 26.9, with wide ranges (minimum, 29; maximum, 145). Following multivariable regression, the strongest associations with FR-QoL were the number of recent disease flares (5 flares β = -12.7; P < 0.001), the IBD-specific QoL (β = 0.33; P < 0.001), and IBD-related distress (β = -0.26; P < 0.001). Patients with poorer FR-QoL had lower intakes of fiber (nonstarch polysaccharide; Q1 to Q5 difference = 2.1 g/d; 95% CI: 0.4-3.8; P = 0.048), calcium (192.6 mg/d; 95% CI: 112.5-272.6; P < 0.001), phosphorus (167 mg/d; 95% CI: 58-276; P = 0.041), and magnesium (34.4 mg/d; 95% CI: 9.3-59.4; P = 0.041). CONCLUSIONS Impaired FR-QoL is prevalent in IBD and is associated with recurrent disease flares, a reduced IBD-specific QoL, and greater IBD-related distress. A poorer FR-QoL was associated with lower intakes of key nutrients of importance to IBD, including those relating to gut health and bone mineralization.
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Affiliation(s)
- Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, United Kingdom
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Fraser Cummings
- University Southampton Hospital National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | | | - Anne Todd
- NHS Forth Valley, Forth Valley Royal Hospital, Larbert, United Kingdom
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Hull York Medical School, Hull, United Kingdom
| | - Alan Lobo
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Miranda C E Lomer
- Department of Nutritional Sciences, King's College London, London, United Kingdom
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - James O Lindsay
- Bart's Health NHS Trust, London, United Kingdom
- Queen Mary University of London, Blizard Institute, London, United Kingdom
| | - Wladyslawa Czuber-Dochan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, United Kingdom
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Friebel TR, Narayan N, Ramakrishnan V, Morgan M, Cellek S, Griffiths M. Comparison of PEAK PlasmaBlade™ to conventional diathermy in abdominal-based free-flap breast reconstruction surgery-A single-centre double-blinded randomised controlled trial. J Plast Reconstr Aesthet Surg 2020; 74:1731-1742. [PMID: 33422499 DOI: 10.1016/j.bjps.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/08/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electrosurgery makes dissection with simultaneous haemostasis possible. The produced heat can cause injury to the surrounding tissue. The PEAK PlasmaBlade™(PPB) is a new electrosurgery device which may overcome this by having the ability to operate on a lower temperature, therefore reducing collateral thermal damage. METHOD A single-centre, double-blinded, randomised controlled trial (RCT) was conducted which included 108 abdominal-based free-flap breast reconstruction patients who had their flap raise performed using either the PPB (n = 56) or the conventional diathermy (n = 52). Data were collected during their in-patient stay and out-patient appointments. The primary outcome value was the number of days the abdominal drains were required. RESULTS Baseline characteristics were similar between the groups, except a significantly lower flap weight in the PPB group. The median number of days the drains were required did not differ significantly (p = 0.48; 6.0 days for the diathermy and 5.0 days for the PPB). The total drain output (p = 0.68), the inflammatory cytokine in the drain fluid (p>0.054) and complications (p>0.24) did not differ significantly between the two groups. At the 2-week follow-up appointment, there was a trend towards less abdominal seromas on abdominal ultrasound (p = 0.09) in the PPB group which were significantly smaller (p = 0.04). CONCLUSION The use of the PPB did not result in a significant reduction of drain requirement, total drain output or inflammatory cytokines but did reduce the size of seroma collections at the 2-week follow-up appointment. Therefore, the use of the PPB device could reduce early seroma formation after drain removal.
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Affiliation(s)
- T R Friebel
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom; Anglia Ruskin University, Bishop Hall Ln, Chelmsford CM11SQ, United Kingdom.
| | - N Narayan
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
| | - V Ramakrishnan
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
| | - M Morgan
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
| | - S Cellek
- Anglia Ruskin University, Bishop Hall Ln, Chelmsford CM11SQ, United Kingdom
| | - M Griffiths
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
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27
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Sainsbury K, Walburn J, Foster L, Morgan M, Sarkany R, Weinman J, Araujo-Soares V. Improving photoprotection in adults with xeroderma pigmentosum: personalisation and tailoring in the 'XPAND' intervention. Health Psychol Behav Med 2020; 8:543-572. [PMID: 34040885 PMCID: PMC8114353 DOI: 10.1080/21642850.2020.1840379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Individualised behaviour change interventions can result in greater effects than one-size-fits-all approaches. Factors linked to success include dynamic (vs. static) tailoring, and tailoring on behaviour, multiple theoretical variables, and participant characteristics. XP is a very rare (∼100 UK patients) genetic disease, involving an inability to repair ultraviolet radiation (UVR)-induced damage, resulting in skin cancers and eye damage from an early age, and mean life expectancy of 32-years. Management involves rigorous UVR photoprotection, which is often inadequate, and no interventions have been published. UK-based care is personalised and delivered by a multidisciplinary team at the National XP Service in London. Following an intensive, mixed-methods formative phase with patients diagnosed with XP (n-of-1, qualitative interviews, objective UVR measurement, cross-sectional survey) and relevant stakeholder consultation (clinical and patient/public teams), the 'XPAND' intervention was developed. This paper describes the comprehensive and novel tailoring and personalisation processes used to deliver the intervention. METHODS XPAND consists of core and personalised modules targeting cue-based (time of day, weather, symptoms), belief-based (motivation, priority), self-regulatory (effort, barriers, planning), and emotional (stress, self-consciousness, mental exhaustion) factors, social support, disclosure, habit, and willingness, using appropriately-matched BCTs. A-priori, phase I data and a baseline profiling questionnaire (data sources) were used to allocate modules to participants ('personalisation') and to adapt module content ('tailoring'). Iterative decisions about delivery were based on patient response to feedback, identification of additional barriers (e.g. reasons for varying protection across contexts), and emergence of new barriers as improvements in protection were attempted or achieved (e.g. appearance concerns). CONCLUSIONS Dynamic multi-level personalisation and tailoring based on mixed-methods in XPAND allowed for insights and decision-making not possible with cross-sectional quantitative or qualitative methods alone. Data collection and allocation/adaptation methods may be of use in other rare conditions where small patient numbers mean that within-participant, individual-level delivery is well-suited and feasible.
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Affiliation(s)
- Kirby Sainsbury
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Jessica Walburn
- School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Lesley Foster
- XP NCG Service, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Myfanwy Morgan
- School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Robert Sarkany
- XP NCG Service, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Vera Araujo-Soares
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
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28
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Dursun F, Pan MM, Morgan M, Gonzalez RR, Satkunasivam R. 532 nm green-light laser vaporization of upper tract urothelial carcinoma. BMC Urol 2020; 20:172. [PMID: 33115473 PMCID: PMC7594425 DOI: 10.1186/s12894-020-00744-w] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background Endoscopic management of low risk upper tract urothelial carcinoma (UTUC) may be considered in select clinical scenarios, which allows sparing the morbidity of radical nephroureterectomy while achieving acceptable oncological outcomes and preservation of kidney function. Herein, we present a case with UTUC in a solitary kidney managed with 532 nm laser vaporization through a percutaneous approach. Case presentation The patient in this video (Additional file 1) is an 85-year-old woman who presented with a bulky tumor in the collecting system of a congenital solitary left kidney, which was a biopsy proven low grade urothelial carcinoma. Prior to the procedure, a lower pole percutaneous nephrostomy tube was successfully placed under sedation by Interventional Radiology. The procedure was done in a prone split leg position. The mass, which was predominantly localized to the renal pelvis was efficiently vaporized with the 532 nm laser in a systematic manner with continuous irrigation of normal saline through the cystoscope. The patient was discharged home on postoperative day 2 with the nephroureterostomy catheter open to drainage. This catheter was subsequently clamped and removed two weeks later without complications. Follow up uretroscopy showed excellent treatment response and the patient remains well without complications. Conclusion This case report details the potential utility of 532 nm laser vaporization of UTUC, however, ongoing studies are required to demonstrate peri-operative safety and durable oncologic efficacy.
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Affiliation(s)
- F Dursun
- Department of Urology, Houston Methodist Hospital, 6560 Fannin Street, Suite 2100, Houston, TX, 77030, USA
| | - M M Pan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - M Morgan
- Department of Urology, Houston Methodist Hospital, 6560 Fannin Street, Suite 2100, Houston, TX, 77030, USA
| | - R R Gonzalez
- Department of Urology, Houston Methodist Hospital, 6560 Fannin Street, Suite 2100, Houston, TX, 77030, USA
| | - R Satkunasivam
- Department of Urology, Houston Methodist Hospital, 6560 Fannin Street, Suite 2100, Houston, TX, 77030, USA.
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Walburn J, Sainsbury K, Foster L, Weinman J, Morgan M, Norton S, Canfield M, Chadwick P, Sarkany B, Araújo-Soares V. Why? What? How? Using an Intervention Mapping approach to develop a personalised intervention to improve adherence to photoprotection in patients with Xeroderma Pigmentosum. Health Psychol Behav Med 2020; 8:475-500. [PMID: 34040882 PMCID: PMC8114411 DOI: 10.1080/21642850.2020.1819287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Intervention Mapping (IM) is a systematic approach for developing theory-based interventions across a variety of contexts and settings. This paper describes the development of a complex intervention designed to reduce the dose of ultraviolet radiation (UVR) reaching the face of adults with Xeroderma Pigmentosum (XP), by improving photoprotection. XP is a genetic condition that without extreme UVR photoprotection, leads to high risk of developing skin cancer. Methods: The IM protocol of 6 steps was applied, involving comprehensive mixed-methods formative research. Key stakeholders (XP clinical staff and Patient and Public Involvement Panel), were instrumental at every step. Behaviour change methods were informed by the IM taxonomy, therapeutic approaches (e.g. ACT, CBT) and coded according to the taxonomy of behaviour change techniques (version 1). Results: We designed a personalised modular intervention to target psychosocial determinants of photoprotective activities that influence the amount of UVR reaching the face. Content was developed to target determinants of motivation to protect and factors preventing the enactment of behaviours. Participants received personalised content addressing determinants/barriers most relevant to them, as well as core ‘behaviour-change’ material, considered important for all (e.g. SMART goals). Core and personalised content was delivered via 7 one-to-one sessions with a trained facilitator using a manual and purpose designed materials: Magazine; text messages; sunscreen application video; goal-setting tools (e.g. UVR dial and face protection guide); activity sheets. Novel features included use of ACT-based values to enhance intrinsic motivation, targeting of emotional barriers to photoprotection, addressing appearance concerns and facilitating habit formation. Conclusion: IM was an effective approach for complex intervention design. The structure (e.g. use of matrices) tethered the intervention tightly to theory and evidence-based approaches. The significant amount of time required needs to be considered and may hinder translation of IM into clinical and non-academic settings.
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Affiliation(s)
- Jessica Walburn
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Kirby Sainsbury
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lesley Foster
- National Xeroderma Pigmentosum Service, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Myfanwy Morgan
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martha Canfield
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, UK
| | - Bob Sarkany
- National Xeroderma Pigmentosum Service, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Vera Araújo-Soares
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Noble A, Nevitt S, Holmes E, Ridsdale L, Morgan M, Tudur-Smith C, Hughes D, Goodacre S, Marson T, Snape D. Seizure first aid training for people with epilepsy attending emergency departments and their significant others: the SAFE intervention and feasibility RCT. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
No seizure first aid training intervention exists for people with epilepsy who regularly attend emergency departments and their significant others, despite such an intervention’s potential to reduce clinically unnecessary and costly visits.
Objectives
The objectives were to (1) develop Seizure first Aid training For Epilepsy (SAFE) by adapting a broader intervention and (2) determine the feasibility and optimal design of a definitive randomised controlled trial to test SAFE’s efficacy.
Design
The study involved (1) the development of an intervention informed by a co-design approach with qualitative feedback and (2) a pilot randomised controlled trial with follow-ups at 3, 6 and 12 months and assessments of treatment fidelity and the cost of SAFE’s delivery.
Setting
The setting was (1) third-sector patient support groups and professional health-care organisations and (2) three NHS emergency departments in England.
Participants
Participants were (1) people with epilepsy who had visited emergency departments in the prior 2 years, their significant others and emergency department, paramedic, general practice, commissioning, neurology and nursing representatives and (2) people with epilepsy aged ≥ 16 years who had been diagnosed for ≥ 1 year and who had made two or more emergency department visits in the prior 12 months, and one of their significant others. Emergency departments identified ostensibly eligible people with epilepsy from attendance records and patients confirmed their eligibility.
Interventions
Participants in the pilot randomised controlled trial were randomly allocated 1 : 1 to SAFE plus treatment as usual or to treatment as usual only.
Main outcome measures
Consent rate and availability of routine data on emergency department use at 12 months were the main outcome measures. Other measures of interest included eligibility rate, ease with which people with epilepsy could be identified and routine data secured, availability of self-reported emergency department data, self-reported emergency department data’s comparability with routine data, SAFE’s effect on emergency department use, and emergency department use in the treatment as usual arm, which could be used in sample size calculations.
Results
(1) Nine health-care professionals and 23 service users provided feedback that generated an intervention considered to be NHS feasible and well positioned to achieve its purpose. (2) The consent rate was 12.5%, with 53 people with epilepsy and 38 significant others recruited. The eligibility rate was 10.6%. Identifying people with epilepsy from attendance records was resource intensive for emergency department staff. Those recruited felt more stigmatised because of epilepsy than the wider epilepsy population. Routine data on emergency department use at 12 months were secured for 94.1% of people with epilepsy, but the application process took 8.5 months. Self-reported emergency department data were available for 66.7% of people with epilepsy, and people with epilepsy self-reported more emergency department visits than were captured in routine data. Most participants (76.9%) randomised to SAFE received the intervention. The intervention was delivered with high fidelity. No related serious adverse events occurred. Emergency department use at 12 months was lower in the SAFE plus treatment as usual arm than in the treatment as usual only arm, but not significantly so. Calculations indicated that a definitive trial would need ≈ 674 people with epilepsy and ≈ 39 emergency department sites.
Limitations
Contrary to patient statements on recruitment, routine data secured at the pilot trial’s end indicated that ≈ 40% may not have satisfied the inclusion criterion of two or more emergency department visits.
Conclusions
An intervention was successfully developed, a pilot randomised controlled trial conducted and outcome data secured for most participants. The consent rate did not satisfy a predetermined ‘stop/go’ level of ≥ 20%. The time that emergency department staff needed to identify eligible people with epilepsy is unlikely to be replicable. A definitive trial is currently not feasible.
Future work
Research to more easily identify and recruit people from the target population is required.
Trial registration
Current Controlled Trials ISRCTN13871327.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 39. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adam Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Emily Holmes
- Centre for Health Economics and Medicine Evaluation, Bangor University, Bangor, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King’s College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | | | - Dyfrig Hughes
- Centre for Health Economics and Medicine Evaluation, Bangor University, Bangor, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Darlene Snape
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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Reuter C, Kappler P, Brunotte S, Ivanyi P, Morgan M. 666P Prognostic role of docetaxel-induced reduction of free testosterone serum levels in metastatic prostate cancer patients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.925] [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: 11/16/2022] Open
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Baxter M, Bethune C, Powell R, Morgan M. Point prevalence of penicillin allergy in hospital inpatients. J Hosp Infect 2020; 106:65-70. [DOI: 10.1016/j.jhin.2020.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
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Tidbury N, Browning N, Shaw M, Morgan M, Kemp I, Matata B. Neutrophil Gelatinase-associated Lipocalin as a Marker of Postoperative Acute Kidney Injury Following Cardiac Surgery in Patients with Preoperative Kidney Impairment. Cardiovasc Hematol Disord Drug Targets 2020; 19:239-248. [PMID: 30987577 DOI: 10.2174/1871529x19666190415115106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 03/08/2019] [Accepted: 03/22/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) is a serious complication of cardiac surgery. The current 'gold standard' for determining AKI is change in serum creatinine and urine output, however, this change occurs relatively late after the actual injury occurs. Identification of new biomarkers that detect early AKI is required. Recently, new biomarkers, such as the NephroCheck® Test and AKIRisk have also been tested and found to be good indicators of AKI. Neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in paediatric patients but has displayed varied results in adult populations, particularly post cardiac surgery. The aim of this study was to assess the value of urinary NGAL as a biomarker of AKI in patients with pre-existing renal impairment (eGFR >15ml/min to eGFR<60ml/min). METHODS A post-hoc analysis of urinary NGAL concentrations from 125 patients with pre-existing kidney impairment, who participated in a randomised trial of haemofiltration during cardiac surgery, was undertaken. Urinary NGAL was measured using ELISA at baseline, post-operatively and 24 and 48 hours after surgery, and serum creatinine was measured pre and postoperatively and then at 24, 48, 72 and 96 hours as routine patient care. NGAL concentrations were compared in patients with and without AKI determined by changes in serum creatinine concentrations. A Kaplan-Meier plot compared survival for patients with or without AKI and a Cox proportional hazards analysis was performed to identify factors with the greatest influence on survival. RESULTS Following surgery, 43% of patients developed AKI (based on KDIGO definition). Baseline urinary NGAL was not found to be significantly different between patients that did and did not develop AKI. Urinary NGAL concentration was increased in all patients following surgery, regardless of whether they developed AKI and was also significant between groups at 24 (p=0.003) and 48 hours (p<0.0001). Urinary NGAL concentrations at 48 hours correlated with serum creatinine concentrations at 48 hours (r=0.477, p<0.0001), 72 hours (r=0.488, p<0.0001) and 96 hours (r=0.463, p<0.0001). Urinary NGAL at 48 hours after surgery strongly predicted AKI (AUC=0.76; P=0.0001). A Kaplan- Meier plot showed that patients with postoperative AKI had a significantly lower 7-year survival compared with those without AKI. Postoperative urinary NGAL at 48 hours >156ng/mL also strongly predicted 7-year survival. However, additive EuroSCORE, age, current smoking and post-operative antibiotics usage were distinctly significantly more predictive of 7-year survival as compared with postoperative urinary NGAL at 48 hours >156ng/mL. CONCLUSIONS Our study demonstrated that postoperative urinary NGAL levels at 48 hours postsurgery strongly predicts the onset or severity of postoperative AKI based on KDIGO classification in patients with preoperative kidney impairment and were also strongly related to 7-year survival.
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Affiliation(s)
- N Tidbury
- Liverpool Heart & Chest Hospital NHS Foundation Trust, University of Liverpool, Liverpool L14 3PE, United Kingdom
| | - N Browning
- Liverpool Heart & Chest Hospital NHS Foundation Trust, University of Liverpool, Liverpool L14 3PE, United Kingdom
| | - M Shaw
- Liverpool Heart & Chest Hospital NHS Foundation Trust, University of Liverpool, Liverpool L14 3PE, United Kingdom
| | - M Morgan
- Liverpool Heart & Chest Hospital NHS Foundation Trust, University of Liverpool, Liverpool L14 3PE, United Kingdom
| | - I Kemp
- Liverpool Heart & Chest Hospital NHS Foundation Trust, University of Liverpool, Liverpool L14 3PE, United Kingdom
| | - B Matata
- Liverpool Heart & Chest Hospital NHS Foundation Trust, University of Liverpool, Liverpool L14 3PE, United Kingdom.,Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool L14 3PE, United Kingdom
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McKinlay A, Morgan M, Noble A, Ridsdale L. Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study. Seizure 2020; 80:56-62. [PMID: 32540637 PMCID: PMC7443693 DOI: 10.1016/j.seizure.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Emergency Department (ED) visits are costly to the health service and alternative care pathways may address this whilst improving outcomes. We aimed to describe decision-making and preferences of people with epilepsy (PWE) during emergency service use, and views of ED alternatives, including use of an Urgent Treatment Centre and telephone-based support from an epilepsy nurse specialist. METHODS We conducted a community-based interview study in South East England, informed by a qualitative framework approach. 25 adults with epilepsy and 5 of their carers took part. RESULTS Participants' choice to attend ED generally corresponded with guidelines, including continuing seizures and injury. Nevertheless, over half reported unwanted or unnecessary ED attendance, mainly due to lack of access to individual patient history, a carer, or seizures occurring in a public place. Participants used proactive strategies to communicate their care needs to others, including 24 -h alarm devices and care plans. Some suggested preventative strategies including referral after ED. Participants highlighted the importance of ambulance staff in providing fast and efficient care that gives reassurance. CONCLUSION Improving communication and access to preventative, proactive services may facilitate better outcomes within existing care pathways. PWE felt ED alternatives were helpful in some circumstances, but Urgent Treatment Centres or epilepsy nurse specialists were not viewed as an ED replacement.
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Affiliation(s)
- Alison McKinlay
- King's College London, Department of Basic and Clinical Neuroscience, London, UK.
| | - Myfanwy Morgan
- King's College London, Institute of Pharmaceutical Science, London, UK.
| | - Adam Noble
- University of Liverpool, Department of Health Services Research, UK.
| | - Leone Ridsdale
- King's College London, Department of Basic and Clinical Neuroscience, London, UK.
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Anderson R, Walburn J, Morgan M. Approaches to Photoprotection and Normalization in Highly Adherent Families of Children With Xeroderma Pigmentosum in the United Kingdom. Qual Health Res 2020; 30:1275-1286. [PMID: 30741094 DOI: 10.1177/1049732319826561] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this study, we examine photoprotection for children with Xeroderma pigmentosum (XP), a rare genetic skin disease requiring rigorous photoprotection, to reduce risks of severe burning and skin cancers from exposure to ultraviolet radiation (UVR). We elicit the views and experiences of both children and their parents to inform the care and support provided. Qualitative semistructured interviews were undertaken with 12 child-parent dyads recruited from the National XP Specialist service in London. We employed a framework approach to analysis. This identified a high level of photoprotection based either on "protection" to facilitate normal activities or "avoidance" of outdoor activity with priority given to normality in the future. These approaches were shaped by perceptions of clinical risk, the emphasis given to a normal family life and families' circumstances and resources. The findings contribute to notions of normalization and coping with demanding care regimens and inform approaches to working with families.
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Noble AJ, Snape D, Nevitt S, Holmes EA, Morgan M, Tudur-Smith C, Hughes DA, Buchanan M, McVicar J, MacCallum E, Goodacre S, Ridsdale L, Marson AG. Seizure First Aid Training For people with Epilepsy (SAFE) frequently attending emergency departments and their significant others: results of a UK multi-centre randomised controlled pilot trial. BMJ Open 2020; 10:e035516. [PMID: 32303515 PMCID: PMC7201300 DOI: 10.1136/bmjopen-2019-035516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine the feasibility and optimal design of a randomised controlled trial (RCT) of Seizure First Aid Training For Epilepsy (SAFE). DESIGN Pilot RCT with embedded microcosting. SETTING Three English hospital emergency departments (EDs). PARTICIPANTS Patients aged ≥16 with established epilepsy reporting ≥2 ED visits in the prior 12 months and their significant others (SOs). INTERVENTIONS Patients (and their SOs) were randomly allocated (1:1) to SAFE plus treatment-as-usual (TAU) or TAU alone. SAFE is a 4-hour group course. MAIN OUTCOME MEASURES Two criteria evaluated a definitive RCT's feasibility: (1) ≥20% of eligible patients needed to be consented into the pilot trial; (2) routine data on use of ED over the 12 months postrandomisation needed securing for ≥75%. Other measures included eligibility, ease of obtaining routine data, availability of self-report ED data and comparability, SAFE's effect and intervention cost. RESULTS Of ED attendees with a suspected seizure, 424 (10.6%) patients were eligible; 53 (12.5%) patients and 38 SOs consented. Fifty-one patients (and 37 SOs) were randomised. Routine data on ED use at 12 months were secured for 94.1% patients. Self-report ED data were available for 66.7% patients. Patients reported more visits compared with routine data. Most (76.9%) patients randomised to SAFE received it and no related serious adverse events occurred. ED use at 12 months was lower in the SAFE+TAU arm compared with TAU alone, but not significantly (rate ratio=0.62, 95% CI 0.33 to 1.17). A definitive trial would need ~674 patient participants and ~39 recruitment sites. Obtaining routine data was challenging, taking ~8.5 months. CONCLUSIONS In satisfying only one predetermined 'stop/go' criterion, a definitive RCT is not feasible. The low consent rate in the pilot trial raises concerns about a definitive trial's finding's external validity and means it would be expensive to conduct. Research is required into how to optimise recruitment from the target population. TRIAL REGISTRATION NUMBER ISRCTN13871327.
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Affiliation(s)
- Adam J Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Dee Snape
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Emily A Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | | | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Mark Buchanan
- Emergency Department, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Jane McVicar
- MacKinnon Memorial Hospital / Broadford Hospital, NHS Highland, Broadford, Isle of Skye, UK
| | - Elizabeth MacCallum
- Emergency Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Zhang L, Rossi A, Lange L, Meumann N, Koitzsch U, Christie K, Nesbit MA, Moore CBT, Hacker UT, Morgan M, Hoffmann D, Zengel J, Carette JE, Schambach A, Salvetti A, Odenthal M, Büning H. Capsid Engineering Overcomes Barriers Toward Adeno-Associated Virus Vector-Mediated Transduction of Endothelial Cells. Hum Gene Ther 2020; 30:1284-1296. [PMID: 31407607 DOI: 10.1089/hum.2019.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Endothelial cells (EC) are targets in gene therapy and regenerative medicine, but they are inefficiently transduced with adeno-associated virus (AAV) vectors of various serotypes. To identify barriers hampering efficient transduction and to develop an optimized AAV variant for EC transduction, we screened an AAV serotype 2-based peptide display library on primary human macrovascular EC. Using a new high-throughput selection and monitoring protocol, we identified a capsid variant, AAV-VEC, which outperformed the parental serotype as well as first-generation targeting vectors in EC transduction. AAV vector uptake was improved, resulting in significantly higher transgene expression levels from single-stranded vector genomes detectable within a few hours post-transduction. Notably, AAV-VEC transduced not only proliferating EC but also quiescent EC, although higher particle-per-cell ratios had to be applied. Also, induced pluripotent stem cell-derived endothelial progenitor cells, a novel tool in regenerative medicine and gene therapy, were highly susceptible toward AAV-VEC transduction. Thus, overcoming barriers by capsid engineering significantly expands the AAV tool kit for a wide range of applications targeting EC.
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Affiliation(s)
- L Zhang
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - A Rossi
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.,International Center for Research in Infectiology (CIRI), INSERM U1111, CNRS UMR5308, Lyon, France
| | - L Lange
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.,REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany
| | - N Meumann
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - U Koitzsch
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - K Christie
- Biomedical Sciences Research Institute, Ulster University, Ulster, Northern Ireland
| | - M A Nesbit
- Biomedical Sciences Research Institute, Ulster University, Ulster, Northern Ireland
| | - C B T Moore
- Biomedical Sciences Research Institute, Ulster University, Ulster, Northern Ireland.,Avellino Labs USA, Menlo Park, California
| | - U T Hacker
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.,1st Medical Department, University Cancer Center Leipzig, University Leipzig Medical Center, Leipzig, Germany
| | - M Morgan
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.,REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany
| | - D Hoffmann
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.,REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany
| | - J Zengel
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California
| | - J E Carette
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California
| | - A Schambach
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.,REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Salvetti
- International Center for Research in Infectiology (CIRI), INSERM U1111, CNRS UMR5308, Lyon, France
| | - M Odenthal
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - H Büning
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.,REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Sites Bonn-Cologne and Hannover-Braunschweig, Braunschweig, Germany
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Higginbottom GMA, Evans C, Morgan M, Bharj KK, Eldridge J, Hussain B, Salt K. Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08140] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes.
Objectives
Our objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies.
Review methods
An information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence.
Results
We identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated.
Limitations
Our review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women.
Conclusions
Available evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this.
Future work
Studies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource.
Study registration
This study is registered as PROSPERO CRD42015023605.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gina MA Higginbottom
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Karen Salt
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
- Centre for Research into Race and Rights, University of Nottingham, Nottingham, UK
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Walburn J, Anderson R, Morgan M. Forms, interactions, and responses to social support: A qualitative study of support and adherence to photoprotection amongst patients with Xeroderma Pigmentosum. Br J Health Psychol 2020; 25:89-106. [PMID: 31756279 PMCID: PMC7004138 DOI: 10.1111/bjhp.12396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/23/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Social support influences adherence to treatment in chronic illness, but there is uncertainty about its facilitators and constraints. This study explored the forms, processes, and responses associated with mobilization of informal support across three life contexts amongst patients with Xeroderma Pigmentosum (XP), a condition requiring rigorous photoprotection to reduce cancer risks. DESIGN Qualitative interview study. METHODS A total of 25 adults with XP participated in semi-structured interviews conducted face to face. An inductive thematic analysis was applied using a framework approach. RESULTS Practical support, involving both assistance with recommended photoprotection and adjusting daily activities to reduce exposure, was the key form of support provided by family and friends. However, responses to this support differed with two groups identified based on the relative priority given to photoprotection in daily life and processes of disclosure. For 'positive responders', support aligned with their own priorities to photoprotect, conveyed feelings of being cared-for and was facilitated by talking openly. In contrast, for 'negative responders' support conflicted with their priority of living 'normally' and their limited disclosure hindered receipt of helpful support in personal, clinic, and work interactions. Fears of workplace stigma also reduced disclosure amongst participants open in other contexts. CONCLUSIONS Practical support conveyed psychosocial support with positive effects on adherence. This suggests the traditional separation into practical and emotional support is overly simplistic, with measures potentially missing important aspects. Interactional processes contribute to the effects of support, which can be addressed by targeting disclosure, stigma, and other barriers at individual and organizational levels. Statement of contribution What is already known on this subject? Social support can be both a facilitator and a hindrance to treatment adherence. Practical support is identified as the most important form of support in the context of adherence. The processes of support underpinning its relationship to adherence are unclear. What does this study add? Variations in the provision and impacts of support are influenced by participants' disclosure and attitudes to photoprotection, with two key groups comprising 'positive responders' and 'negative responders'. The influence of emotional support on adherence may be underestimated through neglect of the ways in which practical support often conveys feelings of being valued and cared-for. Barriers to mobilizing effective adherence support extends across life spheres, with fears of stigma and discrimination in work settings highlighting the need to intervene at individual and organizational levels.
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Affiliation(s)
- Jessica Walburn
- Faculty of Life Sciences and MedicineSchool of Cancer and Pharmaceutical SciencesKing’s College LondonUK
| | - Rebecca Anderson
- Faculty of Life Sciences and MedicineSchool of Cancer and Pharmaceutical SciencesKing’s College LondonUK
| | - Myfanwy Morgan
- Faculty of Life Sciences and MedicineSchool of Cancer and Pharmaceutical SciencesKing’s College LondonUK
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Abstract
UNLABELLED One in four births in the UK is to foreign-born women. In 2016, the figure was 28.2%, the highest figure on record, with maternal and perinatal mortality also disproportionately higher for some immigrant women. Our objective was to examine issues of access and experience of maternity care by immigrant women based on a systematic review and narrative synthesis of empirical research. REVIEW METHODS A research librarian designed the search strategies (retrieving literature published from 1990 to end June 2017). We retrieved 45 954 citations and used a screening tool to identify relevance. We searched for grey literature reported in databases/websites. We contacted stakeholders with expertise to identify additional research. RESULTS We identified 40 studies for inclusion: 22 qualitative, 8 quantitative and 10 mixed methods. Immigrant women, particularly asylum-seekers, often booked and accessed antenatal care later than the recommended first 10 weeks. Primary factors included limited English language proficiency, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Maternity care experiences were both positive and negative. Women with positive perceptions described healthcare professionals as caring, confidential and openly communicative in meeting their medical, emotional, psychological and social needs. Those with negative views perceived health professionals as rude, discriminatory and insensitive to their cultural and social needs. These women therefore avoided continuously utilising maternity care.We found few interventions focused on improving maternity care, and the effectiveness of existing interventions have not been scientifically evaluated. CONCLUSIONS The experiences of immigrant women in accessing and using maternity care services were both positive and negative. Further education and training of health professionals in meeting the challenges of a super-diverse population may enhance quality of care, and the perceptions and experiences of maternity care by immigrant women.
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Affiliation(s)
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | | | - Jeanette Eldridge
- Research and Learning Services, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Noble AJ, Mathieson A, Ridsdale L, Holmes EA, Morgan M, McKinlay A, Dickson JM, Jackson M, Hughes DA, Goodacre S, Marson AG. Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational 'Collaborate' project. BMJ Open 2019; 9:e031696. [PMID: 31678950 PMCID: PMC6830638 DOI: 10.1136/bmjopen-2019-031696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emergency department (ED) visits for epilepsy are common, costly, often clinically unnecessary and typically lead to little benefit for epilepsy management. An 'Alternative Care Pathway' (ACP) for epilepsy, which diverts people with epilepsy (PWE) away from ED when '999' is called and leads to care elsewhere, might generate savings and facilitate improved ambulatory care. It is unknown though what features it should incorporate to make it acceptable to persons from this particularly vulnerable target population. It also needs to be National Health Service (NHS) feasible. This project seeks to identify the optimal ACP configuration. METHODS AND ANALYSIS Mixed-methods project comprising three-linked stages. In Stage 1, NHS bodies will be surveyed on ACPs they are considering and semi-structured interviews with PWE and their carers will explore attributes of care important to them and their concerns and expectations regarding ACPs. In Stage 2, Discrete Choice Experiments (DCE) will be completed with PWE and carers to identify the relative importance placed on different care attributes under common seizure scenarios and the trade-offs people are willing to make. The uptake of different ACP configurations will be estimated. In Stage 3, two Knowledge Exchange workshops using a nominal group technique will be run. NHS managers, health professionals, commissioners and patient and carer representatives will discuss DCE results and form a consensus on which ACP configuration best meets users' needs and is NHS feasible. ETHICS AND DISSEMINATION Ethical approval: NRES Committee (19/WM/0012) and King's College London ethics Committee (LRS-18/19-10353). Primary output will be identification of optimal ACP configuration which should be prioritised for implementation and evaluation. A pro-active dissemination strategy will make those considering developing or supporting an epilepsy ACP aware of the project and opportunities to take part in it. It will also ensure they are informed of its findings. PROJECT REGISTRATION NUMBER Researchregistry4723.
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Affiliation(s)
- Adam J Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - E A Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Alison McKinlay
- Basic & Clinical Neuroscience, King's College London, London, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Steve Goodacre
- Medical Care Research Unit, University of Sheffield, Sheffield, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Symvoulakis E, Markaki A, Rachiotis G, Linardakis M, Klinis S, Morgan M. Organ donation attitudes and general self-efficacy: exploratory views from a rural primary care setting. Rural Remote Health 2019; 19:5241. [PMID: 31661290 DOI: 10.22605/rrh5241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Behavioral determinants can enable or hinder motivation towards registration and donorship and, subsequently, action or inertia towards organ donation. Nevertheless, there is limited information about the role of self-efficacy in relation to organ donation awareness and presumed consent among individuals and their families. The aim of this study was to explore knowledge, attitudes and general self-efficacy as behavioral determinants for organ donation among rural primary care attendants, in order to tailor awareness strategies for reversing inertia within an opt-out system. METHODS This was a prospective face-to-face survey during regularly scheduled appointments of 203 attendants at a rural primary care unit in northern Greece. Responses to a 12-item adapted 'Organ donation awareness' questionnaire measuring knowledge, attitudes and awareness were related to participants' General Self-Efficacy (GSE) Scale score. Hierarchical modelling of a multiple linear regression model was adopted with GSE score added. RESULTS About one-third of respondents (34.0%) had discussed presumed consent with a partner, family member or friend. More than half (54.2%) were concerned that donated organs might be used without consent for other purposes, such as medical research. A total of 30% found organ donation unacceptable because of religious beliefs. Organ donation awareness was not influenced by respondents' specific characteristics, but was significantly related to the GSE score (standard β=0.155, p=0.033). CONCLUSION Overall, organ donation perceptions among rural primary care recipients were determined by knowledge of the presumed consent procurement system, pre-conceptions, religious beliefs, altruism and GSE scores. The association of self-efficacy with raised awareness could potentially explain the gap between high intent to consent as a donor and subsequent lack of follow-up action. Further comparative research across behavioral determinants between rural/urban groups is needed in order to tailor awareness strategies suitable for an opt-out system.
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Affiliation(s)
- Emmanouil Symvoulakis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Greece
| | | | - George Rachiotis
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Greece
| | - Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | | | - Myfanwy Morgan
- Institute of Pharmaceutical Science King's College London, London, UK
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Twose P, Thomas C, Morgan M, Broad MA. Comparison of high-flow oxygen therapy with standard oxygen therapy for prevention of postoperative pulmonary complications after major head and neck surgery involving insertion of a tracheostomy: a feasibility study. Br J Oral Maxillofac Surg 2019; 57:1014-1018. [PMID: 31515152 DOI: 10.1016/j.bjoms.2019.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/27/2018] [Accepted: 08/23/2019] [Indexed: 11/19/2022]
Abstract
Major operations on the head and neck that involve microvascular reconstruction and a tracheostomy are prolonged procedures with considerable postoperative risk. Postoperative pulmonary complications are common because of mechanical ventilation, immobility, and inadequate humidification. High-flow heated oxygen therapy (HFOT) may overcome some of these issues, but we know of no published studies to support its use. The aim of this single-site randomised controlled trial therefore was to explore its feasibility and safety in these patients. Twenty patients were randomised to have HFOT (10 patients) or standard oxygen therapy (10 patients). HFOT was used from cessation of mechanical ventilation until decannulation of the tracheostomy. The primary outcome was feasibility. The secondary outcome measures explored the incidence of postoperative pulmonary complications, achievement of milestones of weaning from the tracheostomy, and hospital length of stay. A total of 21 patients were consecutively recruited and all provided informed consent. One who did not require a tracheostomy was later excluded. All patients initially had the intervention as planned, and one was electively changed to the control group because of discomfort caused by the high-flow oxygen. There were no adverse events or safety concerns in either group. Secondary outcomes showed a reduction in the incidence of pulmonary complications in the HFOT group. The use of HFOT is safe and feasible in patients who have microvascular reconstruction of the head and neck and a tracheostomy.
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Affiliation(s)
- P Twose
- Physiotherapy Department, University Hospital of Wales, Cardiff CF14 4XW.
| | - C Thomas
- Department of Oro-Maxillofacial Surgery, University of Wales, Cardiff CF14 4XW
| | - M Morgan
- Critical Care Department, University Hospital of Wales, Cardiff CF14 4XW
| | - M-A Broad
- Queen Elizabeth Hospital Kings Lynn, Gayton Road, Kings Lynn PE30 4ET
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Jauneikaite E, Ferguson T, Mosavie M, Fallowfield JL, Davey T, Thorpe N, Allsopp A, Shaw AM, Fudge D, O'Shea MK, Wilson D, Morgan M, Pichon B, Kearns AM, Sriskandan S, Lamb LE. Staphylococcus aureus colonization and acquisition of skin and soft tissue infection among Royal Marines recruits: a prospective cohort study. Clin Microbiol Infect 2019; 26:381.e1-381.e6. [PMID: 31357012 DOI: 10.1016/j.cmi.2019.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/03/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Skin and soft tissue infections (SSTIs) are a serious health issue for military personnel. Of particular importance are those caused by methicillin-resistant Staphylococcus aureus and Panton-Valentine leucocidin (PVL)-positive S. aureus (PVL-SA), as they have been associated with outbreaks of SSTIs. A prospective observational study was conducted in Royal Marine (RM) recruits to investigate the prevalence of PVL-SA carriage and any association with SSTIs. METHODS A total of 1012 RM recruits were followed through a 32-week training programme, with nose and throat swabs obtained at weeks 1, 6, 15 and 32. S. aureus isolates were characterized by antibiotic susceptibility testing, spa typing, presence of mecA/C and PVL genes. Retrospective review of the clinical notes for SSTI acquisition was conducted. RESULTS S. aureus colonization decreased from Week 1 to Week 32 (41% to 26%, p < 0.0001). Of 1168 S. aureus isolates, three out of 1168 (0.3%) were MRSA and ten out of 1168 (0.9%) PVL-positive (all MSSA) and 169 out of 1168 (14.5%) were resistant to clindamycin. Isolates showed genetic diversity with 238 different spa types associated with 25 multi-locus sequence type (MLST) clonal complexes. SSTIs were seen in 35% (351/989) of recruits with 3 training days lost per recruit. SSTI acquisition rate was reduced amongst persistent carriers (p < 0.0283). CONCLUSIONS Nose and throat carriage of MRSA and PVL-SA was low among recruits, despite a high incidence of SSTIs being reported, particularly cellulitis. Carriage strains were predominantly MSSA with a marked diversity of genotypes. Persistent nose and/or throat carriage was not associated with SSTI acquisition. Putative person-to-person transmission within troops was identified based on spa typing requiring further research to confirm and explore potential transmission routes.
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Affiliation(s)
- E Jauneikaite
- Department of Medicine, Imperial College London, London, UK; NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare-associated Infections, Imperial College London, London, UK; Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - T Ferguson
- Department of Medicine, Imperial College London, London, UK
| | - M Mosavie
- Department of Medicine, Imperial College London, London, UK; NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare-associated Infections, Imperial College London, London, UK
| | | | - T Davey
- Institute of Naval Medicine, Alverstoke, UK
| | - N Thorpe
- Institute of Naval Medicine, Alverstoke, UK
| | - A Allsopp
- Institute of Naval Medicine, Alverstoke, UK
| | - A M Shaw
- Institute of Naval Medicine, Alverstoke, UK
| | - D Fudge
- Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK
| | - M K O'Shea
- Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK; Institute of Microbiology and Infection, The University of Birmingham, Birmingham, UK
| | - D Wilson
- Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK
| | - M Morgan
- Department of Microbiology, Royal Devon and Exeter Hospital, Exeter, UK
| | - B Pichon
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - A M Kearns
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - S Sriskandan
- Department of Medicine, Imperial College London, London, UK; NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare-associated Infections, Imperial College London, London, UK
| | - L E Lamb
- Department of Medicine, Imperial College London, London, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK; Royal Free London NHS Foundation Trust, London, UK.
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Walburn J, Norton S, Sarkany R, Sainsbury K, Araújo-Soares V, Morgan M, Canfield M, Foster L, Heydenreich J, McCrone P, Mander A, Sniehotta FF, Wulf HC, Weinman J. Evaluation of a personalised adherence intervention to improve photoprotection in adults with Xeroderma Pigmentosum (XP): protocol for the trial of XPAND. BMJ Open 2019; 9:e028577. [PMID: 31320353 PMCID: PMC6661555 DOI: 10.1136/bmjopen-2018-028577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Poor adherence to photoprotection for people with xeroderma pigmentosum (XP) can be life-threatening. A randomised controlled trial (RCT) is being conducted to test the efficacy of a personalised adherence intervention (XPAND) to reduce the level of ultraviolet radiation (UVR) reaching the face, by improving photoprotection activities in adults with XP. METHODS AND ANALYSIS A two-armed parallel groups RCT, where we randomised 24 patients with suboptimal adherence to either an intervention group who received XPAND in 2018 or a delayed intervention group who will receive XPAND in 2019. XPAND involves seven sessions, one-to-one with a facilitator, using behaviour change techniques and specially designed materials to target barriers to photoprotection. Following baseline assessment in April 2018 (t0) and intervention, the primary outcome will be measured across 21 consecutive days in June and July 2018 (t1). The primary outcome is the average daily UVR dose to the face (D-to-F), calculated by combining objective UVR exposure at the wrist (measured by a dosimeter) with face photoprotection activities recorded on a daily UVR protection diary. Secondary outcomes include average daily UVR D-to-F across 21 days in August (t2); psychosocial process variables measured by daily questions (t0, t1, t2) and self-report questionnaires (t0, t1, t2, December 2018 (t3)). Intervention cost-utility is assessed by service use and personal cost questionnaires (t0, t3). The delayed intervention control arm participants will complete three further assessments in April 2019 (t4) and June-July 2019 (t5), and December 2019 (t6) with dosimetry and UVR protection diary completed for 21 days at t4 and t5. A process evaluation will be conducted using mixed methods. ETHICS AND DISSEMINATION Ethical approval has been received from West London & GTAC REC 17/LO/2110. Results will be disseminated in peer-reviewed journals and at conferences. This study tests a novel intervention, which, if successful, will be integrated into routine care. TRIAL REGISTRATION NUMBER NCT03445052; Pre-results.
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Affiliation(s)
- Jessica Walburn
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Robert Sarkany
- National Xeroderma Pigmentosum Service, Guy’s and St Thomas' NHS Foundation Trust, London, UK
| | - Kirby Sainsbury
- Faculty of Medical Sciences, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Vera Araújo-Soares
- Faculty of Medical Sciences, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Myfanwy Morgan
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Martha Canfield
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lesley Foster
- National Xeroderma Pigmentosum Service, Guy’s and St Thomas' NHS Foundation Trust, London, UK
| | | | - Paul McCrone
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
| | - Adrian Mander
- MRC Biostatistics Unit, School of Clinical Medicine, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Falko F Sniehotta
- Faculty of Medical Sciences, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - John Weinman
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Wojciehoski C, Kailasam A, Morgan M, Hansen K, Ayers A, Shepherd J. Alvimopan for routine use in gynecologic oncology surgical cases to prevent postoperative ileus: A cost-effectiveness analysis. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.439] [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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Czuber-Dochan W, Murrells T, Morgan M, Lomer M, Lindsay JO, Whelan K. OWE-36 Prevalence and factors associated with impaired food-related quality of life in 1223 people with IBD. Nutrition 2019. [DOI: 10.1136/gutjnl-2019-bsgabstracts.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Czuber-Dochan W, Morgan M, Hughes LD, Lomer MCE, Lindsay JO, Whelan K. Perceptions and psychosocial impact of food, nutrition, eating and drinking in people with inflammatory bowel disease: a qualitative investigation of food-related quality of life. J Hum Nutr Diet 2019; 33:115-127. [PMID: 31131484 DOI: 10.1111/jhn.12668] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Extensive research has provided an important understanding of the impact of inflammatory bowel disease (IBD) on nutrient intake, requirements and metabolism. By contrast, there has been limited research examining the psychosocial aspects of food, eating and drinking in IBD. The present study aimed to address this unmet need. METHODS Qualitative semi-structured interviews regarding the perceptions and psychosocial impact of food, eating and drinking were undertaken with 28 purposively selected people with IBD. Interviews were audio-recorded and transcribed verbatim. Colaizzi's framework was used to structure the data analysis. RESULTS Five major themes were identified. IBD symptoms and both surgical and medical treatments were described as having a direct impact on eating and drinking, with participants also using different food-related strategies to control IBD symptoms. These included a process of experimentation to identify trigger foods, following a severely restricted and limited diet, eating small portions, and eating more frequently. However, their limited knowledge about if, and how, food affected their symptoms, often resulted in negative coping strategies that impacted on psychosocial functioning, including a lack of enjoyment of eating, being afraid to eat and finding social occasions stressful. Managing food and drinking also made food shopping and preparation more burdensome, creating problems with families, at work and for social life, as well as the need for careful preparation and advanced planning of activities. CONCLUSIONS Inflammatory bowel disease has a profound impact on psychosocial aspects of food and nutrition, which impacts on 'food-related quality of life' (FRQoL). Further research is required to identify interventions that will improve FRQoL in patients with IBD.
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Affiliation(s)
- W Czuber-Dochan
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - M Morgan
- Institute of Pharmacological Sciences, King's College London, London, UK
| | - L D Hughes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M C E Lomer
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J O Lindsay
- Barts Health NHS Trust, The Royal London Hospital, London, UK.,Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - K Whelan
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Ridsdale L, McKinlay A, Wojewodka G, Robinson EJ, Mosweu I, Feehan SJ, Noble AJ, Morgan M, Taylor SJ, McCrone P, Landau S, Richardson M, Baker G, Goldstein LH. Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial. Health Technol Assess 2019; 22:1-142. [PMID: 29717699 DOI: 10.3310/hta22210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Epilepsy is a common neurological condition resulting in recurrent seizures. Research evidence in long-term conditions suggests that patients benefit from self-management education and that this may improve quality of life (QoL). Epilepsy self-management education has yet to be tested in a UK setting. OBJECTIVES To determine the effectiveness and cost-effectiveness of Self-Management education for people with poorly controlled epILEpsy [SMILE (UK)]. DESIGN A parallel pragmatic randomised controlled trial. SETTING Participants were recruited from eight hospitals in London and south-east England. PARTICIPANTS Adults aged ≥ 16 years with epilepsy and two or more epileptic seizures in the past year, who were currently being prescribed antiepileptic drugs. INTERVENTION A 2-day group self-management course alongside treatment as usual (TAU). The control group received TAU. MAIN OUTCOME MEASURES The primary outcome is QoL in people with epilepsy at 12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale. Other outcomes were seizure control, impact of epilepsy, medication adverse effects, psychological distress, perceived stigma, self-mastery and medication adherence. Cost-effectiveness analyses and a process evaluation were undertaken. RANDOMISATION A 1 : 1 ratio between trial arms using fixed block sizes of two. BLINDING Participants were not blinded to their group allocation because of the nature of the study. Researchers involved in data collection and analysis remained blinded throughout. RESULTS The trial completed successfully. A total of 404 participants were enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the intervention group, 61.5% completed all sessions of the course. No adverse events were found to be related to the intervention. At baseline, participants had a mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms were reported in 53.6% of the group and depression symptoms in 28.0%. The results following an intention-to-treat analysis showed no change in any measures at the 12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5, SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL. The process evaluation with 20 participants revealed that a group course increased confidence by sharing with others and improved self-management behaviours. CONCLUSIONS For people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve QoL after 12-months or reduce anxiety or depression symptoms. A psychological intervention may help with anxiety and depression. Interviewed participants reported attending a group course increased their confidence and helped them improve their self-management. FUTURE WORK More research is needed on self-management courses, with psychological components and integration with routine monitoring. TRIAL REGISTRATION Current Controlled Trials ISRCTN57937389. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Leone Ridsdale
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alison McKinlay
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gabriella Wojewodka
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily J Robinson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iris Mosweu
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah J Feehan
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam J Noble
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Stephanie Jc Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Primary Care and Public Health, London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Morgan M. SP-0636 The DNA damage response to radiotherapy: mechanisms and therapeutic opportunities. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31056-4] [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: 11/15/2022]
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