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Fredericksen RJ, Baker R, Sibley A, Estadt AT, Colston D, Mixson LS, Walters S, Bresett J, Levander XA, Leichtling G, Davy-Mendez T, Powell M, Stopka TJ, Pho M, Feinberg J, Ezell J, Zule W, Seal D, Cooper HLF, Whitney BM, Delaney JAC, Crane HM, Tsui JI. Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry. Harm Reduct J 2024; 21:74. [PMID: 38561753 PMCID: PMC10985853 DOI: 10.1186/s12954-024-00986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. METHODS We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. RESULTS We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. CONCLUSION In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.
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Affiliation(s)
| | - R Baker
- Oregon Health & Science University, Portland, USA
| | - A Sibley
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - A T Estadt
- The Ohio State University, Colombus, USA
| | - D Colston
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - J Bresett
- Southern Illinois University School of Medicine, Springfield, USA
| | - X A Levander
- Oregon Health & Science University, Portland, USA
| | | | - T Davy-Mendez
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M Powell
- University of Washington, Seattle, USA
| | - T J Stopka
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Medford, USA
| | - M Pho
- University of Chicago, Chicago, USA
| | - J Feinberg
- West Virginia University, Morgantown, USA
| | - J Ezell
- Cornell University, Ithaca, USA
| | - W Zule
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - D Seal
- Tulane University, New Orleans, USA
| | | | | | | | - H M Crane
- University of Washington, Seattle, USA
| | - J I Tsui
- University of Washington, Seattle, USA
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Stopka TJ, Estadt AT, Leichtling G, Schleicher JC, Mixson LS, Bresett J, Romo E, Dowd P, Walters SM, Young AM, Zule W, Friedmann PD, Go VF, Baker R, Fredericksen RJ. Barriers to opioid use disorder treatment among people who use drugs in the rural United States: A qualitative, multi-site study. Soc Sci Med 2024; 346:116660. [PMID: 38484417 PMCID: PMC10997882 DOI: 10.1016/j.socscimed.2024.116660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/26/2023] [Accepted: 02/05/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND In 2020, 2.8 million people required substance use disorder (SUD) treatment in nonmetropolitan or 'rural' areas in the U.S. Among this population, only 10% received SUD treatment from a specialty facility, and 1 in 500 received medication for opioid use disorder (MOUD). We explored the context surrounding barriers to SUD treatment in the rural United States. METHODS We conducted semi-structured, in-depth interviews from 2018 to 2019 to assess barriers to SUD treatment among people who use drugs (PWUD) across seven rural U.S. study sites. Using the social-ecological model (SEM), we examined individual, interpersonal, organizational, community, and policy factors contributing to perceived barriers to SUD treatment. We employed deductive and inductive coding and analytical approaches to identify themes. We also calculated descriptive statistics for participant characteristics and salient themes. RESULTS Among 304 participants (55% male, mean age 36 years), we identified barriers to SUD treatment in rural areas across SEM levels. At the individual/interpersonal level, relevant themes included: fear of withdrawal, the need to "get things in order" before entering treatment, close-knit communities and limited confidentiality, networks and settings that perpetuated drug use, and stigma. Organizational-level barriers included: strict facility rules, treatment programs managed like corrections facilities, lack of gender-specific treatment programs, and concerns about jeopardizing employment. Community-level barriers included: limited availability of treatment in local rural communities, long distances and limited transportation, waitlists, and a lack of information about treatment options. Policy-level themes included insurance challenges and system-imposed barriers such as arrest and incarceration. CONCLUSION Our findings highlight multi-level barriers to SUD treatment in rural U.S. communities. Salient barriers included the need to travel long distances to treatment, challenges to confidentiality due to small, close-knit communities where people are highly familiar with one another, and high-threshold treatment program practices. Our findings point to the need to facilitate the elimination of treatment barriers at each level of the SEM in rural America.
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Affiliation(s)
- T J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - A T Estadt
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | | | - J C Schleicher
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - L S Mixson
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - J Bresett
- Southern Illinois University at Carbondale, Dept of Public Health, Carbondale, IL, USA
| | - E Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - P Dowd
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - S M Walters
- New York University's Grossman School of Medicine, New York, NY, USA
| | - A M Young
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - W Zule
- RTI International, Research Triangle, NC, USA
| | - P D Friedmann
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - V F Go
- University, of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - R Baker
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - R J Fredericksen
- University of Washington, Department of Medicine, Seattle, WA, USA
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, 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S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Jarvis MS, Blackburn J, Hailstone C, Small CL, Dixon C, Rook W, Maniar R, Graham J, Sengar T, Dunn SJ, Tooley L, Blurton E, Mak K, Dunham R, Baker R, Lacey V, Basheer N, Freeman A, Delahunt S, Gurung S, Akhtar N, Parmar R, Whitney D, Shatananda L, Wallengren C, Pilsbury J, Cochran D, Sandur N, Girotra V, Greenwood J, Baines D, Olojede B, Bhat A, Baxendale L, Porter M, Whapples A, Kumar A, Ramamoorthy M, Perry R, Magill L. A survey in the West Midlands of the United Kingdom of current practice in managing hypotension in lower segment caesarean section under spinal anaesthesia. Int J Obstet Anesth 2023; 55:103899. [PMID: 37329691 DOI: 10.1016/j.ijoa.2023.103899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/07/2023] [Accepted: 05/22/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Spinal anaesthesia, the most common form of anaesthesia for caesarean section, leads to sympathetic blockade and profound maternal hypotension resulting in adverse maternal and neonatal outcomes. Hypotension, nausea and vomiting remain common but until the publication of the National Institute of Health and Care Excellence (NICE) 2021 guidance, no national guideline existed on how best to manage maternal hypotension following spinal anaesthesia for caesarean section. A 2017 international consensus statement recommended prophylactic vasopressor administration to maintain a systolic blood pressure of >90% of an accurate pre-spinal value, and to avoid a drop to <80% of this value. This survey aimed to assess regional adherence to these recommendations, the presence of local guidelines for management of hypotension during caesarean section under spinal anaesthesia, and the individual clinician's treatment thresholds for maternal hypotension and tachycardia. METHODS The West Midlands Trainee-led Research in Anaesthesia and Intensive Care Network co-ordinated surveys of obstetric anaesthetic departments and consultant obstetric anaesthetists across 11 National Health Service Trusts in the Midlands, England. RESULTS One-hundred-and-two consultant obstetric anaesthetists returned the survey and 73% of sites had a policy for vasopressor use; 91% used phenylephrine as the first-line drug but a wide range of recommended delivery methods was noted and target blood pressure was only listed in 50% of policies. Significant variation existed in both vasopressor delivery methods and target blood pressures. CONCLUSIONS Although NICE has since recommended prophylactic phenylephrine infusion and a target blood pressure, the previous international consensus statement was not adhered to routinely.
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Affiliation(s)
- M S Jarvis
- University Hospitals of North Midlands NHS Trust, UK.
| | - J Blackburn
- Birmingham Women's and Children's NHS Foundation Trust, UK
| | - C Hailstone
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | | | - W Rook
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - R Maniar
- Kettering General Hospital NHS Foundation Trust, UK
| | - J Graham
- Worcestershire Acute Hospitals NHS Trust, UK
| | - T Sengar
- Kettering General Hospital NHS Foundation Trust, UK
| | - S J Dunn
- Royal Wolverhampton NHS Trust, UK
| | - L Tooley
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - E Blurton
- University Hospitals of Derby and Burton NHS Foundation Trust, UK
| | - K Mak
- University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - R Dunham
- Birmingham Women's and Children's NHS Foundation Trust, UK
| | - R Baker
- The Dudley Group NHS Foundation Trust, UK
| | | | | | - A Freeman
- Worcestershire Acute Hospitals NHS Trust, UK
| | - S Delahunt
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - S Gurung
- University Hospitals of Derby and Burton NHS Foundation Trust, UK
| | - N Akhtar
- University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - R Parmar
- Worcestershire Acute Hospitals NHS Trust, UK
| | - D Whitney
- Worcestershire Acute Hospitals NHS Trust, UK
| | | | | | - J Pilsbury
- Birmingham Women's and Children's NHS Foundation Trust, UK
| | | | - N Sandur
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - V Girotra
- Kettering General Hospital NHS Foundation Trust, UK
| | - J Greenwood
- Worcestershire Acute Hospitals NHS Trust, UK
| | - D Baines
- Kettering General Hospital NHS Foundation Trust, UK
| | | | - A Bhat
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - L Baxendale
- University Hospitals of Derby and Burton NHS Foundation Trust, UK
| | - M Porter
- University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - A Whapples
- Birmingham Women's and Children's NHS Foundation Trust, UK
| | - A Kumar
- University Hospitals of North Midlands NHS Trust, UK
| | | | - R Perry
- University of Birmingham, UK
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Ho YC, Brake SJ, Ahuja K, Acott N, Tiao J, Baker R, Adams MJ. IgG fractions from patients with antiphospholipid syndrome and systemic lupus erythematosus bind to platelets, but do not affect collagen-induced platelet activation. Biotech Histochem 2022; 97:604-615. [PMID: 35394397 DOI: 10.1080/10520295.2022.2049878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Anti-beta-2 glycoprotein 1 (anti-β2GP1) is an antiphospholipid antibody found in patients with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). Its presence commonly is associated with thrombosis; however, the mechanisms of interaction of anti-β2GP1 antibodies and platelets remain unclear. We investigated the effects of APS and SLE patient-derived IgG fractions on collagen-mediated platelet aggregation and examined the binding of patient-derived IgG to platelets before and after activation by collagen. IgG fractions, 150, 200, 300 or 350 µg/ml, isolated from 11 patients with APS and SLE were incubated with two sets of platelet-rich plasma (PRP) in the incubation wells of an aggregometer. The first set was activated by collagen and the other set was incubated for an additional 10 min. All platelets were collected by centrifugation and fixed in cell blocks. We assessed binding of IgG to platelets using immunocytochemistry (ICC). Patient-derived IgG fractions did not affect collagen-induced platelet aggregation. ICC staining using anti-human IgG antibodies demonstrated that patient-derived IgG fractions had greater affinity for non-activated platelets than those activated by 0.75 µg/ml collagen. Patient-derived IgG fractions bound to the surface of platelets and potentially could be internalized by platelets. IgG fractions from APS and SLE patients may sensitize non-activated platelets, which could increase platelet reactivity and thrombotic risk in patients. We did not detect secondary effects of patient-derived IgG fractions.
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Affiliation(s)
- Y C Ho
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - S J Brake
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Kdk Ahuja
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - N Acott
- PathWest Laboratory Medicine Western Australia, Nedlands, Western Australia, Australia
| | - J Tiao
- Western Australian Centre for Thrombosis and Haemostasis, Murdoch University, Murdoch, Western Australia, Australia
| | - R Baker
- Western Australian Centre for Thrombosis and Haemostasis, Murdoch University, Murdoch, Western Australia, Australia
| | - M J Adams
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
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Giorga A, Thompson J, Lo T, Baker R. 902 Safe Elective & Emergency Surgery During the COVID-19 Crisis: Experience of a Large Tertiary Centre During the First Wave of the Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
In addition to a reduction in elective surgery, the COVID-19 pandemic has been associated with concerning rates of post-operative mortality in COVID-19 patients highlighting the threat of nosocomial transmission. Relocation of elective patients into a protected cold wing of a tertiary centre, vigilant testing and staff test, and trace were implemented to address these issues.
Method
Retrospective analysis of 5069 consecutive patients who underwent procedures in theatre from 11/03/20 – 08/09/20 was performed. Comparison of numbers of procedures was compared with the same study dates in 2019. Detailed analysis of nosocomial transmission of COVID-19 and mortality was performed using patient notes and death certificates.
Results
5854 procedures were performed in 2020 compared with 13219 in 2019, representing a reduction of 55.7%. The overall mortality in 2020 was 2.7% (135/5069). COVID-19 negative mortality was 2.36% (119/5033). 74 patients tested positive for COVID-19 at any time (1.3%); mortality amongst patients who tested positive seven days pre- to 30 days post-procedure was 5.4% (4/74). Nosocomial transmission rate was 0.27% in elective admissions (10/3773) and 0.97% in acute admissions (20/2052).
Conclusions
The first wave of the pandemic has predictably caused a significant reduction in elective activity. Our hospital infection prevention measures have kept nosocomial transmission rates low, particularly for elective admissions. We have observed lower rates of post-operative mortality in COVID-19 patients than published in other centres. Continuation of surgical services is important for patient outcomes, and essential for training the surgeons of tomorrow.
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Affiliation(s)
- A Giorga
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - J Thompson
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - T Lo
- Hull University Teaching Hospitals Trust, Hull, United Kingdom
| | - R Baker
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
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Baker R, Dellacqua G, Richards A, Thornton J. LB822 Nutraceuticals known to promote hair growth do not interfere with the inhibitory action of tamoxifen in breast cancer cells. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ferrigan L, Hartley R, Hadley E, Steward L, Ngwenya S, Harmer J, Robinson A, Cosmos S, Wilkinson I, Tucker P, Flores A, Baker R. 475 DEVELOPING A VIRTUAL CARE HOME SUPPORT FORUM DURING THE COVID-19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8344445 DOI: 10.1093/ageing/afab116.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction COVID-19 has had a devastating effect on care homes, increasing both morbidity and mortality of residents and staff. Between 2 March and 12 June 2020, COVID-19 was the main cause of death in male care home residents (33.5%) and second for female (26.6%).1 By 1 May 2020, the death rate from all causes in care homes exceeded that in hospital (6,409 versus 6,397).2 Thus, care homes had to rapidly adapt to facilitate safe care of patients and staff. Method An expert outreach team visited a number of care homes in Surrey and Sussex to explore COVID-19 issues in care homes. Key themes were identified that informed topics for the Virtual Care Home Forum, where a series of virtual teaching, training and peer support sessions were hosted either live or on-demand, accessible for all care home staff. Results 12 sessions were held with an average attendance of 25 people, predominantly care home managers and community healthcare professionals. Real time qualitative feedback was collected and an electronic survey was completed at the end of the series which showed 100% felt the sessions had improved their understanding of the topic, 100% felt the knowledge and skills obtained from the sessions would be useful in their job, 87.5% agreed the sessions would impact or change their practise and 100% felt more supported during the pandemic. Conclusion It has been an unprecedented year for the NHS, and the care home sector has suffered significantly. In order to provide the best level of care for patients and support for our community colleagues, we must work collaboratively, including provision of education and training. To ensure equal access for all, maintaining user-safety and compliance with government legislation, virtual webinars proved to be an excellent modality. We plan to continue providing training, teaching and support through this means in the future.
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Affiliation(s)
| | - R Hartley
- Surrey and Sussex Healthc are NHS Trust
| | - E Hadley
- Surrey and Sussex Healthc are NHS Trust
| | - L Steward
- Integrated Response Team Sussex Community Foundation Trust
| | - S Ngwenya
- Integrated Response Team Sussex Community Foundation Trust
| | - J Harmer
- Integrated Response Team Sussex Community Foundation Trust
- First Community Health and Care CIC, East Surrey
| | - A Robinson
- Integrated Response Team Sussex Community Foundation Trust
| | - S Cosmos
- First Community Health and Care CIC, East Surrey
| | | | - P Tucker
- Surrey and Sussex Healthc are NHS Trust
| | - A Flores
- Surrey and Sussex Healthc are NHS Trust
| | - R Baker
- Surrey and Sussex Healthc are NHS Trust
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Zinzani PL, Capra M, Özcan M, Lv F, Li W, Yañez E, Sapunarova K, Lin T, Jin J, Jurczak W, Hamed A, Wang M, Baker R, Bondarenko I, Zhang Q, Feng J, Geissler K, Lazaroiu M, Saydam G, Szomor Á, Bouabdallah K, Galiulin R, Uchida T, Mongay Soler L, Cao A, Hiemeyer F, Mehra A, Childs BH, Shi Y, Matasar MJ. CHRONOS‐3: RANDOMIZED PHASE III STUDY OF COPANLISIB PLUS RITUXIMAB
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RITUXIMAB/PLACEBO IN RELAPSED INDOLENT NON‐HODGKIN LYMPHOMA (INHL). Hematol Oncol 2021. [DOI: 10.1002/hon.24_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P. L. Zinzani
- IRCCS Azienda Ospedaliero‐Universitaria di Bologna Istituto di Ematologia “Seràgnoli” Università di Bologna, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale Bologna Italy
| | - M. Capra
- Hospital Mãe de Deus Centro de Hematologia e Oncologia Porto Alegre Brazil
| | - M. Özcan
- Ankara University School of Medicine Hematology Department Ankara Turkey
| | - F. Lv
- Fudan University Shanghai Cancer Center Department of Medical Oncology Shanghai China
| | - W. Li
- The First Hospital of Jilin University Department of Hematology Changchun China
| | - E. Yañez
- University of La Frontera, Department of Internal Medicine Oncology‐Hematology Unit Temuco Chile
| | - K. Sapunarova
- Medical University Department of Internal Medicine Hematology Division Plovdiv Bulgaria
| | - T. Lin
- Sun Yat‐sen University Cancer Center Department of Medical Oncology Guangzhou China
| | - J. Jin
- The First Affiliated Hospital of Zhejiang University College of Medicine Department of Hematology Hangzhou China
| | - W. Jurczak
- Maria Skłodowska‐Curie National Research Institute of Oncology Department of Clinical Oncology Krakow Poland
| | - A. Hamed
- Petz Aladár Megyei Oktató Kórház Hematológiai Osztály Gyor Hungary
| | - M.‐C. Wang
- Chang Gung Memorial Hospital Kaohsiung Department of Medicine Kaohsiung Taiwan
| | - R. Baker
- Perth Blood Institute, Murdoch University Western Australia Centre for Thrombosis and Haemostasis Perth Australia
| | - I. Bondarenko
- City Dnipropetrovsk Multi‐field Clinical Hospital 4 DSMA, Chemotherapy Department Dnipro Ukraine
| | - Q. Zhang
- Harbin Medical University Cancer Hospital Department of Medical Oncology Harbin China
| | - J. Feng
- Jiangsu Cancer Hospital Department of Medical Oncology Nanjing China
| | - K. Geissler
- Sigmund Freud University, 5th Medical Department with Hematology Oncology and Palliative Medicine Vienna Austria
| | - M. Lazaroiu
- S.C. Policlinica de Diagnostic Rapid S.A. Department of Hematology Brasov Romania
| | - G. Saydam
- Ege Üniversitesi Tıp Fakültesi Division of Hematology Izmir Turkey
| | - Á. Szomor
- Pécsi Tudományegyetem Klinikai Központ 1st Department of Internal Medicine Pécs Hungary
| | - K. Bouabdallah
- University Hospital of Bordeaux Hematology and Cellular Therapy Department Bordeaux France
| | - R. Galiulin
- Clinical Oncological Dispensary of Omsk Region Department of Chemotherapy for Children and Adults Omsk Russian Federation
| | - T. Uchida
- Japanese Red Cross Nagoya Daini Hospital Department of Hematology and Oncology Nagoya Japan
| | - L. Mongay Soler
- Bayer HealthCare Pharmaceuticals, Inc. Clinical Development Whippany USA
| | - A. Cao
- Bayer HealthCare Pharmaceuticals, Inc. Clinical Statistics Whippany USA
| | - F. Hiemeyer
- Pharmaceuticals Division, Bayer AG Clinical Statistics Berlin Germany
| | - A. Mehra
- Bayer HealthCare Pharmaceuticals, Inc. Clinical Development Whippany USA
| | - B. H. Childs
- Bayer HealthCare Pharmaceuticals, Inc. Clinical Development Whippany USA
| | - Y. Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Department of Medical Oncology Beijing China
| | - M. J. Matasar
- Memorial Sloan Kettering Cancer Center Department of Medicine New York USA
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11
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Chadwell A, Kenney L, Thies S, Head J, Galpin A, Baker R. Addressing unpredictability may be the key to improving performance with current clinically prescribed myoelectric prostheses. Sci Rep 2021; 11:3300. [PMID: 33558547 PMCID: PMC7870859 DOI: 10.1038/s41598-021-82764-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
The efferent control chain for an upper-limb myoelectric prosthesis can be separated into 3 key areas: signal generation, signal acquisition, and device response. Data were collected from twenty trans-radial myoelectric prosthesis users using their own clinically prescribed devices, to establish the relative impact of these potential control factors on user performance (user functionality and everyday prosthesis usage). By identifying the key factor(s), we can guide future developments to ensure clinical impact. Skill in generating muscle signals was assessed via reaction times and signal tracking. To assess the predictability of signal acquisition, we inspected reaction time spread and undesired hand activations. As a measure of device response, we recorded the electromechanical delay between electrode stimulation and the onset of hand movement. Results suggest abstract measures of skill in controlling muscle signals are poorly correlated with performance. Undesired activations of the hand or incorrect responses were correlated with almost all kinematics and gaze measures suggesting unpredictability is a key factor. Significant correlations were also found between several measures of performance and the electromechanical delay; however, unexpectedly, longer electromechanical delays correlated with better performance. Future research should focus on exploring causes of unpredictability, their relative impacts on performance and interventions to address this.
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Affiliation(s)
- A Chadwell
- Centre for Health Sciences Research, University of Salford, Salford, UK.
| | - L Kenney
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - S Thies
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - J Head
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - A Galpin
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - R Baker
- Salford Business School, University of Salford, Salford, UK
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12
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O'Brien J, Dawson L, Chowdhury E, Tran L, Baker R, Newcomb A, Smith J, Reid C, Duffy S. Long-term Outcomes in Indigenous Australians Following Coronary Artery Bypass Surgery. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Nellipudi J, Baker R, Newland R, Krieg B, Bennetts J. M10 Disparities in Sternal Wound Infection After Cardiac Surgery Between Indigenous and non-Indigenous Australians. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Jones D, Chew D, Horsfall M, Sinhal A, Chuang A, Baker R, Bennetts J, Selvanayagam J, Joseph M, Lehman S. 607 Frailty Improves After Aortic Valve Intervention for Severe Aortic Stenosis. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Doran J, Bo R, Dempsey K, Cass A, Ilton M, Brunsdon G, Mc Donald M, Heal C, Mein J, Canty D, Grey N, Bennets J, Baker R, Stewart M, Kangaharan N. 702 Long-Term Survival and Predictors of Outcomes of Indigenous Northern Territorians Undergoing Primary and Re-Do Surgery for Rheumatic Heart Disease in Australia. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Jones D, Chew D, Horsfall M, Sinhal A, Chuang A, Baker R, Bennetts J, Selvanayagam J, Joseph M, Lehman S. 597 Augmentation Index Predicts Poor Symptomatic Recovery After Aortic Valve Intervention. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.604] [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: 10/23/2022]
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17
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Baker R, Kauffman JE, Laskar A, Shklyaev OE, Potomkin M, Dominguez-Rubio L, Shum H, Cruz-Rivera Y, Aranson IS, Balazs AC, Sen A. Fight the flow: the role of shear in artificial rheotaxis for individual and collective motion. Nanoscale 2019; 11:10944-10951. [PMID: 31139774 DOI: 10.1039/c8nr10257k] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To navigate in complex fluid environments, swimming organisms like fish or bacteria often reorient their bodies antiparallel or against the flow, more commonly known as rheotaxis. This reorientation motion enables the organisms to migrate against the fluid flow, as observed in salmon swimming upstream to spawn. Rheotaxis can also be realized in artificial microswimmers - self-propelled particles that mimic swimming microorganisms. Here we study experimentally and by computer simulations the rheotaxis of self-propelled gold-platinum nanorods in microfluidic channels. We observed two distinct modes of artificial rheotaxis: a high shear domain near the bottom wall of the microfluidic channel and a low shear regime in the corners. Reduced fluid drag in the corners promotes the formation of many particle aggregates that rheotax collectively. Our study provides insight into the biomimetic functionality of artificial self-propelled nanorods for dynamic self-assembly and the delivery of payloads to targeted locations.
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Affiliation(s)
- Remmi Baker
- Department of Material Science and Engineering, The Pennsylvania State University, University Park, PA 16802, USA
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18
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Gay MC, Baker R, Vrignaud P, Thomas P, Heinzlef O, Haag P, Banovic I, Thomas S. Cross-cultural validation of a French version of the Emotional Processing Scale (EPS-25). European Review of Applied Psychology 2019. [DOI: 10.1016/j.erap.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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19
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Pastor AM, Calvo PM, de la Cruz RR, Baker R, Straka H. Discharge properties of morphologically identified vestibular neurons recorded during horizontal eye movements in the goldfish. J Neurophysiol 2019; 121:1865-1878. [DOI: 10.1152/jn.00772.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Computational capability and connectivity are key elements for understanding how central vestibular neurons contribute to gaze-stabilizing eye movements during self-motion. In the well-characterized and segmentally distributed hindbrain oculomotor network of goldfish, we determined afferent and efferent connections along with discharge patterns of descending octaval nucleus (DO) neurons during different eye motions. Based on activity correlated with horizontal eye and head movements, DO neurons were categorized into two complementary groups that either increased discharge during both contraversive (type II) eye (e) and ipsiversive (type I) head (h) movements (eIIhI) or vice versa (eIhII). Matching time courses of slow-phase eye velocity and corresponding firing rates during prolonged visual and head rotation suggested direct causality in generating extraocular motor commands. The axons of the dominant eIIhI subgroup projected either ipsi- or contralaterally and terminated in the abducens nucleus, Area II, and Area I with additional recurrent collaterals of ipsilaterally projecting neurons within the parent nucleus. Distinct feedforward commissural pathways between bilateral DO neurons likely contribute to the generation of eye velocity signals in eIhII cells. The shared contribution of DO and Area II neurons to eye velocity storage likely represents an ancestral condition in goldfish that is clearly at variance with the task separation between mammalian medial vestibular and prepositus hypoglossi neurons. This difference in signal processing between fish and mammals might correlate with a larger repertoire of visuo-vestibular-driven eye movements in the latter species that potentially required a shift in sensitivity and connectivity within the hindbrain-cerebello-oculomotor network. NEW & NOTEWORTHY We describe the structure and function of neurons within the goldfish descending octaval nucleus. Our findings indicate that eye and head velocity signals are processed by vestibular and Area II velocity storage integrator circuitries whereas the velocity-to-position Area I neural integrator generates eye position solely. This ancestral condition differs from that of mammals, in which vestibular neurons generally lack eye position signals that are processed and stored within the nucleus prepositus hypoglossi.
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Affiliation(s)
- A. M. Pastor
- Departamento de Fisiología, Facultad de Biología, Universidad de Sevilla, Seville, Spain
| | - P. M. Calvo
- Departamento de Fisiología, Facultad de Biología, Universidad de Sevilla, Seville, Spain
| | - R. R. de la Cruz
- Departamento de Fisiología, Facultad de Biología, Universidad de Sevilla, Seville, Spain
| | - R. Baker
- Department of Neuroscience and Physiology, New York University Langone Medical Center, New York, New York
| | - H. Straka
- Department of Biology II, Ludwig-Maximillians-Universität Munich, Planegg, Germany
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Ginieri-Coccossis M, Triantafillou E, Papanikolaou N, Baker R, Antoniou C, Skevington SM, Christodoulou GN. Quality of life and depression in chronic sexually transmitted infections in UK and Greece: The use of WHOQOL-HIV/STI BREF. Psychiatriki 2019; 29:209-219. [PMID: 30605425 DOI: 10.22365/jpsych.2018.293.209] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This is a comparative study aiming to investigate quality of life (QoL) and depression in individuals diagnosed either with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), or genital warts (GW) and genital herpes (GH), in two healthcare settings, in the United Kingdom (UK) or in Greece (Gr). Using a matched-pairs design, two equalized patient samples with sexually transmitted infections (STI) were recruited: from UK (n=43) and from Greece (n=43). QoL was assessed with WHOQOL-HIV BREF for HIV patients and WHOQOL-STI BREF -a newly adapted instrument- for genital warts and genital herpes patients. Depressive symptomatology was measured by the Centre for Epidemiological Studies- Depression Scale (CES-D) along with sociodemographic data. Results indicate that in both country- healthcare settings, a high percentage of individuals diagnosed with any type of STI, reported considerable depressive symptomatology: 35.7% for UK and 41.5% for Greek participants respectively. Regarding QoL, participants in the Greek healthcare settings reported significantly lower scores in the environment domain, and even lower scores were reported by the GW/GH group, in comparison to HIV. Specifically, these groups indicated significantly lower values in the following WHOQOL-BREF environment facets: (i) physical safety and security, (ii) participation in and opportunities for recreation/leisure activities, (iii) home environment, (iv) accessibility and quality in health and social care, and (v) transport facilities. Regarding correlation of QoL and depression, regression analysis provided significant evidence for depression having a differential effect on WHOQOL-BREF QoL domains. Evidence of increased depressive symptomatology in both STI patient- cohorts may shed light into unmet healthcare needs that should be addressed by healthcare providers in UK and Greece respectively. Furthermore, all types of Greek STI participants reported lower QoL, particularly the GW/GH group, indicating important unmet QoL needs in the environment domain, such as health and social care accessibility and quality, or environmental and social resources, all lowering everyday QoL. The present findings may provide guidelines for tailored mental health interventions alleviating depressive symptomatology in STI patients. Provision of targeted-interventions at healthcare and social-environmental levels will contribute to QoL/ health improvement in STI patients.
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Affiliation(s)
- M Ginieri-Coccossis
- 1st Department of Psychiatry, University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - E Triantafillou
- 1st Department of Psychiatry, University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - N Papanikolaou
- 1st Department of Psychiatry, University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - R Baker
- Department of Medicine and Social Care Education, Leicester Medical School, UK
| | - C Antoniou
- 1st Dermatologic Clinic, Medical School, University of Athens, Hospital "A. Syggrou", Athens, Greece
| | - S M Skevington
- Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester, UK
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21
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Leboeuf F, Baker R, Barré A, Reay J, Jones R, Sangeux M. The conventional gait model, an open-source implementation that reproduces the past but prepares for the future. Gait Posture 2019; 69:126-129. [PMID: 30708095 DOI: 10.1016/j.gaitpost.2019.01.034] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Conventional Gait Model (CGM), known by a variety of different names, is widely used in clinical gait analysis. We present pyCGM2, an open-source implementation of the CGM with two versions. The first, CGM1.0, is a clone of Vicon Plug In Gait (PiG) with all its variants. CGM1.0 provides a platform to test the effect of modifications to the CGM on data collected and processed retrospectively or to provide backward compatibility. The second version, CGM1.1, offers some practical modifications and includes three well documented improvements. RESEARCH QUESTION How do improvements of the conventional gait model affect joint kinematics and kinetics? METHOD The practical modifications include the possibility to use a medial knee epicondyle marker, during static calibration only, to define the medio-lateral axis of the femur in place of the knee alignment device. The three improvements correspond to the change of pelvis angle decomposition sequence, the adoption of a single tibia coordinate system, and the default decomposition of the joint moments in the joint coordinate system. We validated the outputs of version CGM1.0 against Vicon-PiG, and estimated the effect of the modifications included in version CGM1.1 using gait data collected in 16 healthy participants. RESULTS Kinematics and kinetics of CGM1.0 were superimposed with that of Vicon-PiG, with root mean square differences less than 0.04° for kinematics and less than 0.05 N.m.kg-1 for kinetics. SIGNIFICANCE The differences between the CGM1.1 and CGM1.0 were minimal in the healthy participant cohort but we discussed the expected difference in participants with different gait pathologies. We hope that the pyCGM2 will facilitate the systematic testing and the use of improved processing methods for the conventional gait model.
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Affiliation(s)
- F Leboeuf
- School of Health & Society, The University of Salford, UK.
| | - R Baker
- School of Health & Society, The University of Salford, UK
| | - A Barré
- Moveck Solution inc., Canada
| | - J Reay
- School of Health & Society, The University of Salford, UK
| | - R Jones
- School of Health & Society, The University of Salford, UK
| | - M Sangeux
- The Murdoch Children's Research Institute, Melbourne, Australia
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22
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Brunner C, Botten J, Wennike N, Ford L, Michaels K, Stephens A, Baker R. Early Supported Discharge for patients with febrile neutropenia - Experience at a large district hospital in the UK. Acute Med 2019; 18:14-19. [PMID: 32608388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neutropenic sepsis can be life threatening, with mortality 2-21%. The heterogeneity of patients referred with "suspected neutropenic sepsis" has led to strategies being developed to risk-stratify patients and identify those with a low risk of septic complications that could be managed in the outpatient setting, such as The Multinational Association for Supportive Care in Cancer score (MASCC). Outcomes for patients referred with suspected neutropenic sepsis were assessed before and after use of MASCC guided early-supported discharge. 50/123 (41%) patients over 24 months were eligible for early-supported discharge. 26/50 patients had same-day discharge, 14 had overnight admission, 8 stayed 2 nights and 2 stayed 3 nights. Patients received on average 2 follow-up telephone consultations. There were 5 readmissions (10%) and no adverse events. In comparison group; 8 patients over 3-months would have been suitable, potentially saving 40 bed-days. This shows MASCC guided early-supported discharge is safe and cost-effective.
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Affiliation(s)
- C Brunner
- MB BChir MRCP, Oncology Trust Grade Doctor at Taunton and Somerset NHS Foundation Trust
| | - J Botten
- MB BSc (Hons), MRCP (Med Oncology); Taunton and Somerset NHS Foundation Trust
| | - N Wennike
- FRCP; Taunton and Somerset NHS Foundation Trust
| | - L Ford
- RGN; Taunton and Somerset NHS Foundation Trust
| | - K Michaels
- RGN Onc Cert BSc Hons; Taunton and Somerset NHS Foundation Trust
| | - A Stephens
- RGN; Taunton and Somerset NHS Foundation Trust
| | - R Baker
- PhD; Taunton and Somerset NHS Foundation Trust
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23
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Abstract
BACKGROUND Malnutrition affects up to 33.6% of hospitalised patients, with consequences that are detrimental for both patients and healthcare providers. In 2015, an audit demonstrated inadequate nutritional provision and consumption by hospitalised patients, comprising a major risk factor for malnutrition. This re-audit evaluates whether patients are meeting recommended energy and protein standards and estimated individual requirements, subsequent to food service improvements since 2015. METHODS Patients (n = 111) were included from a South West hospital, and Malnutrition Universal Screening Tool scores (MUST) categorised patients as 'nutritionally well' (MUST 0) or 'nutritionally vulnerable' (MUST ≥ 1). Individual energy and protein requirements were estimated using weight-based equations. Nutritional intakes were assessed via 24-h dietary recall and compared against the British Dietetic Association's Nutrition and Hydration Digest standards, as well as estimated individual requirements. RESULTS In total, the Digest standards for energy and protein were met by 35% and 63% of patients respectively, which is an increase of 19% and 36% since 2015. 'Nutritionally well' patients were more likely to meet nutrient standards for protein (62%) than estimated individual requirements (30%) (P ≤ 0.001). 'Nutritionally vulnerable' patients were more likely to meet estimated individual requirements for energy (60%) than the Digest standards (30%) (P = 0.047). CONCLUSIONS The proportion of patients meeting the Digest standards has increased considerably following numerous food service changes. Nutritional training for housekeepers, energy/protein-dense snacks and drinks, and fortified dietary items may further increase nutritional intakes. Additionally, as a result of discrepancies between the Digest standards and individual estimated requirements, more research is required to identify the most appropriate auditing standards that reflect best practice.
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Affiliation(s)
- S Beavan
- Department of Nutrition and Dietetics, Cambridge University Hospital, Cambridge, UK
| | - R Baker
- Department of Nutrition and Dietetics, East Sussex Healthcare NHS Trust, Conquest Hospital, St Leonards-on-Sea, UK
| | - H Sadler
- Department of Nutrition and Dietetics, Derriford Hospital, Plymouth, UK
| | - A Collinson
- School of Health Professions, University of Plymouth, PAHC, Plymouth, UK
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24
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Litton E, Bass F, Delaney A, Hillis G, Marasco S, McGuinness S, Myles PS, Reid CM, Smith JA, Bagshaw SM, Keri-Anne Cowdrey HB, Frengley R, Ferrier J, Gilder E, Henderson S, Larobina M, Merthens J, Morgan M, Navarra L, Rudas M, Turner L, Reid K, Wise M, Young N, Young P, McGiffin D, Duncan J, Kaczmarek M, Seevanayagam S, Shaw M, Shardey G, Skillington P, Chorley T, Baker L, Zhang B, Bright C, Baker R, Canning N, Gilfillan, Kruger R, Fayers T, Kyte M, Doran C, Smith J, Baxter H, Seah P, Scaybrook S, James A, Goodwin K, Dignan R, Hewitt N, Gerrard K, Curtis L, Smith J, Baxter H, Tiruvoipati R, Broukal N, Wolfenden H, Muir, Worthington M, Wong C, Tatoulis J, Wynne R, Marshman D, Sze D, Wilson M, Turner L, Passage J, Kolybaba M, Fermanis G, Newbon P, Passage J, Kolybaba M, Newcomb A, Mack J, Duve K, Jansz P, Hunter T, Bissaker P, Dennis N, Burke N, Yadav S, Cooper K, Chard R, Halaka M, Tran L, Huq M, Billah B, Reid CM. Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study. J Cardiothorac Vasc Anesth 2018; 32:2067-2073. [DOI: 10.1053/j.jvca.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Indexed: 11/11/2022]
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Frank-Beaumont M, Baker R, Fitch S, Cheah M, Arlachova K, Weerasuriya N. 120IMPROVING THE QUALITY OF ELECTRONIC DISCHARGE SUMMARIES FOR OLDER ADULTS WITH A HIP FRACTURE. Age Ageing 2018. [DOI: 10.1093/ageing/afy126.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Frank-Beaumont
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham
| | - R Baker
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham
| | - S Fitch
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham
| | - M Cheah
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham
| | - K Arlachova
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham
| | - N Weerasuriya
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham
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26
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Kendrick D, Baker R, Hill T, Beckett K, Coupland C, Kellezi B, Joseph S, Barnes J, Sleney J, Christie N, Morriss R. Early risk factors for depression, anxiety and post-traumatic distress after hospital admission for unintentional injury: Multicentre cohort study. J Psychosom Res 2018; 112:15-24. [PMID: 30097131 DOI: 10.1016/j.jpsychores.2018.06.008] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To quantify psychological morbidity and identify baseline factors associated with depression, anxiety and post-traumatic distress symptoms up to 12 months post-injury. METHODS Multicentre cohort study of 668 adults, aged 16 to 70, admitted to 4 UK NHS hospital trusts. Data on injury, socio-demographic characteristics and health status was collected at recruitment. Depression, anxiety and post-traumatic distress were measured at 1, 2, 4 and 12 months post-injury. Multilevel linear regression assessed associations between patient and injury characteristics and psychological outcomes over 12 months follow-up. RESULTS Depression, anxiety and post-traumatic distress scores were highest 1 month post-injury, and remained above baseline at 2, 4 and 12 months post-injury. Moderate or severe injuries, previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age (45-64 years), greater deprivation and lower pre-injury quality of life (QoL) were associated with higher depression scores post-injury. Previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age, greater deprivation and lower pre-injury QoL were associated with higher anxiety scores post-injury. Traffic injuries or injuries from being struck by objects, multiple injures (≥3), being female, previous psychiatric diagnoses, higher pre-injury anxiety scores and greater deprivation were associated with higher post-traumatic distress scores post-injury. CONCLUSION A range of risk factors, identifiable shortly after injury, are associated with psychological morbidity occurring up to 12 months post-injury in a general trauma population. Further research is required to explore the utility of these, and other risk factors in predicting psychological morbidity on an individual patient basis.
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Affiliation(s)
- D Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK.
| | - R Baker
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - T Hill
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - K Beckett
- Centre for Health & Clinical Research, University of the West of England, BS16 1DD, UK
| | - C Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - B Kellezi
- Department of Psychology, Nottingham Trent University, NG1 4BU, UK
| | - S Joseph
- School of Education, University of Nottingham, NG8 1BB, UK
| | - J Barnes
- Loughborough Design School, Loughborough University, LE11 3TU, UK
| | - J Sleney
- Department of Sociology, University of Surrey, GU2 7XH, UK
| | - N Christie
- Centre for Transport Studies, University College London, WC1E 6BT, UK
| | - R Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, NG7 2TU, UK
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Chibber S, Baker R, Giuliani E, Conway D, Dalton V, Marsh E. The power of policy: trends in emergency department utilization for emergency contraception, 2006-2014. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.144] [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: 10/28/2022]
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Said H, Wild J, Baker R. Survival following multimodal treatment for squamous cell carcinoma of the anus: Results from a decades experience at a UK tertiary referral unit. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.237] [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: 11/17/2022]
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Jones D, Lehman S, Chew D, Bennetts J, Selvanayagam J, Horsfall M, Chuang A, Sinhal A, Joseph M, Baker R. Effect of Expanded Aortic Stenosis Management Services on Outcomes. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1020] [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: 10/28/2022]
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Peek MCL, Ahmed M, Scudder J, Baker R, Charalampoudis P, Pinder SE, Douek M. High-intensity focused ultrasound in the treatment of breast fibroadenomata (HIFU-F trial). Int J Hyperthermia 2017; 34:1002-1009. [PMID: 28854826 DOI: 10.1080/02656736.2017.1373865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND High-intensity focussed ultrasound (HIFU) is a non-invasive ablative technique utilising the application of high frequency ultrasound (US) pressure waves to cause tissue necrosis. This emerging technology is currently limited by prolonged treatment times. The aim of the HIFU-F trial was to perform circumferential HIFU treatment as a means of shortening treatment times. METHODS A prospective trial was set up to treat 50 consecutive patients ≥18 years of age. Eligible patients possessed symptomatic fibroadenomata, visible on US. Patients ≥25 years of age required histological confirmation of the diagnosis. Primary outcome measures were reduction in treatment time, reduction in volume on US after 12 months and complication rates. RESULTS HIFU treatment was performed in 51 patients (53 treatments) with a mean age of 29.8 years (SD 7.2 years) and a diameter of 2.6 cm (SD 1.4 cm). Circumferential ablation reduced treatment times by an estimated 19.9 min (SD 25.1 min), which is a 29.4% (SD 15.2%) reduction compared with whole lesion ablation. Volume reduction of 43.2% (SD 35.4%; p < 0.005, paired t-test) was observed on US at 12 months post-treatment. Local complications completely resolved at 1 month apart from skin hyper-pigmentation, which persisted in nine cases at three months, six cases at 6 months and six at 12 months. CONCLUSION Circumferential HIFU treatment for breast fibroadenomata is feasible to reduce both lesion size and treatment time. HIFU is a non-invasive alternative technique for the treatment of breast fibroadenomata. ISRCTN registration: 76622747.
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Affiliation(s)
- M C L Peek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - M Ahmed
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - J Scudder
- b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - R Baker
- c School of Business , University of Salford , Salford , Great Britain
| | - P Charalampoudis
- b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - S E Pinder
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - M Douek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
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Ahmed M, Jozsa F, Baker R, Rubio IT, Benson J, Douek M. Erratum to: Meta-analysis of tumour burden in pre-operative axillary ultrasound positive and negative breast cancer patients. Breast Cancer Res Treat 2017; 166:337. [PMID: 28856616 DOI: 10.1007/s10549-017-4457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Muneer Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK
| | - F Jozsa
- Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK
| | - R Baker
- Department of Statistics, School of Business, University of Salford, 612, Maxwell Building, Salford, M5 4WT, UK
| | - I T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - J Benson
- Breast Surgical Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - M Douek
- Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK.
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Doran J, Remeny B, Ilton M, Canty D, Cass A, Dempsey K, Townsend R, Royse C, Royse A, Kaethner A, Brunsdon G, Boardmann C, Bennets J, Baker R, Oatway S, Thiele B, Perry D, Doran K, Doran U, Grey N, Kangaharan N. Retrospective Audit of Rheumatic Heart Valve Surgical Outcomes in the Top End of Northern Territory, Australia. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Background In England, coronary heart disease (CHD) mortality has declined, but variations remain. Methods This study aimed to describe under 75-year CHD mortality variations across geographically defined populations. Regression slopes for mortality data as a function of time were calculated for all 151 English primary care trusts (PCTs), giving the change in the expected age adjusted rate for each extra year. Results Between 1993 and 2010, the mean age-standardized CHD mortality rate decreased from 107.76 to 35.12 per 100 000, but the coefficient of variation increased from 0.21 to 0.27. The slope of decline was significantly less after 2004 (β −4.91 for 1993–2003, −3.04 for 2004–2010). The proportion of smokers decreased by 24.6%. The estimated proportion of the population with controlled hypertension increased by 74.4% (2003–2010), but diabetes increased by 138% (1994–2010) and the proportion of obese people increased by 74.3% (1993–2010). There was a greater decline in CHD mortality in PCTs with greater deprivation and smoking (2006–2010). Conclusions Since 2004, there has not been a relative reduction of variations in CHD mortality. Appropriate strategies to improve early detection and effective management of risk factors are needed to lower overall CHD mortality further and to reduce persistent variations across England.
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Affiliation(s)
- L.S. Levene
- Department of Health Sciences, University of Leicester, 22-28 Princess Road W, Leicester LE1 6TP, UK
| | - R. Baker
- Department of Health Sciences, University of Leicester, 22-28 Princess Road W, Leicester LE1 6TP, UK
| | - K. Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences & Psychology, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - M.J.G. Bankart
- Department of Health Sciences, University of Leicester, 22-28 Princess Road W, Leicester LE1 6TP, UK
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Rebollo‐Mesa I, Nova‐Lamperti E, Mobillo P, Runglall M, Christakoudi S, Norris S, Smallcombe N, Kamra Y, Hilton R, Bhandari S, Baker R, Berglund D, Carr S, Game D, Griffin S, Kalra PA, Lewis R, Mark PB, Marks S, Macphee I, McKane W, Mohaupt MG, Pararajasingam R, Kon SP, Serón D, Sinha MD, Tucker B, Viklický O, Lechler RI, Lord GM, Hernandez‐Fuentes MP. Biomarkers of Tolerance in Kidney Transplantation: Are We Predicting Tolerance or Response to Immunosuppressive Treatment? Am J Transplant 2016; 16:3443-3457. [PMID: 27328267 PMCID: PMC5132071 DOI: 10.1111/ajt.13932] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/12/2016] [Accepted: 06/08/2016] [Indexed: 01/25/2023]
Abstract
We and others have previously described signatures of tolerance in kidney transplantation showing the differential expression of B cell-related genes and the relative expansions of B cell subsets. However, in all of these studies, the index group-namely, the tolerant recipients-were not receiving immunosuppression (IS) treatment, unlike the rest of the comparator groups. We aimed to assess the confounding effect of these regimens and develop a novel IS-independent signature of tolerance. Analyzing gene expression in three independent kidney transplant patient cohorts (232 recipients and 14 tolerant patients), we have established that the expression of the previously reported signature was biased by IS regimens, which also influenced transitional B cells. We have defined and validated a new gene expression signature that is independent of drug effects and also differentiates tolerant patients from healthy controls (cross-validated area under the receiver operating characteristic curve [AUC] = 0.81). In a prospective cohort, we have demonstrated that the new signature remained stable before and after steroid withdrawal. In addition, we report on a validated and highly accurate gene expression signature that can be reliably used to identify patients suitable for IS reduction (approximately 12% of stable patients), irrespective of the IS drugs they are receiving. Only a similar approach will make the conduct of pilot clinical trials for IS minimization safe and hence allow critical improvements in kidney posttransplant management.
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Affiliation(s)
- I. Rebollo‐Mesa
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,BiostatisticsInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom,UCB CelltechUCB Pharma S.A.SloughUnited Kingdom
| | - E. Nova‐Lamperti
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom
| | - P. Mobillo
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom
| | - M. Runglall
- National Institute for Health Research Biomedical Research CentreGuy's and St. Thomas’ National Health Service Foundation TrustKing's College LondonLondonUnited Kingdom
| | - S. Christakoudi
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,BiostatisticsInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - S. Norris
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,University College LondonLondonUnited Kingdom
| | - N. Smallcombe
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom
| | - Y. Kamra
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,Peter Gorer Department of ImmunobiologyKing's College LondonLondonUnited Kingdom
| | - R. Hilton
- Guy's and St. Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - Indices of Tolerance EU Consortium
- King's College LondonLondonUnited Kingdom,Oxford UniversityOxfordUnited Kingdom,Imperial College LondonLondonUnited Kingdom,Institute for Medical Immunology, Université Libre de BruxellesBruxellesBelgium,Miltenyi BiotecBergisch GladbachGermany,University of NantesNantesFrance,Charité, Universitaatsmedizin BerlinBerlinGermany
| | - S. Bhandari
- Hull and East Yorkshire Hospitals NHS TrustHullUnited Kingdom
| | - R. Baker
- St. James's University HospitalLeedsUnited Kingdom
| | | | - S. Carr
- Leicester General HospitalLeicesterUnited Kingdom
| | - D. Game
- Guy's and St. Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - S. Griffin
- Cardiff and Vale University Health BoardCardiffUnited Kingdom
| | | | - R. Lewis
- Queen Alexandra HospitalPortsmouthUnited Kingdom
| | - P. B. Mark
- University of GlasgowGlasgowUnited Kingdom
| | - S. Marks
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUnited Kingdom
| | - I. Macphee
- St. George's HospitalLondonUnited Kingdom
| | - W. McKane
- Northern General HospitalSheffieldUnited Kingdom
| | - M. G. Mohaupt
- INSELSPITALUniversitätsspital BernKlinik für Nephrologie/Hypertonie Abteilung für HypertonieBernSwitzerland
| | | | - S. P. Kon
- King's College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - D. Serón
- Hospital Universitari Vall d'Hebr_onBarcelonaSpain
| | - M. D. Sinha
- Evelina London Children's HospitalLondonUnited Kingdom
| | - B. Tucker
- King's College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - O. Viklický
- Transplantační laboratoř IKEMPragueCzech Republic
| | - R. I. Lechler
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,King's Health PartnersLondonUnited Kingdom
| | - G. M. Lord
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,National Institute for Health Research Biomedical Research CentreGuy's and St. Thomas’ National Health Service Foundation TrustKing's College LondonLondonUnited Kingdom,Guy's and St. Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - M. P. Hernandez‐Fuentes
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,National Institute for Health Research Biomedical Research CentreGuy's and St. Thomas’ National Health Service Foundation TrustKing's College LondonLondonUnited Kingdom
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Boltz D, Curry P, Baker R. Development of models for Zika virus infection in mice and Rhesus macaques using a contemporary virus strain. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Theadom A, Mitchell K, Roxburgh R, Rodrigues M, Taylor T, Baker R, Jones K, Stewart J, Poke G, Hammond-Tooke G, O'Grady G, Love D, Ranta A, Ao BT, Parmar P, Vandal A, Krishnamurthi R, Brown P, Feigin V. Unmet needs of people living with myotonic dystrophy: Data from a national, population-based study. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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Jäger C, Steinhäuser J, Freund T, Baker R, Agarwal S, Godycki-Cwirko M, Kowalczyk A, Aakhus E, Granlund I, van Lieshout J, Szecsenyi J, Wensing M. Process evaluation of five tailored programs to improve the implementation of evidence-based recommendations for chronic conditions in primary care. Implement Sci 2016; 11:123. [PMID: 27624776 PMCID: PMC5022166 DOI: 10.1186/s13012-016-0473-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 07/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background Although there is evidence that tailored implementation strategies can be effective, there is little evidence on which methods of tailoring improve the effect. We designed and evaluated five tailored programs (TPs) each consisting of various strategies. The aim of this study was to examine (a) how determinants of practice prioritized in the design phase of the TPs were perceived by health care professionals who had been exposed to the TPs and whether they suggested other important determinants of practice and (b) how professionals used the offered strategies and whether they suggested other strategies that might have been more effective. Methods We conducted a mixed-method process evaluation linked to five cluster-randomized trials carried out in five European countries to implement recommendations for five chronic conditions in primary care settings. The five TPs used a total of 28 strategies which aimed to address 38 determinants of practice. Interviews of professionals in the intervention groups and a survey of professionals in the intervention and control groups were performed. Data collection was conducted by each research team in the respective national language. The interview data were first analyzed inductively by each research team, and subsequently, a meta-synthesis was conducted. The survey was analyzed descriptively. Results We conducted 71 interviews; 125 professionals completed the survey. The survey showed that 76 % (n = 29) of targeted determinants of practice were perceived as relevant and 95 % (n = 36) as being modified by the implementation interventions by 66 to 100 % of professionals. On average, 47 % of professionals reported using the strategies and 51 % considered them helpful, albeit with substantial variance between countries and strategies. In the interviews, 89 determinants of practice were identified, of which 70 % (n = 62) had been identified and 45 % (n = 40) had been prioritized in the design phase. The interviewees suggested 65 additional strategies, of which 54 % (n = 35) had been identified and 20 % (n = 13) had been prioritized, but not selected in the final programs. Conclusions This study largely confirmed the perceived relevance of the targeted determinants of practice. This contrasts with the fact that no impact of the trials on the implementation of the recommendations could be observed. The findings suggest that better methods for prioritization of determinants and strategies are needed. Trial registration Each of the five trials was registered separately in recognized trial registries. Details are given in the respective trial outcome papers. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0473-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Jäger
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4. OG, 69120, Heidelberg, Germany.
| | - J Steinhäuser
- University Hospital Schleswig-Holstein, Campus Lübeck, Institute of Family Practice, Ratzburger Allee 160, Haus 50, 23538, Lübeck, Germany
| | - T Freund
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4. OG, 69120, Heidelberg, Germany
| | - R Baker
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE16TP, UK
| | - S Agarwal
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE16TP, UK
| | - M Godycki-Cwirko
- Centre for Family and Community Medicine, Medical University of Lodz, Kopcinskiego 20, 90-153, Lodz, Poland
| | - A Kowalczyk
- Centre for Family and Community Medicine, Medical University of Lodz, Kopcinskiego 20, 90-153, Lodz, Poland
| | - E Aakhus
- Research Center for Old Age Psychiatry in Innlandet Hospital Trust, N-2312, Ottestad, Norway.,Norwegian Knowledge Centre for the Health Services, Postboks 7004, St. Olavs plass, 0130, Oslo, Norway
| | - I Granlund
- Norwegian Knowledge Centre for the Health Services, Postboks 7004, St. Olavs plass, 0130, Oslo, Norway
| | - J van Lieshout
- Medical Centre, Scientific Institute for Quality of Healthcare, Radboud University, PO Box 9101, 114 IQ Healthcare, 6500 HB, Nijmegen, The Netherlands
| | - J Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4. OG, 69120, Heidelberg, Germany
| | - M Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4. OG, 69120, Heidelberg, Germany
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Zada A, Peek MCL, Ahmed M, Anninga B, Baker R, Kusakabe M, Sekino M, Klaase JM, Ten Haken B, Douek M. Meta-analysis of sentinel lymph node biopsy in breast cancer using the magnetic technique. Br J Surg 2016; 103:1409-19. [PMID: 27611729 DOI: 10.1002/bjs.10283] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/19/2016] [Accepted: 06/30/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The standard for sentinel lymph node biopsy (SLNB), the dual technique (radiolabelled tracer and blue dye), has several drawbacks. A novel magnetic technique without these drawbacks has been evaluated in a number of clinical trials. It uses a magnetic tracer and a handheld magnetometer to identify and excise sentinel lymph nodes. A systematic review and meta-analysis was performed to assess the performance and utility of the magnetic in comparison to the standard technique. METHODS MEDLINE, PubMed, Embase and the Cochrane online literature databases were used to identify all original articles evaluating the magnetic technique for SLNB published up to April 2016. Studies were included if they were prospectively conducted clinical trials comparing the magnetic with the standard technique for SLNB in patients with breast cancer. RESULTS Seven studies were included. The magnetic technique was non-inferior to the standard technique (z = 3·87, P < 0·001), at a 2 per cent non-inferiority margin. The mean identification rates for the standard and magnetic techniques were 96·8 (range 94·2-99·0) and 97·1 (94·4-98·0) per cent respectively (risk difference (RD) 0·00, 95 per cent c.i. -0·01 to 0·01; P = 0·690). The total lymph node retrieval was significantly higher with the magnetic compared with the standard technique: 2113 (1·9 per patient) versus 2000 (1·8 per patient) (RD 0·05, 0·03 to 0·06; P = 0·003). False-negative rates were 10·9 (range 6-22) per cent for the standard technique and 8·4 (2-22) per cent for the magnetic technique (RD 0·03, 0·00 to 0·06; P = 0·551). The mean discordance rate was 3·9 (range 1·7-6·9) per cent. CONCLUSION The magnetic technique for SLNB is non-inferior to the standard technique, with a high identification rate but with a significantly higher lymph node retrieval rate.
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Affiliation(s)
- A Zada
- Division of Cancer Studies, King's College, London, UK.,Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - M C L Peek
- Division of Cancer Studies, King's College, London, UK
| | - M Ahmed
- Division of Cancer Studies, King's College, London, UK
| | - B Anninga
- Division of Cancer Studies, King's College, London, UK
| | - R Baker
- School of Business, University of Salford, Salford, UK
| | - M Kusakabe
- Advanced Technology Research Laboratory Research Centre for Food Safety, Graduate School of Agricultural and Life Sciences, Tokyo, Japan
| | - M Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, University of Tokyo, Tokyo, Japan
| | - J M Klaase
- Surgical Oncology, Medisch Spectrum Twente, University of Twente, Enschede, The Netherlands
| | - B Ten Haken
- Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - M Douek
- Division of Cancer Studies, King's College, London, UK. .,Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
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Peek MCL, Ahmed M, Scudder J, Baker R, Pinder SE, Douek M. High intensity focused ultrasound in the treatment of breast fibroadenomata: results of the HIFU-F trial. Int J Hyperthermia 2016; 32:881-888. [DOI: 10.1080/02656736.2016.1212278] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- M. C. L. Peek
- Division of Cancer Studies, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M. Ahmed
- Division of Cancer Studies, King’s College London, London, UK
| | - J. Scudder
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - R. Baker
- School of Business, University of Salford, Salford, UK
| | - S. E. Pinder
- Division of Cancer Studies, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M. Douek
- Division of Cancer Studies, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Ahmed M, Baker R, Rubio IT. Meta-analysis of aberrant lymphatic drainage in recurrent breast cancer. Br J Surg 2016; 103:1579-1588. [DOI: 10.1002/bjs.10289] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/19/2016] [Accepted: 07/03/2016] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Sentinel node biopsy (SNB) in recurrent breast cancer offers targeted axillary staging compared with axillary lymph node dissection (ALND) or no treatment. The evidence for lymphatic mapping in recurrent breast cancer is reviewed, focusing on aberrant drainage and its implications for patient management.
Methods
A meta-analysis of studies evaluating lymphatic mapping in recurrent breast cancer was performed. Outcomes included sentinel node identification, aberrant lymphatic pathways and metastatic node rates in aberrant drainage and ipsilateral axilla. Pooled odds ratios (ORs) and 95 per cent confidence intervals (c.i.) were estimated using fixed-effect analyses, or random-effects analyses in the event of statistically significant heterogeneity.
Results
Seven studies reported data on lymphatic mapping in 1053 patients with recurrent breast cancer. The intraoperative sentinel node identification rate was 59·6 (95 per cent c.i. 56·7 to 62·6) per cent, and significantly greater when the original axillary surgery was SNB compared with ALND (OR 2·97, 95 per cent c.i. 1·66 to 5·32). The rate of aberrant lymphatic drainage identification was 25·7 (23·0 to 28·3) per cent, and significantly greater when the original axillary surgery was ALND (OR 0·27, 0·19 to 0·38). The metastatic sentinel node rate was 10·4 (8·6 to 12·3) per cent, and a significantly greater metastatic nodal burden was identified in the ipsilateral axilla (OR 6·31, 1·03 to 38·79).
Conclusion
Lymphatic mapping is feasible in recurrent breast cancer. It avoids ALND in over 50 per cent of patients who have undergone SNB, and allows the 4 per cent of patients with metastatically involved aberrant nodes to receive targeted surgical and adjuvant therapies.
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Affiliation(s)
- M Ahmed
- Research Oncology, Division of Cancer Studies, King's College London, London
| | - R Baker
- Department of Statistics, School of Business 612, University of Salford, Salford, UK
| | - I T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Pearson IC, Baker R, Sullivan AK, Nelson MR, Gazzard BG. Meningococcal infection in patients with the human immunodeficiency virus and acquired immunodeficency syndrome. Int J STD AIDS 2016; 12:410-1. [PMID: 11368827 DOI: 10.1258/0956462011923237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Meningococcal infection is believed to be rare in HIV-positive individuals. We present 2 cases from our reference caseload within the last 10 years.
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Affiliation(s)
- I C Pearson
- Department of HIV Medicine, Chelsea & Westminster Hospital, Fulham Road, London SW10 9NH, UK
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Vivo A, Lantelme B, Baker R, Barrett R. Stitching methods at the European Synchrotron Radiation Facility (ESRF). Rev Sci Instrum 2016; 87:051908. [PMID: 27250380 DOI: 10.1063/1.4950745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
X-ray mirror quality has continuously improved over the past 20 years and manufacturers are now able to provide long mirrors with slope errors below 0.2 μrad. Nevertheless, these mirrors are mounted on holders or even mechanical benders to adjust their curvature and their intrinsic quality must be preserved from any parasitic deformation such as twist. The most direct method of detecting these deformations is to measure the 3D topography of the optical surface. At the ESRF metrology laboratory, three different stitching systems are under development based on Fizeau sub-aperture measurements. The first one consists of measuring long flat mirrors, the second based on the relative angle determinable stitching interferometry (RADSI) method developed at SPring-8 is aimed primarily at the measurement of short mirrors with strong curvature down to a few meters, and the last, also based on the RADSI method, is dedicated to characterize longer mirrors with intermediate curvature. For each method we will describe the measurement setup and discuss first results obtained. Micro-stitching interferometry is also currently used at the ESRF metrology laboratory. The technique is suitable for measuring deeply curved aspherical profiles and will be illustrated with results from a Kirkpatrick-Baez mirror system for nano-focusing.
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Affiliation(s)
- A Vivo
- ESRF, 71 Avenue des Martyrs-CS 40220, 38043 Grenoble Cedex, France
| | - B Lantelme
- ESRF, 71 Avenue des Martyrs-CS 40220, 38043 Grenoble Cedex, France
| | - R Baker
- ESRF, 71 Avenue des Martyrs-CS 40220, 38043 Grenoble Cedex, France
| | - R Barrett
- ESRF, 71 Avenue des Martyrs-CS 40220, 38043 Grenoble Cedex, France
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Lei M, Schumacher L, Lai Y, Yeh C, Murray P, Wu P, Jiang T, Baker R, Juan W, Widelitz R, Yang L, Chuong C. 747 Cellular and molecular mechanisms during self-organization of mouse skin progenitor cells into reconstituted hairy skin. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barham E, Sharrock S, Lane C, Baker R. The International Plant Sentinel Network: a tool for Regional and National Plant Protection Organizations. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/epp.12283] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Barham
- Botanic Gardens Conservation International; 199 Kew Road Richmond TW9 3BW (UK)
| | - S. Sharrock
- Botanic Gardens Conservation International; 199 Kew Road Richmond TW9 3BW (UK)
| | - C. Lane
- Fera; Sand Hutton York YO41 1LZ (UK)
| | - R. Baker
- Department for Environment; Food and Rural Affairs; Sand Hutton York YO41 1LZ (UK)
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Kay S, Wilks DJ, Bellew M, Baker R. Commentary on The health technology assessment of the compulsory accident insurance scheme of hand transplantation in Switzerland. Brügger et al. J Hand Surg Eur. 2015, 40: 914-23. J Hand Surg Eur Vol 2015; 40:924-6. [PMID: 26494908 DOI: 10.1177/1753193414568052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S Kay
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK
| | - D J Wilks
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK
| | - M Bellew
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK
| | - R Baker
- Renal Unit, St James's University Hospital, Leeds, UK
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Thomas S, Kersten P, Thomas PW, Slingsby V, Nock A, Jones R, Davies Smith A, Galvin KT, Baker R, Hillier C. Exploring strategies used following a group-based fatigue management programme for people with multiple sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ). BMJ Open 2015; 5:e008274. [PMID: 26486976 PMCID: PMC4620165 DOI: 10.1136/bmjopen-2015-008274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore cross-sectional patterns of use of fatigue management strategies in people with multiple sclerosis (MS) who had attended a group-based fatigue management programme, Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle ('FACETS'). In a multicentre randomised controlled trial (RCT) the FACETS programme was shown to reduce fatigue severity and improve self-efficacy and quality of life. DESIGN A questionnaire substudy within a RCT involving the self-completed Fatigue Management Strategies Questionnaire (FMSQ). The FMSQ includes: (1) closed questions about the use and helpfulness of fatigue management strategies taught in FACETS and (2) open items about changes to lifestyle, attitudes or expectations, barriers or difficulties encountered and helpful strategies not covered in FACETS. PARTICIPANTS All had a clinical diagnosis of MS, significant fatigue, were ambulatory and had attended at least 4 of 6 scheduled FACETS sessions. METHODS Participants (n=72) were posted the FMSQ with a prepaid return envelope 4 months after the end of the FACETS programme. RESULTS 82% (59/72) of participants returned the FMSQ. The fatigue management strategies most frequently used since attending FACETS were prioritisation (80%), pacing (78%), saying no to others (78%), grading tasks (75%) and challenging unhelpful thoughts (71%). Adding in those participants who were already using the respective strategies prior to FACETS, the three most used strategies at 4 months were prioritisation (55/59), grading (54/59) and pacing (53/58). Free-text comments illustrated the complex interplay between attitudes/expectations, behaviours, emotions and the environment. Issues related to expectations featured strongly in participants' comments. Expectations (from self and others) were both facilitators and barriers to effective fatigue management. CONCLUSIONS Individuals' comments highlighted the complex, multifaceted nature of fatigue management. Revising expectations and a greater acceptance of fatigue were important shifts following the programme. Findings support the relevance of a cognitive behavioural approach for fatigue management. Booster sessions might be a useful addition to the FACETS programme. TRIAL REGISTRATION NUMBER Current controlled trials ISRCTN76517470; Results.
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Affiliation(s)
- S Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - P Kersten
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - P W Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - V Slingsby
- Dorset MS Service, Poole Hospital NHS Foundation Trust, Poole, UK
| | - A Nock
- Dorset MS Service, Poole Hospital NHS Foundation Trust, Poole, UK
| | - R Jones
- MS Research Unit, Bristol and Avon MS Clinical Centre, Southmead Hospital, Bristol, UK
| | - A Davies Smith
- MS Research Unit, Bristol and Avon MS Clinical Centre, Southmead Hospital, Bristol, UK
| | - K T Galvin
- Faculty of Health and Social Care, University of Hull, Hull, Yorkshire, UK
| | - R Baker
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - C Hillier
- Dorset MS Service, Poole Hospital NHS Foundation Trust, Poole, UK
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Thies SB, Price C, Kenney LPJ, Baker R. Effects of shoe sole geometry on toe clearance and walking stability in older adults. Gait Posture 2015; 42:105-9. [PMID: 26032398 DOI: 10.1016/j.gaitpost.2015.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/10/2015] [Accepted: 04/20/2015] [Indexed: 02/02/2023]
Abstract
Thirty-five percent of people above age 65 fall each year, and half of their falls are associated with tripping: tripping, an apparently 'mundane' everyday problem, therefore, significantly impacts on older people's health and associated medical costs. To avoid tripping and subsequent falling, sufficient toe clearance during the swing phase is crucial. We previously found that a rocker-shaped shoe sole enhances toe clearance in young adults, thereby decreasing their trip-risk. This study investigates whether such sole design also enhances older adults' toe clearance, without inadvertently affecting their walking stability. Toe clearance and its variability are reported together with measures of walking stability for twelve older adults, walking in shoes with rocker angles of 10°, 15°, and 20°. Surface inclinations (flat, incline, decline) were chosen to reflect a potential real-world environment. Toe clearance increased substantially from the 10° to the 15° rocker angle (p=0.003) without compromising measures of walking stability (p>0.05). A further increase in rocker angle to 20° resulted in less substantial enhancement of toe clearance and came at the cost of a decrease in gait speed on the decline. The novelty of this investigation lies in the exploration of the trade-off between reduction of trip-risk through footwear design and adverse effects on walking stability on real-life relevant surfaces. Our two studies suggest that the current focus on slip-resistance in footwear design may need to be generalised to include other factors that affect trip-risk.
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Affiliation(s)
- S B Thies
- Centre for Health Sciences Research, Salford University, UK.
| | - C Price
- Centre for Health Sciences Research, Salford University, UK
| | - L P J Kenney
- Centre for Health Sciences Research, Salford University, UK
| | - R Baker
- Operations Management, Management Science and Statistics, Salford University, UK
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Tahir W, Hakeem A, Dawrant M, Prasad P, Lee M, Menon K, Attia M, Baker R, Ahmad N. Early Sirolimus Conversion as Rescue Therapy in Kidneys With Prolonged Delayed Graft Function in Deceased Donor Renal Transplant. Transplant Proc 2015; 47:1610-5. [DOI: 10.1016/j.transproceed.2015.04.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 03/23/2015] [Accepted: 04/07/2015] [Indexed: 12/25/2022]
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Crouch G, Sinhal A, Rice G, Baker R, Bennetts J. Long term outcomes of an Australian TAVI program – better than PARTNER? Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2014.12.038] [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: 10/23/2022]
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Crouch G, Main A, Rice G, Baker R, Bennetts J. Mitral valve repair or bioprosthetic replacement: The conundrum in Indigenous rheumatic mitral disease. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2014.12.049] [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: 10/23/2022]
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