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Dissanayaka N, Pourzinal D, Byrne GJ, Yang J, McMahon KL, Pontone GM, O'Sullivan JD, Adam R, Littleford R, Chatfield M, Lehn A, Mari Z, Bakker A. Levetiracetam for the treatment of mild cognitive impairment in Parkinson's disease: a double-blind controlled proof-of-concept trial protocol. Pilot Feasibility Stud 2023; 9:189. [PMID: 37993889 PMCID: PMC10664284 DOI: 10.1186/s40814-023-01406-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Mild memory impairment, termed amnestic mild cognitive impairment (aMCI), is associated with rapid progression towards dementia in Parkinson's disease (PD). Studies have shown hyperactivation of hippocampal DG/CA3 subfields during an episodic memory task as a biomarker of aMCI related to Alzheimer's disease. This project investigates the feasibility of a trial to establish the efficacy of a repurposed antiepileptic drug, levetiracetam, in low doses as a putative treatment to target DG/CA3 hyperactivation and improve episodic memory deficits in aMCI in PD. Based on previous work, it is hypothesized that levetiracetam will normalize DG/CA3 overactivation in PD-aMCI participants and improve memory performance. METHODS Twenty-eight PD-aMCI participants, 28 PD participants without memory impairment (PD-nMI), and 28 healthy controls will be recruited. PD-aMCI participants will undertake a 12-week randomized, placebo-controlled, double-blind cross-over trial with a 14-day treatment of 125 mg levetiracetam or placebo twice daily, separated by a 4-week washout period. After each treatment period, participants will complete an episodic memory task designed to tax hippocampal subregion-specific function during high-resolution functional magnetic resonance imaging (fMRI). PD-nMI and healthy controls will undergo the fMRI protocol only, to compare baseline DG/CA3 subfield activity. RESULTS Episodic memory task performance and functional activation in the DG/CA3 subfield during the fMRI task will be primary outcome measures. Global cognition, PD severity, and adverse events will be measured as secondary outcomes. Recruitment, eligibility, and study completion rates will be explored as feasibility outcomes. CONCLUSIONS This study, the first of its kind, will establish hippocampal subregion functional impairment and proof of concept of levetiracetam as an early therapeutic option to reduce dementia risk in PD. TRIAL REGISTRATION ClinicalTrials.gov, NCT04643327 . Registered on 25 November 2020.
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Affiliation(s)
- Nadeeka Dissanayaka
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia.
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia.
| | - Dana Pourzinal
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Jihyun Yang
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gregory M Pontone
- Department of Neurology, Johns Hopkins University, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, USA
| | - John D O'Sullivan
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Robert Adam
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Roberta Littleford
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Mark Chatfield
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University, Baltimore, USA
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, USA
| | - Arnold Bakker
- Department of Neurology, Johns Hopkins University, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, USA
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Morpeth SC, Venkatesh B, Totterdell JA, McPhee GM, Mahar RK, Jones M, Bandara M, Barina LA, Basnet BK, Bowen AC, Burke AJ, Cochrane B, Denholm JT, Dhungana A, Dore GJ, Dotel R, Duffy E, Dummer J, Foo H, Gilbey TL, Hammond NE, Hudson BJ, Jha V, Jevaji PR, John O, Joshi R, Kang G, Kaur B, Kim S, Das SK, Lau JSY, Littleford R, Marsh JA, Marschner IC, Matthews G, Maze MJ, McArthur CJ, McFadyen JD, McMahon JH, McQuilten ZK, Molton J, Mora JM, Mudaliar V, Nguyen V, O'Sullivan MVN, Pant S, Park JE, Paterson DL, Price DJ, Raymond N, Rees MA, Robinson JO, Rogers BA, Ryu WS, Sasadeusz J, Shum O, Snelling TL, Sommerville C, Trask N, Lewin SR, Hills TE, Davis JS, Roberts JA, Tong SYC. A Randomized Trial of Nafamostat for Covid-19. NEJM Evid 2023; 2:EVIDoa2300132. [PMID: 38320527 DOI: 10.1056/evidoa2300132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
A Randomized Trial of Nafamostat for Covid-19Nafamostat mesylate is a potent in vitro antiviral that inhibits the host transmembrane protease serine 2 enzyme used by SARS-CoV-2 for cell entry. Morpeth et al report the results of an open-label randomized clinical trial of nafamostat for noncritically ill patients with Covid-19.
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Affiliation(s)
- Susan C Morpeth
- Department of Microbiology and Infectious Diseases, Middlemore Hospital, Te Whatu Ora Counties Makukau, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Balasubramanian Venkatesh
- Department of Intensive Care Medicine, The University of Queensland at Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Department of Intensive Care Medicine, The University of Queensland at The Wesley Hospital, Toowong, QLD, Australia
- The George Institute for Global Health, Newtown, NSW, Australia
| | - James A Totterdell
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney
| | - Grace M McPhee
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Robert K Mahar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mark Jones
- Department of Health and Clinical Analytics, The University of Sydney School of Public Health, Sydney
| | - Methma Bandara
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Lauren A Barina
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Bhupendra K Basnet
- Department of Medicine, Bir Hospital, Kathmandu, Nepal
- Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - Andrew J Burke
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Department of Infectious Diseases, Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - Belinda Cochrane
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Campbelltown, NSW, Australia
- Western Sydney University School of Medicine, Campbelltown, NSW, Australia
| | - Justin T Denholm
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ashesh Dhungana
- Department of Medicine, National Academy of Medical Sciences at Bir Hospital, Kathmandu, Nepal
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, University of New South Wales, Kensington, NSW, Australia
- Department of Infectious Diseases, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Ravindra Dotel
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, NSW, Australia
| | - Eamon Duffy
- Department of Infectious Diseases, Te Whatu Ora Health New Zealand at Auckland City Hospital, Auckland, New Zealand
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jack Dummer
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Respiratory Services, Dunedin Hospital, Dunedin, New Zealand
| | - Hong Foo
- Department of Microbiology and Infectious Diseases, NSW Health Pathology Liverpool, Liverpool, NSW, Australia
| | - Timothy L Gilbey
- Department of Medicine and Infectious Diseases, Wagga Wagga Base Hospital, Wagga Wagga, Australia
| | - Naomi E Hammond
- Critical Care Program, The George Institute for Global Health, New Town, NSW, Australia
- Critical Care Program, The University of New South Wales, Sydney
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Bernard J Hudson
- Department of Microbiology and Infectious Diseases, NSW Health Pathology, St. Leonards, St. Leonards, NSW, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Purnima R Jevaji
- Department of Research, The George Institute for Global Health, Pune, Maharashta, India
| | - Oommen John
- Department of Research, The George Institute for Global Health, Vellore, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, India
| | - Rajesh Joshi
- Department of Research, The George Institute for Global Health, Pune, Maharashta, India
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Chartered Accountants Australia and New Zealand, Sydney
| | - Baldeep Kaur
- Critical Care Program, The George Institute for Global Health, New Town, NSW, Australia
| | - Seungtaek Kim
- Zoonotic Virus Laboratory, Institut Pasteur Korea, Bundang-gu, Gyeonggi-do, Republic of Korea
| | - Santa Kumar Das
- Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Jillian S Y Lau
- Department of Infectious Diseases, Eastern Health, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Roberta Littleford
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, QLD, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Centre for Child Health Research, University of Western Australia Medical School, Nedlands, WA, Australia
| | - Ian C Marschner
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney
| | - Gail Matthews
- Department of Infectious Diseases, St. Vincent's Hospital Sydney, Sydney
- Therapeutic and Vaccine Research Program, The Kirby Institute at The University of New South Wales, Kensington, NSW, Australia
| | - Michael J Maze
- Department of Medicine, University of Otago Christchurch, Christchurch, New England
| | - Colin J McArthur
- Department of Critical Care Medicine, Te Whatu Ora - Health New Zealand, Wellington, New Zealand
| | - James D McFadyen
- Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
- Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - James H McMahon
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Zoe K McQuilten
- Department of Haematology, Monash Health, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - James Molton
- Department of Infectious Diseases, Western Health, Footscray, VIC, Australia
| | - Jocelyn M Mora
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Vijaybabu Mudaliar
- Department of Research, The George Institute for Global Health, Pune, Maharashta, India
| | - Vi Nguyen
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew V N O'Sullivan
- Department of Microbiology and Infectious Diseases, NSW Health Pathology Westmead Hospital, Newcastle, NSW, Australia
- Faculty of Medicine and Health, University of Sydney Westmead Clinical School, Sydney
| | - Suman Pant
- Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Jaha E Park
- Business Development Team, Chong Kun Dang Pharmaceutical Corp., Dongbaekjukjeon-daero, Giheung-gu Yongin, Kyeonggi-do, Republic of Korea
| | - David L Paterson
- Saw Swee Hock School of Public Health, National Institute of Singapore, Singapore
| | - David J Price
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nigel Raymond
- Department of Medicine, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
- Department of Medicine, Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Megan A Rees
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - James O Robinson
- Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Benjamin A Rogers
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- Department of Infectious Diseases, Monash Health, Clayton, VIC, Australia
| | - Wang-Shick Ryu
- Virology, Institute Pasteur Korea, Bundang-gu, Gyeonggi-do, Republic of Korea
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Omar Shum
- Department of Infectious Diseases, Wollongong Hospital, Kingoonya, NSW, Australia
- Graduate School of Medicine, University of Wollongong, Wollonngong, NSW, Australia
| | - Thomas L Snelling
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - Christine Sommerville
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Nanette Trask
- Chartered Accountants Australia and New Zealand, Sydney
| | - Sharon R Lewin
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Thomas E Hills
- Department of Clinical Research, Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand
| | - Joshua S Davis
- School of Medicine and Public Health, The University of Newcastle, New Castle, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Jason A Roberts
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
- Metro North Health, Herston Infectious Diseases Institute, Herston, QLD, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Division of Anaesthesiology, Critical Care Emergency and Pain Medicine, Nîmes University Hospital at The University of Montpellier, Nîmes, France
| | - Steven Y C Tong
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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Hancox J, Ayling K, Bedford L, Vedhara K, Roberston JFR, Young B, das Nair R, Sullivan FM, Schembri S, Mair FS, Littleford R, Kendrick D. Psychological impact of lung cancer screening using a novel antibody blood test followed by imaging: the ECLS randomized controlled trial. J Public Health (Oxf) 2023; 45:e275-e284. [PMID: 35285902 PMCID: PMC10273385 DOI: 10.1093/pubmed/fdac032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/04/2021] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The Early CDT®-Lung antibody blood test plus serial computed tomography scans for test-positives (TPGs) reduces late-stage lung cancer presentation. This study assessed the psychological outcomes of this approach. METHODS Randomized controlled trial (n = 12 208) comparing psychological outcomes 1-12 months post-recruitment in a subsample (n = 1032) of TPG, test-negative (TNG) and control groups (CG). RESULTS Compared to TNG, TPG had lower positive affect (difference between means (DBM), 3 months (3m: -1.49 (-2.65, - 0.33)), greater impact of worries (DBM 1m: 0.26 (0.05, 0.47); 3m: 0.28 (0.07, 0.50)), screening distress (DBM 1m: 3.59 (2.28, 4.90); 3m: 2.29 (0.97, 3.61); 6m: 1.94 (0.61, 3.27)), worry about tests (odds ratio (OR) 1m: 5.79 (2.66, 12.63) and more frequent lung cancer worry (OR 1m: 2.52 (1.31, 4.83); 3m: 2.43 (1.26, 4.68); 6m: 2.87 (1.48, 5.60)). Compared to CG, TPG had greater worry about tests (OR 1m: 3.40 (1.69, 6.84)). TNG had lower negative affect (log-transformed DBM 3m: -0.08 (-0.13, -0.02)), higher positive affect (DBM 1m: 1.52 (0.43, 2.61); 3m: 1.43 (0.33, 2.53); 6m: 1.27 (0.17, 2.37)), less impact of worries (DBM 3m: -0.27 (-0.48, -0.07)) and less-frequent lung cancer worry (OR 3m: 0.49 (0.26, 0.92)). CONCLUSIONS Negative psychological effects in TPG and positive effects in TNG were short-lived and most differences were small.
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Affiliation(s)
- J Hancox
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
| | - K Ayling
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
| | - L Bedford
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - K Vedhara
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
| | - J F R Roberston
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, DE22 3DT Derby, UK
| | - B Young
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
| | - R das Nair
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, NG7 2TU Nottingham, UK
| | - F M Sullivan
- School of Medicine, University of St Andrews, KY16 9TF St Andrews, UK
| | - S Schembri
- Respiratory Medicine, NHS Tayside, DD2 1UB Dundee UK
| | - F S Mair
- Institute of Health & Wellbeing, University of Glasgow, G12 8RZ Glasgow, UK
| | - R Littleford
- Centre for Clinical Research, University of Queensland, 4072 Saint Lucia, Australia
| | - D Kendrick
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
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Symons TJ, Straiton N, Gagnon R, Littleford R, Campbell AJ, Bowen AC, Stewart AG, Tong SYC, Davis JS. Consumer perspectives on simplified, layered consent for a low risk, but complex pragmatic trial. Trials 2022; 23:1055. [PMID: 36578070 PMCID: PMC9795139 DOI: 10.1186/s13063-022-07023-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND For decades, the research community has called for participant information sheets/consent forms (PICFs) to be improved. Recommendations include simplifying content, reducing length, presenting information in layers and using multimedia. However, there are relatively few studies that have evaluated health consumers' (patients/carers) perspectives on the type and organisation of information, and the level of detail to be included in a PICF to optimise an informed decision to enter a trial. We aimed to elicit consumers' views on a layered approach to consent that provides the key information for decision-making in a short PICF (layer 1) with additional optional information that is accessed separately (layer 2). We also elicited consumers' views on the optimal content and layout of the layered consent materials for a large and complex Bayesian adaptive platform trial (the SNAP trial). METHODS We conducted a qualitative multicentre study (4 focus groups and 2 semi-structured interviews) involving adolescent and adult survivors of Staphylococcus aureus bloodstream infection (22) and their carers (2). Interview transcripts were examined using inductive thematic analysis. RESULTS Consumers supported a layered approach to consent. The primary theme that emerged was the value of agency; the ability to exert some control over the amount of information read before the consent form is signed. Three other themes emerged; the need to prioritise participants' information needs; the importance of health literacy; the importance of information about a trial's benefits (over its risks) for decision-making and the interplay between the two. CONCLUSIONS Our findings suggest that consumers may challenge the one-size-fits-all approach currently applied to the development of PICFs in countries like Australia. Consumers supported a layered approach to consent that offers choice in the amount of information to be read before deciding whether to enter a trial. A 3-page PICF was considered sufficient for decision-making for the SNAP trial, provided that further information was available and accessible.
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Affiliation(s)
- Tanya J. Symons
- grid.1013.30000 0004 1936 834XDepartment of Medicine and Health Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Nicola Straiton
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rosie Gagnon
- grid.15822.3c0000 0001 0710 330XMiddlesex University, London, UK
| | - Roberta Littleford
- grid.1003.20000 0000 9320 7537Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD Australia
| | - Anita J. Campbell
- grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Australia ,grid.414659.b0000 0000 8828 1230Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Asha C. Bowen
- grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Australia ,grid.414659.b0000 0000 8828 1230Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Adam G. Stewart
- grid.1003.20000 0000 9320 7537Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD Australia
| | - Steven Y. C. Tong
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joshua S. Davis
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Newcastle, Australia ,grid.413648.cInfection Research Program, Hunter Medical Research Institute, Newcastle, Australia ,grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Australia
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Robertson JF, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Amy Cheung S, Cullberg M, de Bruin EC, Koulai L, Lindemann JP, Pass M, Rugman P, Schiavon G, Deb R, Finlay P, Foxley A, Gee JM. Correction: Proliferation and AKT Activity Biomarker Analyses after Capivasertib (AZD5363) Treatment of Patients with ER+ Invasive Breast Cancer (STAKT). Clin Cancer Res 2022; 28:5469. [DOI: 10.1158/1078-0432.ccr-22-3568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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van Cruchten RTP, van As D, Glennon JC, van Engelen BGM, 't Hoen PAC, Wenninger S, Daidj F, Cumming S, Littleford R, Monckton DG, Lochmüller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, Wansink DG, Impens F, Gabriels R, Claeys T, Ravel-Chapuis A, Jasmin BJ, Mahon N, Nieuwenhuis S, Martens L, Novak P, Furling D, Baak A, Gourdon G, MacKenzie A, Martinat C, Neault N, Roos A, Duchesne E, Salz R, Thompson R, Baghdoyan S, Varghese AM, Blom P, Spendiff S, Manta A. Clinical improvement of DM1 patients reflected by reversal of disease-induced gene expression in blood. BMC Med 2022; 20:395. [PMID: 36352383 PMCID: PMC9646470 DOI: 10.1186/s12916-022-02591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is an incurable multisystem disease caused by a CTG-repeat expansion in the DM1 protein kinase (DMPK) gene. The OPTIMISTIC clinical trial demonstrated positive and heterogenous effects of cognitive behavioral therapy (CBT) on the capacity for activity and social participations in DM1 patients. Through a process of reverse engineering, this study aims to identify druggable molecular biomarkers associated with the clinical improvement in the OPTIMISTIC cohort. METHODS Based on full blood samples collected during OPTIMISTIC, we performed paired mRNA sequencing for 27 patients before and after the CBT intervention. Linear mixed effect models were used to identify biomarkers associated with the disease-causing CTG expansion and the mean clinical improvement across all clinical outcome measures. RESULTS We identified 608 genes for which their expression was significantly associated with the CTG-repeat expansion, as well as 1176 genes significantly associated with the average clinical response towards the intervention. Remarkably, all 97 genes associated with both returned to more normal levels in patients who benefited the most from CBT. This main finding has been replicated based on an external dataset of mRNA data of DM1 patients and controls, singling these genes out as candidate biomarkers for therapy response. Among these candidate genes were DNAJB12, HDAC5, and TRIM8, each belonging to a protein family that is being studied in the context of neurological disorders or muscular dystrophies. Across the different gene sets, gene pathway enrichment analysis revealed disease-relevant impaired signaling in, among others, insulin-, metabolism-, and immune-related pathways. Furthermore, evidence for shared dysregulations with another neuromuscular disease, Duchenne muscular dystrophy, was found, suggesting a partial overlap in blood-based gene dysregulation. CONCLUSIONS DM1-relevant disease signatures can be identified on a molecular level in peripheral blood, opening new avenues for drug discovery and therapy efficacy assessments.
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Affiliation(s)
- Remco T P van Cruchten
- Center for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniël van As
- Center for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeffrey C Glennon
- Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter A C 't Hoen
- Center for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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7
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Lambert MA, Houston JG, Littleford R, Fitton CA, Struthers A, Sullivan F, Gandy S, Belch JJF. Tayside Screening For Cardiac Events (TASCFORCE) study: a prospective cardiovascular risk screening study. BMJ Open 2022; 12:e063594. [PMID: 36270757 PMCID: PMC9594527 DOI: 10.1136/bmjopen-2022-063594] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Risk factor-based models struggle to accurately predict the development of cardiovascular disease (CVD) at the level of the individual. Ways of identifying people with low predicted risk who will develop CVD would allow stratified advice and support informed treatment decisions about the initiation or adjustment of preventive medication, and this is the aim of this prospective cohort study. PARTICIPANTS The Tayside Screening for Cardiac Events (TASCFORCE) study recruited men and women aged≥40 years, free from known CVD, with a predicted 10-year risk of coronary heart disease<20%. If B-type natriuretic peptide (BNP) was greater than their gender median, participants were offered a whole-body contrast-enhanced MRI (WBCE-MRI) scan (cardiac imaging, whole-body angiography to determine left ventricular parameters, delayed gadolinium enhancement, atheroma burden). Blood, including DNA, was stored for future biomarker assays. Participants are being followed up using electronic record-linkage cardiovascular outcomes. FINDINGS TO DATE 4423 (1740, 39.3% men) were recruited. Mean age was 52.3 years with a median BNP of 7.50 ng/L and 15.30 ng/L for men and women, respectively. 602 had a predicted 10-year risk of 10%-19.9%, with the remainder<10%. Age, female sex, ex-smoking status, lower heart rate, higher high-density lipoprotein and lower total cholesterol were independently associated with higher log10 BNP levels. Mean left ventricular mass was 129.2 g and 87.0 g in men and women, respectively. FUTURE PLANS The TASCFORCE study is investigating the ability of a screening programme, using BNP and WBCE-MRI, at the time of enrolment, to evaluate prediction of CVD in a population at low/intermediate risk. Blood stored for future biomarker analyses will allow testing/development of novel biomarkers. We believe this could be a new UK Framingham study allowing study for many years to come. CLINICAL TRIAL REGISTRATION ISRCTN38976321.
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Affiliation(s)
| | - J Graeme Houston
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Roberta Littleford
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Catherine A Fitton
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Allan Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, UK
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Jill J F Belch
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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Stewart AG, Harris PNA, Chatfield MD, Littleford R, Paterson DL. Ceftolozane-tazobactam versus meropenem for definitive treatment of bloodstream infection due to extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales ("MERINO-3"): study protocol for a multicentre, open-label randomised non-inferiority trial. Trials 2021; 22:301. [PMID: 33888139 PMCID: PMC8060904 DOI: 10.1186/s13063-021-05206-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/18/2021] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales are common causes of bloodstream infection. ESBL-producing bacteria are typically resistant to third-generation cephalosporins and result in a sizeable economic and public health burden. AmpC-producing Enterobacterales may develop third-generation cephalosporin resistance through enzyme hyper-expression. In no observational study has the outcome of treatment of these infections been surpassed by carbapenems. Widespread use of carbapenems may drive the development of carbapenem-resistant Gram-negative bacilli. METHODS This study will use a multicentre, parallel group open-label non-inferiority trial design comparing ceftolozane-tazobactam and meropenem in adult patients with bloodstream infection caused by ESBL or AmpC-producing Enterobacterales. Trial recruitment will occur in up to 40 sites in six countries (Australia, Singapore, Italy, Spain, Saudi Arabia and Lebanon). The sample size is determined by a predefined quantity of ceftolozane-tazobactam to be supplied by Merck, Sharpe and Dohme (MSD). We anticipate that a trial with 600 patients contributing to the primary outcome analysis would have 80% power to declare non-inferiority with a 5% non-inferiority margin, assuming a 30-day mortality of 5% in both randomised groups. Once randomised, definitive treatment will be for a minimum of 5 days and a maximum of 14 days with the total duration determined by treating clinicians. Data describing demographic information, risk factors, concomitant antibiotics, illness scores, microbiology, multidrug-resistant organism screening, discharge and mortality will be collected. DISCUSSION Participants will have bloodstream infection due to third-generation cephalosporin non-susceptible E. coli and Klebsiella spp. or Enterobacter spp., Citrobacter freundii, Morganella morganii, Providencia spp. or Serratia marcescens. They will be randomised 1:1 to ceftolozane-tazobactam 3 g versus meropenem 1 g, both every 8 h. Secondary outcomes will be a comparison of 14-day all-cause mortality, clinical and microbiological success at day 5, functional bacteraemia score, microbiological relapse, new bloodstream infection, length of hospital stay, serious adverse events, C. difficile infection, multidrug-resistant organism colonisation. The estimated trial completion date is December 2024. TRIAL REGISTRATION The MERINO-3 trial is registered under the US National Institute of Health ClinicalTrials.gov register, reference number: NCT04238390 . Registered on 23 January 2020.
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Affiliation(s)
- Adam G Stewart
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia.
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Patrick N A Harris
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
- Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
| | - Roberta Littleford
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
| | - David L Paterson
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Ruffles T, Jones CJ, Palmer C, Turner S, Grigg J, Tavendale R, Hogarth F, Rauchhaus P, Pilvinyte K, Hannah R, Smith H, Littleford R, Lipworth B, Mukhopadhyay S. Asthma prescribing according to Arg16Gly beta-2 genotype: a randomised trial in adolescents. Eur Respir J 2021; 58:13993003.04107-2020. [PMID: 33479111 DOI: 10.1183/13993003.04107-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/01/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The A allele of rs1042713 (Arg16 amino acid) in the beta-2 (β2) adrenoreceptor is associated with poor response to long-acting β2-agonist (LABA) in young people with asthma. Our aim was to assess whether the prescribing of second line controller with LABA or a leukotriene receptor antagonist (LTRA) according to Arg16Gly genotype would result in improvements in pediatric asthma-related quality of life questionnaire (PAQLQ). METHODS We performed a pragmatic randomised controlled trial (RCT) via a primary care clinical research network covering England and Scotland. We enrolled participants aged 12-18 years with asthma taking inhaled corticosteroids. A total of 241 participants (mean (sd) age 14.7 years (1.91)) were randomised (1:1) to receive personalised care (genotype directed prescribing) or standard guideline care. Following 4-week run-in participants were followed for 12-months. The primary outcome measure was change in PAQLQ. Asthma control, asthma exacerbation frequency and healthcare utilisation were secondary outcomes. RESULTS Genotype directed prescribing resulted in an improvement in PAQLQ compared to standard care 0.16, (95%CI 0.00-0.31; p=0.049), although this improvement was below the pre-determined clinical threshold of 0.25. The AA genotype was associated with a larger improvement in PAQLQ with personalised versus standard care 0.42, (95%CI 0.02-0.81; p=0.041). CONCLUSION This is the first RCT demonstrating that genotype driven asthma prescribing is associated with a significant improvement in a clinical outcome compared to standard care. Adolescents with the AA homozygous genotype benefited most. The potential role of such β2-adrenoceptor genotype directed therapy in younger and more severe childhood asthma warrants further exploration.
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Affiliation(s)
- Tom Ruffles
- Academic Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton & Sussex Medical School, Brighton, UK
| | - Christina J Jones
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Colin Palmer
- Division of Population and Health Genomics, University of Dundee, Ninewells Hospital & Medical School University of Dundee, Dundee, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Jonathan Grigg
- Blizard Institute, Queen Mary University of London, London, UK
| | - Roger Tavendale
- Division of Population and Health Genomics, University of Dundee, Ninewells Hospital & Medical School University of Dundee, Dundee, UK
| | - Fiona Hogarth
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Petra Rauchhaus
- Tayside Medical Science Centre TASC, University of Dundee, Dundee, UK
| | | | - Romanie Hannah
- Academic Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton & Sussex Medical School, Brighton, UK
| | - Helen Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Roberta Littleford
- Center for Clinical Research, University of Queensland, Brisbane, Australia
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Somnath Mukhopadhyay
- Academic Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton & Sussex Medical School, Brighton, UK.,Division of Population and Health Genomics, University of Dundee, Ninewells Hospital & Medical School University of Dundee, Dundee, UK
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Sullivan FM, Mair FS, Anderson W, Armory P, Briggs A, Chew C, Dorward A, Haughney J, Hogarth F, Kendrick D, Littleford R, McConnachie A, McCowan C, McMeekin N, Patel M, Rauchhaus P, Ritchie L, Robertson C, Robertson J, Robles-Zurita J, Sarvesvaran J, Sewell H, Sproule M, Taylor T, Tello A, Treweek S, Vedhara K, Schembri S. Earlier diagnosis of lung cancer in a randomised trial of an autoantibody blood test followed by imaging. Eur Respir J 2021; 57:2000670. [PMID: 32732334 PMCID: PMC7806972 DOI: 10.1183/13993003.00670-2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022]
Abstract
The EarlyCDT-Lung test is a high-specificity blood-based autoantibody biomarker that could contribute to predicting lung cancer risk. We report on the results of a phase IV biomarker evaluation of whether using the EarlyCDT-Lung test and any subsequent computed tomography (CT) scanning to identify those at high risk of lung cancer reduces the incidence of patients with stage III/IV/unspecified lung cancer at diagnosis compared with the standard clinical practice at the time the study began.The Early Diagnosis of Lung Cancer Scotland (ECLS) trial was a randomised controlled trial of 12 208 participants at risk of developing lung cancer in Scotland in the UK. The intervention arm received the EarlyCDT-Lung test and, if test-positive, low-dose CT scanning 6-monthly for up to 2 years. EarlyCDT-Lung test-negative and control arm participants received standard clinical care. Outcomes were assessed at 2 years post-randomisation using validated data on cancer occurrence, cancer staging, mortality and comorbidities.At 2 years, 127 lung cancers were detected in the study population (1.0%). In the intervention arm, 33 out of 56 (58.9%) lung cancers were diagnosed at stage III/IV compared with 52 out of 71 (73.2%) in the control arm. The hazard ratio for stage III/IV presentation was 0.64 (95% CI 0.41-0.99). There were nonsignificant differences in lung cancer and all-cause mortality after 2 years.ECLS compared EarlyCDT-Lung plus CT screening to standard clinical care (symptomatic presentation) and was not designed to assess the incremental contribution of the EarlyCDT-Lung test. The observation of a stage shift towards earlier-stage lung cancer diagnosis merits further investigations to evaluate whether the EarlyCDT-Lung test adds anything to the emerging standard of low-dose CT.
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Affiliation(s)
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Pauline Armory
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Andrew Briggs
- Dept of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cindy Chew
- Radiology, NHS Lanarkshire, Bothwell, UK
| | - Alistair Dorward
- Respiratory Medicine, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - John Haughney
- General Practice, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Fiona Hogarth
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Denise Kendrick
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Roberta Littleford
- Centre for Clinical Research, University of Queensland, Saint Lucia, Australia
| | - Alex McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Manish Patel
- Respiratory Medicine, NHS Lanarkshire, Bothwell, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Lewis Ritchie
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Chris Robertson
- Dept of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - John Robertson
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | - Herbert Sewell
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Agnes Tello
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kavita Vedhara
- School of Medicine, University of Nottingham, Nottingham, UK
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11
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Young B, Bedford L, das Nair R, Gallant S, Littleford R, Robertson JFR, Schembri S, Sullivan FM, Vedhara K, Kendrick D. Unconditional and conditional monetary incentives to increase response to mailed questionnaires: A randomized controlled study within a trial (SWAT). J Eval Clin Pract 2020; 26:893-902. [PMID: 31328399 DOI: 10.1111/jep.13230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 12/22/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES High response rates to research questionnaires can help to ensure results are more representative of the population studied and provide increased statistical power, on which the study may have been predicated. Improving speed and quality of response can reduce costs. METHOD We conducted a randomized study within a trial (SWAT) to assess questionnaire response rates, reminders sent, and data completeness with unconditional compared with conditional monetary incentives. Eligible individuals were mailed a series of psychological questionnaires as a follow-up to a baseline host trial questionnaire. Half received a £5 gift voucher with questionnaires (unconditional), and half were promised the voucher after returning questionnaires (conditional). RESULTS Of 1079 individuals, response rates to the first follow-up questionnaire were 94.2% and 91.7% in the unconditional and conditional monetary incentive groups, respectively (OR 1.78; 95% CI, 0.85-3.72). There were significantly greater odds of returning repeat questionnaires in the unconditional group at 6 months (OR 2.97; 95% CI, 1.01-8.71; .047) but not at 12 months (OR 1.12; 95% CI, 0.44-2.85). Incentive condition had no impact at any time point on the proportion of sent questionnaires that needed reminders. Odds of incomplete questionnaires were significantly greater at 3 months in the unconditional compared with the conditional incentive group (OR 2.45; 95% CI, 1.32-4.55; .004). CONCLUSIONS Unconditional monetary incentives can produce a transitory greater likelihood of mailed questionnaire response in a clinical trial participant group, consistent with the direction of effect in other settings. However, this could have been a chance finding. The use of multiple strategies to promote response may have created a ceiling effect. This strategy has potential to reduce administrative and postage costs, weighed against the cost of incentives used, but could risk compromising the completeness of data.
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Affiliation(s)
- Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Laura Bedford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Roshan das Nair
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | | | | | - John F R Robertson
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
| | | | | | - Kavita Vedhara
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Witham MD, Band M, Chong H, Donnan PT, Hampson G, Hu MK, Littleford R, Lamb E, Kalra PA, Kennedy G, McNamee P, Plews D, Rauchhaus P, Soiza RL, Sumukadas D, Warwick G, Avenell A. Sodium bicarbonate to improve physical function in patients over 60 years with advanced chronic kidney disease: the BiCARB RCT. Health Technol Assess 2020; 24:1-90. [PMID: 32568065 PMCID: PMC7336221 DOI: 10.3310/hta24270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Advanced chronic kidney disease is common in older people and is frequently accompanied by metabolic acidosis. Oral sodium bicarbonate is used to treat this acidosis, but evidence is lacking on whether or not this provides a net gain in health or quality of life for older people. OBJECTIVES The objectives were to determine whether or not oral bicarbonate therapy improves physical function, quality of life, markers of renal function, bone turnover and vascular health compared with placebo in older people with chronic kidney disease and mild acidosis; to assess the safety of oral bicarbonate; and to establish whether or not oral bicarbonate therapy is cost-effective in this setting. DESIGN A parallel-group, double-blind, placebo-controlled randomised trial. SETTING The setting was nephrology and geriatric medicine outpatient departments in 27 UK hospitals. PARTICIPANTS Participants were adults aged ≥ 60 years with advanced chronic kidney disease (glomerular filtration rate category 4 or 5, not on dialysis) with a serum bicarbonate concentration of < 22 mmol/l. INTERVENTIONS Eligible participants were randomised 1 : 1 to oral sodium bicarbonate or matching placebo. Dosing started at 500 mg three times daily, increasing to 1 g three times daily if the serum bicarbonate concentration was < 22 mmol/l at 3 months. MAIN OUTCOME MEASURES The primary outcome was the between-group difference in the Short Physical Performance Battery score at 12 months, adjusted for baseline. Other outcome measures included generic and disease-specific health-related quality of life, anthropometry, 6-minute walk speed, grip strength, renal function, markers of bone turnover, blood pressure and brain natriuretic peptide. All adverse events were recorded, including commencement of renal replacement therapy. For the health economic analysis, the incremental cost per quality-adjusted life-year was the main outcome. RESULTS In total, 300 participants were randomised, 152 to bicarbonate and 148 to placebo. The mean age of participants was 74 years and 86 (29%) were female. Adherence to study medication was 73% in both groups. A total of 220 (73%) participants were assessed at the 12-month visit. No significant treatment effect was evident for the primary outcome of the between-group difference in the Short Physical Performance Battery score at 12 months (-0.4 points, 95% confidence interval -0.9 to 0.1 points; p = 0.15). No significant treatment benefit was seen for any of the secondary outcomes. Adverse events were more frequent in the bicarbonate arm (457 vs. 400). Time to commencement of renal replacement therapy was similar in both groups (hazard ratio 1.22, 95% confidence interval 0.74 to 2.02; p = 0.43). Health economic analysis showed higher costs and lower quality of life in the bicarbonate arm at 1 year, with additional costs of £564 (95% confidence interval £88 to £1154) and a quality-adjusted life-year difference of -0.05 (95% confidence interval -0.08 to -0.01); placebo dominated bicarbonate under all sensitivity analyses for incremental cost-effectiveness. LIMITATIONS The trial population was predominantly white and male, limiting generalisability. The increment in serum bicarbonate concentrations achieved was small and a benefit from larger doses of bicarbonate cannot be excluded. CONCLUSIONS Oral sodium bicarbonate did not improve a range of health measures in people aged ≥ 60 years with chronic kidney disease category 4 or 5 and mild acidosis, and is unlikely to be cost-effective for use in the NHS in this patient group. Once other current trials of bicarbonate therapy in chronic kidney disease are complete, an individual participant meta-analysis would be helpful to determine which subgroups, if any, are more likely to benefit and which treatment regimens are more beneficial. TRIAL REGISTRATION Current Controlled Trials ISRCTN09486651 and EudraCT 2011-005271-16. The systematic review is registered as PROSPERO CRD42018112908. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 27. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation, Trust, Newcastle upon Tyne, UK
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Margaret Band
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Huey Chong
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Peter T Donnan
- Division of Population Health and Genomics, Medical School, University of Dundee, Dundee, UK
| | - Geeta Hampson
- Department of Clinical Chemistry and Metabolic Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Edmund Lamb
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | | | - Gwen Kennedy
- The Immunoassay Biomarker Core Laboratory, University of Dundee, Dundee, UK
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Deirdre Plews
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Roy L Soiza
- Ageing Clinical and Experimental Research, University of Aberdeen, Aberdeen, UK
| | - Deepa Sumukadas
- Department of Medicine for the Elderly, NHS Tayside, Dundee, UK
| | - Graham Warwick
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Robertson JFR, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Cheung SYA, Cullberg M, de Bruin EC, Koulai L, Lindemann JPO, Pass M, Rugman P, Schiavon G, Deb R, Finlay P, Foxley A, Gee JMW. Proliferation and AKT Activity Biomarker Analyses after Capivasertib (AZD5363) Treatment of Patients with ER + Invasive Breast Cancer (STAKT). Clin Cancer Res 2020; 26:1574-1585. [PMID: 31836609 DOI: 10.1158/1078-0432.ccr-19-3053] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/22/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The STAKT study examined short-term exposure (4.5 days) to the oral selective pan-AKT inhibitor capivasertib (AZD5363) to determine if this drug can reach its therapeutic target in sufficient concentration to significantly modulate key biomarkers of the AKT pathway and tumor proliferation. PATIENTS AND METHODS STAKT was a two-stage, double-blind, randomized, placebo-controlled, "window-of-opportunity" study in patients with newly diagnosed ER+ invasive breast cancer. Stage 1 assessed capivasertib 480 mg b.i.d. (recommended monotherapy dose) and placebo, and stage 2 assessed capivasertib 360 and 240 mg b.i.d. Primary endpoints were changes from baseline in AKT pathway markers pPRAS40, pGSK3β, and proliferation protein Ki67. Pharmacologic and pharmacodynamic properties were analyzed from blood sampling, and tolerability by adverse-event monitoring. RESULTS After 4.5 days' exposure, capivasertib 480 mg b.i.d. (n = 17) produced significant decreases from baseline versus placebo (n = 11) in pGSK3β (H-score absolute change: -55.3, P = 0.006) and pPRAS40 (-83.8, P < 0.0001), and a decrease in Ki67 (absolute change in percentage positive nuclei: -9.6%, P = 0.031). Significant changes also occurred in secondary signaling biomarker pS6 (-42.3, P = 0.004), while pAKT (and nuclear FOXO3a) also increased in accordance with capivasertib's mechanism (pAKT: 81.3, P = 0.005). At doses of 360 mg b.i.d. (n = 5) and 240 mg b.i.d. (n = 6), changes in primary and secondary biomarkers were also observed, albeit of smaller magnitude. Biomarker modulation was dose and concentration dependent, and no new safety signals were evident. CONCLUSIONS Capivasertib 480 mg b.i.d. rapidly modulates key biomarkers of the AKT pathway and decreases proliferation marker Ki67, suggesting future potential as an effective therapy in AKT-dependent breast cancers.
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Affiliation(s)
| | | | | | | | | | - Anthony Skene
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Daniel Rea
- University of Birmingham, Birmingham, UK
| | | | - Ali Jahan
- King's Mill Hospital, Nottingham, UK
| | | | | | | | | | | | | | | | | | - Martin Pass
- IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - Paul Rugman
- IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | | | - Rahul Deb
- Department of Histopathology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Witham MD, Band M, Chong H, Donnan PT, Hampson G, Hu MK, Kalra P, Kennedy G, Lamb E, Littleford R, McNamee P, Plews D, Rauchhaus P, Soiza RL, Sumukadas D, Warwick G, Avenell A. 104 Oral Sodium Bicarbonate Therapy for Older Patients with Chronic Kidney Disease and Low-Grade Acidosis: The BiCARB Randomised Controlled Trial. Age Ageing 2020. [DOI: 10.1093/ageing/afz196.06] [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] Open
Abstract
Abstract
Background
Oral sodium bicarbonate is often used to treat metabolic acidosis in older people with advanced chronic kidney disease, but evidence is lacking on whether this provides a net gain in health or quality of life.
Methods
We conducted a multicentre, parallel group, double-blind, placebo-controlled randomised trial. Adults aged 60 years and over with category 4 or 5 chronic kidney disease, not on dialysis, with serum bicarbonate concentrations <22 mmol/L were recruited from 27 UK centres. Participants were randomised 1:1 to oral sodium bicarbonate or matching placebo. The primary outcome was the between-group difference in the Short Physical Performance Battery at 12 months, adjusted for baseline. Other key outcome measures included generic and disease-specific health-related quality of life, anthropometry, physical performance, renal function, adverse events including commencement of renal replacement therapy, and health economic analysis.
Results
We randomised 300 participants, mean age 74 years; 86 (29%) were female. Mean baseline estimated GFR was 19 ml/min/1.73m2. Study medication adherence was 73% in both groups. No significant treatment effect was evident for the primary outcome of the between-group difference in the Short Physical Performance Battery at 12 months (-0.4 points; 95% CI -0.9 to 0.1, p=0.15). No significant treatment benefit was seen for any of the secondary outcomes. Adverse events were more frequent in the bicarbonate arm (457 versus 400). Time to commencing renal replacement therapy was similar in both groups (HR 1.22, 95% CI 0.74 to 2.02, p=0.43). Health economic analysis showed lower quality of life and higher costs in the bicarbonate arm at one year (£1234 vs £807); placebo dominated bicarbonate under all sensitivity analyses for incremental cost-effectiveness.
Conclusions
Oral sodium bicarbonate did not improve a wide range of health measures in this trial, and is unlikely to be cost-effective for use in the UK NHS in this patient group.
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Affiliation(s)
- M D Witham
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - M Band
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - H Chong
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - P T Donnan
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - G Hampson
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - M K Hu
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - P Kalra
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - G Kennedy
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - E Lamb
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - R Littleford
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - P McNamee
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - D Plews
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - P Rauchhaus
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - R L Soiza
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - D Sumukadas
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - G Warwick
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - A Avenell
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
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15
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Treweek S, Bevan S, Bower P, Briel M, Campbell M, Christie J, Collett C, Cotton S, Devane D, El Feky A, Galvin S, Gardner H, Gillies K, Hood K, Jansen J, Littleford R, Parker A, Ramsay C, Restrup L, Sullivan F, Torgerson D, Tremain L, von Elm E, Westmore M, Williams H, Williamson PR, Clarke M. Trial Forge Guidance 2: how to decide if a further Study Within A Trial (SWAT) is needed. Trials 2020; 21:33. [PMID: 31910861 PMCID: PMC6945587 DOI: 10.1186/s13063-019-3980-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 10/18/2018] [Accepted: 12/09/2019] [Indexed: 12/29/2022] Open
Abstract
The evidence base available to trialists to support trial process decisions—e.g. how best to recruit and retain participants, how to collect data or how to share the results with participants—is thin. One way to fill gaps in evidence is to run Studies Within A Trial, or SWATs. These are self-contained research studies embedded within a host trial that aim to evaluate or explore alternative ways of delivering or organising a particular trial process. SWATs are increasingly being supported by funders and considered by trialists, especially in the UK and Ireland. At some point, increasing SWAT evidence will lead funders and trialists to ask: given the current body of evidence for a SWAT, do we need a further evaluation in another host trial? A framework for answering such a question is needed to avoid SWATs themselves contributing to research waste. This paper presents criteria on when enough evidence is available for SWATs that use randomised allocation to compare different interventions.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Simon Bevan
- National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, Southampton, UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Declan Devane
- HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland
| | - Adel El Feky
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sandra Galvin
- HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Jan Jansen
- Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Roberta Littleford
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | | | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Frank Sullivan
- School of Medicine, St Andrews University, St Andrews, UK
| | | | - Liz Tremain
- National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, Southampton, UK
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Matthew Westmore
- National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, Southampton, UK
| | - Hywel Williams
- Centre of Evidence-Based Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics University of Liverpool, Liverpool, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
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16
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Cumming SA, Jimenez-Moreno C, Okkersen K, Wenninger S, Daidj F, Hogarth F, Littleford R, Gorman G, Bassez G, Schoser B, Lochmüller H, van Engelen BGM, Monckton DG. Genetic determinants of disease severity in the myotonic dystrophy type 1 OPTIMISTIC cohort. Neurology 2019; 93:e995-e1009. [PMID: 31395669 PMCID: PMC6745735 DOI: 10.1212/wnl.0000000000008056] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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: 07/02/2018] [Accepted: 04/10/2019] [Indexed: 01/11/2023] Open
Abstract
Objective To evaluate the role of genetic variation at the DMPK locus on symptomatic diversity in 250 adult, ambulant patients with myotonic dystrophy type 1 (DM1) recruited to the Observational Prolonged Trial in Myotonic Dystrophy Type 1 to Improve Quality of Life—Standards, a Target Identification Collaboration (OPTIMISTIC) clinical trial. Methods We used small pool PCR to correct age at sampling biases and estimate the progenitor allele CTG repeat length and somatic mutational dynamics, and AciI digests and repeat primed PCR to test for the presence of variant repeats. Results We confirmed disease severity is driven by progenitor allele length, is further modified by age, and, in some cases, sex, and that patients in whom the CTG repeat expands more rapidly in the soma develop symptoms earlier than predicted. We revealed a key role for variant repeats in reducing disease severity and quantified their role in delaying age at onset by approximately 13.2 years (95% confidence interval 5.7–20.7, 2-tailed t test t = −3.7, p = 0.0019). Conclusions Careful characterization of the DMPK CTG repeat to define progenitor allele length and presence of variant repeats has increased utility in understanding clinical variability in a trial cohort and provides a genetic route for defining disease-specific outcome measures, and the basis of treatment response and stratification in DM1 trials.
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Affiliation(s)
- Sarah A Cumming
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Cecilia Jimenez-Moreno
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Kees Okkersen
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Stephan Wenninger
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Ferroudja Daidj
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Fiona Hogarth
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Roberta Littleford
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Gráinne Gorman
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Guillaume Bassez
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Benedikt Schoser
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Hanns Lochmüller
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Baziel G M van Engelen
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK
| | - Darren G Monckton
- From the Institute of Molecular, Cell and Systems Biology (S.A.C., D.G.M.), University of Glasgow; Institute of Genetic Medicine (C.J.-M., H.L.) and Institute of Neurosciences (G.G.), Newcastle University, Newcastle upon Tyne, UK; Department of Neurology (K.O., B.G.M.v.E.), Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology (S.W., B.S.), Friedrich-Baur-Institute, Ludwig-Maximilians-Universität München, Munich, Germany; Neuromuscular Reference Centre (F.D., G.B.), Assistance Publique-Hôpitaux de Paris, France; and Tayside Clinical Trials Unit (F.H., R.L.), The University of Dundee, UK.
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17
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Gee J, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Finlay P, Cheung A, Cullberg M, de Bruin E, Foxley A, Koulai L, Pass M, Schiavon G, Rugman P, Deb R, Robertson JFR. Abstract P2-12-01: Dose- and exposure-response relationship and biomarker correlation analysis in breast tumors from patients treated with capivasertib, an AKT inhibitor, in the STAKT randomized, placebo controlled pre-surgical study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-12-01] [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: 11/16/2022]
Abstract
Abstract
Background: Capivasertib (AZD5363), an AKT1,2,3 inhibitor, significantly improved progression-free and overall survival when added to paclitaxel in triple negative breast cancer (BC) patients (Schmid et al. ASCO 2018). We have previously reported in STAKT, robust target inhibition at 480mg BD versus placebo, including significant decreases in the primary biomarkers (PBs) - Ki67, pPRAS40 & pGSK3β - in primary BCs (Robertson et al. SABCS 2017). We now report the dose- and exposure-response relationship of capivasertib and the correlation between primary and secondary (pAKT, pS6, nuclear FOXO3a) tumor biomarkers.
Design: STAKT was a two-stage, double blind, randomized, placebo controlled 'window-of-opportunity' trial in newly diagnosed ER+ BC patients. Stage 1 assessed capivasertib at a dose of 480mg BD p.o. versus placebo. Stage 2 assessed capivasertib at two lower doses 360mg and 240mg BD. Tumor biopsies were taken prior to 1st dose and after 4.5 days of dosing. Evaluable patients (who required pre-defined minimum baseline PD values for PBs) included placebo (n=11), capivasertib at 480mg (n=17), 360mg (n=5) and 240mg (n=6). Blood samples for pharmacokinetic (PK) studies were scheduled at pre-dose; 2, 4, optional 6 & 8 hrs post first dose on Day 1; ˜2-4 h post last dose on Day 5 (before biopsy). The % change from baseline for PBs were evaluated against the following exposure variables (placebo=0): i) Dose, ii) Observed Cmax Day 1 (˜2h post-dose), iii) Observed plasma concentration on Day 5, iv) Model-predicted plasma concentration Day 5 at time of biopsy, and v) Model-predicted AUC on Day 5. Spearman correlation coefficient measured the strength and direction of association between biomarkers.
Results:
· Significant mean reductions in % change from baseline were observed for the PBs pGSK3β (-39%; p<0.006), pPRAS40 (-50%; p<0.0001) and Ki67 (-23%; p=0.052) at 480mg versus placebo. At 360mg and 240mg, mean % changes from baseline in pGSK3β were -27% and -9%, respectively; in pPRAS40 -45% and -28%, respectively; and in Ki67 0% and +22%, respectively.
· Dose-response relationships for individual % change from baseline could be described by an Emax model for all PBs. Overall, the correlation to PK exposure (observed or predicted) was similar to the correlation to dose.
· Correlation coefficient analyses between biomarkers at capivasertib 480mg BD identified- i) Positive correlations for pGSK3β with Ki67 (ρ = 0.52, p-value < 0.05) & with pS6 (ρ = 0.54, p-value<0.05); ii) Negative correlations between FOXO3a and Ki67 (ρ = -0.75, p-value<0.001) pGSK3β (ρ = -0.71, p-value<0.001) & also pS6 (ρ = -0.61, p-value<0.001).Correlation coefficients for lower doses are not robust due to small sample size in these groups.
Conclusions
· Capivasertib caused dose- and concentration- dependent effects on biomarkers after only 4.5 days.
· Significant changes in the PBs were demonstrated at 480 mg BD. Biomarker changes was observed at 360mg and 240mg BD, but statistical analysis was limited by the small sample size at lower doses.
· Correlation between a number of tumor biomarkers (relative changes) were identified for capivasertib 480mg BD.
Citation Format: Gee J, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Finlay P, Cheung A, Cullberg M, de Bruin E, Foxley A, Koulai L, Pass M, Schiavon G, Rugman P, Deb R, Robertson JFR. Dose- and exposure-response relationship and biomarker correlation analysis in breast tumors from patients treated with capivasertib, an AKT inhibitor, in the STAKT randomized, placebo controlled pre-surgical study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-12-01.
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Affiliation(s)
- J Gee
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - RE Coleman
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - KL Cheung
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Evans
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - C Holcombe
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Skene
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - D Rea
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - S Ahmed
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Jahan
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - K Horgan
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Rauchhaus
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - R Littleford
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Finlay
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Cheung
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - M Cullberg
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - E de Bruin
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Foxley
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - L Koulai
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - M Pass
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - G Schiavon
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Rugman
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - R Deb
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - JFR Robertson
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
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18
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Young B, Vedhara K, Kendrick D, Littleford R, Robertson JFR, Sullivan FM, Schembri S, das Nair R. Determinants of motivation to quit in smokers screened for the early detection of lung cancer: a qualitative study. BMC Public Health 2018; 18:1276. [PMID: 30453929 PMCID: PMC6245764 DOI: 10.1186/s12889-018-6211-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 11/08/2018] [Indexed: 12/05/2022] Open
Abstract
Background The promotion of smoking cessation within lung cancer screening could lead to benefits for smoking-related disease and improve cost-effectiveness of screening. Little is known about how smokers respond to lung cancer screening and how this impacts smoking behaviour. We aimed to understand how lung cancer screening influences individual motivations about smoking, including in those who have stopped smoking since screening. Methods Thirty one long-term smokers aged 51–74 took part in semi-structured interviews about smoking. They had been screened with the EarlyCDT-Lung Test (13 positive result; 18 negative) as part of the Early Cancer Detection Test Lung Cancer Scotland Study. They were purposively sampled for interview based on their self-reported post-screening smoking behaviour. Eleven participants had stopped smoking since screening. Verbatim interview transcripts were analysed using thematic analysis. Results Two key overarching themes were interpretations of screening test results and emotional responses to those interpretations. Participants’ understanding of the risk implied by their test result was often inaccurate, for example a negative result interpreted as an ‘all-clear’ from lung cancer and a positive result as meaning lung cancer would definitely develop. Those interpretations led to emotional responses (fear, shock, worry, relief, indifference) influencing motivations about smoking. Other themes included a wake-up call causing changes in perceived risk of smoking-related disease, a feeling that now is the time to stop smoking and family influences. There was no clear pattern in smoking motivations in those who received positive or negative test results. Of those who had stopped smoking, some cited screening experiences as the sole motivation, some cited screening along with other coinciding factors, and others cited non-screening reasons. Cues to change were experienced at different stages of the screening process. Some participants indicated they underwent screening to try and stop smoking, while others expressed little or no desire to stop. Conclusions We observed complex and individualised motivations about smoking following lung cancer screening. To be most effective, smoking cessation support in this context should explore understanding of screening test results and may need to be highly tailored to individual emotional responses to screening. Electronic supplementary material The online version of this article (10.1186/s12889-018-6211-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kavita Vedhara
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - John F R Robertson
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
| | | | | | - Roshan das Nair
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
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19
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Parker A, Knapp P, Treweek S, Madhurasinghe V, Littleford R, Gallant S, Sullivan F, Schembri S, Rick J, Graffy J, Collier DJ, Eldridge S, Kennedy A, Bower P. The effect of optimised patient information materials on recruitment in a lung cancer screening trial: an embedded randomised recruitment trial. Trials 2018; 19:503. [PMID: 30227890 PMCID: PMC6145341 DOI: 10.1186/s13063-018-2896-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 08/31/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Written participant information materials are important for ensuring that potential trial participants receive necessary information so that they can provide informed consent. However, such materials are frequently long and complex, which may negatively impact patient understanding and willingness to participate. Improving readability, ease of comprehension and presentation may assist with improved participant recruitment. The Systematic Techniques for Assisting Recruitment to Trials (MRC START) study aimed to develop and evaluate interventions to improve trial recruitment. This study aimed to assess the effectiveness of an optimised participant information brochure and cover letter developed by MRC START regarding response and participant recruitment rates. METHODS We conducted a study within a trial (SWAT) embedded in the EarlyCDT Lung Cancer Scotland (ECLS) trial that aimed to assess the effectiveness of a new test in reducing the incidence of patients with late-stage lung cancer at diagnosis compared with standard care. Potential participants approached for ECLS were randomised to receive the original participant information brochure and accompanying letter (control group) or optimised versions of these materials which had undergone user testing and a process of re-writing, re-organisation and professional graphic design (intervention group). The primary outcome was the number of patients recruited to ECLS. The secondary outcome was the proportion of patients expressing an interest in participating in ECLS. RESULTS In total, 2262 patients were randomised, 1136 of whom were sent the intervention materials and 1126 of whom were sent the control materials. The proportion of patients enrolled and randomised into ECLS was 180 of 1136 (15.8%) in the intervention group and 176 of 1126 (15.6%) in the control group (OR = 1.016, 95% CI, 0.660 to 1.564). The proportion of patients who positively responded to the invitation was 224 of 1136 (19.7%) in the intervention group and 205 of 1126 (18.2%) in the control group (OR = 1.103, 95% CI, 0.778 to 1.565). CONCLUSIONS Optimised patient information materials made little difference to the proportion of patients positively responding to a trial invitation or to the proportion subsequently randomised to the host trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT01925625 . Registered on 15 August 2015. Study Within A Trial, SWAT-23. Registered on 12 April 2016.
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Affiliation(s)
- Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Peter Knapp
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Vichithranie Madhurasinghe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT UK
| | | | - Stephanie Gallant
- Centre for Public Health Nutrition Research, University of Dundee, Dundee, UK
| | - Frank Sullivan
- School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, UK
| | - Stuart Schembri
- School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY Scotland, UK
| | - Jo Rick
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Manchester, M13 9PT UK
| | - Jonathan Graffy
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, CB2 OSR UK
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, 39 Whitely Road, Bristol, BS8 2PS UK
| | - David J. Collier
- William Harvey Research Institute, Barts and the London Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Sandra Eldridge
- Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT UK
| | - Anne Kennedy
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Manchester, M13 9PT UK
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20
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Clark ME, Bedford LE, Young B, Robertson JFR, das Nair R, Vedhara K, Littleford R, Sullivan FM, Mair FS, Schembri S, Rauchhaus P, Kendrick D. Lung cancer CT screening: Psychological responses in the presence and absence of pulmonary nodules. Lung Cancer 2018; 124:160-167. [PMID: 30268456 DOI: 10.1016/j.lungcan.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To determine the psychological response (thoughts, perceptions and affect) to a diagnosis of pulmonary nodules following a novel antibody blood test and computed tomography (CT) scans within a UK population. MATERIALS AND METHODS This study was nested within a randomised controlled trial of a blood test (Early CDT®-Lung test), followed by a chest x-ray and serial CT-scanning of those with a positive blood test for early detection of lung cancer (ECLS Study). Trial participants with a positive Early CDT®-Lung test were invited to participate (n = 338) and those agreeing completed questionnaires assessing psychological outcomes at 1, 3 and 6 months following trial recruitment. Responses of individuals with pulmonary nodules on their first CT scan were compared to those without (classified as normal CT) at 3 and 6 months follow-up using random effects regression models to account for multiple observations per participant, with loge transformation of data where modelling assumptions were not met. RESULTS There were no statistically significant differences between the nodule and normal CT groups in affect, lung cancer worry, health anxiety, illness perceptions, lung cancer risk perception or intrusive thoughts at 3 or 6 months post-recruitment. The nodule group had statistically significantly fewer avoidance symptoms compared to the normal CT group at 3 months (impact of events scale avoidance (IES-A) difference between means -1.99, 95%CI -4.18, 0.21) than at 6 months (IES-A difference between means 0.88, 95%CI -1.32, 3.08; p-value for change over time = 0.003) with similar findings using loge transformed data. CONCLUSION A diagnosis of pulmonary nodules following an Early CDT®-Lung test and CT scan did not appear to result in adverse psychological responses compared to those with a normal CT scan.
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Affiliation(s)
- Marcia E Clark
- University of Nottingham, Division of Primary Care, United Kingdom
| | - Laura E Bedford
- University of Nottingham, Division of Primary Care, United Kingdom
| | - Ben Young
- University of Nottingham, Division of Primary Care, United Kingdom
| | - John F R Robertson
- University of Nottingham, Division of Medical Sciences and Graduate Entry Medicine, United Kingdom
| | - Roshan das Nair
- University of Nottingham, Institute of Mental Health, United Kingdom
| | - Kavita Vedhara
- University of Nottingham, Division of Primary Care, United Kingdom
| | | | | | - Frances S Mair
- University of Glasgow, General Practice and Primary Care, United Kingdom
| | - Stuart Schembri
- University of Dundee, Scottish Centre for Respiratory Research, United Kingdom
| | - Petra Rauchhaus
- University of Dundee, Tayside Clinical Trials Unit, United Kingdom
| | - Denise Kendrick
- University of Nottingham, Division of Primary Care, United Kingdom.
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21
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Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmüller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. Lancet Neurol 2018; 17:671-680. [PMID: 29934199 DOI: 10.1016/s1474-4422(18)30203-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [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: 02/19/2018] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Myotonic dystrophy type 1 is the most common form of muscular dystrophy in adults and leads to severe fatigue, substantial physical functional impairment, and restricted social participation. In this study, we aimed to determine whether cognitive behavioural therapy optionally combined with graded exercise compared with standard care alone improved the health status of patients with myotonic dystrophy type 1. METHODS We did a multicentre, single-blind, randomised trial, at four neuromuscular referral centres with experience in treating patients with myotonic dystrophy type 1 located in Paris (France), Munich (Germany), Nijmegen (Netherlands), and Newcastle (UK). Eligible participants were patients aged 18 years and older with a confirmed genetic diagnosis of myotonic dystrophy type 1, who were severely fatigued (ie, a score of ≥35 on the checklist-individual strength, subscale fatigue). We randomly assigned participants (1:1) to either cognitive behavioural therapy plus standard care and optional graded exercise or standard care alone. Randomisation was done via a central web-based system, stratified by study site. Cognitive behavioural therapy focused on addressing reduced patient initiative, increasing physical activity, optimising social interaction, regulating sleep-wake patterns, coping with pain, and addressing beliefs about fatigue and myotonic dystrophy type 1. Cognitive behavioural therapy was delivered over a 10-month period in 10-14 sessions. A graded exercise module could be added to cognitive behavioural therapy in Nijmegen and Newcastle. The primary outcome was the 10-month change from baseline in scores on the DM1-Activ-c scale, a measure of capacity for activity and social participation (score range 0-100). Statistical analysis of the primary outcome included all participants for whom data were available, using mixed-effects linear regression models with baseline scores as a covariate. Safety data were presented as descriptives. This trial is registered with ClinicalTrials.gov, number NCT02118779. FINDINGS Between April 2, 2014, and May 29, 2015, we randomly assigned 255 patients to treatment: 128 to cognitive behavioural therapy plus standard care and 127 to standard care alone. 33 (26%) of 128 assigned to cognitive behavioural therapy also received the graded exercise module. Follow-up continued until Oct 17, 2016. The DM1-Activ-c score increased from a mean (SD) of 61·22 (17·35) points at baseline to 63·92 (17·41) at month 10 in the cognitive behavioural therapy group (adjusted mean difference 1·53, 95% CI -0·14 to 3·20), and decreased from 63·00 (17·35) to 60·79 (18·49) in the standard care group (-2·02, -4·02 to -0·01), with a mean difference between groups of 3·27 points (95% CI 0·93 to 5·62, p=0·007). 244 adverse events occurred in 65 (51%) patients in the cognitive behavioural therapy group and 155 in 63 (50%) patients in the standard care alone group, the most common of which were falls (155 events in 40 [31%] patients in the cognitive behavioural therapy group and 71 in 33 [26%] patients in the standard care alone group). 24 serious adverse events were recorded in 19 (15%) patients in the cognitive behavioural therapy group and 23 in 15 (12%) patients in the standard care alone group, the most common of which were gastrointestinal and cardiac. INTERPRETATION Cognitive behavioural therapy increased the capacity for activity and social participation in patients with myotonic dystrophy type 1 at 10 months. With no curative treatment and few symptomatic treatments, cognitive behavioural therapy could be considered for use in severely fatigued patients with myotonic dystrophy type 1. FUNDING The European Union Seventh Framework Programme.
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Affiliation(s)
- Kees Okkersen
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
| | | | - Stephan Wenninger
- Friedrich-Baur-Institute, Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ferroudja Daidj
- Neuromuscular Reference Centre, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jeffrey Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sarah Cumming
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hanns Lochmüller
- Institute of Genetic Medicine, University of Newcastle, Newcastle, UK; Department of Neuropediatrics and Muscle Disorders, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany; Centro Nacional de Análisis Genómico, Center for Genomic Regulation, Barcelona Institute of Science and Technology, Barcelona, Catalonia, Spain
| | - Michael Catt
- National Innovation Centre for Ageing, University of Newcastle, Newcastle, UK; Catt-Sci, Wellingborough, UK
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Gráinne Gorman
- Institute of Neuroscience, University of Newcastle, Newcastle, UK
| | - Guillaume Bassez
- Neuromuscular Reference Centre, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benedikt Schoser
- Friedrich-Baur-Institute, Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hans Knoop
- Academic Medical Center, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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22
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Lambert MA, Weir-McCall JR, Salsano M, Gandy SJ, Levin D, Cavin I, Littleford R, MacFarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan F, Henderson SA, White RD, Belch JJF, Houston JG. Prevalence and Distribution of Atherosclerosis in a Low- to Intermediate-Risk Population: Assessment with Whole-Body MR Angiography. Radiology 2018; 287:795-804. [PMID: 29714681 PMCID: PMC5979784 DOI: 10.1148/radiol.2018171609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 11/11/2022]
Abstract
Purpose To quantify the burden and distribution of asymptomatic atherosclerosis in a population with a low to intermediate risk of cardiovascular disease. Materials and Methods Between June 2008 and February 2013, 1528 participants with 10-year risk of cardiovascular disease less than 20% were prospectively enrolled. They underwent whole-body magnetic resonance (MR) angiography at 3.0 T by using a two-injection, four-station acquisition technique. Thirty-one arterial segments were scored according to maximum stenosis. Scores were summed and normalized for the number of assessable arterial segments to provide a standardized atheroma score (SAS). Multiple linear regression was performed to assess effects of risk factors on atheroma burden. Results A total of 1513 participants (577 [37.9%] men; median age, 53.5 years; range, 40-83 years) completed the study protocol. Among 46 903 potentially analyzable segments, 46 601 (99.4%) were interpretable. Among these, 2468 segments (5%) demonstrated stenoses, of which 1649 (3.5%) showed stenosis less than 50% and 484 (1.0%) showed stenosis greater than or equal to 50%. Vascular stenoses were distributed throughout the body with no localized distribution. Seven hundred forty-seven (49.4%) participants had at least one stenotic vessel, and 408 (27.0%) participants had multiple stenotic vessels. At multivariable linear regression, SAS correlated with age (B = 3.4; 95% confidence interval: 2.61, 4.20), heart rate (B = 1.23; 95% confidence interval: 0.51, 1.95), systolic blood pressure (B = 0.02; 95% confidence interval: 0.01, 0.03), smoking status (B = 0.79; 95% confidence interval: 0.44, 1.15), and socioeconomic status (B = -0.06; 95% confidence interval: -0.10, -0.02) (P < .01 for all). Conclusion Whole-body MR angiography identifies early vascular disease at a population level. Although disease prevalence is low on a per-vessel level, vascular disease is common on a per-participant level, even in this low- to intermediate-risk cohort. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Marco Salsano
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Stephen J. Gandy
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Daniel Levin
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Ian Cavin
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Roberta Littleford
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Jennifer A. MacFarlane
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Shona Z. Matthew
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Richard S. Nicholas
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Allan D. Struthers
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Frank Sullivan
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Shelley A. Henderson
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Richard D. White
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Jill J. F. Belch
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - J. Graeme Houston
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
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23
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Treweek S, Bevan S, Bower P, Campbell M, Christie J, Clarke M, Collett C, Cotton S, Devane D, El Feky A, Flemyng E, Galvin S, Gardner H, Gillies K, Jansen J, Littleford R, Parker A, Ramsay C, Restrup L, Sullivan F, Torgerson D, Tremain L, Westmore M, Williamson PR. Trial Forge Guidance 1: what is a Study Within A Trial (SWAT)? Trials 2018; 19:139. [PMID: 29475444 PMCID: PMC5824570 DOI: 10.1186/s13063-018-2535-5] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
Randomised trials are a central component of all evidence-informed health care systems and the evidence coming from them helps to support health care users, health professionals and others to make more informed decisions about treatment. The evidence available to trialists to support decisions on design, conduct and reporting of randomised trials is, however, sparse. Trial Forge is an initiative that aims to increase the evidence base for trial decision-making and in doing so, to improve trial efficiency.One way to fill gaps in evidence is to run Studies Within A Trial, or SWATs. This guidance document provides a brief definition of SWATs, an explanation of why they are important and some practical 'top tips' that come from existing experience of doing SWATs. We hope the guidance will be useful to trialists, methodologists, funders, approvals agencies and others in making clear what a SWAT is, as well as what is involved in doing one.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Simon Bevan
- National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, UK
| | - Peter Bower
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mike Clarke
- Northern Ireland Network for Trials Methodology Research, Queen’s University Belfast, Belfast, UK
| | | | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Declan Devane
- HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland
| | - Adel El Feky
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Sandra Galvin
- HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jan Jansen
- Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, AL USA
| | | | | | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Frank Sullivan
- School of Medicine, St Andrews University, St Andrews, UK
| | | | - Liz Tremain
- National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, UK
| | - Matthew Westmore
- National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, UK
| | - Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
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24
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Robertson JFR, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Kelly S, Horgan K, Rauchhaus P, Littleford R, Foxley A, Lindemann JPO, Pass M, Rugman P, Deb R, Finlay P, Gee JMW. Abstract P4-04-06: AZD5363, an AKT inhibitor, significantly inhibits key biomarkers of the AKT pathway and Ki67, in a randomized, placebo, controlled study (STAKT) in human breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-04-06] [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: 11/16/2022]
Abstract
Abstract
Background: AKT is an important intracellular control point through which Type 1 growth factors and IGFR signal. Mutations in PIK3CA, AKT and PTEN are prevalent in estrogen receptor positive (ER+) breast cancer (BC) and have been implicated in resistance to endocrine therapies. AZD5363 is an inhibitor of AKT 1, 2 and 3 currently in Phase 2 trials for BC and other solid cancers.
Design: The study examined whether AZD5363 impacts on key biomarkers within the AKT pathway and their subsequent effects on Ki67, a marker of tumor proliferation. STAKT is a multi-center, two-stage, double blind, randomized, placebo controlled, biomarker 'window-of-opportunity' trial in women with newly diagnosed, previously untreated ER+ BC who were deemed would require chemotherapy as part of their primary treatment regimen. Stage 1 assessed AZD5363 at a dose of 480mg bd p.o. versus matching placebo. Up to 30 patients per arm were permitted, to allow 12 subjects per arm with evaluable paired biopsies - obtained at baseline, and after 4.5 days of AZD5363 / placebo. Primary endpoint markers were pPRAS40, pGSK3β and Ki67 assessed by immunohistochemistry. pPRAS40 and pGSK3β were assessed by H-scores and measured separately for cytoplasmic (cyto), nuclear (nuc) and total (cyto+nuc) staining. Ki67 was assessed as % positive staining of 500 tumor nuclei. Laboratory staff were blinded to treatment arm and whether the biopsies were taken before or after AZD5363/placebo. Changes in marker expression (both absolute and %) between biopsies were calculated, and compared between the two groups. An ANOVA test was applied for normally distributed data and Wilcoxon Mann-Whitney used if not normally distributed.
Results: 28/36 patients were evaluable with patient & tumor characteristics as follows: 17 received AZD5363 and 11 placebo; the median ages were 48 & 49 years respectively. 27 patients were Caucasian and 1 African-American. Tumors were all ER+. For HER2 status 8 were positive & 9 negative in the AZD5363 treated group compared to 2 & 9 respectively in the placebo group.
For pPRAS40 and pGSK3β cyto was the predominant staining while for Ki67 staining was nuclear. Changes in each marker with associated p-values are shown in the table.
MarkerType of change vs baselineDegree of change in AZD5363 arm (n=17)p-value versus placebo arm (n=11)pPRAS40 (H-score)TotalAbsolute-83.8<0.0001Total%-50.2<0.0001CytoAbsolute-90.0<0.0001Cyto%-55.8<0.0001NucAbsolute+6.90.42Nuc%+8.90.94pGSK3β (H-score)TotalAbsolute-55.30.006Total%-39.00.006CytoAbsolute-53.60.006Cyto%-39.20.006NucAbsolute-2.80.065Nuc%-36.50.058Ki67 (% cells+)Absolute-9.60.031%-29.40.052
Conclusions• AZD5363 for 4.5 days caused highly significant falls in pGSK3β and pPRAS40, key markers of AKT pathway activation
• AZD53643 also caused a significant decline in Ki67 even after only 4.5 days of drug. This is one of the shortest 'window'-studies to report such an early effect on proliferation.
• Placebo controlled 'window' studies of this short duration can provide important evidence of the therapeutic potential early in a drug's development.
Citation Format: Robertson JFR, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Kelly S, Horgan K, Rauchhaus P, Littleford R, Foxley A, Lindemann JPO, Pass M, Rugman P, Deb R, Finlay P, Gee JMW. AZD5363, an AKT inhibitor, significantly inhibits key biomarkers of the AKT pathway and Ki67, in a randomized, placebo, controlled study (STAKT) in human breast cancers [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-04-06.
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Affiliation(s)
- JFR Robertson
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - RE Coleman
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - KL Cheung
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Evans
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - C Holcombe
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Skene
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - D Rea
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - S Ahmed
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Jahan
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - S Kelly
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - K Horgan
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - P Rauchhaus
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - R Littleford
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Foxley
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - JPO Lindemann
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - M Pass
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - P Rugman
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - R Deb
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - P Finlay
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - JMW Gee
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
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25
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Weir-McCall JR, Lambert M, Gandy SJ, Belch JJF, Cavin I, Henderson SA, Littleford R, Macfarlane JA, Matthew SZ, Stephen Nicholas R, Struthers AD, Sullivan F, White RD, Graeme Houston J. Systemic arteriosclerosis is associated with left ventricular remodeling but not atherosclerosis: a TASCFORCE study. J Cardiovasc Magn Reson 2018; 20:7. [PMID: 29382349 PMCID: PMC5791244 DOI: 10.1186/s12968-018-0428-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/15/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Arteriosclerosis (arterial stiffening) is associated with future cardiovascular events, with this effect postulated to be due to its effect on cardiac afterload, atherosclerosis (plaque formation) progression or both, but with limited evidence examining these early in disease formation. The aim of the current study is to examine the association between arteriosclerosis, atherosclerosis and ventricular remodelling in a population at low-intermediate cardiovascular risk. METHODS One thousand six hundred fifty-one subjects free of clinical cardiovascular disease and with a < 20% 10 year cardiovascular risk score underwent a cardiovascular magnetic resonance (CMR) study and whole body CMR angiogram. Arteriosclerosis was measured using total arterial compliance (TAC) - calculated as the indexed stroke volume divided by the pulse pressure. Atherosclerosis was quantified using a standardised atheroma score (SAS) which was calculated by scoring 30 arterial segments within the body based on the degree of stenosis, summating these scores and normalising it to the number of assessable segments. Left ventricular remodelling was measured using left ventricular mass to volume ratio (LVMVR). RESULTS One thousand five hundred fifteen (38% male, 53.8 ± 8.2 years old) completed the study. On univariate analysis TAC was associated with SAS but this was lost after accounting for cardiovascular risk factors in both males (B = - 0.001 (- 0.004-0.002),p = 0.62) and females (B = 0.000(95%CI -0.002--0.002),p = 0.78). In contrast compliance correlated with LVMVR after accounting for cardiovascular risk factors (B = - 0.12(95%CI -0.16--0.091),p < 0.001 in males; B = - 0.12(95%CI -0.15--0.086),p < 0.001 in females). CONCLUSION Systemic arteriosclerosis is associated with left ventricular remodelling but not atherosclerosis. Future efforts in cardiovascular risk prevention should thus seek to address both arteriosclerosis and atherosclerosis individually.
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Affiliation(s)
- Jonathan R. Weir-McCall
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | - Matthew Lambert
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | | | - Jill J. F. Belch
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | - Ian Cavin
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | | | - Roberta Littleford
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | | | - Shona Z. Matthew
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | | | - Allan D. Struthers
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | - Frank Sullivan
- Department of Research and Innovation, North York General Hospital, University of Toronto, Toronto, Canada
| | - Richard D. White
- Department of Clinical Radiology, University Hospital of Wales, Cardiff, CF14 4XW UK
| | - J. Graeme Houston
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
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26
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Abstract
Once the excitement of trial design, grant-writing and award are behind us, the great open expanse of the next few years is filled almost exclusively by trial management, the nitty-gritty of getting stuff done – delivering the goal. The most important members of the trial team now are not the professors and investigators but the trial managers. These trial managers have limited published information to help them make informed decisions about how to handle the day-to-day challenges that trials present. This special series aims to highlight the fact that writing on trial management is important, publishable and that Trials would welcome more of it.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Roberta Littleford
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
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27
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Weir-McCall JR, Fitzgerald K, Papagiorcopulo CJ, Gandy SJ, Lambert M, Belch JJF, Cavin I, Littleford R, Macfarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan FM, Waugh SA, White RD, Houston JG. Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis. Eur Heart J Cardiovasc Imaging 2017; 18:657-662. [PMID: 27550660 PMCID: PMC5439404 DOI: 10.1093/ehjci/jew155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/29/2016] [Indexed: 12/18/2022] Open
Abstract
Aims Unrecognized myocardial infarctions (UMIs) have been described in 19–30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI). Methods and results A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31–133) vs. 22.6 (5–175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36–62) vs. 68.9 (38–89)%, P = 0.007], and larger end-systolic volume [36.3 (27–61) vs. 21.7 (5–65) mL/m2, P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54–70) vs. 72 (46–98) mmHg, P = 0.013] but no differences in their cardiac function. Conclusion Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.
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Affiliation(s)
- Jonathan R Weir-McCall
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Kerrie Fitzgerald
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Carla J Papagiorcopulo
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | | | - Matthew Lambert
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Jill J F Belch
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Ian Cavin
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | - Roberta Littleford
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | | | - Shona Z Matthew
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | | | - Allan D Struthers
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Frank M Sullivan
- Department of Research and Innovation, North York General Hospital, University of Toronto, Toronto, UK
| | | | - Richard D White
- Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - J Graeme Houston
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
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28
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Weir-McCall JR, Yeap PM, Papagiorcopulo C, Fitzgerald K, Gandy SJ, Lambert M, Belch JJF, Cavin I, Littleford R, Macfarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan F, Henderson SA, White RD, Houston JG. Reply: The Enigma of Left Ventricular Non-Compaction. J Am Coll Cardiol 2017; 69:2470-2471. [PMID: 28494989 DOI: 10.1016/j.jacc.2017.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
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Sullivan FM, Farmer E, Mair FS, Treweek S, Kendrick D, Jackson C, Robertson C, Briggs A, McCowan C, Bedford L, Young B, Vedhara K, Gallant S, Littleford R, Robertson J, Sewell H, Dorward A, Sarvesvaran J, Schembri S. Detection in blood of autoantibodies to tumour antigens as a case-finding method in lung cancer using the EarlyCDT®-Lung Test (ECLS): study protocol for a randomized controlled trial. BMC Cancer 2017; 17:187. [PMID: 28284200 PMCID: PMC5346215 DOI: 10.1186/s12885-017-3175-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/04/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung cancer is the most common cause of cancer related death worldwide. The majority of cases are detected at a late stage when prognosis is poor. The EarlyCDT®-Lung Test detects autoantibodies to abnormal cell surface proteins in the earliest stages of the disease which may allow tumour detection at an earlier stage thus altering prognosis. The primary research question is: Does using the EarlyCDT®-Lung Test to identify those at high risk of lung cancer, followed by X-ray and computed tomography (CT) scanning, reduce the incidence of patients with late-stage lung cancer (III & IV) or unclassified presentation (U) at diagnosis, compared to standard practice? METHODS A randomised controlled trial of 12 000 participants in areas of Scotland targeting general practices serving patients in the most deprived quintile of the Scottish Index of Multiple Deprivation. Adults aged 50-75 who are at high risk of lung cancer and healthy enough to undergo potentially curative therapy (Performance Status 0-2) are eligible to participate. The intervention is the EarlyCDT®-Lung Test, followed by X-ray and CT in those with a positive result. The comparator is standard clinical practice in the UK. The primary outcome is the difference, after 24 months, between the rates of patients with stage III, IV or unclassified lung cancer at diagnosis. The secondary outcomes include: all-cause mortality; disease specific mortality; a range of morbidity outcomes; cost-effectiveness and measures examining the psychological and behavioural consequences of screening. Participants with a positive test result but for whom the CT scan does not lead to a lung cancer diagnosis will be offered 6 monthly thoracic CTs for 24 months. An initial chest X-ray will be used to determine the speed and the need for contrast in the first screening CT. Participants who are found to have lung cancer will be followed-up to assess both time to diagnosis and stage of disease at diagnosis. DISCUSSION The study will determine the clinical and cost effectiveness of EarlyCDT®-Lung Test for early lung cancer detection and assess its suitability for a large-scale, accredited screening service. The study will also assess the potential psychological and behavioural harms arising from false positive or false negative results, as well as the potential benefits to patients of true negative EarlyCDT lung test results. A cost-effectiveness model of lung cancer screening based on the results of the EarlyCDT Lung Test study will be developed. TRIAL REGISTRATION NCT01925625 . August 19, 2013.
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Affiliation(s)
- F. M. Sullivan
- Gordon F. Cheesbrough Research Chair & Director of UTOPIAN, Department of Family and Community Medicine University of Toronto, North York General Hospital, 4001 Leslie St LE140, Toronto, ON M2K 1E1 Canada
| | - Eoghan Farmer
- School of Medicine,, St Andrews University, St Andrews, UK
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Denise Kendrick
- School of Medicine, Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham, UK
| | - Cathy Jackson
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH UK
| | - Andrew Briggs
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Laura Bedford
- School of Medicine, Division of Primary Care, Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Ben Young
- School of Medicine, Division of Primary Care, Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Kavita Vedhara
- School of Medicine, Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham, UK
| | - Stephanie Gallant
- Clinical Trial Manager, Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Roberta Littleford
- Senior Clinical Trial Manager, Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - John Robertson
- Graduate Entry Medicine & Health School (GEMS), University of Nottingham, Royal Derby Hospital, Nottingham, UK
| | - Herb Sewell
- Division of Immunology, School of Life Sciences, Queens Medical Centre, Nottingham, UK
| | | | - Joseph Sarvesvaran
- The Queen Elizabeth University Hospital Glasgow, 1345 Govan Road, Glasgow, G51 4TF UK
| | - Stuart Schembri
- Consultant Respiratory Physician, Ninewells Hospital, Dundee, UK
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30
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Roberston JFR, Cheung KL, Ahmed S, Coleman RE, Evans A, Holcombe C, Rea D, Rauchhaus P, Skene A, Littleford R, Jahan A, Kelly S, Lindermann JPO, Horgan K, Foxley A, Rugman P, Pass M. Abstract P3-06-03: The short term effects of an AKT inhibitor (AZD5363) on biomarkers of the AKT pathway and anti-tumour activity in a breast cancer paired biopsy study (STAKT trial). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-06-03] [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: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- JFR Roberston
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - KL Cheung
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - S Ahmed
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - RE Coleman
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Evans
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - C Holcombe
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - D Rea
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - P Rauchhaus
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Skene
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - R Littleford
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Jahan
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - S Kelly
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - JPO Lindermann
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - K Horgan
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Foxley
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - P Rugman
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - M Pass
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
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Sullivan F, Dorward A, Mair F, Schembri S, Vedhara K, Kendrick D, Treweek S, Mccowan C, Mcconnachie A, Sproule M, Briggs A, Ritchie L, Milroy R, Taylor T, Littleford R, Brewster D. P2.06-038 An RCT of the Detection of Autoantibodies to Tumor Antigens in Lung Cancer Using the EarlyCDT-Lung Test in Scotland (ECLS) in 12 208 Study Subjects. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1531] [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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Gandy SJ, Lambert M, Belch J, Cavin I, Crowe E, Littleford R, MacFarlane JA, Matthew SZ, Martin P, Nicholas RS, Struthers A, Sullivan F, Waugh SA, White RD, Weir-McCall JR, Houston JG. 3T MRI investigation of cardiac left ventricular structure and function in a UK population: The tayside screening for the prevention of cardiac events (TASCFORCE) study. J Magn Reson Imaging 2016; 44:1186-1196. [PMID: 27143317 PMCID: PMC5082537 DOI: 10.1002/jmri.25267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/28/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To scan a volunteer population using 3.0T magnetic resonance imaging (MRI). MRI of the left ventricular (LV) structure and function in healthy volunteers has been reported extensively at 1.5T. MATERIALS AND METHODS A population of 1528 volunteers was scanned. A standardized approach was taken to acquire steady-state free precession (SSFP) LV data in the short-axis plane, and images were quantified using commercial software. Six observers undertook the segmentation analysis. RESULTS Mean values (±standard deviation, SD) were: ejection fraction (EF) = 69 ± 6%, end diastolic volume index (EDVI) = 71 ± 13 ml/m2 , end systolic volume index (ESVI) = 22 ± 7 ml/m2 , stroke volume index (SVI) = 49 ± 8 ml/m2 , and LV mass index (LVMI) = 55 ± 12 g/m2 . The mean EF was slightly larger for females (69%) than for males (68%), but all other variables were smaller for females (EDVI 68v77 ml/m2 , ESVI 21v25 ml/m2 , SVI 46v52 ml/m2 , LVMI 49v64 g/m2 , all P < 0.05). The mean LV volume data mostly decreased with each age decade (EDVI males: -2.9 ± 1.3 ml/m2 , females: -3.1 ± 0.8 ml/m2 ; ESVI males: -1.3 ± 0.7 ml/m2 , females: -1.7 ± 0.5 ml/m2 ; SVI males: -1.7 ± 0.9 ml/m2 , females: -1.4 ± 0.6 ml/m2 ; LVMI males: -1.6 ± 1.1 g/m2 , females: -0.2 ± 0.6 g/m2 ) but the mean EF was virtually stable in males (0.6 ± 0.6%) and rose slightly in females (1.2 ± 0.5%) with age. CONCLUSION LV reference ranges are provided in this population-based MR study at 3.0T. The variables are similar to those described at 1.5T, including variations with age and gender. These data may help to support future population-based MR research studies that involve the use of 3.0T MRI scanners. J. Magn. Reson. Imaging 2016;44:1186-1196.
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Affiliation(s)
- Stephen J Gandy
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | | | - Jill Belch
- University of Dundee School of Medicine, Dundee, UK
| | - Ian Cavin
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | - Elena Crowe
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
| | | | | | | | - Patricia Martin
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
| | - R Stephen Nicholas
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | | | - Frank Sullivan
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Canada
| | | | - Richard D White
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
- Department of Clinical Radiology, University Hospital of Wales, UK
| | | | - J Graeme Houston
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK.
- University of Dundee School of Medicine, Dundee, UK.
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Weir-McCall JR, Fitzgerald K, Papagiorcopulo C, Gandy SJ, Lambert M, Belch JJF, Cavin I, Littleford R, MacFarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan F, Waugh SA, White RD, Houston JG. 015 Prevalence, pattern and significance of late gadolinium enhancement in a healthy asymptomatic cohort. Heart 2016. [DOI: 10.1136/heartjnl-2016-309680.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Weir-McCall J, Cassidy DB, Belch JJF, Gandy SJ, Houston JG, Lambert MA, Littleford R, Rowland J, Struthers AD, Khan F. 014 Patterns of early atherosclerosis formation and cardiac remodelling in healthy adults of south asian and european descent. Heart 2016. [DOI: 10.1136/heartjnl-2016-309680.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jones C, Jefferson E, Hogarth F, Littleford R, Band M. Supporting clinical trials through healthcare informatics. Trials 2015. [PMCID: PMC4658697 DOI: 10.1186/1745-6215-16-s2-o67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Mcmurdo MET, Sumukadas D, Donnan PT, Cvoro V, Rauchhaus P, Argo I, Waldie H, Littleford R, Struthers AD, Witham MD. Spironolactone for People Age 70 Years and Older With Osteoarthritic Knee Pain: A Proof-of-Concept Trial. Arthritis Care Res (Hoboken) 2015; 68:716-21. [PMID: 26413749 PMCID: PMC4855683 DOI: 10.1002/acr.22724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 05/21/2015] [Revised: 07/15/2015] [Accepted: 09/08/2015] [Indexed: 11/19/2022]
Abstract
Objective To determine whether spironolactone could benefit older people with osteoarthritis (OA), based on a previous study showing that spironolactone improved quality of life. Methods This parallel‐group, randomized, placebo‐controlled, double‐blind trial randomized community‐dwelling people ages ≥70 years with symptomatic knee OA to 12 weeks of 25 mg daily oral spironolactone or matching placebo. The primary outcome was between‐group difference in change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale scores. Secondary outcomes included WOMAC stiffness and physical function subscores, EuroQol 5‐domain (EQ‐5D) 3L score, and mechanistic markers. Analysis was by intent to treat, using mixed‐model regression, adjusting for baseline values of test variables. Results A total of 421 people had eligibility assessed, and 86 were randomized. Mean ± SD age was 77 ± 5 years and 53 of 86 (62%) were women. Adherence to study medication was 99%, and all participants completed the 12‐week assessment. No significant improvement was seen in the WOMAC pain score (adjusted treatment effect 0.5 points [95% confidence interval (95% CI) − 0.3, 1.3]; P = 0.19). No improvement was seen in WOMAC stiffness score (0.2 points [95% CI −0.6, 1.1]; P = 0.58), WOMAC physical function score (0.0 points [95% CI −0.7, 0.8]; P = 0.98), or EQ‐5D 3L score (0.04 points [95% CI −0.04, 0.12]; P = 0.34). Cortisol, matrix metalloproteinase 3, and urinary C‐telopeptide of type II collagen were not significantly different between groups. More minor adverse events were noted in the spironolactone group (47 versus 32), but no increase in death or hospitalization was evident. Conclusion Spironolactone did not improve symptoms, physical function, or health‐related quality of life in older people with knee OA.
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Treweek S, Altman DG, Bower P, Campbell M, Chalmers I, Cotton S, Craig P, Crosby D, Davidson P, Devane D, Duley L, Dunn J, Elbourne D, Farrell B, Gamble C, Gillies K, Hood K, Lang T, Littleford R, Loudon K, McDonald A, McPherson G, Nelson A, Norrie J, Ramsay C, Sandercock P, Shanahan DR, Summerskill W, Sydes M, Williamson P, Clarke M. Making randomised trials more efficient: report of the first meeting to discuss the Trial Forge platform. Trials 2015; 16:261. [PMID: 26044814 PMCID: PMC4475334 DOI: 10.1186/s13063-015-0776-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022] Open
Abstract
Randomised trials are at the heart of evidence-based healthcare, but the methods and infrastructure for conducting these sometimes complex studies are largely evidence free. Trial Forge ( www.trialforge.org ) is an initiative that aims to increase the evidence base for trial decision making and, in doing so, to improve trial efficiency.This paper summarises a one-day workshop held in Edinburgh on 10 July 2014 to discuss Trial Forge and how to advance this initiative. We first outline the problem of inefficiency in randomised trials and go on to describe Trial Forge. We present participants' views on the processes in the life of a randomised trial that should be covered by Trial Forge.General support existed at the workshop for the Trial Forge approach to increase the evidence base for making randomised trial decisions and for improving trial efficiency. Agreed upon key processes included choosing the right research question; logistical planning for delivery, training of staff, recruitment, and retention; data management and dissemination; and close down. The process of linking to existing initiatives where possible was considered crucial. Trial Forge will not be a guideline or a checklist but a 'go to' website for research on randomised trials methods, with a linked programme of applied methodology research, coupled to an effective evidence-dissemination process. Moreover, it will support an informal network of interested trialists who meet virtually (online) and occasionally in person to build capacity and knowledge in the design and conduct of efficient randomised trials.Some of the resources invested in randomised trials are wasted because of limited evidence upon which to base many aspects of design, conduct, analysis, and reporting of clinical trials. Trial Forge will help to address this lack of evidence.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Doug G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedics Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - Peter Bower
- Medical Research Council North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | | | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - David Crosby
- Medical Research Council, Methodology Research Programme (MRC MRP), London, UK.
| | - Peter Davidson
- Consultant in Public Health and Head of Health Technology Assessment, National Institute for Health Research, Evaluation, Trials, and Studies Coordinating Centre, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK.
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Lelia Duley
- Nottingham Clinical Trials Unit (NCTU), Nottingham Health Science Partners, C Floor, South Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
| | - Janet Dunn
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
| | - Diana Elbourne
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Barbara Farrell
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
| | - Carrol Gamble
- North West Hub for Trials Methodology Research, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA, UK.
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Kerry Hood
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Cardiff, UK.
| | - Trudie Lang
- The Global Health Network, Oxford University Centre for Tropical Medicine, University of Oxford, Oxford, UK.
| | | | - Kirsty Loudon
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Gladys McPherson
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University School of Medicine, Heath Park, Cardiff, Wales, CF14 4YS, UK.
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Peter Sandercock
- Division of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
| | | | | | - Matt Sydes
- Medical Research Council, Clinical Trials Unit (MRC CTU), London, UK.
| | - Paula Williamson
- North West Hub for Trials Methodology Research and Department of Biostatistics, University of Liverpool, 1st floor Duncan Building Daulby Street, Liverpool, L69 3GA, UK.
| | - Mike Clarke
- Institute of Clinical Sciences, Block B, Queens University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
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Green FC, Levison R, Newton DJ, Littleford R, Stonebridge PA, Belch JJF. Detecting diabetes and impaired glucose tolerance in patients with atherosclerotic peripheral arterial disease. INT ANGIOL 2012; 31:125-128. [PMID: 22466976] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM In patients with peripheral arterial disease (PAD), diabetes mellitus is associated with increased mortality rates. The aim of this study was to estimate the prevalence of undiagnosed diabetes in PAD patients, and to assess whether a glucose tolerance test is more sensitive than a simple fasting glucose measurement for diagnosis in this group. METHODS A standard glucose tolerance test and fasting glucose measurements were performed in 53 patients with PAD, who were then categorised into diagnostic groups according to each test result. RESULTS Using the glucose tolerance test results, 11.5% of patients were diagnosed with diabetes mellitus and 28.8% had either impaired fasting glucose or impaired glucose tolerance. Using fasting glucose levels only, 7.7% received a diagnosis of diabetes mellitus and 17.3% had impaired fasting glucose. The glucose tolerance data and the fasting glucose data were in agreement in 82.7% of cases, but the glucose tolerance test identified an additional 3.8% of cases with diabetes and an additional 13.5% of cases with impaired glucose tolerance. CONCLUSION Undiagnosed diabetes and impaired glucose homeostasis are common in patients with PAD. Routine screening using a simple glucose tolerance test should be considered in the clinical assessment of this group.
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Affiliation(s)
- F C Green
- Vascular Laboratory, Ninewells Hospital and Medical School, Dundee, UK.
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