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Hughes SE, McMullan C, Aiyegbusi OL, Shaw K, Kinsella F, Ferguson P, Khatsuria F, Burns D, Pyatt L, Ansell J, Chakera E, Richardson-Abraham J, Denniston AK, Davies EH, Craddock C, Calvert M. Protocol for a mixed-methods study to develop and feasibility test a digital system for the capture of patient-reported outcomes (PROs) in patients receiving chimeric antigen receptor T-cell (CAR-T) therapies (the PRO-CAR-T study). BMJ Open 2024; 14:e085392. [PMID: 38553074 PMCID: PMC10982800 DOI: 10.1136/bmjopen-2024-085392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Chimeric antigen receptor (CAR) T-cell therapies are novel, potentially curative therapies for haematological malignancies. CAR T-cell therapies are associated with severe toxicities, meaning patients require monitoring during acute and postacute treatment phases. Electronic patient-reported outcomes (ePROs), self-reports of health status provided via online questionnaires, can complement clinician observation with potential to improve patient outcomes. This study will develop and evaluate feasibility of a new ePRO system for CAR-T patients in routine care. METHODS AND ANALYSIS Multiphase, mixed-methods study involving multiple stakeholder groups (patients, family members, carers, clinicians, academics/researchers and policy-makers). The intervention development phase comprises a Delphi study to select PRO measures for the digital system, a codesign workshop and consensus meetings to establish thresholds for notifications to the clinical team if a patient reports severe symptoms or side effects. Usability testing will evaluate how users interact with the digital system and, lastly, we will evaluate ePRO system feasibility with 30 CAR-T patients (adults aged 18+ years) when used in addition to usual care. Feasibility study participants will use the ePRO system to submit self-reports of symptoms, treatment tolerability and quality of life at specific time points. The CAR-T clinical team will respond to system notifications triggered by patients' submitted responses with actions in line with standard clinical practice. Feasibility measures will be collected at prespecified time points following CAR T-cell infusion. A qualitative substudy involving patients and clinical team members will explore acceptability of the ePRO system. ETHICS AND DISSEMINATION Favourable ethical opinion was granted by the Health and Social Care Research Ethics Committee B(HSC REC B) (ref: 23/NI/0104) on 28 September 2023. Findings will be submitted for publication in high-quality, peer-reviewed journals. Summaries of results, codeveloped with the Blood and Transplant Research Unit Patient and Public Involvement and Engagement group, will be disseminated to all interested groups. TRIAL REGISTRATION NUMBER ISCTRN11232653.
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Affiliation(s)
- Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - Karen Shaw
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
| | - Francesca Kinsella
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Paul Ferguson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Foram Khatsuria
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - David Burns
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | - Alastair K Denniston
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Opthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Charles Craddock
- University of Birmingham, Birmingham, UK
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
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Hughes SE, Aiyegbusi OL, McMullan C, Turner GM, Anderson N, Cruz Rivera S, Collis P, Glasby J, Lasserson D, Calvert M. Patient-reported outcomes in integrated health and social care: A scoping review. JRSM Open 2024; 15:20542704241232866. [PMID: 38529208 PMCID: PMC10962043 DOI: 10.1177/20542704241232866] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Background Patient-reported outcomes (PROs) have potential to support integrated health and social care research and practice; however, evidence of their utilisation has not been synthesised. Objective To identify PRO measures utilised in integrated care and adult social care research and practice and to chart the evidence of implementation factors influencing their uptake. Design Scoping review of peer-reviewed literature. Data sources Six databases (01 January 2010 to 19 May 2023). Study selection Articles reporting PRO use with adults (18+ years) in integrated care or social care settings. Review methods We screened articles against pre-specified eligibility criteria; 36 studies (23%) were extracted in duplicate for verification. We summarised the data using thematic analysis and descriptive statistics. Results We identified 159 articles reporting on 216 PRO measures deployed in a social care or integrated care setting. Most articles used PRO measures as research tools. Eight (5.0%) articles used PRO measures as an intervention. Articles focused on community-dwelling participants (35.8%) or long-term care home residents (23.9%), with three articles (1.9%) focussing on integrated care settings. Stakeholders viewed PROs as feasible and acceptable, with benefits for care planning, health and wellbeing monitoring as well as quality assurance. Patient-reported outcome measure selection, administration and PRO data management were perceived implementation barriers. Conclusion This scoping review showed increasing utilisation of PROs in adult social care and integrated care. Further research is needed to optimise PROs for care planning, design effective training resources and develop policies and service delivery models that prioritise secure, ethical management of PRO data.
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Affiliation(s)
- Sarah E Hughes
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Blood and Transplant Research Unit in Precision Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Blood and Transplant Research Unit in Precision Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Blood and Transplant Research Unit in Precision Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Grace M Turner
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Anderson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
| | | | - Jon Glasby
- School of Social Policy, University of Birmingham, Birmingham, UK
- IMPACT (Improving Adult Social Care Together), University of Birmingham, Birmingham, UK
| | - Daniel Lasserson
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Geriatric Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Blood and Transplant Research Unit in Precision Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
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Aiyegbusi OL, Cruz Rivera S, Roydhouse J, Kamudoni P, Alder Y, Anderson N, Baldwin RM, Bhatnagar V, Black J, Bottomley A, Brundage M, Cella D, Collis P, Davies EH, Denniston AK, Efficace F, Gardner A, Gnanasakthy A, Golub RM, Hughes SE, Jeyes F, Kern S, King-Kallimanis BL, Martin A, McMullan C, Mercieca-Bebber R, Monteiro J, Peipert JD, Quijano-Campos JC, Quinten C, Rantell KR, Regnault A, Sasseville M, Schougaard LMV, Sherafat-Kazemzadeh R, Snyder C, Stover AM, Verdi R, Wilson R, Calvert MJ. Recommendations to address respondent burden associated with patient-reported outcome assessment. Nat Med 2024; 30:650-659. [PMID: 38424214 DOI: 10.1038/s41591-024-02827-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
Patient-reported outcomes (PROs) are increasingly used in healthcare research to provide evidence of the benefits and risks of interventions from the patient perspective and to inform regulatory decisions and health policy. The use of PROs in clinical practice can facilitate symptom monitoring, tailor care to individual needs, aid clinical decision-making and inform value-based healthcare initiatives. Despite their benefits, there are concerns that the potential burden on respondents may reduce their willingness to complete PROs, with potential impact on the completeness and quality of the data for decision-making. We therefore conducted an initial literature review to generate a list of candidate recommendations aimed at reducing respondent burden. This was followed by a two-stage Delphi survey by an international multi-stakeholder group. A consensus meeting was held to finalize the recommendations. The final consensus statement includes 19 recommendations to address PRO respondent burden in healthcare research and clinical practice. If implemented, these recommendations may reduce PRO respondent burden.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK.
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
| | - Samantha Cruz Rivera
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | | | - Yvonne Alder
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Anderson
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Vishal Bhatnagar
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Philip Collis
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Alastair K Denniston
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston University, Birmingham, UK
| | | | - Robert M Golub
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Hughes
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Flic Jeyes
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Christel McMullan
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Rebecca Mercieca-Bebber
- The NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Juan Carlos Quijano-Campos
- William Harvey Research Institute, Queen Mary University of London, London, UK
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | | | | | - Claire Snyder
- Johns Hopkins Schools of Medicine and Public Health, Baltimore, MD, USA
| | - Angela M Stover
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Rav Verdi
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Cancer Research Advocacy Forum, London, UK
| | - Melanie J Calvert
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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Seylanova N, Chernyavskaya A, Degtyareva N, Mursalova A, Ajam A, Xiao L, Aktulaeva K, Roshchin P, Bobkova P, Aiyegbusi OL, Anbu AT, Apfelbacher C, Asadi-Pooya AA, Ashkenazi-Hoffnung L, Brackel C, Buonsenso D, de Groote W, Diaz JV, Dona D, Dunn Galvin A, Genuneit J, Goss H, Hughes SE, Jones CJ, Kuppalli K, Malone LA, McFarland S, Needham DM, Nekliudov N, Nicholson TR, Oliveira CR, Schiess N, Segal TY, Sigfrid L, Thorne C, Vijverberg S, Warner JO, Were WM, Williamson PR, Munblit D. Core outcome measurement set for research and clinical practice in post-COVID-19 condition (long COVID) in children and young people: an international Delphi consensus study "PC-COS Children". Eur Respir J 2024; 63:2301761. [PMID: 38359962 PMCID: PMC10938351 DOI: 10.1183/13993003.01761-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic substantially impacted different age groups, with children and young people not exempted. Many have experienced enduring health consequences. Presently, there is no consensus on the health outcomes to assess in children and young people with post-COVID-19 condition. Furthermore, it is unclear which measurement instruments are appropriate for use in research and clinical management of children and young people with post-COVID-19. To address these unmet needs, we conducted a consensus study, aiming to develop a core outcome set (COS) and an associated core outcome measurement set (COMS) for evaluating post-COVID-19 condition in children and young people. Our methodology comprised of two phases. In phase 1 (to create a COS), we performed an extensive literature review and categorisation of outcomes, and prioritised those outcomes in a two-round online modified Delphi process followed by a consensus meeting. In phase 2 (to create the COMS), we performed another modified Delphi consensus process to evaluate measurement instruments for previously defined core outcomes from phase 1, followed by an online consensus workshop to finalise recommendations regarding the most appropriate instruments for each core outcome. In phase 1, 214 participants from 37 countries participated, with 154 (72%) contributing to both Delphi rounds. The subsequent online consensus meeting resulted in a final COS which encompassed seven critical outcomes: fatigue; post-exertion symptoms; work/occupational and study changes; as well as functional changes, symptoms, and conditions relating to cardiovascular, neuro-cognitive, gastrointestinal and physical outcomes. In phase 2, 11 international experts were involved in a modified Delphi process, selecting measurement instruments for a subsequent online consensus workshop where 30 voting participants discussed and independently scored the selected instruments. As a result of this consensus process, four instruments met a priori consensus criteria for inclusion: PedsQL multidimensional fatigue scale for "fatigue"; PedsQL gastrointestinal symptom scales for "gastrointestinal"; PedsQL cognitive functioning scale for "neurocognitive" and EQ-5D for "physical functioning". Despite proposing outcome measurement instruments for the remaining three core outcomes ("cardiovascular", "post-exertional malaise", "work/occupational and study changes"), a consensus was not achieved. Our international, consensus-based initiative presents a robust framework for evaluating post-COVID-19 condition in children and young people in research and clinical practice via a rigorously defined COS and associated COMS. It will aid in the uniform measurement and reporting of relevant health outcomes worldwide.
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Affiliation(s)
- Nina Seylanova
- Independent researcher, London, UK
- Authors contributed equally to the study; apart from the two joint first authors, who contributed equally, the primary study team members and the last author, authors are listed in alphabetical order
| | - Anastasia Chernyavskaya
- Department of Paediatrics and Paediatric Rheumatology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- National Medical Research Center for Children's Health, Moscow, Russia
- Authors contributed equally to the study; apart from the two joint first authors, who contributed equally, the primary study team members and the last author, authors are listed in alphabetical order
| | - Natalia Degtyareva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Ali Ajam
- University of Birmingham, Birmingham, UK
| | - Lin Xiao
- University of Birmingham, Birmingham, UK
| | | | | | | | | | | | | | - Ali Akbar Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Caroline Brackel
- Department of Paediatric Pulmonology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Danilo Buonsenso
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Janet V Diaz
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Daniele Dona
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krutika Kuppalli
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Laura A Malone
- Kennedy Krieger Institute, Baltimore, MD, USA
- Departments of Neurology and Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Sammie McFarland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
- Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nikita Nekliudov
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carlos R Oliveira
- Yale University School of Medicine, Department of Pediatrics, Section of Infectious Diseases, New Haven, CT, USA
- Yale University School of Public Health, Department of Biostatistics, Division of Health Informatics, New Haven, CT, USA
- Yale New Haven Children's Hospital, New Haven, CT, USA
| | - Nicoline Schiess
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneva, Switzerland
| | - Terry Y Segal
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Claire Thorne
- Population, Policy and Practice Research and Teaching Dept, University College London GOS Institute of Child Health, London, UK
| | | | | | - Wilson Milton Were
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Paula R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Division of Care in Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Authors contributed equally to the study; apart from the two joint first authors, who contributed equally, the primary study team members and the last author, authors are listed in alphabetical order
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Ramirez JL, Kim E, Fregenal AC, Vigran HJ, Hughes SE, Reynolds CW, Varban OA, Carlin AM, Ehlers AP, Bonham AJ, Finks JF. Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients. Surg Endosc 2023; 37:9582-9590. [PMID: 37735218 DOI: 10.1007/s00464-023-10353-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/30/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Depression is strongly associated with obesity and is common among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use. METHODS The Michigan Bariatric Surgery Collaborative is a statewide quality improvement program that maintains a large clinical registry. We evaluated patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 2017 and 2022. Patients self-reported symptoms of depression (PHQ-8) and use of alcohol (AUDIT-C), smoking, prescription opiates, and marijuana at baseline. Preoperative PHQ-8 scores stratified patients based on severity: no depression (0-4), mild (5-9), moderate (10-14), or severe (15-24). We compared 30-day outcomes and substance use between patients with and without depression. RESULTS Among 44,301 patients, 30.8% had some level of depression, with 19.8% mild, 7.5% moderate, and 3.5% severe. Patients with depression were more likely to have an extended length of stay (LOS) (> 3 days) than those without depression (no depression 2.1% vs. severe depression 3.0%, p = 0.0452). There were no significant differences between no depression and severe depression groups in rates of complications (5.7% vs. 5.2%, p = 0.1564), reoperations (0.9%, vs. 0.8%, p = 0.7394), ED visits (7.7% vs. 7.8%, p = 0.5353), or readmissions (3.2% vs. 3.9%, p = 0.3034). Patients with severe depression had significantly higher rates of smoking (9.7% vs. 12.5%, p < 0.0001), alcohol use disorder (8.6% vs. 14.0%, p < 0.0001), opiate use (14.5% vs. 22.4%, p < 0.0001) and marijuana use (8.4%, vs. 15.5%, p = 0.0008). CONCLUSIONS This study demonstrated that nearly one-third of patients undergoing bariatric surgery have depression, with over 10% in the moderate to severe range. There was a significant association between preoperative depressive symptoms and extended LOS after bariatric surgery, as well as higher rates of smoking and use of marijuana, prescription opiates and alcohol. There was no significant effect on adverse events or other measures of healthcare utilization.
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Affiliation(s)
| | - Erin Kim
- University of Michigan Medical School, Ann Arbor, MI, USA.
| | | | | | - Sarah E Hughes
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Oliver A Varban
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Anne P Ehlers
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
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6
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Shaver N, Katz M, Darko Asamoah G, Linkins LA, Abdelkader W, Beck A, Bennett A, Hughes SE, Smith M, Begin M, Coyle D, Piggott T, Kagina BM, Welch V, Colijn C, Earn DJD, El Emam K, Heffernan J, O'Brien SF, Wilson K, Collins E, Navarro T, Beyene J, Boutron I, Bowdish D, Cooper C, Costa A, Curran J, Griffith L, Hsu A, Grimshaw J, Langlois MA, Li X, Pham-Huy A, Raina P, Rubini M, Thabane L, Wang H, Xu L, Brouwers M, Horsley T, Lavis J, Iorio A, Little J. Protocol for a living evidence synthesis on variants of concern and COVID-19 vaccine effectiveness. Vaccine 2023; 41:6411-6418. [PMID: 37718186 DOI: 10.1016/j.vaccine.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/17/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND It is evident that COVID-19 will remain a public health concern in the coming years, largely driven by variants of concern (VOC). It is critical to continuously monitor vaccine effectiveness as new variants emerge and new vaccines and/or boosters are developed. Systematic surveillance of the scientific evidence base is necessary to inform public health action and identify key uncertainties. Evidence syntheses may also be used to populate models to fill in research gaps and help to prepare for future public health crises. This protocol outlines the rationale and methods for a living evidence synthesis of the effectiveness of COVID-19 vaccines in reducing the morbidity and mortality associated with, and transmission of, VOC of SARS-CoV-2. METHODS Living evidence syntheses of vaccine effectiveness will be carried out over one year for (1) a range of potential outcomes in the index individual associated with VOC (pathogenesis); and (2) transmission of VOC. The literature search will be conducted up to May 2023. Observational and database-linkage primary studies will be included, as well as RCTs. Information sources include electronic databases (MEDLINE; Embase; Cochrane, L*OVE; the CNKI and Wangfang platforms), pre-print servers (medRxiv, BiorXiv), and online repositories of grey literature. Title and abstract and full-text screening will be performed by two reviewers using a liberal accelerated method. Data extraction and risk of bias assessment will be completed by one reviewer with verification of the assessment by a second reviewer. Results from included studies will be pooled via random effects meta-analysis when appropriate, or otherwise summarized narratively. DISCUSSION Evidence generated from our living evidence synthesis will be used to inform policy making, modelling, and prioritization of future research on the effectiveness of COVID-19 vaccines against VOC.
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Affiliation(s)
- Nicole Shaver
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Melanie Katz
- Public Health Agency of Canada, Ottawa, Ontario, Canada.
| | - Gideon Darko Asamoah
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Lori-Ann Linkins
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | | | - Andrew Beck
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Alexandria Bennett
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
| | - Maureen Smith
- The Cochrane Consumer Network, Ottawa, Ontario, Canada.
| | - Mpho Begin
- Cassidy e-Care Solutions Inc, Winnipeg, Manitoba, Canada.
| | - Doug Coyle
- Faculty of Medicine, University of Ottawa, Ontario, Canada.
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Peterborough Public Health, Peterborough, Ontario, Canada; Department of Family Medicine, Queens University, Kingston, Ontario, Canada.
| | - Benjamin M Kagina
- Vaccines for Africa Initiative; NITAGs Support Hub (NISH), Faculty of Health Sciences, School of Public Health, University of Cape Town, South Africa.
| | - Vivian Welch
- Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada.
| | - Caroline Colijn
- Department of mathematics, Faculty of Science, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - David J D Earn
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada.
| | | | - Jane Heffernan
- Centre for Disease Modelling, Department of Mathematics & Statistics, Faculty of Science, York University, Toronto, Ontario, Canada.
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada.
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA.
| | - Erin Collins
- Public Health Agency of Canada, Ottawa, Ontario, Canada.
| | | | - Joseph Beyene
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Isabelle Boutron
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), F75004 Paris, France.
| | - Dawn Bowdish
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Curtis Cooper
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Andrew Costa
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Janet Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Lauren Griffith
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Amy Hsu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Jeremy Grimshaw
- Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | | | - Xiaoguang Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Anne Pham-Huy
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Parminder Raina
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Michele Rubini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.
| | - Hui Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Lan Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Melissa Brouwers
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada.
| | - John Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada.
| | - Alfonso Iorio
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Julian Little
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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7
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McMullan C, Retzer A, Hughes SE, Aiyegbusi OL, Bathurst C, Boyd A, Coleman J, Davies EH, Denniston AK, Dunster H, Frost C, Harding R, Hunn A, Kyte D, Malpass R, McNamara G, Mitchell S, Mittal S, Newsome PN, Price G, Rowe A, van Reil W, Walker A, Wilson R, Calvert M. Development and usability testing of an electronic patient-reported outcome (ePRO) solution for patients with inflammatory diseases in an Advanced Therapy Medicinal Product (ATMP) basket trial. J Patient Rep Outcomes 2023; 7:98. [PMID: 37812323 PMCID: PMC10562321 DOI: 10.1186/s41687-023-00634-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/10/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Electronic patient-reported outcome (ePRO) systems are increasingly used in clinical trials to provide evidence of efficacy and tolerability of treatment from the patient perspective. The aim of this study is twofold: (1) to describe how we developed an electronic platform for patients to report their symptoms, and (2) to develop and undertake usability testing of an ePRO solution for use in a study of cell therapy seeking to provide early evidence of efficacy and tolerability of treatment and test the feasibility of the system for use in later phase studies. METHODS An ePRO system was designed to be used in a single arm, multi-centre, phase II basket trial investigating the safety and activity of the use of ORBCEL-C™ in the treatment of patients with inflammatory conditions. ORBCEL-C™ is an enriched Mesenchymal Stromal Cells product isolated from human umbilical cord tissue using CD362+ cell selection. Usability testing sessions were conducted using cognitive interviews and the 'Think Aloud' method with patient advisory group members and Research Nurses to assess the usability of the system. RESULTS Nine patient partners and seven research nurses took part in one usability testing session. Measures of fatigue and health-related quality of life, the PRO-CTCAE™ and FACT-GP5 global tolerability question were included in the ePRO system. Alert notifications to the clinical team were triggered by PRO-CTCAE™ and FACT-GP5 scores. Patient participants liked the simplicity and responsiveness of the patient-facing app. Two patients were unable to complete the testing session, due to technical issues. Research Nurses suggested minor modifications to improve functionality and the layout of the clinician dashboard and the training materials. CONCLUSION By testing the effectiveness, efficiency, and satisfaction of our novel ePRO system (PROmicsR), we learnt that most people with an inflammatory condition found it easy to report their symptoms using an app on their own device. Their experiences using the PROmicsR ePRO system within a trial environment will be further explored in our upcoming feasibility testing. Research nurses were also positive and found the clinical dashboard easy-to-use. Using ePROs in early phase trials is important in order to provide evidence of therapeutic responses and tolerability, increase the evidence based, and inform methodology development. TRIAL REGISTRATION ISRCTN, ISRCTN80103507. Registered 01 April 2022, https://www.isrctn.com/ISRCTN80103507.
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Affiliation(s)
- Christel McMullan
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK.
| | - Ameeta Retzer
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Camilla Bathurst
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Jamie Coleman
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Alastair K Denniston
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute of Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, UK
| | | | | | - Rosie Harding
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | | | - Derek Kyte
- School of Allied Health & Community, University of Worcester, Worcester, UK
| | - Rebecca Malpass
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Philip N Newsome
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Anna Rowe
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Wilma van Reil
- Research Governance, University Hospital Birmingham, Birmingham, UK
| | - Anita Walker
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- National Cancer Research Institute (NCRI) Consumer Forum, London, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, UK
- Midlands Health Data Research UK, Birmingham, UK
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8
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Aiyegbusi OL, Davies EH, Myles P, Williams T, Frost C, Haroon S, Hughes SE, Wilson R, McMullan C, Subramanian A, Nirantharakumar K, Calvert MJ. Digitally enabled decentralised research: opportunities to improve the efficiency of clinical trials and observational studies. BMJ Evid Based Med 2023; 28:328-331. [PMID: 36810190 PMCID: PMC10579468 DOI: 10.1136/bmjebm-2023-112253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcome Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Puja Myles
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Tim Williams
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcome Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Roger Wilson
- Centre for Patient Reported Outcome Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcome Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | | | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcome Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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9
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Aiyegbusi OL, McMullan C, Hughes SE, Turner GM, Subramanian A, Hotham R, Davies EH, Frost C, Alder Y, Agyen L, Buckland L, Camaradou J, Chong A, Jeyes F, Kumar S, Matthews KL, Moore P, Ormerod J, Price G, Saint-Cricq M, Stanton D, Walker A, Haroon S, Denniston AK, Calvert MJ. Considerations for patient and public involvement and engagement in health research. Nat Med 2023; 29:1922-1929. [PMID: 37474660 DOI: 10.1038/s41591-023-02445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
Patient and public involvement and engagement (PPIE) can provide valuable insights into the experiences of those living with and affected by a disease or health condition. Inclusive collaboration between patients, the public and researchers can lead to productive relationships, ensuring that health research addresses patient needs. Guidelines are available to support effective PPIE; however, evaluation of the impact of PPIE strategies in health research is limited. In this Review, we evaluate the impact of PPIE in the 'Therapies for Long COVID in non-hospitalised individuals' (TLC) Study, using a combination of group discussions and interviews with patient partners and researchers. We identify areas of good practice and reflect on areas for improvement. Using these insights and the results of a survey, we synthesize two checklists of considerations for PPIE, and we propose that research teams use these checklists to optimize the impact of PPIE for both patients and researchers in future studies.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK.
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK.
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Grace M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
| | | | - Richard Hotham
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Lisa Agyen
- CPROR, University of Birmingham, Birmingham, UK
| | | | | | - Amy Chong
- CPROR, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | - Gary Price
- CPROR, University of Birmingham, Birmingham, UK
| | | | | | - Anita Walker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
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10
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McMullan C, Hughes SE, Aiyegbusi OL, Calvert M. Usability testing of an electronic patient-reported outcome system linked to an electronic chemotherapy prescribing and patient management system for patients with cancer. Heliyon 2023; 9:e16453. [PMID: 37260889 PMCID: PMC10227339 DOI: 10.1016/j.heliyon.2023.e16453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Background People affected by cancer experience a wide range of symptoms which have a major impact on their functioning and health-related quality of life (HRQoL). One way to measure the impact of cancer symptoms is through the use of patient-reported outcomes. Methods An electronic patient-reported outcome (ePRO) application (ChemoPRO®) was designed to be used by cancer patients to report their symptoms and communicate with their clinical team. Usability testing sessions were conducted with people with lived experience of cancer to understand how real users interact with the ChemoPRO® system. One-to-one testing sessions were conducted to assess use of the system and identify areas for further refinement. User satisfaction was assessed using a brief satisfaction questionnaire previously used by Aiyegbusi et al. (date). Results Ten people with lived experience of cancer took part in the usability study. Symptoms and HRQoL measures, including the Euroqol EQ5D5L and the PRO-CTCAE™ were included in the ePRO system. Participants had a mean age of 62.3 years. Three critical errors and 21 non-critical errors were reported. All participants were enthusiastic about the app. Participants liked the simplicity and responsiveness of the patient-facing app and highlighted the potential for communicating with their clinical team. The overall usability and satisfaction score was 4.5 (sd = 0.09). Conclusion This usability study suggests that people with lived experience of cancer found the ChemoPRO® app acceptable and easy to use. One of the key features of this particular ePRO system that should be developed further is system functionality to facilitate communication between patients and clinicians. Future testing should include testing in a clinical setting and testing with people from ethnic minorities.
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Affiliation(s)
- Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Sarah E. Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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11
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Routen A, O'Mahoney L, Aiyegbusi OL, Alder Y, Banerjee A, Buckland L, Brightling C, Calvert M, Camaradou J, Chaturvedi N, Chong A, Dalrymple E, Eggo RM, Elliott P, Evans RA, Gibson A, Haroon S, Herrett E, Houchen-Wolloff L, Hughes SE, Jeyes F, Matthews K, McMullan C, Morley J, Shafran R, Smith N, Stanton D, Stephenson T, Sterne J, Turner GM, Ward H, Khunti K. Patient and public involvement within epidemiological studies of long COVID in the UK. Nat Med 2023; 29:771-773. [PMID: 36932242 DOI: 10.1038/s41591-023-02251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Ash Routen
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Lauren O'Mahoney
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BBRC), University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
| | - Yvonne Alder
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amitava Banerjee
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Lewis Buckland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chris Brightling
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BBRC), University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), University of Birmingham, Birmingham, UK
| | - Jenny Camaradou
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nishi Chaturvedi
- Department of Population Science and Experimental Medicine, UCL, London, UK
| | - Amy Chong
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Dalrymple
- Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Rosalind M Eggo
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Elliott
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Andy Gibson
- Department of Health and Social Sciences, University of West England, Bristol, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emily Herrett
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BBRC), University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
| | - Flic Jeyes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karen Matthews
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BBRC), University of Birmingham, Birmingham, UK
- NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
- Department of Population Science and Experimental Medicine, UCL, London, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
| | - Jessica Morley
- Bennett Institute for Applied Data Science, University of Oxford, Oxford, UK
| | - Roz Shafran
- Great Ormond Street Institute of Child Health, UCL, London, UK
| | | | - David Stanton
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Jonathan Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Grace M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen Ward
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
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Turner GM, McMullan C, Aiyegbusi OL, Hughes SE, Walker A, Jeyes F, Adler Y, Chong A, Buckland L, Stanton D, Davies EH, Haroon S, Calvert M. Co-production of a feasibility trial of pacing interventions for Long COVID. Res Involv Engagem 2023; 9:18. [PMID: 36997975 PMCID: PMC10061378 DOI: 10.1186/s40900-023-00429-2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The high incidence of COVID-19 globally has led to a large prevalence of Long COVID but there is a lack of evidence-based treatments. There is a need to evaluate existing treatments for symptoms associated with Long COVID. However, there is first a need to evaluate the feasibility of undertaking randomised controlled trials of interventions for the condition. We aimed to co-produce a feasibility study of non-pharmacological interventions to support people with Long COVID. METHODS A consensus workshop on research prioritisation was conducted with patients and other stakeholders. This was followed by the co-production of the feasibility trial with a group of patient partners, which included the design of the study, the selection of interventions, and the production of dissemination strategies. RESULTS The consensus workshop was attended by 23 stakeholders, including six patients. The consensus from the workshop was to develop a clinical trial platform that focused on testing different pacing interventions and resources. For the co-production of the feasibility trial, patient partners selected three pacing resources to evaluate (video, mobile application, and book) and co-designed feasibility study processes, study materials and undertook usability testing of the digital trial platform. CONCLUSION In conclusion, this paper reports the principles and process used to co-produce a feasibility study of pacing interventions for Long COVID. Co-production was effective and influenced important aspects of the study.
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Affiliation(s)
- Grace M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK.
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Anita Walker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Felicity Jeyes
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Yvonne Adler
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Amy Chong
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Lewis Buckland
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - David Stanton
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | | | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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13
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Cruz Rivera S, Liu X, Hughes SE, Dunster H, Manna E, Denniston AK, Calvert MJ. Embedding patient-reported outcomes at the heart of artificial intelligence health-care technologies. Lancet Digit Health 2023; 5:e168-e173. [PMID: 36828609 DOI: 10.1016/s2589-7500(22)00252-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/01/2022] [Accepted: 12/07/2022] [Indexed: 02/24/2023]
Abstract
Integration of patient-reported outcome measures (PROMs) in artificial intelligence (AI) studies is a critical part of the humanisation of AI for health. It allows AI technologies to incorporate patients' own views of their symptoms and predict outcomes, reflecting a more holistic picture of health and wellbeing and ultimately helping patients and clinicians to make the best health-care decisions together. By positioning patient-reported outcomes (PROs) as a model input or output we propose a framework to embed PROMs within the function and evaluation of AI health care. However, the integration of PROs in AI systems presents several challenges. These challenges include (1) fragmentation of PRO data collection; (2) validation of AI systems trained and validated against clinician performance, rather than outcome data; (3) scarcity of large-scale PRO datasets; (4) inadequate selection of PROMs for the target population and inadequate infrastructure for collecting PROs; and (5) clinicians might not recognise the value of PROs and therefore not prioritise their adoption; and (6) studies involving PRO or AI frequently present suboptimal design. Notwithstanding these challenges, we propose considerations for the inclusion of PROs in AI health-care technologies to avoid promoting survival at the expense of wellbeing.
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Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; Data-Enabled Medical Technologies and Devices Hub, University of Birmingham, Birmingham, UK.
| | - Xiaoxuan Liu
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah E Hughes
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; National Institute of Health Research Applied Research Collaborative West Midlands, Birmingham, UK
| | - Helen Dunster
- University of Birmingham Enterprise, University of Birmingham, Birmingham, UK
| | - Elaine Manna
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; Data-Enabled Medical Technologies and Devices Hub, University of Birmingham, Birmingham, UK; Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Health Data Research UK, London, UK; National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Hospital London NHS Foundation Trust and Institute of Ophthalmology, University College London, London, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; Data-Enabled Medical Technologies and Devices Hub, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK; Health Data Research UK, London, UK; National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Hospital London NHS Foundation Trust and Institute of Ophthalmology, University College London, London, UK; National Institute for Health and Care Research Birmingham-Oxford Blood and Transplant Research Unit in Precision Transplant and Cellular Theraputics, Birmingham, UK; National Institute for Health and Care Research Birmingham Biomedical Research Centre, Birmingham, UK; National Institute for Health and Care Research Surgical Reconstruction and Microbiology Centre, Birmingham, UK
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14
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Chandan JS, Brown KR, Simms-Williams N, Bashir NZ, Camaradou J, Heining D, Turner GM, Rivera SC, Hotham R, Minhas S, Nirantharakumar K, Sivan M, Khunti K, Raindi D, Marwaha S, Hughes SE, McMullan C, Marshall T, Calvert MJ, Haroon S, Aiyegbusi OL. Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review. Int J Environ Res Public Health 2023; 20:3477. [PMID: 36834176 PMCID: PMC9967466 DOI: 10.3390/ijerph20043477] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS. METHODS We conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo. The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability. We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 January 2001 to 29 October 2021. The relevant outcome data were extracted, the study quality was appraised using the Cochrane risk-of-bias tool, and the findings were synthesised narratively. FINDINGS Overall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria. Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients. INTERPRETATION In this study, we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID. Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS. REGISTRATION The study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022.
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Affiliation(s)
- Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Kirsty R. Brown
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Nikita Simms-Williams
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Nasir Z. Bashir
- School of Oral and Dental Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Jenny Camaradou
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - Dominic Heining
- Department of Microbiology, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Grace M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Samantha Cruz Rivera
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
| | - Richard Hotham
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Sonica Minhas
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Midlands Health Data Research UK, Birmingham B15 2TT, UK
| | - Manoj Sivan
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Devan Raindi
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham B5 7EG, UK
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham and Solihull Mental Health NHS Foundation Trust, Unit 1, B1, 50 Summer Hill Road, Birmingham B1 3RB, UK
| | - Sarah E. Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration, Birmingham B15 2TT, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Melanie J. Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration, Birmingham B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham B15 2TT, UK
- Health Data Research UK, London WC1E 6BT, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration, Birmingham B15 2TT, UK
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15
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Aiyegbusi OL, Hughes SE, Peipert JD, Schougaard LMV, Wilson R, Calvert MJ. Reducing the pressures of outpatient care: the potential role of patient-reported outcomes. J R Soc Med 2023; 116:44-64. [PMID: 36758615 PMCID: PMC9944235 DOI: 10.1177/01410768231152222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The global demand for hospital treatment exceeds capacity.The COVID-19 pandemic has exacerbated this issue, leading to increased backlogs and longer wait times for patients. The amount of outpatient attendances undertaken in many settings is still below pre-pandemic levels and this, combined with delayed referrals, means that patients are facing delays in treatment and poorer health outcomes. Use of digital health technologies, notably the use of remote symptom monitoring systems based on patient-reported outcomes (PROs), may offer a solution to reduce outpatient waiting lists and tailor care to those in greatest need. Drawing on international examples, the authors explore the use of electronic PRO systems to triage clinical care. We summarise the key benefits of the approach and also highlight the challenges for implementation, which need to be addressed to promote equitable healthcare delivery.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, B15 2TT, UK
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Liv Marit Valen Schougaard
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, 7400, Herning, Denmark
| | - Roger Wilson
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, B15 2TT, UK
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16
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Boisvert I, Dunn AG, Lundmark E, Smith-Merry J, Lipworth W, Willink A, Hughes SE, Nealon M, Calvert M. Disruptions to the hearing health sector. Nat Med 2023; 29:19-21. [PMID: 36604541 DOI: 10.1038/s41591-022-02086-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Isabelle Boisvert
- Communication Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. .,Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erik Lundmark
- Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Lipworth
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
| | - Amber Willink
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) West Midlands, Birmingham, UK.,UK SPINE, University of Birmingham, Birmingham, UK
| | - Michele Nealon
- Collaborator with lived experience of hearing loss. Disability Leadership Institute, Sydney, New South Wales, Australia
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) West Midlands, Birmingham, UK.,UK SPINE, University of Birmingham, Birmingham, UK.,DEMAND Hub, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
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17
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Hughes SE, Boisvert I, McMahon CM, Steyn A, Neal K. Perceived listening ability and hearing loss: Systematic review and qualitative meta-synthesis. PLoS One 2022; 17:e0276265. [PMID: 36282860 PMCID: PMC9595527 DOI: 10.1371/journal.pone.0276265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Hearing loss (HL) can affect communication in complex ways. Understanding how adults with HL reflect on and conceptualise the way they listen (metacognition) is required if interventions, and the outcome measures used to evaluate them, are to address barriers to functional communication arising from HL. OBJECTIVES This study describes how adults with HL experience and report the processes, behaviours, and components of listening, as presented in published studies. DESIGN Systematic review and meta-synthesis of qualitative studies. METHODS Systematic searches identified English-language, peer-reviewed journal articles reporting the results of qualitative or mixed-methods studies of adults' with HL perceived listening abilities. Medline, PsychInfo, Web of Science, Embase, and Google Scholar were searched from inception to November 2021. Handsearching reference lists of included studies identified additional studies for inclusion. The Critical Appraisal Skills Programme (CASP) qualitative checklist was used to appraise studies' methodological quality. Data from included studies were analysed using thematic meta-synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Confidence in the Evidence from Reviews of QUALitative (CERQual) approach assessed confidence in the review findings. Two reviewers independently completed all screening and quality appraisal. Thematic meta-synthesis and GRADE CERQual assessment was completed by one reviewer and confirmed by a second reviewer. Discrepancies were resolved through discussion. RESULTS Data from 46 studies were included in the review. Thematic meta-synthesis identified six descriptive themes: 1) perceived listening ability; 2) external modifiers; 3) psychosocial impacts of hearing loss; 4) communication partner perspectives; 5) self-efficacy for listening; and 6) cognitive load. GRADE CERQual ratings for descriptive themes ranged from low to moderate confidence. Descriptive themes were related by analytic themes of liminality and reciprocity. CONCLUSIONS Adults with HL provide in-depth accounts of components and processes of listening, with studies reporting both cognitive and affective experiences consistent with theoretical models of metacognition. The findings will inform content generation for a hearing-specific patient-reported outcome measure of perceived listening ability in everyday communication.
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Affiliation(s)
- Sarah E. Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC), West Midlands, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, United Kingdom
- Narra Consulting Limited, Wales, United Kingdom
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, United Kingdom
- * E-mail:
| | - Isabelle Boisvert
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- HEAR Centre, Macquarie University, Sydney, Australia
| | - Catherine M. McMahon
- HEAR Centre, Macquarie University, Sydney, Australia
- Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | | | - Katie Neal
- HEAR Centre, Macquarie University, Sydney, Australia
- Department of Linguistics, Macquarie University, Sydney, NSW, Australia
- The Shepherd Centre, Sydney, NSW, Australia
- The Listening Lab, Sydney, NSW, Australia
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18
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Hughes SE, McMullan C, Rowe A, Retzer A, Malpass R, Bathurst C, Davies EH, Frost C, McNamara G, Harding R, Price G, Wilson R, Walker A, Newsome PN, Calvert M. Feasibility of a new electronic patient-reported outcome (ePRO) system for an advanced therapy clinical trial in immune-mediated inflammatory disease (PROmics): protocol for a qualitative feasibility study. BMJ Open 2022; 12:e063199. [PMID: 36691123 PMCID: PMC9453996 DOI: 10.1136/bmjopen-2022-063199] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The use of electronic patient-reported outcome (ePRO) systems to capture PRO data in clinical trials is increasing; however, their feasibility, acceptability and utility in clinical trials of advanced therapy medicinal products (ATMPs) are not yet well understood. This protocol describes a qualitative study that aims to evaluate the feasibility and acceptability of ePRO data capture using a trial-specific ePRO system (the PROmics system) within an advanced therapy trial involving patients with immune-mediated inflammatory disease (rheumatoid arthritis, lupus, primary sclerosing cholangitis (PSC) and Crohn's disease). METHODS AND ANALYSIS This protocol for a remote, qualitative, interview-based feasibility study is embedded within the POLARISE trial, a single-arm, phase II, multisite ATMP basket trial in the UK. 10-15 patients enrolled in the POLARISE trial and 10-15 research team members at the trial sites will be recruited. Participants will take part in semistructured interviews which will be transcribed verbatim and analysed thematically according to the framework method. Data collection and analysis will occur concurrently and iteratively. Researcher triangulation will be used to achieve a consensus-based analysis, enhancing rigour and trustworthiness. ETHICS AND DISSEMINATION This study was approved by the London-West London and GTAC Research Ethics Committee (Ref: 21/LO/0475). Informed consent will be obtained from all participants prior to data collection. The study findings will be published in peer-review journals and disseminated via conference presentations and other media. Our patient and public involvement and engagement group and ATMP stakeholder networks will be consulted to maximise dissemination and impact. TRIAL REGISTRATION NUMBER ISRCTN80103507.
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Affiliation(s)
- Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Centre (ARC) West Midlands, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, UK
- National Institute fo Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Centre for Trauma Research, University of Birmingham, Birmingham, UK
| | - Anna Rowe
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Ameeta Retzer
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute fo Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Rebecca Malpass
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Camilla Bathurst
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Rosie Harding
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- National Cancer Research Institute (NCRI) Consumer Forum, Sarcoma Patients Euronet, Church Stretton, UK
| | - Anita Walker
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Philip N Newsome
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham and Institute of Applied Health Research, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Centre (ARC) West Midlands, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, UK
- National Institute fo Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham and Institute of Applied Health Research, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
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19
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Alrubaiy L, Hutchings HA, Hughes SE, Dobbs T. Saving time and effort: Best practice for adapting existing patient-reported outcome measures in hepatology. World J Hepatol 2022; 14:896-910. [PMID: 35721294 PMCID: PMC9157705 DOI: 10.4254/wjh.v14.i5.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/29/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
It is increasingly recognised that collecting patient reported outcome measures (PROMs) data is an important part of healthcare and should be considered alongside traditional clinical assessments. As part of a more holistic view of healthcare provision, there has been an increased drive to implement PROM collection as part of routine clinical care in hepatology. This drive has resulted in an increase in the number of PROMs currently developed to be used in various liver conditions. However, the development and validation of a new PROM is time-consuming and costly. Therefore, before deciding to develop a new PROM, researchers should consider identifying existing PROMs to assess their appropriateness and, if necessary, make adaptations to existing PROMs to ensure their rigour when used with the target population. Little is written in the literature on how to identify and adapt the existing PROMs in hepatology. This article aims to provide a summary of the current literature and guidance regarding identifying and adapting existing PROMs in clinical practice.
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Affiliation(s)
- Laith Alrubaiy
- Department of Gastroenterology, St Mark's Hospital, London HA1 3UJ, United Kingdom
| | - Hayley A Hutchings
- Institute of Life Sciences 2, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, United Kingdom
| | - Sarah E Hughes
- Swansea University Medical School, Swansea University, Swansea SA2 8PP, United Kingdom
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Thomas Dobbs
- Swansea University, Swansea SA2 8PP, United Kingdom
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20
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Hughes SE, Haroon S, Subramanian A, McMullan C, Aiyegbusi OL, Turner GM, Jackson L, Davies EH, Frost C, McNamara G, Price G, Matthews K, Camaradou J, Ormerod J, Walker A, Calvert MJ. Development and validation of the symptom burden questionnaire for long covid (SBQ-LC): Rasch analysis. BMJ 2022; 377:e070230. [PMID: 35477524 PMCID: PMC9043395 DOI: 10.1136/bmj-2022-070230] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To describe the development and validation of a novel patient reported outcome measure for symptom burden from long covid, the symptom burden questionnaire for long covid (SBQ-LC). DESIGN Multiphase, prospective mixed methods study. SETTING Remote data collection and social media channels in the United Kingdom, 14 April to 1 August 2021. PARTICIPANTS 13 adults (aged ≥18 years) with self-reported long covid and 10 clinicians evaluated content validity. 274 adults with long covid field tested the draft questionnaire. MAIN OUTCOME MEASURES Published systematic reviews informed development of SBQ-LC's conceptual framework and initial item pool. Thematic analysis of transcripts from cognitive debriefing interviews and online clinician surveys established content validity. Consensus discussions with the patient and public involvement group of the Therapies for Long COVID in non-hospitalised individuals: From symptoms, patient reported outcomes and immunology to targeted therapies (TLC Study) confirmed face validity. Rasch analysis of field test data guided item and scale refinement and provided initial evidence of the SBQ-LC's measurement properties. RESULTS SBQ-LC (version 1.0) is a modular instrument measuring patient reported outcomes and is composed of 17 independent scales with promising psychometric properties. Respondents rate their symptom burden during the past seven days using a dichotomous response or 4 point rating scale. Each scale provides coverage of a different symptom domain and returns a summed raw score that can be transformed to a linear (0-100) score. Higher scores represent higher symptom burden. After rating scale refinement and item reduction, all scales satisfied the Rasch model requirements for unidimensionality (principal component analysis of residuals: first residual contrast values <2.00 eigenvalue units) and item fit (outfit mean square values within 0.5 -1.5 logits). Rating scale categories were ordered with acceptable category fit statistics (outfit mean square values <2.0 logits). 14 item pairs had evidence of local dependency (residual correlation values >0.4). Across the 17 scales, person reliability ranged from 0.34 to 0.87, person separation ranged from 0.71 to 2.56, item separation ranged from 1.34 to 13.86, and internal consistency reliability (Cronbach's alpha) ranged from 0.56 to 0.91. CONCLUSIONS SBQ-LC (version 1.0) is a comprehensive patient reported outcome instrument developed using modern psychometric methods. It measures symptoms of long covid important to people with lived experience of the condition and may be used to evaluate the impact of interventions and inform best practice in clinical management.
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Affiliation(s)
- Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Christel McMullan
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham and University of Birmingham, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Grace M Turner
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise Jackson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Gary Price
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Karen Matthews
- LongCOVIDSOS, Faringdon, UK
- Therapies for Long COVID (TLC) Study, University of Birmingham, Birmingham, UK
| | - Jennifer Camaradou
- Therapies for Long COVID (TLC) Study, University of Birmingham, Birmingham, UK
- COVID-END (COVID-19 Evidence synthesis Network to support Decision-making), McMaster University, Hamilton, ON, Canada
| | | | - Anita Walker
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Melanie J Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham and University of Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, UK
- UK SPINE, University of Birmingham, Birmingham, UK
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21
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Haroon S, Nirantharakumar K, Hughes SE, Subramanian A, Aiyegbusi OL, Davies EH, Myles P, Williams T, Turner G, Chandan JS, McMullan C, Lord J, Wraith DC, McGee K, Denniston AK, Taverner T, Jackson LJ, Sapey E, Gkoutos G, Gokhale K, Leggett E, Iles C, Frost C, McNamara G, Bamford A, Marshall T, Zemedikun DT, Price G, Marwaha S, Simms-Williams N, Brown K, Walker A, Jones K, Matthews K, Camaradou J, Saint-Cricq M, Kumar S, Alder Y, Stanton DE, Agyen L, Baber M, Blaize H, Calvert M. Therapies for Long COVID in non-hospitalised individuals: from symptoms, patient-reported outcomes and immunology to targeted therapies (The TLC Study). BMJ Open 2022; 12:e060413. [PMID: 35473737 PMCID: PMC9044550 DOI: 10.1136/bmjopen-2021-060413] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Individuals with COVID-19 frequently experience symptoms and impaired quality of life beyond 4-12 weeks, commonly referred to as Long COVID. Whether Long COVID is one or several distinct syndromes is unknown. Establishing the evidence base for appropriate therapies is needed. We aim to evaluate the symptom burden and underlying pathophysiology of Long COVID syndromes in non-hospitalised individuals and evaluate potential therapies. METHODS AND ANALYSIS A cohort of 4000 non-hospitalised individuals with a past COVID-19 diagnosis and 1000 matched controls will be selected from anonymised primary care records from the Clinical Practice Research Datalink, and invited by their general practitioners to participate on a digital platform (Atom5). Individuals will report symptoms, quality of life, work capability and patient-reported outcome measures. Data will be collected monthly for 1 year.Statistical clustering methods will be used to identify distinct Long COVID-19 symptom clusters. Individuals from the four most prevalent clusters and two control groups will be invited to participate in the BioWear substudy which will further phenotype Long COVID symptom clusters by measurement of immunological parameters and actigraphy.We will review existing evidence on interventions for postviral syndromes and Long COVID to map and prioritise interventions for each newly characterised Long COVID syndrome. Recommendations will be made using the cumulative evidence in an expert consensus workshop. A virtual supportive intervention will be coproduced with patients and health service providers for future evaluation.Individuals with lived experience of Long COVID will be involved throughout this programme through a patient and public involvement group. ETHICS AND DISSEMINATION Ethical approval was obtained from the Solihull Research Ethics Committee, West Midlands (21/WM/0203). Research findings will be presented at international conferences, in peer-reviewed journals, to Long COVID patient support groups and to policymakers. TRIAL REGISTRATION NUMBER 1567490.
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Affiliation(s)
- Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Health Data Research UK (HDR UK) Midlands, Birmingham, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, Birmingham, UK
| | | | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, Birmingham, UK
| | | | - Puja Myles
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Tim Williams
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Grace Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Janet Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Kirsty McGee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Thomas Taverner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - George Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Edward Leggett
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Clare Iles
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | | | - Amy Bamford
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | | | - Kirsty Brown
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Walker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karen Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | | | | | | | | | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Health Data Research UK (HDR UK) Midlands, Birmingham, UK
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22
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Chandan JS, Brown K, Simms-Williams N, Camaradou J, Bashir N, Heining D, Aiyegbusi OL, Turner G, Cruz Rivera S, Hotham R, Nirantharakumar K, Sivan M, Khunti K, Raindi D, Marwaha S, Hughes SE, McMullan C, Calvert M, Haroon S. Non-pharmacological therapies for postviral syndromes, including Long COVID: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e057885. [PMID: 35410933 PMCID: PMC9002258 DOI: 10.1136/bmjopen-2021-057885] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Postviral syndromes (PVS) describe the sustained presence of symptoms following an acute viral infection, for months or even years. Exposure to the SARS-CoV-2 virus and subsequent development of COVID-19 has shown to have similar effects with individuals continuing to exhibit symptoms for greater than 12 weeks. The sustained presence of symptoms is variably referred to as 'post COVID-19 syndrome', 'post-COVID condition' or more commonly 'Long COVID'. Knowledge of the long-term health impacts and treatments for Long COVID are evolving. To minimise overlap with existing work in the field exploring treatments of Long COVID, we have only chosen to focus on non-pharmacological treatments. AIMS This review aims to summarise the effectiveness of non-pharmacological treatments for PVS, including Long COVID. A secondary aim is to summarise the symptoms and health impacts associated with PVS in individuals recruited to treatment studies. METHODS AND ANALYSIS Primary electronic searches will be performed in bibliographic databases including: Embase, MEDLINE, PyscINFO, CINAHL and MedRxiv from 1 January 2001 to 29 October 2021. At least two independent reviewers will screen each study for inclusion and data will be extracted from all eligible studies onto a data extraction form. The quality of all included studies will be assessed using Cochrane risk of bias tools and the Newcastle-Ottawa grading system. Non-pharmacological treatments for PVS and Long COVID will be narratively summarised and effect estimates will be pooled using random effects meta-analysis where there is sufficient methodological homogeneity. The symptoms and health impacts reported in the included studies on non-pharmacological interventions will be extracted and narratively reported. ETHICS AND DISSEMINATION This systematic review does not require ethical approval. The findings from this study will be submitted for peer-reviewed publication, shared at conference presentations and disseminated to both clinical and patient groups. PROSPERO REGISTRATION NUMBER The review will adhere to this protocol which has also been registered with PROSPERO (CRD42021282074).
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Affiliation(s)
- Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Health Data Research UK, Birmingham, UK
| | - Kirsty Brown
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | - Nasir Bashir
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - Dominic Heining
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
| | - Grace Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Samantha Cruz Rivera
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Richard Hotham
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Health Data Research UK, Birmingham, UK
| | | | - Kamlesh Khunti
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Devan Raindi
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Health Data Research UK, Birmingham, UK
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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23
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Neal K, McMahon CM, Hughes SE, Boisvert I. Listening-Based Communication Ability in Adults With Hearing Loss: A Scoping Review of Existing Measures. Front Psychol 2022; 13:786347. [PMID: 35360643 PMCID: PMC8960922 DOI: 10.3389/fpsyg.2022.786347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Hearing loss in adults has a pervasive impact on health and well-being. Its effects on everyday listening and communication can directly influence participation across multiple spheres of life. These impacts, however, remain poorly assessed within clinical settings. Whilst various tests and questionnaires that measure listening and communication abilities are available, there is a lack of consensus about which measures assess the factors that are most relevant to optimising auditory rehabilitation. This study aimed to map current measures used in published studies to evaluate listening skills needed for oral communication in adults with hearing loss. Methods A scoping review was conducted using systematic searches in Medline, EMBASE, Web of Science and Google Scholar to retrieve peer-reviewed articles that used one or more linguistic-based measure necessary to oral communication in adults with hearing loss. The range of measures identified and their frequency where charted in relation to auditory hierarchies, linguistic domains, health status domains, and associated neuropsychological and cognitive domains. Results 9121 articles were identified and 2579 articles that reported on 6714 discrete measures were included for further analysis. The predominant linguistic-based measure reported was word or sentence identification in quiet (65.9%). In contrast, discourse-based measures were used in 2.7% of the articles included. Of the included studies, 36.6% used a self-reported instrument purporting to measures of listening for communication. Consistent with previous studies, a large number of self-reported measures were identified (n = 139), but 60.4% of these measures were used in only one study and 80.7% were cited five times or fewer. Discussion Current measures used in published studies to assess listening abilities relevant to oral communication target a narrow set of domains. Concepts of communicative interaction have limited representation in current measurement. The lack of measurement consensus and heterogeneity amongst the assessments limit comparisons across studies. Furthermore, extracted measures rarely consider the broader linguistic, cognitive and interactive elements of communication. Consequently, existing measures may have limited clinical application if assessing the listening-related skills required for communication in daily life, as experienced by adults with hearing loss.
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Affiliation(s)
- Katie Neal
- Department of Lingustics, Macquarie University, Sydney, NSW, Australia
| | - Catherine M McMahon
- Department of Lingustics, Macquarie University, Sydney, NSW, Australia.,Hearing, Macquarie University, Sydney, NSW, Australia
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,National Institute of Health Research (NIHR), Applied Research Collaboration (ARC), West Midlands, United Kingdom.,Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Isabelle Boisvert
- Hearing, Macquarie University, Sydney, NSW, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Hughes SE, Boisvert I, McMahon C, Steyns A, Neal K. Adults' with hearing loss perceived listening ability in daily communication: protocol for a systematic review and qualitative meta-synthesis. BMJ Open 2022; 12:e051183. [PMID: 35354616 PMCID: PMC8968555 DOI: 10.1136/bmjopen-2021-051183] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Understanding how adults with hearing loss perceive their abilities when listening in daily communication situations is vital to understanding the functional listening challenges associated with hearing loss. The aim of this study is to explore how adults with hearing loss describe their own experiences of the processes, behaviours and components of listening in real-world communication through secondary analysis of published qualitative data. METHODS AND ANALYSIS A systematic review and thematic meta-synthesis of qualitative research studies and qualitative components of mixed-methods studies will be conducted. Studies published in English will be identified through searching Medline, PsychInfo, Web of Science, Embase and Google Scholar databases from inception to November 2021. Handsearching of the included studies' reference lists will be completed. Included articles will be assessed for methodological quality using the Critical Appraisal Skills checklist for qualitative studies. Thematic synthesis will proceed as follows: (1) line-by-line coding to label concepts present in the 'results' or 'findings' section(s) of the included studies; (2) grouping of similar codes into descriptive themes; (3) development of higher level analytic themes to develop a new interpretation of the included studies' findings. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Confidence in the Evidence from Reviews of QUALitative (CerQUAL) research approach will be used to establish the degree of confidence that may be placed in synthesis findings and results will be reported alongside the synthesis. Two reviewers will independently undertake screening for eligibility, data extraction and quality appraisal, analysis and GRADE-CERQual assessments. Discrepancies will be resolved through discussion. ETHICS AND DISSEMINATION As secondary data analysis of the published literature, ethical approval is not required. The results will be disseminated in peer-reviewed journals, conference presentations and other research and clinical meetings. This protocol is registered with PROSPERO prospective database of systematic review. PROSPERO REGISTRATION NUMBER CRD42020213389.
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Affiliation(s)
- Sarah E Hughes
- Centre for Patient Reported Outcome Research, University of Birmingham, Birmingham, UK
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Isabelle Boisvert
- School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- HEAR Centre, Macquarie University, Sydney, New South Wales, Australia
| | - Catherine McMahon
- HEAR Centre, Macquarie University, Sydney, New South Wales, Australia
| | - Anne Steyns
- Consumer and Community Involvement Partner, Sydney, New South Wales, Australia
| | - Katie Neal
- HEAR Centre, Macquarie University, Sydney, New South Wales, Australia
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Aiyegbusi OL, Hughes SE, Turner G, Rivera SC, McMullan C, Chandan JS, Haroon S, Price G, Davies EH, Nirantharakumar K, Sapey E, Calvert MJ. Symptoms, complications and management of long COVID: a review. J R Soc Med 2021; 114:428-442. [PMID: 34265229 PMCID: PMC8450986 DOI: 10.1177/01410768211032850] [Citation(s) in RCA: 379] [Impact Index Per Article: 126.3] [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: 05/20/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022] Open
Abstract
Globally, there are now over 160 million confirmed cases of COVID-19 and more than 3 million deaths. While the majority of infected individuals recover, a significant proportion continue to experience symptoms and complications after their acute illness. Patients with 'long COVID' experience a wide range of physical and mental/psychological symptoms. Pooled prevalence data showed the 10 most prevalent reported symptoms were fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell, altered taste and diarrhoea. Other common symptoms were cognitive impairment, memory loss, anxiety and sleep disorders. Beyond symptoms and complications, people with long COVID often reported impaired quality of life, mental health and employment issues. These individuals may require multidisciplinary care involving the long-term monitoring of symptoms, to identify potential complications, physical rehabilitation, mental health and social services support. Resilient healthcare systems are needed to ensure efficient and effective responses to future health challenges.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, Birmingham, UK
| | - Grace Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Samantha Cruz Rivera
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, UK
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Hughes SE, Aiyegbusi OL, Lasserson DS, Collis P, Cruz Rivera S, McMullan C, Turner GM, Glasby J, Calvert M. Protocol for a scoping review exploring the use of patient-reported outcomes in adult social care. BMJ Open 2021; 11:e045206. [PMID: 33849854 PMCID: PMC8051391 DOI: 10.1136/bmjopen-2020-045206] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are measures of a person's own views of their health, functioning and quality of life. They are typically assessed using validated, self-completed questionnaires known as patient-reported outcome measures (PROMs). PROMs are used in healthcare settings to support care planning, clinical decision-making, patient-practitioner communication and quality improvement. PROMs have a potential role in the delivery of social care where people often have multiple and complex long-term health conditions. However, the use of PROMs in this context is currently unclear. The objective of this scoping review is to explore the evidence relating to the use of PROMs in adult social care. METHODS AND ANALYSES The electronic databases Medline (Ovid), PsychInfo (Ovid), ASSIA (ProQuest), Social Care Online (SCIE), Web of Science and EMBASE (Ovid) were searched on 29 September 2020 to identify eligible studies and other publically available documents published since 2010. A grey literature search and hand searching of citations and reference lists of the included studies will also be undertaken. No restrictions on study design or language of publication will be applied. Screening and data extraction will be completed independently by two reviewers. Quality appraisal of the included documents will use the Critical Appraisal Skills Programme and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklists. A customised data charting table will be used for data extraction, with analysis of qualitative data using the framework method. The review findings will be presented as tables and in a narrative summary. ETHICS AND DISSEMINATION Ethical review is not required as scoping reviews are a form of secondary data analysis that synthesise data from publically available sources. Review findings will be shared with service users and other relevant stakeholders and disseminated through a peer-reviewed publication and conference presentations. This protocol is registered on the Open Science Framework (www.osf.io).
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Affiliation(s)
- Sarah E Hughes
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Philip Collis
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
| | - Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Grace M Turner
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon Glasby
- Department of Social Work and Social Care, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
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Esteller-Vico A, Ball BA, Bridges JW, Hughes SE, Squires EL, Troedsson MHT. Changes in circulating concentrations of testosterone and estrone sulfate after human chorionic gonadotropin administration and subsequent to castration of 2-year-old stallions. Anim Reprod Sci 2020; 225:106670. [PMID: 33338983 DOI: 10.1016/j.anireprosci.2020.106670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
Reproductive steroids testosterone (T) and estrone sulfate (E1S) are used as diagnostic markers for cryptorchidism in horses. The human chorionic gonadotropin (hCG) stimulation test is used as a diagnostic aid because administration of this hormone results in greater incremental differences in circulating steroid concentrations. Thoughts regarding optimal sampling times following hCG administration, however, are inconsistent. Additionally, determination of half-life of these steroids is important in postsurgical samples to confirm complete removal of testicular tissue. Objectives of this study, therefore, were to determine optimal sampling periods for peak T and E1S after hCG administration and half-life of these steroids after castration. Eight pony stallions were randomly assigned to control or treatment groups (5000 IU hCG). Blood samples were collected following hCG administration. Subsequently, stallions were castrated and blood samples were collected post-castration. The T concentrations were greatest at 72 h after hCG and were greater (P < 0.02) in samples from hCG-treated than control animals: 9,903.4 ± 384 and 784.0 ± 192 pg/mL, respectively (Mean ± SEM). The T concentrations were also greater at 1, 12, 24, 48 and 96 h. The E1S concentrations did not change after administration of hCG. The T response to hCG administration was biphasic with a maximal response between 48-96 h after administration. Half-lives of T and E1S were 1.1 and 0.7 h, respectively, and concentration of T and E1S was similar to that of geldings at 24 h post-castration, which, therefore, should be considered an optimal time to ensure complete castration has occurred.
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Affiliation(s)
- A Esteller-Vico
- Gluck Equine Research Center, Dept. of Veterinary Science, University of Kentucky, Lexington, KY, 40546, USA
| | - B A Ball
- Gluck Equine Research Center, Dept. of Veterinary Science, University of Kentucky, Lexington, KY, 40546, USA.
| | - J W Bridges
- Gluck Equine Research Center, Dept. of Veterinary Science, University of Kentucky, Lexington, KY, 40546, USA
| | - S E Hughes
- Gluck Equine Research Center, Dept. of Veterinary Science, University of Kentucky, Lexington, KY, 40546, USA; Hagyard Equine Medical Institute, 4250 Iron Works Pike, Lexington, KY, 40511, USA
| | - E L Squires
- Gluck Equine Research Center, Dept. of Veterinary Science, University of Kentucky, Lexington, KY, 40546, USA
| | - M H T Troedsson
- Gluck Equine Research Center, Dept. of Veterinary Science, University of Kentucky, Lexington, KY, 40546, USA
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Rapport F, Hughes SE, Boisvert I, McMahon CM, Braithwaite J, Faris M, Bierbaum M. Adults' cochlear implant journeys through care: a qualitative study. BMC Health Serv Res 2020; 20:457. [PMID: 32448127 PMCID: PMC7247254 DOI: 10.1186/s12913-020-05334-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Background Cochlear implants (CIs) can provide a sound sensation for those with severe sensorineural hearing loss (SNHL), benefitting speech understanding and quality of life. Nevertheless, rates of implantation remain low, and limited research investigates journeys from traditional hearing aids to implantable devices. Method Fifty-five adults (≥ 50 years), hearing aid users and/or CI users, General Practitioners, and Australian and United Kingdom audiologists took part in a multi-methods study. Focus groups, interviews, and surveys were thematically analysed. Results One hundred forty-three data-capture events disclosed 2 themes: 1) “The burden of hearing loss and the impact of Cochlear Implants”, and 2) “Professional Support and Practice, and HCPs Roles and Responsibilities”. Conclusions Care experience can include convoluted, complex journeys towards cochlear implantation. The significant impact of this, as hearing loss progresses, motivates people to consider implants, but they and healthcare professionals need clear supported with defined referral pathways, and less system complexity.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia.
| | - Sarah E Hughes
- Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom.,South Wales Cochlear Implant Programme, Princess of Wales Hospital, Bridgend, Mid Glamorgan, Wales, United Kingdom
| | - Isabelle Boisvert
- H:EAR [Hearing: Education, Application, Research], Australian Hearing Hub, Macquarie University, Macquarie Park, NSW, Australia.,The HEARing Cooperative Research Centre, Melbourne, VIC, Australia
| | - Catherine M McMahon
- H:EAR [Hearing: Education, Application, Research], Australian Hearing Hub, Macquarie University, Macquarie Park, NSW, Australia.,The HEARing Cooperative Research Centre, Melbourne, VIC, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Mona Faris
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
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Hughes SE, Rapport F, Watkins A, Boisvert I, McMahon CM, Hutchings HA. Study protocol for the validation of a new patient-reported outcome measure (PROM) of listening effort in cochlear implantation: the Listening Effort Questionnaire-Cochlear Implant (LEQ-CI). BMJ Open 2019; 9:e028881. [PMID: 31289085 PMCID: PMC6629460 DOI: 10.1136/bmjopen-2018-028881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Listening effort may be defined as the cognitive resources needed to understand an auditory message. A sustained requirement for listening effort is known to have a negative impact on individuals' sense of social connectedness, well-being and quality of life. A number of hearing-specific patient-reported outcome measures (PROMs) exist currently; however, none adequately assess listening effort as it is experienced in the listening situations of everyday life. The Listening Effort Questionnaire-Cochlear Implant (LEQ-CI) is a new, hearing-specific PROM designed to assess perceived listening effort as experienced by adult CI patients. It is the aim of this study to conduct the first psychometric evaluation of the LEQ-CI's measurement properties. METHODS AND ANALYSIS This study is a phased, prospective, multi-site validation study in a UK population of adults with severe-profound sensorineural hearing loss who meet local candidacy criteria for CI. In phase 1, 250 CI patients from four National Health Service CI centres will self-complete a paper version of the LEQ-CI. Factor analysis will establish unidimensionality and Rasch analysis will evaluate item fit, differential item functioning, response scale ordering, targeting of persons and items, and reliability. Classical test theory methods will assess acceptability/data completeness, scaling assumptions, targeting and internal consistency reliability. Phase 1 results will inform refinements to the LEQ-CI. In phase 2, a new sample of adult CI patients (n=100) will self-complete the refined LEQ-CI, the Speech, Spatial and Qualities of Hearing Scale, the Nijmegen Cochlear Implant Questionnaire and the Fatigue Assessment Scale to assess construct validity. ETHICS AND DISSEMINATION This study was approved by the Abertawe Bro Morgannwg University Health Board/Swansea University Joint Study Review Committee and the Newcastle and North Tyneside 2 Research Ethics Committee, Ref: 18/NE/0320. Dissemination will be in high-quality journals, conference presentations and SEH's doctoral dissertation.
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Affiliation(s)
- Sarah E Hughes
- Swansea University Medical School, Swansea University, Swansea, UK
- South Wales Cochlear Implant Programme, Bridgend, UK
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Alan Watkins
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Isabelle Boisvert
- Department of Linguistics (Audiology Section), Macquarie University, Sydney, New South Wales, Australia
- The HEARing CRC, Melbourne, Australia
| | - Catherine M McMahon
- Department of Linguistics (Audiology Section), Macquarie University, Sydney, New South Wales, Australia
- The HEARing CRC, Melbourne, Australia
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Abstract
Objective: Hearing impairment is linked to increased fatigue, yet little is known about the real-world impact of this fatigue. This qualitative study investigated the experience of daily-life fatigue in people with a hearing impairment. Design: Individual face-to-face semi-structured interviews were conducted. Thematic analysis was then used to analyse the data. Study sample: Fourteen hearing impaired participants (aged 44-70 years) who varied in terms of hearing loss, hearing aid status, age and gender. Results: The themes and sub-themes that emerged from the transcripts were: Fatigue (effort-driven fatigue, emotion-driven fatigue, breaks and recovery, the perceived relationship between hearing impairment and fatigue, and sleep), Effort (cognitive effort and physical effort), Coping Strategies (withdrawal, avoidance and planning), Relationships and Emotions, Hearing Aid Impact. Conclusions: The study highlights that hearing impairment-related fatigue is experienced by many but not all, and to different extents. Hearing aids were weakly linked to a beneficial effect on fatigue. In addition to the more widely researched effort-driven fatigue, participants described fatigue linked to the negative emotions related to having a hearing impairment. These findings, in conjunction with the widespread utilisation of different coping strategies, demonstrate that the experience of fatigue is varied and likely dependent on personal factors and lifestyle.
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Affiliation(s)
- Jack A Holman
- a Hearing Sciences (Scottish Section), Division of Clinical Neuroscience , School of Medicine, University of Nottingham , Glasgow , UK
| | - Avril Drummond
- b School of Health Sciences, University of Nottingham , Nottingham , UK
| | - Sarah E Hughes
- c School of Medicine, Swansea University , Swansea , UK.,d South Wales Cochlear Implant Programme , Bridgend , UK
| | - Graham Naylor
- a Hearing Sciences (Scottish Section), Division of Clinical Neuroscience , School of Medicine, University of Nottingham , Glasgow , UK
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Grange JA, Culling JF, Bardsley B, Mackinney LI, Hughes SE, Backhouse SS. Turn an Ear to Hear: How Hearing-Impaired Listeners Can Exploit Head Orientation to Enhance Their Speech Intelligibility in Noisy Social Settings. Trends Hear 2019; 22:2331216518802701. [PMID: 30334495 PMCID: PMC6196611 DOI: 10.1177/2331216518802701] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 11/16/2022] Open
Abstract
Turning an ear toward the talker can enhance spatial release from masking. Here, with their head free, listeners attended to speech at a gradually diminishing signal-to-noise ratio and with the noise source azimuthally separated from the speech source by 180° or 90°. Young normal-hearing adult listeners spontaneously turned an ear toward the speech source in 64% of audio-only trials, but a visible talker’s face or cochlear implant (CI) use significantly reduced this head-turn behavior. All listener groups made more head movements once instructed to explore the potential benefit of head turns and followed the speech to lower signal-to-noise ratios. Unilateral CI users improved the most. In a virtual restaurant simulation with nine interfering noises or voices, hearing-impaired listeners and simulated bilateral CI users typically obtained a 1 to 3 dB head-orientation benefit from a 30° head turn away from the talker. In diffuse interference environments, the advice to U.K. CI users from many CI professionals and the communication guidance available on the Internet most often advise the CI user to face the talker head on. However, CI users would benefit from guidelines that recommend they look sidelong at the talker with their better hearing or implanted ear oriented toward the talker.
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Affiliation(s)
- Jacques A. Grange
- School of Psychology, Cardiff University, UK
- Jacques A. Grange, School of Psychology, Cardiff University, 70 Parc Place, Cardiff CF103AT, UK.
| | | | | | | | - Sarah E. Hughes
- South Wales Cochlear Implant Programme, Princess of Wales Hospital, Bridgend, UK
| | - Steven S. Backhouse
- South Wales Cochlear Implant Programme, Princess of Wales Hospital, Bridgend, UK
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Hughes SE, Rapport FL, Boisvert I, McMahon CM, Hutchings HA. Patient-reported outcome measures (PROMs) for assessing perceived listening effort in hearing loss: protocol for a systematic review. BMJ Open 2017; 7:e014995. [PMID: 28592576 PMCID: PMC5734199 DOI: 10.1136/bmjopen-2016-014995] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In the UK, it is estimated that a disabling hearing loss (HL) affects 1 in 6 people. HL has functional, economic and social-emotional consequences for affected individuals. Intervention for HL focuses on improving access to the auditory signal using hearing aids or cochlear implants. However, even if sounds are audible and speech is understood, individuals with HL often report increased effort when listening.Listening effort (LE) may be measured using self-reported measures such as patient-reported outcome measures (PROMs). PROMs are validated questionnaires completed by patients to measure their perceptions of their own functional status and well-being. When selecting a PROM for use in research or clinical practice, it is necessary to appraise the evidence of a PROM's acceptability to patients, validity, responsiveness and reliability. METHODS AND ANALYSIS A systematic review of studies evaluating the measurement properties of PROMs available to measure LE in HL will be undertaken. MEDLINE, EMBASE, CINAHL, PsychINFO and Web of Science will be searched electronically. Reference lists of included studies, key journals and the grey literature will be hand-searched to identify further studies for inclusion. Two reviewers will independently complete title, abstract and full-text screening to determine study eligibility. Data on the characteristics of each study and each PROM will be extracted. Methodological quality of the included studies will be appraised using the COnsensus-based Standards for the selection of health Measurement INstruments, the quality of included PROMs appraised and the credibility of the evidence assessed. A narrative synthesis will summarise extracted data. ETHICS AND DISSEMINATION Ethical permission is not required, as this study uses data from published research. Dissemination will be through publication in peer-reviewed journals, conference presentations and the lead author's doctoral dissertation. Findings may inform the selection of PROMs used to measure LE in HL.
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Affiliation(s)
- Sarah E Hughes
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
- South Wales Cochlear Implant Programme, Princess of Wales Hospital, Bridgend, UK
| | - Frances L Rapport
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Isabelle Boisvert
- The HEARing CRC, Melbourne, Victoria, Australia
- Department of Linguistics (Audiology Section), Macquarie University, New South Wales, Australia
| | - Catherine M McMahon
- The HEARing CRC, Melbourne, Victoria, Australia
- Department of Linguistics (Audiology Section), Macquarie University, New South Wales, Australia
| | - Hayley A Hutchings
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
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Hughes SE, Spelman T, Gray OM, Boz C, Trojano M, McDonnell GV, Hawkins SA, Kee F, Butzkueven H. PREDICTORS OF POSTPARTUM RELAPSES IN WOMEN WITH MULTIPLE SCLEROSIS: RESULTS FROM THE MSBASE REGISTRY. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Alkaptonuria (endogenous ochronosis) is a rare metabolic disorder caused by a deficiency of homogentisic acid oxidase, an enzyme responsible for the metabolic degradation of tyrosine. Patients with alkaptonuria commonly present with joint pain owing to degenerative arthritis. Other affected patients may present with pigmentation of the ear cartilage and sclera. This article reports a case of aortic stenosis associated with ochronosis in a 48-year-old man who presented with severe cardiac failure. He had no previous diagnosis of alkaptonuria, which was confirmed by mass spectrometry analysis of urine. The pathogenesis of cardiovascular ochronosis is unclear, but is probably related to the extensive extracellular deposits of ochronotic pigment in the cardiac tissue.
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Affiliation(s)
- L V Ffolkes
- Department of Histopathology, University College London Hospitals NHS Trust, London, UK
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Arno G, Kaski JC, Smith DA, Akiyu JP, Hughes SE, Baboonian C. Matrix metalloproteinase-9 expression is associated with the presence of Chlamydia pneumoniae in human coronary atherosclerotic plaques. Heart 2005; 91:521-5. [PMID: 15772219 PMCID: PMC1768801 DOI: 10.1136/hrt.2003.012054] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the association between Chlamydia pneumoniae and matrix metalloproteinase-9 (MMP-9) in atherosclerotic plaques. DESIGN 31 coronary atherosclerotic plaque specimens were studied by immunohistochemistry, polymerase chain reaction (PCR), and reverse transcription PCR for the presence of C pneumoniae antigen and genomic DNA, and of MMP-9 protein and transcripts. RESULTS Immunohistochemical analysis identified a strong association between the presence of C pneumoniae antigen and production of MMP-9 in coronary atherosclerotic plaques (p = 0.001). Furthermore, analysis of the intralesional amount of C pneumoniae and MMP-9 indicated an increased number of cells positive for MMP-9 in arterial sections that had increased C pneumoniae positivity (p < 0.05). CONCLUSIONS This study provides evidence of an association between expression of MMP-9 and the intravascular presence of C pneumoniae and may suggest a potential pathological mechanism whereby C pneumoniae may contribute to the progression of coronary atherosclerosis.
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Affiliation(s)
- G Arno
- Department of Cardiological Sciences, St Georges Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
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36
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Abstract
Sudden cardiac death (SCD) is devastating at any age, but even more so when the individual affected is young and asymptomatic, and the death is entirely unexpected. SCD is a catastrophic complication of hypertrophic cardiomyopathy (HCM) and may be the first manifestation of this disease. HCM is an inherited intrinsic disease of the myocardium characterized by left ventricular hypertrophy without chamber dilatation, in the absence of either a systemic or other cardiac disease, which may cause a similar magnitude of hypertrophy. HCM may be a clinically silent disease. Indeed, the pathologist may be the first to encounter a case of HCM at autopsy. HCM has wide-ranging implications for affected families, who will require cardiac screening and genetic counselling even if mutations are not known. Therefore, prompt and accurate diagnosis of HCM is vital. This review article will focus on the pathological diagnosis of HCM, recent advances in the genetics of this disease, and common pitfalls which may arise, leading to diagnostic uncertainty.
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MESH Headings
- Autopsy/standards
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/genetics
- Cardiomyopathy, Hypertrophic/pathology
- Coronary Vessels/pathology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Female
- Fibrosis
- Genetic Testing
- Humans
- Hypertrophy, Left Ventricular/pathology
- Male
- Mutation
- Myocytes, Cardiac/pathology
- Myocytes, Cardiac/ultrastructure
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Affiliation(s)
- S E Hughes
- Department of Histopathology, Royal Free and University College Medical School, University College London and UCL Hospitals NHS Trust, London, UK.
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Grabau JC, Hughes SE, Foster EA, Kearns CH, Klopf L. False-positive tuberculin skin tests in a state prison system. Int J Tuberc Lung Dis 2003; 7:93-7. [PMID: 12701841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE To assess the existence and extent of false-positive tuberculin skin test (TST) results in a regularly tested population subsequent to switching to a different skin testing product. METHOD Over 9300 state prison inmates were tuberculin skin tested as part of a routine annual testing program. A shortage of Tubersol caused the prison system to purchase and test with Aplisol. Prison health services staff reported an apparent increase in skin test positivity using Aplisol compared to Tubersol. Record reviews were conducted in 34 prisons where inmates read as positive (> or = 5 mm) were retested with Tubersol. RESULTS Among 368 inmates recorded as positive (> or = 5 mm) with Aplisol who were retested with Tubersol, 150 (40.8%) were read as negative (0-4 mm). CONCLUSION The tuberculin skin test is a valuable tool in evaluating patients for TB infection. However, variations in planting and reading the test, and in the consistency between lots and manufacturers, can contribute to errors in determining an individual's infection status. The entire clinical and epidemiological picture for each patient must always be evaluated using the TST as a tool, and not an indisputable answer.
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Affiliation(s)
- J C Grabau
- Bureau of Tuberculosis Control, New York State Department of Health, Albany, New York 12237-0669, USA.
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Gruber SA, Hughes SE, Xiao S, Perera S, Jayasankar V, Rosario AD, Singh J. Pharmacokinetics and pharmacodynamics of 15-deoxyspergualin in a canine renal allograft model of local immunosuppression. J Surg Res 1997; 71:137-44. [PMID: 9299281 DOI: 10.1006/jsre.1997.5156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Local immunosuppression is based on the rationale that one can simultaneously prevent rejection and reduce systemic side effects by administering appropriately chosen immunosuppressive agents directly into the allograft. We utilized a mongrel canine renal transplant model with a programmable, implantable pump/catheter system to estimate the first-pass extraction of 15-deoxyspergualin (DSG) during renal artery infusion and to compare the efficacy and toxicity of continuous intraarterial (ia) versus intravenous (iv) DSG delivery. Six autotransplanted dogs were given DSG by both iv bolus (1 mg/kg) and ia infusion (1.0 mg/kg/d). DSG was administered to allograft recipients by continuous ia infusion at 0.5 (n = 11) and 0.75 (n = 8) mg/kg/day and by continuous iv infusion at 0.5 (n = 12) and 0.75 (n = 6) mg/kg/day. Mean +/- SD elimination half-life was 0.6 +/- 0.1 hr, and the transplanted kidney removed as much as 55-88% (mean 66%) of locally infused DSG. When compared with untreated controls [mean survival time (MST) = 8 days], low-dose (0. 5 mg/kg/day) DSG produced a significant antirejection effect when given ia (MST = 12 days; P = 0.04) but not iv (MST = 9 days; P = 0. 09), with equivalent overall mean drug levels during normal renal function. However, two of the four longest-surviving animals in the ia group died from severe systemic toxicity, manifested by anorexia, diarrhea, leukopenia, and sepsis. High-dose (0.75 mg/kg/day) DSG significantly prolonged survival via both local (MST = 12 days; P = 0.04) and systemic (MST = 11 days; P = 0.02) routes, but half of the iv-treated dogs died from, and four of the longer-surviving ia-treated animals manifested signs of, systemic toxicity, with significantly higher mean drug levels in the iv group. DSG significantly suppressed vascular rejection at both doses when administered locally and systemically, dose-dependently affected the severity of tubulointerstitial rejection and graft edema, and was not nephrotoxic. Our autotransplant pharmacokinetic data overestimated the allografted kidney's ability to extract DSG during local infusion of slightly lower, but immunosuppressive, doses, so that death from systemic toxicity was not prevented and a direct survival benefit of ia vs iv therapy was not realized. Local DSG administration might be combined with other immunosuppressants to therapeutic advantage.
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Affiliation(s)
- S A Gruber
- The Departments of Surgery and Pathology, Albany Medical College, Albany, New York 12208, USA
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Gruber SA, Gallichio M, Rosano TG, Kaplan SS, Hughes SE, Urbauer DL, Singh TP, Lempert N, Conti DJ, Stein DS, Drusano G. Comparative pharmacokinetics and renal effects of cyclosporin A and cyclosporin G in renal allograft recipients. J Clin Pharmacol 1997; 37:575-86. [PMID: 9243350 DOI: 10.1002/j.1552-4604.1997.tb04339.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cyclosporin G (CSG) has produced less nephrotoxicity than cyclosporin A (CSA) at equivalent doses in animal models. Conflicting results have been reported concerning differences in the pharmacokinetics of CSA and CSG in preclinical studies, and no data exist regarding the effect of steady-state oral administration of CSG on renal function in transplant patients or CSG-induced release of endothelin and nitric oxide (NO) in vivo. The objective of the study was to examine steady-state pharmacokinetic profiles of adult renal allograft recipients receiving CSA and CSG in relation to concentrations of endothelin-1 and NO2/NO3 in urine and plasma, creatinine clearance (Clcr), and urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) 9 months after transplantation. Concentrations of CSA and CSG were measured in whole blood over a 12-hour dose interval by both a monoclonal and polyclonal fluorescence polarization radioimmunoassay for CSA. A metabolite fraction was defined as the numerical difference between the levels obtained at each time point by both assays. Patient groups were defined as follows: group 1: initial CSA (n = 6); group 2: initial CSG (n = 7); group 3: five of the seven patients in group 2 taking CSG subsequently undergoing conversion to CSA; group 4: the same five patients in group 3 restudied 1 month after 1:1 dosage conversion to CSA; and group 5: CSA groups 1 and 4 combined (n = 11). In group 1, the metabolite fraction accounted for 32% to 54% of the total measurable drug concentration at each time point, whereas in group 2, the metabolite fraction accounted for at most 10% to 15% of the total drug levels measurable by polyclonal fluorescence polarization radioimmunoassay. Although there were no significant differences in any of the mean pharmacokinetic parameters between groups using monoclonal fluorescence polarization radioimmunoassay, the normalized area under the concentration-time curve (NAUC) value was less in four of five patients after conversion from CSG to CSA, with a more variable and delayed time to reach peak concentration (tmax) but equivalent apparent oral clearance (Clpa) values. Clcr was found to change significantly with time in groups 1 and 5 but not in group 2, with CSA producing a more profound and sustained decrease than CSG. Endothelin-1 and NO2/NO3 levels in plasma and urine remained relatively constant after administration of both CSA and CSG, and there were no significant differences between groups 3 and 4 regarding mean endothelin-1 and NO2/NO3 concentrations in plasma, urinary release of endothelin-1 and NO2/NO3, and mean AUC of endothelin-1 and AUC of NO2/NO3. However, monoclonal NAUC correlated significantly with total urinary endothelin-1 within CSA groups 1 and 5 but not within CSG group 2. Metabolite NAUC correlated significantly with total urinary NAG within CSA group 1. Although limited by the small number of patients, this study suggests that 1) CSG may produce less of a reduction in Clcr over time after oral administration at steady state than does CSA, and 2) this beneficial effect of CSG may be in part due to decreased intrarenal release of endothelin-1, as urinary excretion of endothelin-1 seemed to correlate better with CSA than with CSG exposure.
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Affiliation(s)
- S A Gruber
- Department of Surgery, Albany Medical College, New York, USA
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40
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Abstract
This report describes a systematic analysis of the expression of the fibroblast growth factor receptor (FGFR) multigene family (FGFR1, FGFR2, FGFR3, and FGFR4) in archival serial sections of normal human adult tissues representing the major organ systems, using immunohistochemical techniques. Polyclonal antisera specific for FGFR1, FGFR2, FGFR3, and FGFR4 and a three-stage immunoperoxidase technique were employed to determine the cellular distribution of these receptors at the protein level. The expression profiles for the tissue-specific cellular localization of the FGFR multigene family demonstrated wide-spread and striking differential patterns of expression of individual receptors in the epithelia and mesenchyme of multiple tissues (stomach, salivary glands, pancreas, thymus, ureter, and cornea) and co-expression of FGFR1-4 in the same cell types of other tissues. The wide-spread expression of FGFR1-4 in multiple organ systems suggests an important functional role in normal tissue homeostasis. Differences in the spatial patterns of FGFR gene expression may generate functional diversity in response to FGF-1 and FGF-2, both of which bind with equally high affinity to more than one receptor subtype. In vivo, this may lead to functional differences that are crucial for the regulation of normal physiological processes and are responsible for the pathological mechanisms that orchestrate various disease processes.
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Affiliation(s)
- S E Hughes
- Division of Histopathology, United Medical and Dental Schools, London, United Kingdom
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41
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Abstract
An examination of the mechanisms by which four new immunosuppressive drugs--rapamycin, mizoribine, mycophenolate mofetil, and 15-deoxyspergualin--exert their effects reveals three major categories. Rapamycin binds to an intracellular immunophilin. The resulting drug-immunophilin complex inhibits the action of cytokines, thus blocking the activation and proliferation of T cells. Mizoribine and mycophenolate mofetil are antimetabolites that inhibit a key enzyme in the de novo purine biosynthetic pathway. As a result, the proliferation of T cells and B cells is inhibited selectively compared with that of nonlymphoid cells because the salvage pathway is unavailable to lymphocytes. Finally, 15-deoxyspergualin has a unique mechanism of action, which includes suppressive effects on macrophage function, the induction of cytolytic T cells, B-cell reactivity, and antibody responses. The demonstrated synergism among certain immunosuppressants allows reduction in the dose of each agent to minimize the individual toxicities. As more of these new agents become available, it is likely that azathioprine will be replaced, and it may be possible to eliminate the need for long-term maintenance steroid therapy.
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Affiliation(s)
- S E Hughes
- Department of Surgery, Albany Medical College, New York, USA
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Pottinger TG, Carrick TR, Hughes SE, Balm PH. Testosterone, 11-ketotestosterone, and estradiol-17 beta modify baseline and stress-induced interrenal and corticotropic activity in trout. Gen Comp Endocrinol 1996; 104:284-95. [PMID: 8954761 DOI: 10.1006/gcen.1996.0173] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Estradiol-17 beta (E), 11-ketotestosterone (KT), and testosterone (T) were administered to immature rainbow and brown trout by implantation of steroid-containing cocoa butter pellets. This procedure elevated the levels of these hormones in the blood of the treated fish and had significant effects on plasma ACTH and cortisol levels in both unstressed and stressed rainbow trout and in stressed brown trout. E treatment significantly elevated resting levels of ACTH and cortisol and KT significantly suppressed resting ACTH levels in rainbow trout, although no effect of KT was noted on baseline cortisol levels. One hour of confinement stress increased ACTH levels in rainbow trout, but less so in T- and KT-implanted fish than in sham-implanted fish. A similar pattern was observed in stress-induced plasma cortisol levels where T and KT treatment of rainbow trout resulted in a more than 50% attenuation of plasma cortisol levels while E implantation significantly increased stress-induced plasma cortisol levels. In brown trout subjected to confinement stress for 96 hr, within 1 hr of the onset of confinement the stress-induced increase in plasma ACTH and plasma cortisol was significantly lower in T- and KT-implanted fish than in sham-implanted controls. However, these differences were not sustained at subsequent sample points during the 96-hr period of continuous confinement. Nonetheless, overall mean ACTH levels for the entire confinement period were significantly enhanced in E-implanted brown trout and significantly reduced in KT-implanted fish. Overall mean cortisol levels were significantly lower in T- and KT-implanted fish. The enhancement of stress responsiveness observed in E-treated immature fish was not observed during confinement stress in untreated mature female trout, with naturally high plasma E levels. However, untreated mature male trout displayed a significantly reduced cortisol response to confinement. It is suggested that gonadal steroids are involved in the regulation of both baseline and stress-induced activity of the pituitary-interrenal axis in salmonid fish.
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Affiliation(s)
- T G Pottinger
- Windermere Laboratory, Institute of Freshwater Ecology, Ambleside, Cumbria, United Kingdom
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43
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Hughes SE. Localisation and differential expression of the fibroblast growth factor receptor (FGFR) multigene family in normal and atherosclerotic human arteries. Cardiovasc Res 1996; 32:557-69. [PMID: 8881516] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Aberrant expression of FGF-1 and FGF-2 may be central to the atherosclerotic disease process, promoting both intimal hyperplasia and plaque neovascularisation. FGF-1 and FGF-2 mediate their biological effects by binding to a family of specific high-affinity cell surface receptors with protein tyrosine kinase activity. Four receptors have been identified in the human (FGFR1/flg gene product, FGFR2/bek gene product, FGFR3 and FGFR4), but little is known of their in vivo tissue distribution. Characterisation of the spatial distribution of the FGFR multigene family in both normal and atherosclerotic arteries is a prerequisite to further define the functional role of FGF-1 and FGF-2 in atherosclerosis. The objective of this study was to examine the cell-type-specific expression of the FGFR multigene family members in both normal and atherosclerotic human arteries. METHODS FGFR expression was investigated immunocytochemically with polyclonal antisera to FGFR1-4 and by in situ hybridisation using FGFR1-4 riboprobes in archival material. Total cellular mRNA was analysed using poly d(T) and the levels correlated with the expression of FGFR1-4 mRNA. RESULTS At the protein level, FGFR1-4 were expressed in the medial smooth muscle cells and adventitial vessels of normal arteries. In simple and advanced lesions, the expression profiles of FGFR1-4 showed variability between individual arteries, and cell-type-specific differential FGFR expression was apparent. Widespread co-expression of FGFR1 and FGFR2 was observed in intimal smooth muscle cells, foam cells and the plaque microvasculature of simple and advanced lesions. FGFR3 and FGFR4 exhibited more restricted patterns of distribution within the plaque. In situ hybridisation with poly d(T) confirmed high cellular transcriptional activity in archival atherosclerotic lesions. The high levels of total cellular mRNA and FGFR protein were not always reciprocated at the FGFR1-4 mRNA level, and only FGFR1 and FGFR2 mRNA transcripts were abundant in intimal lesions. CONCLUSION These data provide evidence to suggest involvement of the FGF-FGFR multigene families in human atherogenesis. Differential FGFR expression in plaque subtypes may reflect distinct differences in receptor function which may be relevant to lesion progression during atherosclerosis.
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MESH Headings
- Adult
- Aged
- Arteries/metabolism
- Arteriosclerosis/metabolism
- Female
- Fibroblast Growth Factors
- Filaggrin Proteins
- Gene Expression
- Humans
- Immunohistochemistry
- In Situ Hybridization
- Male
- Middle Aged
- Muscle, Smooth, Vascular/metabolism
- Protein-Tyrosine Kinases
- RNA, Messenger/analysis
- Receptor Protein-Tyrosine Kinases/analysis
- Receptor Protein-Tyrosine Kinases/genetics
- Receptor, Fibroblast Growth Factor, Type 1
- Receptor, Fibroblast Growth Factor, Type 2
- Receptor, Fibroblast Growth Factor, Type 3
- Receptor, Fibroblast Growth Factor, Type 4
- Receptors, Fibroblast Growth Factor/analysis
- Receptors, Fibroblast Growth Factor/genetics
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Affiliation(s)
- S E Hughes
- Division of Histopathology, United Medical and Dental Schools (UMDS), London, UK
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44
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Hughes SE, Xiao S, Perera S, Fluno C, Hasselbarth J, Jayasankar V, Singh J, Del Rosario A, Freed BM, Singh TP, Lempert N, Conti DJ, Gruber SA. Local immunosuppression of canine renal allografts with 15-deoxyspergualin. Transplant Proc 1996; 28:2054-5. [PMID: 8769153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- S E Hughes
- Department of Surgery, Albany Medical College, NY 12208, USA
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Hughes SE. Functional characterization of the spontaneously transformed human umbilical vein endothelial cell line ECV304: use in an in vitro model of angiogenesis. Exp Cell Res 1996; 225:171-85. [PMID: 8635510 DOI: 10.1006/excr.1996.0168] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
To gain insight into the role of the endothelial cell during the pathophysiology of the angiogenic response, investigators have isolated micro- and macrovascular endothelial cells from a wide range of both animal and human vessels, including the umbilical vein. Human umbilical vein endothelial cells (HUVECs) isolated from umbilical cords remain a readily available and popular source of endothelial cell. However, the isolation and culture of these cells have several disadvantages, including the risk of infection, exogenous growth factor requirement, and low proliferative capacity. The heterogeneity of endothelial cells from different vascular beds as well as the heterogeneity between HUVEC isolates from different cords can make the critical interpretation of results difficult. ECV304 is a unique spontaneously transformed human umbilical vein endothelial cell line. In this report, the novel use of ECV304 cells as an alternative to HUVECs in an in vitro model of angiogenesis using the reconstituted basement membrane extract (Matrigel) was investigated. ECV304 cells were characterized immunohistochemically and their angiogenic behavior on Matrigel was analyzed functionally by phase-contrast, electron, and time-lapse video microscopy. ECV304 cells had several practical advantages over HUVEC culture and in contrast to HUVECs, ECV304 cells exhibited an enhanced and highly reproducible capacity for in vitro angiogenesis. However, several differentiated functions were lost or reduced in the ECV304 cell line which also exhibited anomalous cytokeratin expression. ECV304 cells may provide novel insights into the mechanisms governing angiogenesis under both normal physiological and pathological conditions.
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Affiliation(s)
- S E Hughes
- Division of Histopathology, United Medical and Dental Schools, St. Thomas's Campus, London, United Kingdom
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Gruber SA, Gallichio M, Rosano TG, Hughes SE, Singh TP, Lempert N, Conti DJ, Hasselbarth J, Freed BM, Stein D, Drusano G. Comparative pharmacokinetics of cyclosporine A and cyclosporine G in renal allograft recipients. Transplant Proc 1996; 28:892. [PMID: 8623449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- S A Gruber
- Department of Surgery, Albany Medical College, New York 12208, USA
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Hughes SE, Hall PA. Immunolocalization of fibroblast growth factor receptor 1 and its ligands in human tissues. J Transl Med 1993; 69:173-82. [PMID: 7688835] [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: 01/26/2023] Open
Abstract
BACKGROUND The fibroblast growth factors (FGFs) and their receptors have a wide range of biologic actions in a variety of systems. The best characterized are the prototypical acidic and basic FGFs, both of which have the property of binding to the flg gene product, fibroblast growth factor receptor-1/FGFR-1. Although much is known at the molecular level, the available information about the in vivo distribution of FGFs and their receptors in human tissues is limited. Detailed characterization of the spatial distribution of ligands and receptors is a necessary prerequisite for understanding their function. EXPERIMENTAL DESIGN Using immunohistochemical techniques, we have defined the tissue specific cellular location of both FGFR-1 and basic and acidic FGFs in serial sections of a broad range of normal human adult tissues. Immunodetection was performed using highly specific polyclonal antibodies to FGFR-1, acidic FGF, and basic FGF and the avidin-biotin immunoperoxidase method. RESULTS Immunoreactive acidic and basic FGFs were present in almost all tissues examined. A distinct spatial pattern of distribution of these ligands was observed in the kidney, skin, liver, ureter, and the vasculature. FGFR-1 expression tended to be confined to the tissue microvasculature. Interestingly, marked numbers of FGFR-1 reactive vessels were observed in the stomach, salivary glands, lung, and appendix. Intense FGFR-1 positivity was observed in the basal epithelial cell layer of the cervix, palatine tonsil, and respiratory tract as well as breast myoepithelial cells, and the pitutary gland. CONCLUSIONS We have been able to define the distribution of FGFR-1 and its ligands in normal human tissues. The results will be useful for determining the function of these growth factors and their receptors under both normal physiologic and pathologic conditions.
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Affiliation(s)
- S E Hughes
- Department of Histopathology, UMDS, St Thomas's Hospital, London, UK
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Hughes SE, Crossman D, Hall PA. Expression of basic and acidic fibroblast growth factors and their receptor in normal and atherosclerotic human arteries. Cardiovasc Res 1993; 27:1214-9. [PMID: 7504585 DOI: 10.1093/cvr/27.7.1214] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Acidic and basic fibroblast growth factors (FGF) are potent mitogens for vascular endothelial and smooth muscle cells and also promote angiogenesis. Given that atheroma is associated with the proliferation of a range of cell types, including smooth muscle cells, it has been proposed that these growth factors may play a part in the genesis and/or maintenance of atheromatous lesions. The aim of our study was to examine the distribution of acidic and basic FGF and their known receptor, fibroblast growth factor receptor 1 (FGFR-1), in normal and atherosclerotic arteries. METHODS Formalin fixed was embedded archival material from a wide range of vessels was examined using a three stage avidin-biotin immunoperoxidase technique and specific polyclonal antibodies to acidic and basic FGF and FGFR-1. RESULTS In normal arteries basic FGF immunoreactivity was found in medial smooth muscle cells and adventitial blood vessels, the luminal endothelium being non-reactive. Acidic FGF expression was observed predominantly in adventitial fibroblasts, while FGFR-1 expression was confined to the adventitial microvasculature. In early, simple, and advanced lesions acidic and basic FGF were expressed in macrophages and smooth muscle cells, the principal cell types involved in atherosclerotic lesion formation. Increased expression of basic FGF and FGFR-1 was particularly associated with neovascularisation of the atheromatous lesions. CONCLUSIONS Acidic and basic FGF are expressed in early, simple and advanced atherosclerotic plaques. This suggests that in vivo these growth factors may have a role in the genesis of this disease. Basic FGF and FGFR-1 may potentially be involved in plaque neovascularisation. Such FGF driven angiogenic events may be central to the life threatening complications of atheroma and provide new options for therapeutic intervention.
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Affiliation(s)
- S E Hughes
- Division of Histopathology, UMDS, London, United Kingdom
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49
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50
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Hughes SE, Hall PA. Overview of the fibroblast growth factor and receptor families: complexity, functional diversity, and implications for future cardiovascular research. Cardiovasc Res 1993; 27:1199-203. [PMID: 8252578 DOI: 10.1093/cvr/27.7.1199] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- S E Hughes
- Division of Histopathology, UMDS, London, United Kingdom
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