1
|
Allan S, Ward T, Eisner E, Bell IH, Cella M, Chaudhry IB, Torous J, Kiran T, Kabir T, Priyam A, Richardson C, Reininghaus U, Schick A, Schwannauer M, Syrett S, Zhang X, Bucci S. Adverse Events Reporting in Digital Interventions Evaluations for Psychosis: A Systematic Literature Search and Individual Level Content Analysis of Adverse Event Reports. Schizophr Bull 2024:sbae031. [PMID: 38581410 DOI: 10.1093/schbul/sbae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
BACKGROUND Digital health interventions (DHIs) have significant potential to upscale treatment access to people experiencing psychosis but raise questions around patient safety. Adverse event (AE) monitoring is used to identify, record, and manage safety issues in clinical trials, but little is known about the specific content and context contained within extant AE reports. This study aimed to assess current AE reporting in DHIs. STUDY DESIGN A systematic literature search was conducted by the iCharts network (representing academic, clinical, and experts by experience) to identify trials of DHIs in psychosis. Authors were invited to share AE reports recorded in their trials. A content analysis was conducted on the shared reports. STUDY RESULTS We identified 593 AE reports from 18 DHI evaluations, yielding 19 codes. Only 29 AEs (4.9% of total) were preidentified by those who shared AEs as being related to the intervention or trial procedures. While overall results support the safety of DHIs, DHIs were linked to mood problems and psychosis exacerbation in a few cases. Additionally, 27% of studies did not report information on relatedness for all or at least some AEs; 9.6% of AE reports were coded as unclear because it could not be determined what had happened to participants. CONCLUSIONS The results support the safety of DHIs, but AEs must be routinely monitored and evaluated according to best practice. Individual-level analyses of AEs have merit to understand safety in this emerging field. Recommendations for best practice reporting in future studies are provided.
Collapse
Affiliation(s)
- Stephanie Allan
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Thomas Ward
- School of Mental Health and Psychological Sciences, Department of Psychology Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Imogen H Bell
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Matteo Cella
- School of Mental Health and Psychological Sciences, Department of Psychology Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Imran B Chaudhry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
- Ziauddin University and Hospital Karachi, Karachi, Pakistan
- Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tayyeba Kiran
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Thomas Kabir
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Aansha Priyam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Cara Richardson
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Ulrich Reininghaus
- School of Mental Health and Psychological Sciences, Department of Psychology Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anita Schick
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias Schwannauer
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Suzy Syrett
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Xiaolong Zhang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| |
Collapse
|
2
|
Bell IH, Eisner E, Allan S, Cartner S, Torous J, Bucci S, Thomas N. Methodological Characteristics and Feasibility of Ecological Momentary Assessment Studies in Psychosis: a Systematic Review and Meta-Analysis. Schizophr Bull 2024; 50:238-265. [PMID: 37606276 PMCID: PMC10919779 DOI: 10.1093/schbul/sbad127] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Ecological momentary assessment (EMA) involves completing multiple surveys over time in daily life, capturing in-the-moment experiences in real-world contexts. EMA use in psychosis studies has surged over several decades. To critically examine EMA use in psychosis research and assist future researchers in designing new EMA studies, this systematic review aimed to summarize the methodological approaches used for positive symptoms in psychosis populations and evaluate feasibility with a focus on completion rates. METHODS A systematic review of PubMed, PsycINFO, MEDLINE, Web of Science, EBSCOhost, and Embase databases using search terms related to EMA and psychosis was conducted. Excluding duplicate samples, a meta-analysis was conducted of EMA survey completion rates and meta-regression to examine predictors of completion. RESULTS Sixty-eight studies were included in the review. Characteristics and reporting of EMA methodologies were variable across studies. The meta-mean EMA survey completion computed from the 39 unique studies that reported a mean completion rate was 67.15% (95% CI = 62.3, 71.9), with an average of 86.25% of the sample meeting a one-third EMA completion criterion. No significant predictors of completion were found in the meta-regression. A variety of EMA items were used to measure psychotic experiences, of which few were validated. CONCLUSIONS EMA methods have been widely applied in psychosis studies using a range of protocols. Completion rates are high, providing clear evidence of feasibility in psychosis populations. Recommendations for reporting in future studies are provided.
Collapse
Affiliation(s)
- Imogen H Bell
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, Zochonis Building, University of Manchester, Manchester, UK
- Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | | | - Sharla Cartner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, Zochonis Building, University of Manchester, Manchester, UK
- Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| |
Collapse
|
3
|
McGuire N, Gumley A, Hasson-Ohayon I, Allan S, Aunjitsakul W, Aydin O, Bo S, Bonfils KA, Bröcker AL, de Jong S, Dimaggio G, Inchausti F, Jansen JE, Lecomte T, Luther L, MacBeth A, Montag C, Pedersen MB, Pijnenborg GHM, Popolo R, Schwannauer M, Trauelsen AM, van Donkersgoed R, Wu W, Wang K, Lysaker PH, McLeod H. Investigating the relationship between negative symptoms and metacognitive functioning in psychosis: An individual participant data meta-analysis. Psychol Psychother 2023; 96:918-933. [PMID: 37530433 DOI: 10.1111/papt.12484] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/24/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Negative symptoms are a persistent, yet under-explored problem in psychosis. Disturbances in metacognition are a potential causal factor in negative symptom development and maintenance. This meta-analysis uses individual participant data (IPD) from existing research to assess the relationship between negative symptoms and metacognition treated as summed scores and domains. METHODS Data sets containing individuals with negative symptoms and metacognition data, aged 16+ with psychosis, were identified according to pre-specific parameters. IPD integrity and completeness were checked and data were synthesized in two-stage meta-analyses of each negative symptoms cluster compared with metacognition in seemingly unrelated regression using restricted maximum likelihood estimation. Planned and exploratory sensitivity analyses were also conducted. RESULTS Thirty-three eligible data sets were identified with 21 with sufficient similarity and availability to be included in meta-analyses, corresponding to 1301 participants. The strongest relationships observed were between summed scores of negative symptoms and metacognition. Metacognitive domains of self-reflectivity and understanding others' minds, and expressive negative symptoms emerged as significant in some meta-analyses. The uncertainty of several effect estimates increased significantly when controlling for covariates. CONCLUSIONS This robust meta-analysis highlights the impact of using summed versus domain-specific scores of metacognition and negative symptoms, and relationships are not as clear-cut as once believed. Findings support arguments for further differentiation of negative symptom profiles and continued granular exploration of the relationship between metacognition and negative symptoms.
Collapse
Affiliation(s)
| | | | | | | | | | - Orkun Aydin
- International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sune Bo
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Steven de Jong
- Lentis Psychiatric Institute, Groningen, The Netherlands
| | | | - Felix Inchausti
- Department of Mental Health, Servicio Riojano de Salud, Logroño, Spain
| | | | | | | | | | | | - Marlene Buch Pedersen
- Early Psychosis Intervention Centre, Psychiatry East, Region Zealand, Roskilde, Denmark
| | | | | | | | - Anne-Marie Trauelsen
- Assessment and Brief Treatment Team (Newham), East London Foundation Trust, London, UK
| | | | | | - Kai Wang
- Anhui Medical University, Hefei, China
| | | | | |
Collapse
|
4
|
McGuire N, Gumley A, Hasson-Ohayon I, Allan S, Aunjitsakul W, Aydin O, Bo S, Bonfils KA, Bröcker AL, de Jong S, Dimaggio G, Inchausti F, Jansen JE, Lecomte T, Luther L, MacBeth A, Montag C, Pedersen MB, Pijnenborg GHM, Popolo R, Schwannauer M, Trauelsen AM, van Donkersgoed R, Wu W, Wang K, Lysaker PH, McLeod H. Investigating the relationship between specific negative symptoms and metacognitive functioning in psychosis: A systematic review. Psychol Psychother 2023. [PMID: 37864383 DOI: 10.1111/papt.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Disrupted metacognition is implicated in development and maintenance of negative symptoms, but more fine-grained analyses would inform precise treatment targeting for individual negative symptoms. AIMS This systematic review identifies and examines datasets that test whether specific metacognitive capacities distinctly influence negative symptoms. MATERIALS & METHODS PsycINFO, EMBASE, Medline and Cochrane Library databases plus hand searching of relevant articles, journals and grey literature identified quantitative research investigating negative symptoms and metacognition in adults aged 16+ with psychosis. Authors of included articles were contacted to identify unique datasets and missing information. Data were extracted for a risk of bias assessment using the Quality in Prognostic Studies tool. RESULTS 85 published reports met criteria and are estimated to reflect 32 distinct datasets and 1623 unique participants. The data indicated uncertainty about the relationship between summed scores of negative symptoms and domains of metacognition, with significant findings indicating correlation coefficients from 0.88 to -0.23. Only eight studies investigated the relationship between metacognition and individual negative symptoms, with mixed findings. Studies were mostly moderate-to-low risk of bias. DISCUSSION The relationship between negative symptoms and metacognition is rarely the focus of studies reviewed here, and negative symptom scores are often summed. This approach may obscure relationships between metacognitive domains and individual negative symptoms which may be important for understanding how negative symptoms are developed and maintained. CONLCLUSION Methodological challenges around overlapping participants, variation in aggregation of negative symptom items and types of analyses used, make a strong case for use of Individual Participant Data Meta-Analysis to further elucidate these relationships.
Collapse
Affiliation(s)
| | | | | | | | | | - Orkun Aydin
- International University of Sarajevo, Sarajevo, Bosnia and Herzegovinia
| | - Sune Bo
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Steven de Jong
- Lentis Psychiatric Institute, Groningen, The Netherlands
| | | | - Felix Inchausti
- Department of Mental Health, Servicio Riojano de Salud, Logroño, Spain
| | - Jens Einar Jansen
- Mental Health Center Copenhagen, Capital Region, Copenhagen, Denmark
| | | | | | | | | | - Marlene Buch Pedersen
- Early Psychosis Intervention Centre, Psychiatry East, Region Zealand, Roskilde, Denmark
| | | | | | | | | | | | - Weiming Wu
- Anhui Medical University, Hefei City, China
| | - Kai Wang
- Anhui Medical University, Hefei City, China
| | | | | |
Collapse
|
5
|
Allan S. Struggling in the heat: what I need to know about my medication. BMJ 2023; 382:2199. [PMID: 37775138 DOI: 10.1136/bmj.p2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
|
6
|
Allan S, Beedie S, McLeod HJ, Farhall J, Gleeson J, Bradstreet S, Morton E, Bell I, Wilson-Kay A, Whitehill H, Matrunola C, Thomson D, Clark A, Gumley A. Using EMPOWER in daily life: a qualitative investigation of implementation experiences. BMC Psychiatry 2023; 23:597. [PMID: 37592231 PMCID: PMC10433590 DOI: 10.1186/s12888-023-05096-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Digital self-management tools blended with clinical triage and peer support have the potential to improve access to early warning signs (EWS) based relapse prevention in schizophrenia care. However, the implementation of digital interventions in psychosis can be poor. Traditionally, research focused on understanding how people implement interventions has focused on the perspectives of mental health staff. Digital interventions are becoming more commonly used by patients within the context of daily life, which means there is a need to understand implementation from the perspectives of patients and carers. METHODS Semi-structured one-on-one interviews with 16 patients who had access to the EMPOWER digital self-management intervention during their participation in a feasibility trial, six mental health staff members who supported the patients and were enrolled in the trial, and one carer participant. Interviews focused on understanding implementation, including barriers and facilitators. Data were coded using thematic analysis. RESULTS The intervention was well implemented, and EMPOWER was typically perceived positively by patients, mental health staff and the carer we spoke to. However, some patients reported negative views and reported ideas for intervention improvement. Patients reported valuing that the app afforded them access to things like information or increased social contact from peer support workers that went above and beyond that offered in routine care. Patients seemed motivated to continue implementing EMPOWER in daily life when they perceived it was creating positive change to their wellbeing, but seemed less motivated if this did not occur. Mental health staff and carer views suggest they developed increased confidence patients could self-manage and valued using the fact that people they support were using the EMPOWER intervention to open up conversations about self-management and wellbeing. CONCLUSIONS The findings from this study suggest peer worker supported digital self-management like EMPOWER has the potential to be implemented. Further evaluations of these interventions are warranted, and conducting qualitative research on the feasibility gives insight into implementation barriers and facilitators, improving the likelihood of interventions being usable. In particular, the views of patients who demonstrated low usage levels would be valuable.
Collapse
Affiliation(s)
| | | | | | | | - John Gleeson
- Australian Catholic University, Melbourne, Australia
| | | | - Emma Morton
- University of British Columbia, Vancouver, Canada
| | - Imogen Bell
- Orygen Centre of Youth Mental Health, Melbourne, Australia
| | | | | | | | | | | | | |
Collapse
|
7
|
Gupta V, Eames C, Golding L, Greenhill B, Qi R, Allan S, Bryant A, Fisher P. Understanding the identity of lived experience researchers and providers: a conceptual framework and systematic narrative review. Res Involv Engagem 2023; 9:26. [PMID: 37095587 PMCID: PMC10127294 DOI: 10.1186/s40900-023-00439-0] [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: 07/20/2022] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Identity is how we understand ourselves and others through the roles or social groups we occupy. This review focuses on lived experience researchers and providers and the impact of these roles on identity. Lived experience researchers and providers use their lived experience of mental or physical disability either as experts by experience, researchers, peer workers, or mental health professionals with lived experience. They must navigate both professional and personal aspects to their roles which can be complex. Performing roles simultaneously embodying professional and lived experiences contribute towards a lack of clarity to identity. This is not adequately explained by the theoretical evidence base for identity. MAIN BODY This systematic review and narrative synthesis aimed to provide a conceptual framework to understand how identity of lived experience researchers and providers is conceptualised. A search strategy was entered into EBSCO to access Academic search complete, CINAHL, MEDLINE, PsycINFO, Psych Articles, and Connected papers. Out of the 2049 yielded papers, thirteen qualitative papers were eligible and synthesised, resulting in a conceptual framework. Five themes explained identity positions: Professional, Service user, Integrated, Unintegrated and Liminal. The EMERGES framework, an original conception of this review, found themes of: Enablers and Empowerment, Motivation, Empathy of the self and others, Recovery model and medical model, Growth and transformation, Exclusion and Survivor roots contributed to lived experience researcher and provider identities. CONCLUSIONS The EMERGES framework offers a novel way to understand the identities of lived experience researchers and providers, helping support effective team working in mental health, education, and research settings.
Collapse
Affiliation(s)
- Veenu Gupta
- University of Liverpool, Liverpool, UK.
- Manchester Metropolitan University, Manchester, UK.
| | | | | | | | - Robert Qi
- University of Liverpool, Liverpool, UK
| | | | | | | |
Collapse
|
8
|
Gumbleton M, Allan S, Conway H, Boucher K, Marvin J, Hawks J, Burnett W, Van Brocklin M, Whisenant J, Gilcrease G, Gupta S. A phase I open-label study of the safety and efficacy of apatinib (rivoceranib) administered to patients with advanced malignancies to improve sensitivity to pembrolizumab in the second- or later-line setting (APPEASE). BMC Res Notes 2023; 16:16. [PMID: 36797744 PMCID: PMC9936706 DOI: 10.1186/s13104-023-06283-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE APPEASE is a phase I study to assess the safety, dosing, and efficacy of rivoceranib (a selective, small-molecule inhibitor of VEGFR2) in combination with pembrolizumab. We aimed to treat patients with metastatic malignancies who have progressed through at least first-line therapy, with pembrolizumab 200 mg every 3 weeks, as well as escalating doses of rivoceranib until disease progression or unacceptable toxicity. RESULTS Five patients were enrolled on the starting dose of rivoceranib 300 mg once daily. There were no dose-limiting toxicities observed in combination with pembrolizumab. The dose of rivoceranib was not escalated due to study closure. We note a treatment related grade 3 adverse event (AE) rate of 40%, predominantly in urothelial cancer patients, with no deaths related to treatment related AEs. The disease control rate was 75% (3 of 4) and the median progression free survival (PFS) was 3.6 months. Tumor shrinkage was noted in patients who were previously progressing on pembrolizumab alone. Apatinib 300 mg is safe and demonstrates anti-tumor activity in advanced solid tumors in combination with pembrolizumab. Further dose escalation and efficacy need to be investigated in larger disease-specific patient populations. TRIAL REGISTRATION NUMBER Clinical trial registration number: NCT03407976. Date of registration: January 17, 2018.
Collapse
Affiliation(s)
- Matthew Gumbleton
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT USA
- Division of Oncology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Stephanie Allan
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT USA
| | - Hannah Conway
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT USA
| | - Kenneth Boucher
- Division of Epidemiology and Huntsman Cancer Institute, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - James Marvin
- Flow Cytometry Core Facility, Health Science Center, University of Utah, Salt Lake City, UT USA
| | - Josiah Hawks
- Division of Oncology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - William Burnett
- Department of Oncological Sciences, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Matthew Van Brocklin
- Division of Oncology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Jonathan Whisenant
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT USA
- Division of Oncology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Glynn Gilcrease
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT USA
- Division of Oncology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Sumati Gupta
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT USA
- Division of Oncology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Veterans Affairs Medical Center, Salt Lake City, UT USA
| |
Collapse
|
9
|
Allan S, O’Driscoll C, McLeod HJ, Gleeson J, Farhall J, Morton E, Bell I, Bradstreet S, Machin M, Gumley A. Fear of psychotic relapse: exploring dynamic relationships with common early warning signs of relapse using electronic once-a-day self-reports. Psychosis 2023. [DOI: 10.1080/17522439.2022.2162955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Stephanie Allan
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Ciarán O’Driscoll
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Hamish J. McLeod
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Australia
| | - John Farhall
- Department of Psychology and Counselling, LaTrobe University, Melbourne, Australia
| | - Emma Morton
- Department of Psychiatry, University of British Colombia, Vancouver, Canada
| | | | - Simon Bradstreet
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Mathew Machin
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Andrew Gumley
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
10
|
Vincent C, Allan S, Naylor G, Stephen R, Bray S, Thornton A, Kirk A. Fission chamber data acquisition system for neutron flux measurements on the Mega-Amp Spherical Tokamak Upgrade. Rev Sci Instrum 2022; 93:093509. [PMID: 36182454 DOI: 10.1063/5.0106725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
Neutron flux measurements are important in fusion devices for both safety requirements and physics studies. A new system has been built for the Mega-Amp Spherical Tokamak Upgrade (MAST Upgrade) that provides neutron count, DC, and Campbell mode measurements for a 1 µs period at 1 MHz. The acquisition system uses a Red Pitaya board to sample current from two fission chambers mounted on the side of the MAST-U vessel. The system-on-chip design of the Zynq-7020 on the Red Pitaya also allows a web server implementation using Flask for data retrieval and diagnostic configuration over the MAST Upgrade network.
Collapse
Affiliation(s)
- C Vincent
- United Kingdom Atomic Energy Authority, Culham Centre for Fusion Energy, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - S Allan
- United Kingdom Atomic Energy Authority, Culham Centre for Fusion Energy, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - G Naylor
- United Kingdom Atomic Energy Authority, Culham Centre for Fusion Energy, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - R Stephen
- United Kingdom Atomic Energy Authority, Culham Centre for Fusion Energy, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - S Bray
- United Kingdom Atomic Energy Authority, Culham Centre for Fusion Energy, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - A Thornton
- United Kingdom Atomic Energy Authority, Culham Centre for Fusion Energy, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - A Kirk
- United Kingdom Atomic Energy Authority, Culham Centre for Fusion Energy, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| |
Collapse
|
11
|
Zukowska Z, Allan S, Eisner E, Ling L, Gumley A. Fear of relapse in schizophrenia: a mixed-methods systematic review. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1305-1318. [PMID: 35152309 PMCID: PMC9246982 DOI: 10.1007/s00127-022-02220-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Fears of relapse in people diagnosed with schizophrenia have long been recognised as an impediment to recovery and wellbeing. However, the extent of the empirical basis for the fear of relapse concept is unclear. A systematic review is required to collate available evidence and define future research directions. METHODS A pre-registered systematic search (PROSPERO CRD42020196964) of four databases (PubMED, MEDLINE-Ovid, PsycINFO-Ovid, and Cochrane Central Register of Controlled Trials) was conducted from their inception to 05/04/2021. RESULTS We found nine eligible studies. Five were quantitative (4 descriptive and 1 randomised controlled trial), and four were qualitative. The available quantitative evidence suggests that fear of relapse may have concurrent positive relationships with depression (r = 0.72) and suicide ideation (r = 0.48), and negative relationship with self-esteem (r = 0.67). Qualitative synthesis suggests that fear of relapse is a complex phenomenon with behavioural and emotional components which has both direct and indirect effects on wellbeing. CONCLUSIONS Evidence in this area is limited and research with explicit service user and carer involvement is urgently needed to develop new and/or refine existing measurement tools, and to measure wellbeing rather than psychopathology. Nonetheless, clinicians should be aware that fear of relapse exists and appears to be positively associated with depression and suicide ideation, and negatively associated with self-esteem. Fear of relapse can include fears of losing personal autonomy and/or social/occupational functioning. It appears to impact carers as well as those diagnosed with schizophrenia.
Collapse
Affiliation(s)
- Zofia Zukowska
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
| | - Emily Eisner
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Li Ling
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| |
Collapse
|
12
|
Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Birchwood M, Briggs A, Bucci S, Cotton S, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung A, Aucott L, Farhall J, Gleeson J. Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT. Health Technol Assess 2022; 26:1-174. [PMID: 35639493 DOI: 10.3310/hlze0479] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. OBJECTIVE How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? DESIGN A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. SETTINGS Glasgow, UK, and Melbourne, Australia. PARTICIPANTS Service users were aged > 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. INTERVENTIONS The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. MAIN OUTCOME MEASURES The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. RESULTS We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement (> 33%). The median time to discontinuation of > 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference -4.29, 95% confidence interval -7.29 to -1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. LIMITATIONS This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. CONCLUSIONS A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. FUTURE WORK A main trial with a sample size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3-0.4). TRIAL REGISTRATION This trial is registered as ISRCTN99559262. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).
Collapse
Affiliation(s)
- Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Maximillian Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Paul French
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Swaran P Singh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia.,NorthWestern Mental Health, Melbourne, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| |
Collapse
|
13
|
Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Aucott L, Birchwood M, Briggs A, Bucci S, Cotton SM, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung AR, Farhall J, Gleeson J. The EMPOWER blended digital intervention for relapse prevention in schizophrenia: a feasibility cluster randomised controlled trial in Scotland and Australia. Lancet Psychiatry 2022; 9:477-486. [PMID: 35569503 DOI: 10.1016/s2215-0366(22)00103-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Early warning signs monitoring by service users with schizophrenia has shown promise in preventing relapse but the quality of evidence is low. We aimed to establish the feasibility of undertaking a definitive randomised controlled trial to determine the effectiveness of a blended digital intervention for relapse prevention in schizophrenia. METHODS This multicentre, feasibility, cluster randomised controlled trial aimed to compare Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) with treatment as usual in community mental health services (CMHS) in Glasgow and Melbourne. CMHS were the unit of randomisation, selected on the basis of those that probably had five or more care coordinators willing to participate. Participants were eligible if they were older than 16 years, had a schizophrenia or related diagnosis confirmed via case records, were able to provide informed consent, had contact with CMHS, and had had a relapse within the previous 2 years. Participants were randomised within stratified clusters to EMPOWER or to continue their usual approach to care. EMPOWER blended a smartphone for active monitoring of early warning signs with peer support to promote self-management and clinical triage to promote access to relapse prevention. Main outcomes were feasibility, acceptability, usability, and safety, which was assessed through face-to-face interviews. App usage was assessed via the smartphone and self-report. Primary end point was 12 months. Participants, research assistants and other team members involved in delivering the intervention were not masked to treatment conditions. Assessment of relapse was done by an independent adjudication panel masked to randomisation group. The study is registered at ISRCTN (99559262). FINDINGS We identified and randomised eight CMHS (six in Glasgow and two in Melbourne) comprising 47 care coordinators. We recruited 86 service users between Jan 19 and Aug 8, 2018; 73 were randomised (42 [58%] to EMPOWER and 31 [42%] to treatment as usual). There were 37 (51%) men and 36 (49%) women. At 12 months, main outcomes were collected for 32 (76%) of service users in the EMPOWER group and 30 (97%) of service users in the treatment as usual group. Of those randomised to EMPOWER, 30 (71%) met our a priori criterion of more than 33% adherence to daily monitoring that assumed feasibility. Median time to discontinuation of these participants was 31·5 weeks (SD 14·5). There were 29 adverse events in the EMPOWER group and 25 adverse events in the treatment as usual group. There were 13 app-related adverse events, affecting 11 people, one of which was serious. Fear of relapse was lower in the EMPOWER group than in the treatment as usual group at 12 months (mean difference -7·53 (95% CI -14·45 to 0·60; Cohen's d -0·53). INTERPRETATION A trial of digital technology to monitor early warning signs blended with peer support and clinical triage to detect and prevent relapse appears to be feasible, safe, and acceptable. A further main trial is merited. FUNDING UK National Institute for Health Research Health Technology Assessment programme and the Australian National Health and Medical Research Council.
Collapse
Affiliation(s)
- Andrew I Gumley
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Simon Bradstreet
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lorna Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Maximillian Birchwood
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue M Cotton
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul French
- Department of Psychiatry, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- The Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Swaran P Singh
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Suresh Sundram
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Mental Health Program, Monash Health, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Chris Williams
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; School of Medicine, Deakin University, Melbourne, VIC, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia; NorthWestern Mental Health, The Royal Melbourne Hospital, Epping, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| |
Collapse
|
14
|
Ferrari M, Allan S, Arnold C, Eleftheriadis D, Alvarez-Jimenez M, Gumley A, Gleeson JF. Digital Interventions for Psychological Well-Being in University Students: A Systematic Review and Meta-Analysis (Preprint). J Med Internet Res 2022; 24:e39686. [PMID: 36169988 PMCID: PMC9557766 DOI: 10.2196/39686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Life at university provides important opportunities for personal growth; however, this developmental phase also coincides with the peak period of risk for the onset of mental health disorders. In addition, specific university lifestyle factors, including impaired sleep and academic and financial stress, are known to exacerbate psychological distress in students. As a result, university students have been identified as a vulnerable population who often experience significant barriers to accessing psychological treatment. Digital psychological interventions are emerging as a promising solution for this population, but their effectiveness remains unclear. Objective This systematic review and meta-analysis aimed to assess digital interventions targeting psychological well-being among university students. Methods Database searches were conducted on December 2, 2021, via Embase, MEDLINE, PsycINFO, and Web of Science. Results A total of 13 eligible studies were identified, 10 (77%) of which were included in the meta-analysis. Mean pre-post effect sizes indicated that such interventions led to small and significant improvement in psychological well-being (Hedges g=0.32, 95% CI 0.23-0.4; P<.001). These effects remained, albeit smaller, when studies that included a wait-list control group were excluded (Hedges g=0.22, 95% CI 0.08-0.35; P=.002). An analysis of acceptance and commitment therapy approaches revealed small and significant effects (k=6; Hedges g=0.35, 95% CI 0.25-0.45; P<.001). Conclusions Digital psychological interventions hold considerable promise for university students, although features that optimize service delivery and outcomes require further assessment. Trial Registration PROSPERO CRD42020196654; https:/www.crd.york.ac.uk/prospero/display_record.php?RecordID=196654
Collapse
Affiliation(s)
- Madeleine Ferrari
- Healthy Brain and Mind Research Centre, Australian Catholic University, Sydney, Australia
| | - Stephanie Allan
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Chelsea Arnold
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
| | - Dina Eleftheriadis
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, Australia
| | - Andrew Gumley
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John F Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
| |
Collapse
|
15
|
Gardani M, Bradford DRR, Russell K, Allan S, Beattie L, Ellis JG, Akram U. A systematic review and meta-analysis of poor sleep, insomnia symptoms and stress in undergraduate students. Sleep Med Rev 2021; 61:101565. [PMID: 34922108 DOI: 10.1016/j.smrv.2021.101565] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022]
Abstract
University students experience high prevalence of mental health problems and exacerbation of mental health difficulties, including sleep disturbances and stress during their studies. Stress and poor sleep quality and/or insomnia are interlinked outcomes for this population. The aim was to conduct a systematic review, and meta-analyses, of the relationships between sleep quality and/or insomnia with stress in students. Full-text articles of studies exploring the associations of stress with poor sleep quality and/or insomnia in undergraduate students using validated tools and published in peer-reviewed journals were eligible for inclusion. Thirty-four studies, resulting in 37 effect sizes, included and all were suitable for meta-analysis. The weighted pooled effect size between sleep quality and stress was for 0.39 (25 studies, n = 10,065), whereas a slightly higher pooled association of 0.41 was demonstrated for insomnia and stress (12 studies, n = 5564.5). Pooled associations show moderate effects for associations between sleep quality, insomnia and stress in undergraduate students. High heterogeneity in meta-analyses was found, suggesting the findings should be considered cautiously. Future research should focus on longitudinal studies exploring sleep difficulties across the academic year, whilst university services should consider psychoeducation for stress and sleep in university students, especially during transition to university.
Collapse
Affiliation(s)
- Maria Gardani
- School of Health in Social Science, University of Edinburgh, UK.
| | | | - Kirsten Russell
- School of Psychological Sciences and Health, University of Strathclyde, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Louise Beattie
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Jason G Ellis
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, UK
| | - Umair Akram
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, UK
| |
Collapse
|
16
|
Allan S, Mcleod H, Bradstreet S, Bell I, Whitehill H, Wilson-Kay A, Clark A, Matrunola C, Morton E, Farhall J, Gleeson J, Gumley A. Perspectives of Trial Staff on the Barriers to Recruitment in a Digital Intervention for Psychosis and How to Work Around Them: Qualitative Study Within a Trial. JMIR Hum Factors 2021; 8:e24055. [PMID: 33666555 PMCID: PMC7980120 DOI: 10.2196/24055] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background Recruitment processes for clinical trials of digital interventions for psychosis are seldom described in detail in the literature. Although trial staff have expertise in describing barriers to and facilitators of recruitment, a specific focus on understanding recruitment from the point of view of trial staff is rare, and because trial staff are responsible for meeting recruitment targets, a lack of research on their point of view is a key limitation. Objective The primary aim of this study was to understand recruitment from the point of view of trial staff and discover what they consider important. Methods We applied pluralistic ethnographic methods, including analysis of trial documents, observation, and focus groups, and explored the recruitment processes of the EMPOWER (Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-being, Engagement, and Recovery) feasibility trial, which is a digital app–based intervention for people diagnosed with schizophrenia. Results Recruitment barriers were categorized into 2 main themes: service characteristics (lack of time available for mental health staff to support recruitment, staff turnover, patient turnover [within Australia only], management styles of community mental health teams, and physical environment) and clinician expectations (filtering effects and resistance to research participation). Trial staff negotiated these barriers through strategies such as emotional labor (trial staff managing feelings and expressions to successfully recruit participants) and trying to build relationships with clinical staff working within community mental health teams. Conclusions Researchers in clinical trials for digital psychosis interventions face numerous recruitment barriers and do their best to work flexibly and to negotiate these barriers and meet recruitment targets. The recruitment process appeared to be enhanced by trial staff supporting each other throughout the recruitment stage of the trial.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Emma Morton
- University of British Columbia, Vancouver, BC, Canada
| | | | - John Gleeson
- Australian Catholic University, Melbourne, Australia
| | | |
Collapse
|
17
|
Packer L, Allan S, Bradnam S, Jednorog S, Łaszyńska E, Roberts N, Wilson C, Worrall R. Backwards extrapolation activation diagnostics and their dynamic range for pulsed neutron source measurements. Fusion Engineering and Design 2020. [DOI: 10.1016/j.fusengdes.2020.111923] [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: 11/30/2022]
|
18
|
Miltz AR, Rodger AJ, Lepri AC, Sewell J, Nwokolo NC, Allan S, Scott C, Ivens D, Lascar M, Speakman A, Phillips AN, Sherr L, Collins S, Elford J, Lampe FC. Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation. AIDS Behav 2020; 24:1793-1806. [PMID: 31782068 PMCID: PMC7220884 DOI: 10.1007/s10461-019-02724-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013–2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.
Collapse
Affiliation(s)
- A R Miltz
- Institute for Global Health, University College London, London, UK.
| | - A J Rodger
- Institute for Global Health, University College London, London, UK
| | - A Cozzi Lepri
- Institute for Global Health, University College London, London, UK
| | - J Sewell
- Institute for Global Health, University College London, London, UK
| | | | - S Allan
- City of Coventry Healthcare Centre, Coventry, UK
| | - C Scott
- West London Centre for Sexual Health, London, UK
| | - D Ivens
- Royal Free Hospital, London, UK
| | - M Lascar
- Whipps Cross Hospital, London, UK
| | - A Speakman
- Institute for Global Health, University College London, London, UK
| | - A N Phillips
- Institute for Global Health, University College London, London, UK
| | - L Sherr
- Institute for Global Health, University College London, London, UK
| | | | - J Elford
- City, University of London, London, UK
| | - F C Lampe
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
19
|
Ploetner C, Telford M, Braekkan K, Mullen K, Turnbull S, Gumley A, Allan S. Understanding and improving the experience of claiming social security for mental health problems in the west of Scotland: A participatory social welfare study. J Community Psychol 2020; 48:675-692. [PMID: 31730711 DOI: 10.1002/jcop.22278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
A growing body of literature links claimant interactions with the UK social security system and negative psychological consequences. Psychologists for social change developed a framework to outline proposed mechanisms of psychological impact from austerity. This codesigned study aimed to make an informed comment on areas of dis(agreement) between the Austerity Ailments framework and how people claiming for mental health problems describe their own experiences. In line with the participatory social welfare design of the study, qualitative analysis was performed by both claimants and academics. The overall findings indicate that existing framework mostly captured claimant experiences. However, some aspects of the claimant experience (particularly social aspects) were not well captured. Claimants were keen to utilise this study as an opportunity to gather claimant ideas on how to improve the system. Therefore, we report their suggestions that may be useful for those designing and improving social welfare systems.
Collapse
Affiliation(s)
- Caroline Ploetner
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Morgan Telford
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Karina Braekkan
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Kenneth Mullen
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Sue Turnbull
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Andrew Gumley
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephanie Allan
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| |
Collapse
|
20
|
Gumley A, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Beattie L, Bell I, Birchwood M, Briggs A, Bucci S, Castagnini E, Clark A, Cotton SM, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, Matrunola C, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Smith L, Sundram S, Thomson D, Thompson A, Whitehill H, Wilson-Kay A, Williams C, Yung A, Farhall J, Gleeson J. Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-Being, Engagement, and Recovery: Protocol for a Feasibility Cluster Randomized Controlled Trial Harnessing Mobile Phone Technology Blended With Peer Support. JMIR Res Protoc 2020; 9:e15058. [PMID: 31917372 PMCID: PMC6996736 DOI: 10.2196/15058] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022] Open
Abstract
Background Relapse in schizophrenia is a major cause of distress and disability and is predicted by changes in symptoms such as anxiety, depression, and suspiciousness (early warning signs [EWSs]). These can be used as the basis for timely interventions to prevent relapse. However, there is considerable uncertainty regarding the implementation of EWS interventions. Objective This study was designed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) against treatment as usual (TAU). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, safety, and outcome signals of a digital health intervention as an adjunct to usual care that is deliverable in the UK National Health Service and Australian community mental health service (CMHS) settings. We will assess the feasibility of candidate primary outcomes, candidate secondary outcomes, and candidate mechanisms for a definitive trial. Methods We will randomize CMHSs to EMPOWER or TAU. We aim to recruit up to 120 service user participants from 8 CMHSs and follow them for 12 months. Eligible service users will (1) be aged 16 years and above, (2) be in contact with local CMHSs, (3) have either been admitted to a psychiatric inpatient service or received crisis intervention at least once in the previous 2 years for a relapse, and (4) have an International Classification of Diseases-10 diagnosis of a schizophrenia-related disorder. Service users will also be invited to nominate a carer to participate. We will identify the feasibility of the main trial in terms of recruitment and retention to the study and the acceptability, usability, safety, and outcome signals of the EMPOWER intervention. EMPOWER is a mobile phone app that enables the monitoring of well-being and possible EWSs of relapse on a daily basis. An algorithm calculates changes in well-being based on participants’ own baseline to enable tailoring of well-being messaging and clinical triage of possible EWSs. Use of the app is blended with ongoing peer support. Results Recruitment to the trial began September 2018, and follow-up of participants was completed in July 2019. Data collection is continuing. The database was locked in July 2019, followed by analysis and disclosing of group allocation. Conclusions The knowledge gained from the study will inform the design of a definitive trial including finalizing the delivery of our digital health intervention, sample size estimation, methods to ensure successful identification, consent, randomization, and follow-up of participants, and the primary and secondary outcomes. The trial will also inform the final health economic model to be applied in the main trial. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 99559262; http://isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID) DERR1-10.2196/15058
Collapse
Affiliation(s)
- Andrew Gumley
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Simon Bradstreet
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - John Ainsworth
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Stephanie Allan
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Louise Beattie
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Imogen Bell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Max Birchwood
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, United Kingdom
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Emily Castagnini
- La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne, Australia
| | - Andrea Clark
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Research Scotland Mental Health Network, Glasgow, United Kingdom
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | | | - Paul French
- Manchester Metropolitan University, Manchester, United Kingdom
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, Australia
| | - Shon Lewis
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Machin
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Claire Matrunola
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Research Scotland Mental Health Network, Glasgow, United Kingdom
| | - Hamish McLeod
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Nicola McMeekin
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Emma Morton
- Australian Catholic University, Melbourne, Australia
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Frank Reilly
- Scottish Recovery Network, Glasgow, United Kingdom
| | - Matthias Schwannauer
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Swaran P Singh
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, United Kingdom
| | - Lesley Smith
- Scottish Recovery Network, Glasgow, United Kingdom
| | | | - David Thomson
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Division of Mental Health and Wellbeing, University of Warwick, Warwick, United Kingdom
| | - Helen Whitehill
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,Scottish Recovery Network, Glasgow, United Kingdom
| | - Alison Wilson-Kay
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Christopher Williams
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - John Farhall
- La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne, Australia
| | - John Gleeson
- Australian Catholic University, Melbourne, Australia
| |
Collapse
|
21
|
Allan S, Bradstreet S, McLeod HJ, Gleeson J, Farhall J, Lambrou M, Clark A, Gumley AI. Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation. BJPsych Open 2019; 6:e3. [PMID: 31826793 PMCID: PMC7001464 DOI: 10.1192/bjo.2019.88] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Relapse prevention strategies based on monitoring of early warning signs (EWS) are advocated for the management of psychosis. However, there has been a lack of research exploring how staff, carers and patients make sense of the utility of EWS, or how these are implemented in context. AIMS To develop a multiperspective theory of how EWS are understood and used, which is grounded in the experiences of mental health staff, carers and patients. METHOD Twenty-five focus groups were held across Glasgow and Melbourne (EMPOWER Trial, ISRCTN: 99559262). Participants comprised 88 mental health staff, 21 patients and 40 carers from UK and Australia (total n = 149). Data were analysed using constructivist grounded theory. RESULTS All participants appeared to recognise EWS and acknowledged the importance of responding to EWS to support relapse prevention. However, recognition of and acting on EWS were constructed in a context of uncertainty, which appeared linked to risk appraisals that were dependent on distinct stakeholder roles and experiences. Within current relapse management, a process of weighted decision-making (where one factor was seen as more important than others) described how stakeholders weighed up the risks and consequences of relapse alongside the risks and consequences of intervention and help-seeking. CONCLUSIONS Mental health staff, carers and patients speak about using EWS within a weighted decision-making process, which is acted out in the context of relationships that exist in current relapse management, rather than an objective response to specific signs and symptoms.
Collapse
Affiliation(s)
- Stephanie Allan
- Student, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Simon Bradstreet
- Trial Manager, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Hamish J McLeod
- Professor, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - John Gleeson
- Professor, Australian Catholic University, Australia
| | - John Farhall
- Associate Professor, La Trobe University, Australia
| | - Maria Lambrou
- Research Assistant, Australian Catholic University, Australia
| | - Andrea Clark
- Research Assistant, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Andrew I Gumley
- Professor, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| |
Collapse
|
22
|
Allan S, Mcleod H, Bradstreet S, Beedie S, Moir B, Gleeson J, Farhall J, Morton E, Gumley A. Understanding Implementation of a Digital Self-Monitoring Intervention for Relapse Prevention in Psychosis: Protocol for a Mixed Method Process Evaluation. JMIR Res Protoc 2019; 8:e15634. [PMID: 31821154 PMCID: PMC6930509 DOI: 10.2196/15634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
Background Relapse is common in people who experience psychosis and is associated with many negative consequences, both societal and personal. People who relapse often exhibit changes (early warning signs [EWS]) in the period before relapse. Successful identification of EWS offers an opportunity for relapse prevention. However, several known barriers impede the use of EWS monitoring approaches. Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) is a complex digital intervention that uses a mobile app to enhance the detection and management of self-reported changes in well-being. This is currently being tested in a pilot cluster randomized controlled trial. As digital interventions have not been widely used in relapse prevention, little is known about their implementation. Process evaluation studies run in parallel to clinical trials can provide valuable data on intervention feasibility. Objective This study aims to transparently describe the protocol for the process evaluation element of the EMPOWER trial. We will focus on the development of a process evaluation framework sensitive to the worldview of service users, mental health staff, and carers; the aims of the process evaluation itself; the proposed studies to address these aims; and a plan for integration of results from separate process evaluation studies into one overall report. Methods The overall process evaluation will utilize mixed methods across 6 substudies. Among them, 4 will use qualitative methodologies, 1 will use a mixed methods approach, and 1 will use quantitative methodologies. Results The results of all studies will be triangulated into an overall analysis and interpretation of key implementation lessons. EMPOWER was funded in 2016, recruitment finished in January 2018. Data analysis is currently under way and the first results are expected to be submitted for publication in December 2019. Conclusions The findings from this study will help identify implementation facilitators and barriers to EMPOWER. These insights will inform both upscaling decisions and optimization of a definitive trial. Trial Registration ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID) DERR1-10.2196/15634
Collapse
Affiliation(s)
- Stephanie Allan
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Hamish Mcleod
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Simon Bradstreet
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sara Beedie
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Bethany Moir
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Emma Morton
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Andrew Gumley
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
23
|
Fortuna KL, Walker R, Fisher DB, Mois G, Allan S, Deegan PE. Enhancing Standards and Principles in Digital Mental Health With Recovery-Focused Guidelines for Mobile, Online, and Remote Monitoring Technologies. Psychiatr Serv 2019; 70:1080-1081. [PMID: 31615369 PMCID: PMC6889023 DOI: 10.1176/appi.ps.201900166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Karen L Fortuna
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Concord, New Hampshire (Fortuna); Massachusetts Department of Mental Health, Boston (Walker); National Coalition for Mental Health Recovery, Boston (Fisher); University of Georgia School of Social Work, Athens (Mois); Glasgow Mental Health Research Facility, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (Allan); Pat Deegan and Associates, Byfield, Massachusetts (Deegan)
| | - Robert Walker
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Concord, New Hampshire (Fortuna); Massachusetts Department of Mental Health, Boston (Walker); National Coalition for Mental Health Recovery, Boston (Fisher); University of Georgia School of Social Work, Athens (Mois); Glasgow Mental Health Research Facility, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (Allan); Pat Deegan and Associates, Byfield, Massachusetts (Deegan)
| | - Daniel B Fisher
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Concord, New Hampshire (Fortuna); Massachusetts Department of Mental Health, Boston (Walker); National Coalition for Mental Health Recovery, Boston (Fisher); University of Georgia School of Social Work, Athens (Mois); Glasgow Mental Health Research Facility, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (Allan); Pat Deegan and Associates, Byfield, Massachusetts (Deegan)
| | - George Mois
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Concord, New Hampshire (Fortuna); Massachusetts Department of Mental Health, Boston (Walker); National Coalition for Mental Health Recovery, Boston (Fisher); University of Georgia School of Social Work, Athens (Mois); Glasgow Mental Health Research Facility, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (Allan); Pat Deegan and Associates, Byfield, Massachusetts (Deegan)
| | - Stephanie Allan
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Concord, New Hampshire (Fortuna); Massachusetts Department of Mental Health, Boston (Walker); National Coalition for Mental Health Recovery, Boston (Fisher); University of Georgia School of Social Work, Athens (Mois); Glasgow Mental Health Research Facility, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (Allan); Pat Deegan and Associates, Byfield, Massachusetts (Deegan)
| | - Patricia E Deegan
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Concord, New Hampshire (Fortuna); Massachusetts Department of Mental Health, Boston (Walker); National Coalition for Mental Health Recovery, Boston (Fisher); University of Georgia School of Social Work, Athens (Mois); Glasgow Mental Health Research Facility, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (Allan); Pat Deegan and Associates, Byfield, Massachusetts (Deegan)
| |
Collapse
|
24
|
Allan S, Bradstreet S, Mcleod H, Farhall J, Lambrou M, Gleeson J, Clark A, Gumley A. Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study. J Med Internet Res 2019; 21:e14366. [PMID: 31651400 PMCID: PMC6838692 DOI: 10.2196/14366] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 04/12/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker–supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation—both within trials and beyond. Objective Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders’ expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders’ previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262
Collapse
Affiliation(s)
- Stephanie Allan
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Simon Bradstreet
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Hamish Mcleod
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Maria Lambrou
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Andrea Clark
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | -
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Gumley
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
25
|
Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 680] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
26
|
Bradstreet S, Allan S, Gumley A. Adverse event monitoring in mHealth for psychosis interventions provides an important opportunity for learning. J Ment Health 2019; 28:461-466. [PMID: 31240970 DOI: 10.1080/09638237.2019.1630727] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| |
Collapse
|
27
|
Tam LL, Mcguigan B, Connor A, Allan S, Sanmugarajah J. Abstract P1-13-06: Exploring the real-life incidence of toxicities amongst obese breast cancer patients receiving adjuvant chemotherapy dosed based on absolute body weight. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-13-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Obesity is an established risk factor for developing breast cancer and is also a negative prognostic indicator for higher recurrence risk.1 Adjuvant chemotherapy reduces the likelihood of metastatic recurrence and improves disease-free and overall survival.2 However, the practice of optimal dosing of adjuvant breast cancer chemotherapy amongst obese patients remains contentious with concerns regarding excessive toxicity if obese patients are dosed based on actual body weight (ABW).2-4 A 2014 study reported that obese patients were five times more likely to have dose reductions in cycle 1 than non-obese patients.5 Inadequate dosing amongst obese breast cancer patients may have deleterious implications on ultimate prognosis.2-4 This study aimed to investigate whether chemotherapy dosing using ABW in obese breast cancer patients is associated with comparable incidences of toxicity.
Methods:
A retrospective cross-sectional study was conducted amongst 257 patients (aged ≥18) treated in the adjuvant setting with doxorubicin-cyclophosphamide-paclitaxel (AC-P) or docetaxel-cyclophosphamide (TC) with/without trastuzumab between 2014 and 2017. Obesity was classified as a body mass index (BMI) of ≥30, with morbid obesity defined as a BMI≥35. Chemotherapy dosing based on body surface area calculated using ABW was considered the standard protocol with any variations from this dosing method for cycle 1 being recorded. Subsequent dose adjustments were also noted. The primary outcome was tolerability of chemotherapy regimens dosed using ABW with outcome measures of toxicity defined as the incidence of febrile neutropaenia, the incidence of grade 3 or 4 non-haematological toxicities and the number of hospitalisations during the treatment course.
Results:
257 patients were eligible (1 male, 256 females). Median age was 55 (range, 31-78). AC-P was the most commonly used regimen (48.6%), followed by TC (40.1%). Obesity and morbid obesity were noted amongst 17.9% and 15.6% of patients respectively; with 63.8% with a BMI≥25. Chemotherapy dosing was largely based on ABW, with only 4.3% of patients dosed based on ABW or had their dosing body surface area capped at 2.0m2. In patients with a BMI≥25, 25% had febrile neutropaenia compared to 21.8% in those with normal BMI (p=0.58). Incidence of febrile neutropaenia during treatment by BMI – underweight: 33.3% (p=0.61); normal: 24.1%; overweight: 24.4% (p=0.97); obese: 17.4% (p=0.37); morbidly obese: 25%(p=0.92). Grade 3-4 non-haematological toxicities had comparable incidences between the normal BMI group as opposed to the overweight/obese group (23.0% vs 18.9% respectively, p=0.44). Hospitalisations by BMI - underweight: 50% (p=0.85); normal BMI: 46%; overweight: 42.3% (p=0.64); obese: 54.3%(p=0.36); morbidly obese: 57.5%(p=0.23).
Conclusion:
This study demonstrates that obese breast cancer patients do not experience higher toxicities when their adjuvant chemotherapy is dosed based on ABW. This supports current guidelines for dosing amongst obese patients.
Citation Format: Tam LL, Mcguigan B, Connor A, Allan S, Sanmugarajah J. Exploring the real-life incidence of toxicities amongst obese breast cancer patients receiving adjuvant chemotherapy dosed based on absolute body weight [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-13-06.
Collapse
Affiliation(s)
- LL Tam
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - B Mcguigan
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - A Connor
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - S Allan
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - J Sanmugarajah
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| |
Collapse
|
28
|
Sommer W, OJ M, Pruner B, Paster T, Bean A, Dehnadi A, Hanekamp M, Rosales I, Smith N, Colvin R, Benichou G, Allan S, Kawai T, Madsen C. Donor Brain Death Affects Tolerance Induction in Nonhuman Primates. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- W. Sommer
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
- Department for Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - M. OJ
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| | - B. Pruner
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| | - T. Paster
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| | - A. Bean
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| | - A. Dehnadi
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| | - M. Hanekamp
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| | - I. Rosales
- Department of Pathology, Massachusetts General Hospital, Harvard University, Boston, United States
| | - N. Smith
- Department of Pathology, Massachusetts General Hospital, Harvard University, Boston, United States
| | - R.B. Colvin
- Department of Pathology, Massachusetts General Hospital, Harvard University, Boston, United States
| | - G. Benichou
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| | - S. Allan
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| | - T. Kawai
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| | - C. Madsen
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard University, Boston, United States
| |
Collapse
|
29
|
Thurston MD, Allan S. Sexuality and sexual experiences during gender transition: A thematic synthesis. Clin Psychol Rev 2018; 66:39-50. [PMID: 30477689 DOI: 10.1016/j.cpr.2017.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/19/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
AIM To establish what impact, if any, the gender-affirmation process, has on sexuality and sexual experiences. INTRODUCTION Sexuality is a multi-faceted construct that influences our attraction to others. Gender transition is the process of aligning our physical sex characteristics with our psychological gender. Our sexuality and our gender identity are often mistakenly assumed to be inextricably linked. It is important to consider and understand the influence of the gender-affirmation process on sexuality and sexual experiences. METHOD A thematic synthesis of the available qualitative literature regarding sexuality, and sexual experiences in both transgender people and their partners were appraised, and synthesised. Thomas and Harden's (2008) stepwise process for conducting a thematic synthesis was followed. RESULTS A total of seven articles were of relevance and included in the review. Two analytical and six sub-themes were found. The two analytical themes are: 'Re-negotiating previous 'norms" and 'Establishing identity'. CONCLUSION During the gender-affirmation process, sexuality, and sexual experiences alter. This has clinical implications for transgender people and their partners, in particular, valuable therapeutic discussion points that need to be considered during the gender-affirmation process.
Collapse
Affiliation(s)
- M D Thurston
- Department of Clinical Psychology, Derby Children's Hospital, Royal Derby Hospital, Uttoxeter Road, Derby, Derbyshire DE22 3NE, United Kingdom; Clinical Psychology, University of Leicester, Centre for Medicine, Leicester, Leicestershire LE1 7HA, United Kingdom.
| | - S Allan
- Clinical Psychology, University of Leicester, Centre for Medicine, Leicester, Leicestershire LE1 7HA, United Kingdom
| |
Collapse
|
30
|
Affiliation(s)
- Charles Heriot-Maitland
- Glasgow Mental Health Research Facility, University of Glasgow, Institute of Health and Wellbeing, Glasgow G20 0XA, UK.
| | - Stephanie Allan
- Glasgow Mental Health Research Facility, University of Glasgow, Institute of Health and Wellbeing, Glasgow G20 0XA, UK
| | - Simon Bradstreet
- Glasgow Mental Health Research Facility, University of Glasgow, Institute of Health and Wellbeing, Glasgow G20 0XA, UK
| | - Andrew Gumley
- Glasgow Mental Health Research Facility, University of Glasgow, Institute of Health and Wellbeing, Glasgow G20 0XA, UK
| |
Collapse
|
31
|
Dawson L, Allan S, Brough D, Ritchie J, Weber P, Wren S. Targeting the immune system in disease. Highlights from the Society for Medicines Research meeting. Manchester, UK - March 8, 2018. DRUG FUTURE 2018. [DOI: 10.1358/dof.2018.043.04.2808577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
32
|
Hassan AS, Hare J, Kamini G, Yindom LM, Kamali A, Karita E, Kilemba W, Price MA, Borrow P, Bjorkman P, Albert J, Kaleebu P, Allan S, Fast P, Hunter E, Gilmour J, Ndung'u T, Rowland-Jones S, Sanders EJ, Esbjornsson J. A35 Viral evolution and innate immune responses during acute HIV-1 infection and their association with disease pathogenesis. Virus Evol 2017; 3:vew036.034. [PMID: 28845248 PMCID: PMC5565927 DOI: 10.1093/ve/vew036.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A S Hassan
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - J Hare
- IAVI Human Immunology Laboratory, Lomndon, UK
| | - G Kamini
- Kwazulu-Natal Research Institute for Tuberculosis and HIV, Durban, South Africa
| | - L M Yindom
- Nuffield Department of Medicine, University of Oxford, UK
| | - A Kamali
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda
| | - E Karita
- Rwanda and Lusaka, Rwanda/Zambia HIV Research Group (RZHRG) Kigali, Zambia
| | - W Kilemba
- Rwanda and Lusaka, Rwanda/Zambia HIV Research Group (RZHRG) Kigali, Zambia
| | | | - P Borrow
- Nuffield Department of Medicine, University of Oxford, UK
| | - P Bjorkman
- Department of laboratory medicine, Lund University, Sweden
| | - J Albert
- Department of Microbiology Tumor and Cell Biology, Karolinska Institute, Sweden
| | - P Kaleebu
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda
| | - S Allan
- Rwanda and Lusaka, Rwanda/Zambia HIV Research Group (RZHRG) Kigali, Zambia
| | | | - E Hunter
- Rwanda and Lusaka, Rwanda/Zambia HIV Research Group (RZHRG) Kigali, Zambia
| | - J Gilmour
- IAVI Human Immunology Laboratory, Lomndon, UK
| | - T Ndung'u
- Kwazulu-Natal Research Institute for Tuberculosis and HIV, Durban, South Africa
| | | | - E J Sanders
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - J Esbjornsson
- Nuffield Department of Medicine, University of Oxford, UK
| |
Collapse
|
33
|
Affiliation(s)
- Stephanie Allan
- Institute of Health & Wellbeing, University of Glasgow, Glasgow G12 8QQ, Scotland
| |
Collapse
|
34
|
Sanmugarajah J, Allan S, Bagchi R, Laakso EL. Abstract P5-12-02: Can a supervised exercise program compared to usual care prevent aromatase inhibitor-induced musculoskeletal pain in women with breast cancer? Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-12-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Aromatase Inhibitors (AIs) are commonly prescribed as hormone therapy for post-menopausal women with estrogen receptor-positive breast cancer. A number of authors have reported AI side effects that include increased risk for developing osteoporosis, joint pain, weight gain and depression. For example, 30-40% of post-menopausal women treated with AIs experience mild to severe joint pain. Although the exact causes of AI-induced joint pain are unknown, the side-effects are most likely due to low estrogen levels in the body. . Denysschen et al. (2014) reported a significantly lower number of painful joints, reduced depressive symptoms, increased muscle strength, and improvement in quality of life in patients with AI-induced joint pain after an 8 week upper and lower body resistance exercise program. Objective: To investigate whether a supervised exercise program could reduce or prevent musculoskeletal pain in patients with breast cancer undergoing AI therapy. Methods: Twenty participants with breast cancer have thus far been randomised to either: (a) usual care and advice regarding benefits of regular exercise; or (b) usual care + 12 week supervised and home-based exercise program consisting of upper and lower body resistance exercises with self-selected aerobic exercises. Participants accrued 150 mins / week of moderate intensity aerobic exercise at 60-70% HRmax on 5 or more days of each week including 2 supervised sessions / week. Initial exercise intensity is individualized and generally begins at 55% to 60% of HRmax (15 to 30 minutes per session) and progresses to 60% - 70% of HRmax by week 6. Strength training consisted of 2 supervised sessions per week, of two sets of 10 to 12 repetitions of eight different strength exercises at 60% to 75% of estimated one repetition maximum. On at least 3 other days, using the same dosing principles participants executed 4 lower and 4 upper body resistance exercises at home using resistance bands. The primary outcome measures were pain (brief pain inventory; BPI) scores and grip strength (JAMAR dynamometer (kg)) measured at baseline, 3, 6 and 12 months. Two-way repeated ANOVAs were undertaken to evaluate differences between groups and factors. Results: Mean pain scores across 12 months were largely maintained (p>0.05) for participants undertaking the exercise program compared to control participants whose mean BPI scores progressively increased from baseline through to 12 month follow-up. In the exercise group, mean pain scores increased by one BPI unit between baseline and 12 month follow-up. In the control group, mean pain scores increased by five BPI units between baseline and 12 month follow-up. A clinically significant difference in BPI scores is a change of two or more BPI units (Mease et al, 2011). Grip strength measures were significantly different (P<0.001) between groups at each time point with a trend towards improved grip strength between baseline and 6 months in the exercise group. Grip strength decreased in both groups between 6 and 12 months. Conclusion: By managing physical performance and pain as side effects of AIs, a 12 week supervised exercise program may contribute to preventing non-adherence with or withdrawal from AI therapy.
Citation Format: Sanmugarajah J, Allan S, Bagchi R, Laakso E-L. Can a supervised exercise program compared to usual care prevent aromatase inhibitor-induced musculoskeletal pain in women with breast cancer? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-12-02.
Collapse
Affiliation(s)
- J Sanmugarajah
- Gold Coast University Hospital, Gold Coast, Queensland, Australia; Menzies Health Institute/Griffith University, Gold Coast, Queensland, Australia
| | - S Allan
- Gold Coast University Hospital, Gold Coast, Queensland, Australia; Menzies Health Institute/Griffith University, Gold Coast, Queensland, Australia
| | - R Bagchi
- Gold Coast University Hospital, Gold Coast, Queensland, Australia; Menzies Health Institute/Griffith University, Gold Coast, Queensland, Australia
| | - E-L Laakso
- Gold Coast University Hospital, Gold Coast, Queensland, Australia; Menzies Health Institute/Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
35
|
Quilty L, Yiu Y, Shamsi H, Fredericks B, Premachandiran P, Allan S, Bagby R, Pollock B. The Faces of Impulsivity: A Five Factor Model Framework. Personality and Individual Differences 2016. [DOI: 10.1016/j.paid.2016.05.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
36
|
Bouyoucef SE, Uusitalo V, Kamperidis V, De Graaf M, Maaniitty T, Stenstrom I, Broersen A, Scholte A, Saraste A, Bax J, Knuuti J, Furuhashi T, Moroi M, Awaya T, Masai H, Minakawa M, Kunimasa T, Fukuda H, Sugi K, Berezin A, Kremzer A, Clerc O, Kaufmann B, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Kaufmann P, Buechel R, Ferreira M, Cunha M, Albuquerque A, Ramos D, Costa G, Lima J, Pego M, Peix A, Cisneros L, Cabrera L, Padron K, Rodriguez L, Heres F, Carrillo R, Mena E, Fernandez Y, Huizing E, Van Dijk J, Van Dalen J, Timmer J, Ottervanger J, Slump C, Jager P, Venuraju S, Jeevarethinam A, Yerramasu A, Atwal S, Mehta V, Lahiri A, Arjonilla Lopez A, Calero Rueda MJ, Gallardo G, Fernandez-Cuadrado J, Hernandez Aceituno D, Sanchez Hernandez J, Yoshida H, Mizukami A, Matsumura A, Smettei O, Abazid R, Sayed S, Mlynarska A, Mlynarski R, Golba K, Sosnowski M, Winther S, Svensson M, Jorgensen H, Bouchelouche K, Gormsen L, Holm N, Botker H, Ivarsen P, Bottcher M, Cortes CM, Aramayo G E, Daicz M, Casuscelli J, Alaguibe E, Neira Sepulveda A, Cerda M, Ganum G, Embon M, Vigne J, Enilorac B, Lebasnier A, Valancogne L, Peyronnet D, Manrique A, Agostini D, Menendez D, Rajpal S, Kocherla C, Acharya M, Reddy P, Sazonova I, Ilushenkova Y, Batalov R, Rogovskaya Y, Lishmanov Y, Popov S, Varlamova N, Prado Diaz S, Jimenez Rubio C, Gemma D, Refoyo Salicio E, Valbuena Lopez S, Moreno Yanguela M, Torres M, Fernandez-Velilla M, Lopez-Sendon J, Guzman Martinez G, Puente A, Rosales S, Martinez C, Cabada M, Melendez G, Ferreira R, Gonzaga A, Santos J, Vijayan S, Smith S, Smith M, Muthusamy R, Takeishi Y, Oikawa M, Goral JL, Napoli J, Montana O, Damico A, Quiroz M, Damico A, Forcada P, Schmidberg J, Zucchiatti N, Olivieri D, Jeevarethinam A, Venuraju S, Dumo A, Ruano S, Rakhit R, Davar J, Nair D, Cohen M, Darko D, Lahiri A, Yokota S, Ottervanger J, Maas A, Mouden M, Timmer J, Knollema S, Jager P, Sanja Mazic S, Lazovic B, Marina Djelic M, Jelena Suzic Lazic J, Tijana Acimovic T, Milica Deleva M, Vesnina Z, Zafrir N, Bental T, Mats I, Solodky A, Gutstein A, Hasid Y, Belzer D, Kornowski R, Ben Said R, Ben Mansour N, Ibn Haj Amor H, Chourabi C, Hagui A, Fehri W, Hawala H, Shugushev Z, Patrikeev A, Maximkin D, Chepurnoy A, Kallianpur V, Mambetov A, Dokshokov G, Teresinska A, Wozniak O, Maciag A, Wnuk J, Dabrowski A, Czerwiec A, Jezierski J, Biernacka K, Robinson J, Prosser J, Cheung G, Allan S, Mcmaster G, Reid S, Tarbuck A, Martin W, Queiroz R, Falcao A, Giorgi M, Imada R, Nogueira S, Chalela W, Kalil Filho R, Meneghetti W, Matveev V, Bubyenov A, Podzolkov V, Shugushev Z, Maximkin D, Chepurnoy A, Baranovich V, Faibushevich A, Kolzhecova Y, Volkova O, Kallianpur V, Peix A, Cabrera L, Padron K, Rodriguez L, Fernandez J, Lopez G, Mena E, Fernandez Y, Dondi M, Paez D, Butcher C, Reyes E, Al-Housni M, Green R, Santiago H, Ghiotto F, Hinton-Taylor S, Pottle A, Mason M, Underwood S, Casans Tormo I, Diaz-Exposito R, Plancha-Burguera E, Elsaban K, Alsakhri H, Yoshinaga K, Ochi N, Tomiyama Y, Katoh C, Inoue M, Nishida M, Suzuki E, Manabe O, Ito Y, Tamaki N, Tahilyani A, Jafary F, Ho Hee Hwa H, Ozdemir S, Kirilmaz B, Barutcu A, Tan Y, Celik F, Sakgoz S, Cabada Gamboa M, Puente Barragan A, Morales Vitorino N, Medina Servin M, Hindorf C, Akil S, Hedeer F, Jogi J, Engblom H, Martire V, Pis Diez E, Martire M, Portillo D, Hoff C, Balche A, Majgaard J, Tolbod L, Harms H, Bouchelouche K, Soerensen J, Froekiaer J, Gormsen L, Nudi F, Neri G, Procaccini E, Pinto A, Vetere M, Biondi-Zoccai G, Falcao A, Chalela W, Giorgi M, Imada R, Soares J, Do Val R, Oliveira M, Kalil Filho R, Meneghetti J, Tekabe Y, Anthony T, Li Q, Schmidt A, Johnson L, Groenman M, Tarkia M, Kakela M, Halonen P, Kiviniemi T, Pietila M, Yla-Herttuala S, Knuuti J, Roivainen A, Saraste A, Nekolla S, Swirzek S, Higuchi T, Reder S, Schachoff S, Bschorner M, Laitinen I, Robinson S, Yousefi B, Schwaiger M, Kero T, Lindsjo L, Antoni G, Westermark P, Carlson K, Wikstrom G, Sorensen J, Lubberink M, Rouzet F, Cognet T, Guedj K, Morvan M, El Shoukr F, Louedec L, Choqueux C, Nicoletti A, Le Guludec D, Jimenez-Heffernan A, Munoz-Beamud F, Sanchez De Mora E, Borrachero C, Salgado C, Ramos-Font C, Lopez-Martin J, Hidalgo M, Lopez-Aguilar R, Soriano E, Okizaki A, Nakayama M, Ishitoya S, Sato J, Takahashi K, Burchert I, Caobelli F, Wollenweber T, Nierada M, Fulsche J, Dieckmann C, Bengel F, Shuaib S, Mahlum D, Port S, Gemma D, Refoyo E, Cuesta E, Guzman G, Lopez T, Valbuena S, Fernandez-Velilla M, Del Prado S, Moreno M, Lopez-Sendon J, Harbinson M, Donnelly L, Einstein AJ, Johnson LL, Deluca AJ, Kontak AC, Groves DW, Stant J, Pozniakoff T, Cheng B, Rabbani LE, Bokhari S, Caobelli F, Schuetze C, Nierada M, Fulsche J, Dieckmann C, Bengel F, Aguade-Bruix S, Pizzi M, Romero-Farina G, Terricabras M, Villasboas D, Castell-Conesa J, Candell-Riera J, Brunner S, Gross L, Todica A, Lehner S, Di Palo A, Niccoli Asabella A, Magarelli C, Notaristefano A, Ferrari C, Rubini G, Sellem A, Melki S, Elajmi W, Hammami H, Ziadi M, Montero J, Ameriso J, Villavicencio R, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Barinaga Martin C, Martin Fernandez J, Alonso Rodriguez D, Iglesias Garriz I, Gemma D, Refoyo E, Cuesta E, Guzman G, Valbuena S, Rosillo S, Del Prado S, Torres M, Moreno M, Lopez-Sendon J, Taleb S, Cherkaoui Salhi G, Regbaoui Y, Ait Idir M, Guensi A, Puente A, Rosales S, Martinez C, Cabada M, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Martin Lopez CE, Castano Ruiz M, Martin Fernandez J, Iglesias Garriz I. Poster Session 2: Monday 4 May 2015, 08:00-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
37
|
Walkden NR, Adamek J, Allan S, Dudson BD, Elmore S, Fishpool G, Harrison J, Kirk A, Komm M. Profile measurements in the plasma edge of mega amp spherical tokamak using a ball pen probe. Rev Sci Instrum 2015; 86:023510. [PMID: 25725845 DOI: 10.1063/1.4908572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The ball pen probe (BPP) technique is used successfully to make profile measurements of plasma potential, electron temperature, and radial electric field on the Mega Amp Spherical Tokamak. The potential profile measured by the BPP is shown to significantly differ from the floating potential both in polarity and profile shape. By combining the BPP potential and the floating potential, the electron temperature can be measured, which is compared with the Thomson scattering (TS) diagnostic. Excellent agreement between the two diagnostics is obtained when secondary electron emission is accounted for in the floating potential. From the BPP profile, an estimate of the radial electric field is extracted which is shown to be of the order ∼1 kV/m and increases with plasma current. Corrections to the BPP measurement, constrained by the TS comparison, introduce uncertainty into the ER measurements. The uncertainty is most significant in the electric field well inside the separatrix. The electric field is used to estimate toroidal and poloidal rotation velocities from E × B motion. This paper further demonstrates the ability of the ball pen probe to make valuable and important measurements in the boundary plasma of a tokamak.
Collapse
Affiliation(s)
- N R Walkden
- CCFE, Culham Science Centre, Abingdon,Oxon OX14 3DB, United Kingdom
| | - J Adamek
- Institute of Plasma Physics of AS CR, v. v. i., Za Slovankou 3, 182 00 Praha 8, Czech Republic
| | - S Allan
- CCFE, Culham Science Centre, Abingdon,Oxon OX14 3DB, United Kingdom
| | - B D Dudson
- Department of Physics, York Plasma Institute, University of York, Heslington, York YO10 5DD, United Kingdom
| | - S Elmore
- CCFE, Culham Science Centre, Abingdon,Oxon OX14 3DB, United Kingdom
| | - G Fishpool
- CCFE, Culham Science Centre, Abingdon,Oxon OX14 3DB, United Kingdom
| | - J Harrison
- CCFE, Culham Science Centre, Abingdon,Oxon OX14 3DB, United Kingdom
| | - A Kirk
- CCFE, Culham Science Centre, Abingdon,Oxon OX14 3DB, United Kingdom
| | - M Komm
- Institute of Plasma Physics of AS CR, v. v. i., Za Slovankou 3, 182 00 Praha 8, Czech Republic
| |
Collapse
|
38
|
Krüsi A, Pacey K, Bird L, Taylor C, Chettiar J, Allan S, Bennett D, Montaner JS, Kerr T, Shannon K. Criminalisation of clients: reproducing vulnerabilities for violence and poor health among street-based sex workers in Canada-a qualitative study. BMJ Open 2014; 4:e005191. [PMID: 24889853 PMCID: PMC4054637 DOI: 10.1136/bmjopen-2014-005191] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To explore how criminalisation and policing of sex buyers (clients) rather than sex workers shapes sex workers' working conditions and sexual transactions including risk of violence and HIV/sexually transmitted infections (STIs). DESIGN Qualitative and ethnographic study triangulated with sex work-related violence prevalence data and publicly available police statistics. SETTING Vancouver, Canada, provides a unique opportunity to evaluate the impact of policies that criminalise clients as the local police department adopted a sex work enforcement policy in January 2013 that prioritises sex workers' safety over arrest, while continuing to target clients. PARTICIPANTS 26 cisgender and 5 transgender women who were street-based sex workers (n=31) participated in semistructured interviews about their working conditions. All had exchanged sex for money in the previous 30 days in Vancouver. OUTCOME MEASURES Thematic analysis of interview transcripts and ethnographic field notes focused on how police enforcement of clients shaped sex workers' working conditions and sexual transactions, including risk of violence and HIV/STIs, over an 11-month period postpolicy implementation (January-November 2013). RESULTS Sex workers' narratives and ethnographic observations indicated that while police sustained a high level of visibility, they eased charging or arresting sex workers and showed increased concern for their safety. However, participants' accounts and police statistics indicated continued police enforcement of clients. This profoundly impacted the safety strategies sex workers employed. Sex workers continued to mistrust police, had to rush screening clients and were displaced to outlying areas with increased risks of violence, including being forced to engage in unprotected sex. CONCLUSIONS These findings suggest that criminalisation and policing strategies that target clients reproduce the harms created by the criminalisation of sex work, in particular, vulnerability to violence and HIV/STIs. The current findings support decriminalisation of sex work to ensure work conditions that support the health and safety of sex workers in Canada and globally.
Collapse
Affiliation(s)
- A Krüsi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - K Pacey
- Pivot Legal Society, Vancouver, British Columbia, Canada
| | - L Bird
- Sex Workers United Against Violence, Vancouver, British Columbia, Canada
| | - C Taylor
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - J Chettiar
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Sex Workers United Against Violence, Vancouver, British Columbia, Canada
| | - S Allan
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - D Bennett
- Pivot Legal Society, Vancouver, British Columbia, Canada
| | - J S Montaner
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Kerr
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia
| | - K Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
39
|
Oppenheim DE, Spreafico R, Etuk A, Malone D, Amofah E, Peña-Murillo C, Murray T, McLaughlin L, Choi BS, Allan S, Belousov A, Passioukov A, Gerdes C, Umaña P, Farzaneh F, Ross P. Glyco-engineered anti-EGFR mAb elicits ADCC by NK cells from colorectal cancer patients irrespective of chemotherapy. Br J Cancer 2014; 110:1221-7. [PMID: 24496456 PMCID: PMC3950873 DOI: 10.1038/bjc.2014.35] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/23/2013] [Accepted: 01/07/2014] [Indexed: 12/18/2022] Open
Abstract
Background: The epidermal growth factor receptor (EGFR) is overexpressed in colorectal cancer (CRC), and is correlated with poor prognosis, making it an attractive target for monoclonal antibody (mAb) therapy. A component of the therapeutic efficacy of IgG1 mAbs is their stimulation of antibody-dependent cellular cytotoxicity (ADCC) by natural killer (NK) cells bearing the CD16 receptor. As NK cells are functionally impaired in cancer patients and may be further compromised upon chemotherapy, it is crucial to assess whether immunotherapeutic strategies aimed at further enhancing ADCC are viable. Methods: CRC patients before, during and after chemotherapy were immunophenotyped by flow cytometry for major white blood cell populations. ADCC-independent NK cell functionality was assessed in cytotoxicity assays against K562 cells. ADCC-dependent killing of EGFR+ A431 cancer cells by NK cells was measured with a degranulation assay where ADCC was induced by GA201, an anti-EGFR mAb glyco-engineered to enhance ADCC. Results: Here, we confirm the observation that NK cells in cancer patients are dysfunctional. However, GA201 was able to induce robust NK cell-dependent cytotoxicity in CRC patient NK cells, effectively overcoming their impairment. Conclusions: These findings support the evaluation of the therapeutic potential of GA201 in combination with chemotherapy in CRC patients.
Collapse
Affiliation(s)
- D E Oppenheim
- 1] Comprehensive Biomedical Research Centre, King's College London, King's Health Partners, London, UK [2] Experimental Cancer Medicine Centre, King's College London, King's Health Partners, London, UK [3] Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - R Spreafico
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - A Etuk
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - D Malone
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - E Amofah
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - C Peña-Murillo
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - T Murray
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - L McLaughlin
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - B S Choi
- Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - S Allan
- Department of Medical Oncology, Guy's and St Thomas' Hospital, King's College London School of Medicine, King's Health Partners, 4th Floor Thomas Guy House, Guy's Hospital, St Thomas Street, London SE1 9RT, UK
| | - A Belousov
- Roche Diagnostics GmbH, Nonnenwald 2, Penzberg 82377, Germany
| | - A Passioukov
- Roche Glycart AG, Wagistrasse 18, Schlieren 8952, Switzerland
| | - C Gerdes
- Roche Glycart AG, Wagistrasse 18, Schlieren 8952, Switzerland
| | - P Umaña
- Roche Glycart AG, Wagistrasse 18, Schlieren 8952, Switzerland
| | - F Farzaneh
- 1] Comprehensive Biomedical Research Centre, King's College London, King's Health Partners, London, UK [2] Experimental Cancer Medicine Centre, King's College London, King's Health Partners, London, UK [3] Department of Haematological Medicine, King's College London School of Medicine, King's Health Partners, 123 Coldharbour Lane, London SE5 9NU, UK
| | - P Ross
- 1] Comprehensive Biomedical Research Centre, King's College London, King's Health Partners, London, UK [2] Experimental Cancer Medicine Centre, King's College London, King's Health Partners, London, UK [3] Department of Medical Oncology, Guy's and St Thomas' Hospital, King's College London School of Medicine, King's Health Partners, 4th Floor Thomas Guy House, Guy's Hospital, St Thomas Street, London SE1 9RT, UK
| |
Collapse
|
40
|
Sharp SR, Allan S. P129 Improving clinical standards in GU medicine: a retrospective audit of Neisseria gonorrhoeae:. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
41
|
Sharp SR, Allan S. P130 Antibiotic resistance profiles of Neisseria gonorrhoeae(GC): a comparison of data 2007–2011: Abstract P130 Table1. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
42
|
Giles J, Greenhalgh A, Denes A, Thornton P, Rothwell N, McColl B, Allan S. 48 Endovascular inflammation may occur via tissue-specific mechanisms. Heart 2011. [DOI: 10.1136/heartjnl-2011-300920b.48] [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]
|
43
|
Müller GC, Junnila A, Qualls W, Revay EE, Kline DL, Allan S, Schlein Y, Xue RD. Control of Culex quinquefasciatus in a storm drain system in Florida using attractive toxic sugar baits. Med Vet Entomol 2010; 24:346-351. [PMID: 20546128 DOI: 10.1111/j.1365-2915.2010.00876.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Attractive toxic sugar baits (ATSBs) were used to control mosquitoes in the storm drains of a residential area on the outskirts of St Augustine, Florida. The drainage system was newly constructed and no mosquitoes were breeding inside it. The area covered by the storm drains was divided in half; 10 drains served as control drains and 16 drains served as experimental drains. The baits, which consisted of a mixture of brown sugar, fruit juice, green dye marker and boric acid, were presented at the entrances of the treated drains and exit traps were positioned over the drain openings and the connecting tubes leading to retention ponds. Similar baits with orange dye and without toxin were presented at the entrances of control drains. A total of 220 pupae of Culex quinquefasciatus (Diptera: Culicidae) were released in each control and toxin-treated drain, and the numbers of recovered mosquitoes were examined to determine the effectiveness of ATSBs in the storm drain system. An average of 178.2 mosquitoes exited each drain in the control area; 87.0% of these had fed on the baits and were stained orange, whereas 13.0% were unstained. In the toxin-treated drains, 83.7% of hatched females and 86.6% of hatched males were controlled by the baits.
Collapse
Affiliation(s)
- G C Müller
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, Kuvin Centre for the Study of Infectious and Tropical Diseases, Hebrew University, Jerusalem, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Allan S, Daly RA, Yoganathan Y, Barrett S, Joseph A, Tariq A, Saing CW, Williams C, Lane C, Sikorska J. British HIV and ageing study. HIV and ageing: older people with HIV, who are they? J Int AIDS Soc 2010. [PMCID: PMC3113061 DOI: 10.1186/1758-2652-13-s4-p57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
|
45
|
Shenkier TN, Hayes M, Gelmon KA, Chia S, Bajdik C, Norris B, Caroline S, Hassell P, O’Reilly SE, Allan S, Yerushalmi R. A phase II trial of a neoadjuvant platinum-containing regimen for locally advanced breast cancer: Pathologic response, long-term follow-up, and correlation with biomarkers. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e11510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e11510 Background: To determine the response, tolerability, and long-term outcome of a neoadjuvant platinum-containing regimen for locally advanced breast cancer (LABC). To search for correlation between pathologic complete response (pCR) and predefined biomarkers in this cohort. Patients and Methods: Patients with LABC received eight cycles of either sequence A or B. Sequence A was doxorubicin 60 mg/m2 and paclitaxel 175 mg/m2 (AT) q3w X 4 followed by cisplatin (C) 60 mg/m2 and paclitaxel 90 mg/m2 (CT) q2w X 4. Sequence B was CT x 4 followed by AT x 4. In addition to estrogen receptor and HER2, immunohistochemistry (IHC) for MDR-1, MRP-1, topoisomerase IIα(topoIIα) and p53 was performed. Results: 88 patients were evaluable for response and toxicity. Median follow-up was 97 months. The overall pCR rate was 21.5%. For subgroups ER+/HER2-, HER2 +, and double negative (ER-/ HER2-) disease the pCR was 5.9%,23.3% and 35% respectively, p=0.006. Five year(y) overall survival for the entire cohort was 71.1%. Five y overall survival was 88.1% (CI 77.1%, 99.1%) for the ER positive HER2 negative group compared to 68.5% (CI 51.3%, 85.7%) and 49.5 (CI 27.4%, 71.6%) in the HER2 positive and “double negative” group respectively (p=0.0077). Over-expression of topo IIα was correlated with pCR (p<0.001). There were no toxic deaths. Conclusions: A platinum-containing neoadjuvant regimen was well tolerated and achieved a pCR rate which compares favorably to other recent studies of multi-agent chemotherapy. Further studies tailored for specific breast cancer subtypes are required. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | - M. Hayes
- BC Cancer Agency, Vancouver, BC, Canada
| | | | - S. Chia
- BC Cancer Agency, Vancouver, BC, Canada
| | - C. Bajdik
- BC Cancer Agency, Vancouver, BC, Canada
| | - B. Norris
- BC Cancer Agency, Vancouver, BC, Canada
| | | | | | | | - S. Allan
- BC Cancer Agency, Vancouver, BC, Canada
| | | |
Collapse
|
46
|
Boneh A, Allan S, Mendelson D, Spriggs M, Gillam LH, Korman SH. Clinical, ethical and legal considerations in the treatment of newborns with non-ketotic hyperglycinaemia. Mol Genet Metab 2008; 94:143-7. [PMID: 18395481 DOI: 10.1016/j.ymgme.2008.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [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] [Received: 02/27/2008] [Accepted: 02/27/2008] [Indexed: 11/18/2022]
Abstract
Non-ketotic hyperglycinaemia (NKH) is a devastating neurometabolic disorder leading, in its classical form, to early death or severe disability and poor quality of life in survivors. Affected neonates may need ventilatory support during a short period of respiratory depression. The transient dependence on ventilation dictates urgency in decision-making regarding withdrawal of therapy. The occurrence of patients with apparent transient forms of the disease, albeit rare, adds uncertainty to the prediction of clinical outcome and dictates that the current practice of withholding or withdrawing therapy in these neonates be reviewed. Both bioethics and law take the view that treatment decisions should be based on the best interests of the patient. The medical-ethics approach is based on the principles of non-maleficence, beneficence, autonomy and justice. The law relating to withholding or withdrawing life-sustaining treatment is complex and varies between jurisdictions. Physicians treating newborns with NKH need to provide families with accurate and complete information regarding the disease and the relative probability of possible outcomes of the neonatal presentation and to explore the extent to which family members are willing to take part in the decision making process. Cultural and religious attitudes, which may potentially clash with bioethical and juridical principles, need to be considered.
Collapse
Affiliation(s)
- A Boneh
- Metabolic Service, Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Royal children's Hospital, Department of Paediatrics, University of Melbourne, Melbourne, Vic. 3052, Australia.
| | | | | | | | | | | |
Collapse
|
47
|
Haddock G, Cross AK, Allan S, Sharrack B, Callaghan J, Bunning RAD, Buttle DJ, Woodroofe MN. Brevican and phosphacan expression and localization following transient middle cerebral artery occlusion in the rat. Biochem Soc Trans 2007; 35:692-4. [PMID: 17635124 DOI: 10.1042/bst0350692] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The ECM (extracellular matrix) is a complex molecular framework that provides physical support to cells and tissues, while also providing signals for cell growth, migration, differentiation and survival. The ECM of the CNS (central nervous system) is unusual in that it is rich in CSPGs (chondroitin sulfate proteoglycans), hyaluronan and tenascins. The CSPGs are widely expressed throughout the developing and adult CNS and have a role in guiding or limiting neurite outgrowth and cell migration. Alterations in the synthesis or breakdown of the ECM may contribute to disease processes. Here, we examine changes in the brain-specific CSPGs, brevican and phosphacan, following transient middle cerebral artery occlusion, a model of stroke in the rat. We have investigated their expression at various time points as well as their spatial relationship with ADAMTS-4 (adisintegrin and metalloprotease with thrombospondin motifs 4). The co-localization of ADAMTS or its activity may indicate a functional role for this matrix–protease pair in degeneration/regeneration processes that occur in stroke.
Collapse
Affiliation(s)
- G Haddock
- Biomedical Research Centre, Faculty of Health and Well-being, Sheffield Hallam University, Howard St, Sheffield S1 1WB, UK.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Harnett P, Buck M, Beale P, Goldrick A, Allan S, Fitzharris B, De Souza P, Links M, Kalimi G, Davies T, Stuart-Harris R. Phase II study of gemcitabine and oxaliplatin in patients with recurrent ovarian cancer: an Australian and New Zealand Gynaecological Oncology Group study. Int J Gynecol Cancer 2007; 17:359-66. [PMID: 17362313 DOI: 10.1111/j.1525-1438.2007.00763.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Gemcitabine and oxaliplatin have shown single-agent activity in relapsed ovarian cancer. This combination was used to determine response rates, time-to-event efficacy measures, and toxicity in patients with recurrent ovarian cancer. Patients with prior platinum-based chemotherapy who had measurable lesions and/or elevated CA-125 levels were identified as group A (platinum-refractory/platinum-resistant patients) and group B (platinum-sensitive patients). All patients received gemcitabine 1000 mg/m(2) on days 1 and 8 and oxaliplatin 130 mg/m(2) on day 8 every 21 days for up to eight cycles. Seventy-five patients (21 in group A and 54 in group B), with a median age of 58 years (range, 37-78), were enrolled. A median of six cycles (range, 1-8) was administered. By intent-to-treat analysis, 15 patients with measurable disease achieved partial response for an overall best response rate of 20.0% (9.5% in group A and 24.1% in group B). CA-125 response was observed in 48.4% patients (30.0% in group A and 57.1% in group B). Median time to progressive disease was 7.1 months (95% CI, 5.6-9.0 months) with 5.0 months in group A and 8.3 months in group B. Median overall survival was 17.8 months (95% CI, 12.9-21.3 months) with 9.2 months for group A and 20.0 months for group B. Major grade 3/4 toxicities were neutropenia (61.3%), leukopenia (24.0%), nausea (16.0%), and vomiting (22.7%). We conclude that the combination of oxaliplatin and gemcitabine is active in patients with recurrent ovarian cancer, but the regimen is unsatisfactory for further study due to modest response and relatively high toxicity.
Collapse
Affiliation(s)
- P Harnett
- Department of Medical Oncology, Westmead Hospital, Westmead, New South Wales, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Friedlander M, Buck M, Wyld D, Findlay M, Fitzharris B, De Souza P, Davies T, Kalimi G, Allan S, Perez D, Harnett P. Phase II study of carboplatin followed by sequential gemcitabine and paclitaxel as first-line treatment for advanced ovarian cancer. Int J Gynecol Cancer 2007; 17:350-8. [PMID: 17362312 DOI: 10.1111/j.1525-1438.2007.00795.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/28/2022] Open
Abstract
The aim of this exploratory phase II study was to evaluate sequential chemotherapy with carboplatin followed by gemcitabine-paclitaxel combination in chemonaive patients with advanced ovarian cancer. The primary objective was to evaluate time to progressive disease (TTPD); secondary objectives included the evaluation of 1- and 3-year survival, response rates, and toxicity. Following initial debulking surgery or biopsy, patients with FIGO stage IIC-IV disease received four cycles of carboplatin area under the curve (AUC) 6 (day 1) every 21 days, followed by four cycles of gemcitabine 1000 mg/m(2) (days 1 and 8) and paclitaxel 175 mg/m(2) (day 8) every 21 days. A total of 47 patients enrolled, 44 (93.6%) completed the initial four cycles, and 39 patients (82.9%) completed the planned eight cycles. The median and maximum lengths of follow-up were 31.2 and 43.7 months, respectively. Median TTPD was 13.8 months (95% CI, 11.6-21.0 months), and median survival time was 31.2 months (95% CI, 25.2-39.6 months). Survival at 1 and 3 years was 95.7% and 44.2%, respectively. Of the 43 evaluable patients, most (95.3%) of them achieved a CA-125 marker response based on Gynecologic Cancer Intergroup (GCIG) definition. The partial response rate in the seven patients with measurable disease was 46.4%. Myelosuppression was the major toxicity, with grade 3 and 4 neutropenia observed in 76.6% patients and thrombocytopenia in 12.8% patients. The sequential approach of carboplatin followed by gemcitabine-paclitaxel as first-line treatment for patients with ovarian cancer is feasible and well tolerated, and depending upon the findings from other major trials, it may merit further evaluation.
Collapse
Affiliation(s)
- M Friedlander
- Prince of Wales Hospital, Randwick, New South Wales, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Reck M, Perng R, Groen H, Riska H, Pirker R, Sederholm C, Caspar C, Boyer M, Berzinec P, Allan S. Initial safety results of an expanded access program (EAP) of erlotinib in non-small cell lung cancer (NSCLC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7190 Background: Erlotinib is an orally active and selective inhibitor of HER1/EGFR tyrosine kinase. In the BR.21 phase III trial, erlotinib significantly prolonged survival, delayed symptom progression, and improved quality of life in NSCLC patients (pts) (Shepherd et al, NEJM, 2005;353:123). The EAP is an open label, non-randomized, multicentre phase IV trial. Methods: Eligibility criteria included stage III/IV NSCLC pts who failed or were unsuitable for chemotherapy. Pts were given oral erlotinib, 150 mg/d, for as long as treatment provided clinical benefit without unacceptable toxicity. Pts were monitored monthly. Results: In Dec 05, data were available for 1,140 pts from 25 countries, median age 64 y (range 25–91). Key base-line characteristics (% pts) were: males 58%; Caucasian/Oriental 82/15; non-smoker/former or current-smoker 26/73. The % pts with ECOG PS 0/1/2/3 were 20/52/20/8. Most pts (55%) had adenocarcinoma. The % pts receiving erlotinib as 1st/2nd/3rd-line treatment were 12/47/40. As expected, rash was a common adverse event (AE: any grade [gr]: 65%; gr 3/4: 9%). Full safety data were available for 581 pts. Unexpected erlotinib-related AEs were only seen in <2% pts. Erlotinib-related AEs leading to treatment discontinuation were GI disorders in 21 pts (12 pts had gr 3/4 AEs) and skin disorders in 14 pts (6 pts had gr 3/4 rash). Only 10% of pts had dose reductions, mainly due to rash (66%; gr 3 in 8 pts) and diarrhea (17%; gr 3 in 2 pts). The median daily dose of erlotinib was 150mg. Serious erlotinib-related AEs were GI disorders (19 AEs; 11 gr 3/4), mainly diarrhea (8 AEs, 5 were gr 3). Pt accrual and analyses of response, survival data and assessment of various predictive biomarkers are ongoing. Response and survival data will be presented. Conclusions: These interim safety results of erlotinib in the real-life clinical setting in a large number of unselected pts with advanced NSCLC confirm the good tolerability observed in clinical trials. To date, the trial demonstrates that erlotinib is well tolerated, thus, allowing full dose administration to most pts. [Table: see text]
Collapse
Affiliation(s)
- M. Reck
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| | - R. Perng
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| | - H. Groen
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| | - H. Riska
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| | - R. Pirker
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| | - C. Sederholm
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| | - C. Caspar
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| | - M. Boyer
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| | - P. Berzinec
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| | - S. Allan
- Hospital Grosshansdorf, Hamburg, Germany; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; University Hospital Groningen, Groningen, The Netherlands; Helsinki University Central Hospital, Helsinki, Finland; Medical University of Vienna, Vienna, Austria; University Hospital, Linköping, Sweden; Kantonsspital Baden, Baden, Switzerland; Sydney Cancer Centre, Sydney, Australia; Specialized Hospital of St Zoerardus Zobor, Nitra, Slovakia; Palmerston North Hospital, Palmerston North, New Zealand
| |
Collapse
|