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O'Dowd E, Berovic M, Callister M, Chalitsios CV, Chopra D, Das I, Draper A, Garner JL, Gleeson F, Janes S, Kennedy M, Lee R, Mauri F, McKeever TM, McNulty W, Murray J, Nair A, Park J, Rawlinson J, Sagoo GS, Scarsbrook A, Shah P, Sudhir R, Talwar A, Thakrar R, Watkins J, Baldwin DR. Determining the impact of an artificial intelligence tool on the management of pulmonary nodules detected incidentally on CT (DOLCE) study protocol: a prospective, non-interventional multicentre UK study. BMJ Open 2024; 14:e077747. [PMID: 38176863 PMCID: PMC10773382 DOI: 10.1136/bmjopen-2023-077747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION In a small percentage of patients, pulmonary nodules found on CT scans are early lung cancers. Lung cancer detected at an early stage has a much better prognosis. The British Thoracic Society guideline on managing pulmonary nodules recommends using multivariable malignancy risk prediction models to assist in management. While these guidelines seem to be effective in clinical practice, recent data suggest that artificial intelligence (AI)-based malignant-nodule prediction solutions might outperform existing models. METHODS AND ANALYSIS This study is a prospective, observational multicentre study to assess the clinical utility of an AI-assisted CT-based lung cancer prediction tool (LCP) for managing incidental solid and part solid pulmonary nodule patients vs standard care. Two thousand patients will be recruited from 12 different UK hospitals. The primary outcome is the difference between standard care and LCP-guided care in terms of the rate of benign nodules and patients with cancer discharged straight after the assessment of the baseline CT scan. Secondary outcomes investigate adherence to clinical guidelines, other measures of changes to clinical management, patient outcomes and cost-effectiveness. ETHICS AND DISSEMINATION This study has been reviewed and given a favourable opinion by the South Central-Oxford C Research Ethics Committee in UK (REC reference number: 22/SC/0142).Study results will be available publicly following peer-reviewed publication in open-access journals. A patient and public involvement group workshop is planned before the study results are available to discuss best methods to disseminate the results. Study results will also be fed back to participating organisations to inform training and procurement activities. TRIAL REGISTRATION NUMBER NCT05389774.
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Affiliation(s)
- Emma O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK emma.o'
| | - Marko Berovic
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Indrajeet Das
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adrian Draper
- Respiratory Medicine, St George's Hospital, London, UK
| | | | - Fergus Gleeson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sam Janes
- University College London, London, UK
| | | | - Richard Lee
- Royal Marsden Hospital NHS Trust, London, UK
| | | | | | | | - James Murray
- Royal Free London NHS Foundation Trust, London, UK
| | | | - John Park
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Janette Rawlinson
- Consumer Forum, NCRI CSG (lung) Subgroup, BTOG Steering Committee, NHSE CEG, National Cancer Research Institute, London, UK
| | - Gurdeep Singh Sagoo
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Pallav Shah
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rajini Sudhir
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ambika Talwar
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ricky Thakrar
- University College London Hospitals NHS Foundation Trust, London, UK
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Cowell K, Statham P, Sagoo GS, Chandler JH, Herbert A, Rooney P, Wilcox RK, Fermor HL. Cost-effectiveness of decellularised bone allograft compared with fresh-frozen bone allograft for acetabular impaction bone grafting during a revision hip arthroplasty in the UK. BMJ Open 2023; 13:e067876. [PMID: 37802609 PMCID: PMC10565200 DOI: 10.1136/bmjopen-2022-067876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Fresh-frozen allograft is the gold-standard bone graft material used during revision hip arthroplasty. However, new technology has been developed to manufacture decellularised bone with potentially better graft incorporation. As these grafts cost more to manufacture, the aim of this cost-effectiveness study was to estimate whether the potential health benefit of decellularised bone allograft outweighs their increased cost. STUDY DESIGN A Markov model was constructed to estimate the costs and the quality-adjusted life years of impaction bone grafting during a revision hip arthroplasty. SETTING This study took the perspective of the National Health Service in the UK. PARTICIPANTS The Markov model includes patients undergoing a revision hip arthroplasty in the UK. INTERVENTION Impaction bone grafting during a revision hip arthroplasty using either decellularised bone allograft or fresh-frozen allograft. MEASURES Outcome measures included: total costs and quality-adjusted life years of both interventions over the lifetime of the model; and incremental cost-effectiveness ratios for both graft types, using base case parameters, univariate sensitivity analysis and probabilistic analysis. RESULTS The incremental cost-effectiveness ratio for the base case model was found to be £270 059 per quality-adjusted life year. Univariate sensitivity analysis found that changing the discount rate, the decellularised bone graft cost, age of the patient cohort and the revision rate all had a significant effect on the incremental cost-effectiveness ratio. CONCLUSIONS As there are no clinical studies of impaction bone grafting using a decellularised bone allograft, there is a high level of uncertainty around the costs of producing a decellularised bone allograft and the potential health benefits. However, if a decellularised bone graft was manufactured for £2887 and lowered the re-revision rate to less than 64 cases per year per 10 000 revision patients, then it would most likely be cost-effective compared with fresh-frozen allograft.
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Affiliation(s)
- Kern Cowell
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Patrick Statham
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Gurdeep Singh Sagoo
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - James H Chandler
- Institute of Design, Robotics and Optimisation, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Anthony Herbert
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Paul Rooney
- Research and Development, NHS Blood and Transplant Tissue and Eye Services, Speke, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Hazel L Fermor
- Institute of Medical and Biological Eningeering, School of Biomedical Sciences, University of Leeds, Leeds, UK
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Mernenko RK, Littlejohns A, Latchford G, Crouzen E, Moni-Nwinia W, Lakshminarayanan B, Chauhan H, Lawson E, McConachie D, McElwaine JG, Metcalfe F, Sagoo GS, McKechnie L, Sutcliffe J. Developing a method to capture parental experience in a neonatal surgical centre in the context of COVID-19: a qualitative study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001434. [PMID: 36053593 PMCID: PMC9288868 DOI: 10.1136/bmjpo-2022-001434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Improved parental experience is related to improved mental and physical health outcomes for the infant. The COVID-19 pandemic abruptly impacted on healthcare delivery and services need information to shape how to manage the disruption and recovery. METHODS Our aim was to develop a systematic process to capture parents' experience of their neonatal surgical healthcare journey during the pandemic. We identified relevant stakeholders and using semistructured interviews, we explored three key themes.(1) How to recruit and collect data from representative parents?(2) What questions should be asked?(3) How to disseminate results for service development? RESULTS Responses indicated the need to involve 'difficult to access groups' (eg, first language not English, high social deprivation, low health literacy), defined the range of family and patient characteristics variables to be considered for representative responses (eg, antenatal diagnosis, disease complexity, number of siblings, single parent, parental health). The proposed questions were grouped into five main topics: information preadmission; in-patient experience; support during admission; the effect of COVID-19; discharge and posthospital experience. Recommendations for dissemination included local, regional and national fora as well as the need to feedback to participants about the changes made.Based on the analysis, we developed a semistructured interview which underwent cognitive testing, prepilot and pilot phase testing. DISCUSSION This protocol is grounded in the views of relevant stakeholders to ensure it captures relevant information in a pragmatic but methodologically sound way. It will next be used to assess parental experience in a large neonatal surgical unit. We hope that the protocol could be adapted and used by other groups.
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Affiliation(s)
- Rebecca Kate Mernenko
- Department of Paediatric Surgery, Leeds Children's Hospital, Leeds, West Yorkshire, UK
| | - Anna Littlejohns
- Department of Anaesthetics, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Gary Latchford
- University of Leeds, Leeds Institute of Health Sciences, Leeds, West Yorkshire, UK
| | - Emile Crouzen
- Department of Paediatric Surgery, Leeds Children's Hospital, Leeds, West Yorkshire, UK
| | - Waaka Moni-Nwinia
- Department of Paediatric Surgery, Leeds Children's Hospital, Leeds, West Yorkshire, UK
| | | | - Hemma Chauhan
- Leeds Children's Hospital, Leeds Centre for Newborn Care, Leeds, West Yorkshire, UK
| | - Elizabeth Lawson
- University of Leeds School of Medicine, Leeds, West Yorkshire, UK
| | | | - John G McElwaine
- Department of Anaesthetics, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Fiona Metcalfe
- Department of Paediatric Surgery, Leeds Children's Hospital, Leeds, West Yorkshire, UK
| | - Gurdeep Singh Sagoo
- Academic Unit of Health Economics, University of Leeds, Leeds Institute of Health Sciences, Leeds, West Yorkshire, UK
| | - Liz McKechnie
- Leeds Children's Hospital, Leeds Centre for Newborn Care, Leeds, West Yorkshire, UK
| | - Jonathan Sutcliffe
- Department of Paediatric Surgery, Leeds Children's Hospital, Leeds, West Yorkshire, UK
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Sagoo GS, Mohammed S, Barton G, Norbury G, Ahn JW, Ogilvie CM, Kroese M. Cost Effectiveness of Using Array-CGH for Diagnosing Learning Disability. Appl Health Econ Health Policy 2015; 13:421-432. [PMID: 25894741 DOI: 10.1007/s40258-015-0172-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To undertake a cost-effectiveness analysis of using microarray comparative genomic hybridisation (array-CGH) as a first-line test versus as a second-line test for the diagnosis of causal chromosomal abnormalities in patients referred to a NHS clinical genetics service in the U.K. with idiopathic learning disability, developmental delay and/or congenital anomalies. METHODS A cost-effectiveness study was conducted. The perspective is that of a U.K. NHS clinical genetics service provider (with respect to both costs and outcomes). A cohort of patients (n = 1590) referred for array-CGH testing of undiagnosed learning disability and developmental delay by a single NHS regional clinical genetics service (South East Thames Regional Genetics Service), were split into a before-and-after design where 742 patients had array-CGH as a second-line test (before group-comparator intervention) and 848 patients had array-CGH as a first-line test (after group-evaluated intervention). The mean costs were calculated from the clinical genetics testing pathway constructed for each patient including the costs of genetic testing undertaken and clinical appointments scheduled. The outcome was the number of diagnoses each intervention produced so that a mean cost-per-diagnosis could be calculated. The cost effectiveness of the two interventions was calculated as an incremental cost-effectiveness ratio to produce an incremental cost-per-diagnosis (in 2013 GBP). Sensitivity analyses were conducted by altering both costs and effects to check the validity of the outcome. RESULTS The incremental mean cost of testing patients using the first-line testing strategy was -GBP241.56 (95% CIs -GBP256.93 to -GBP226.19) and the incremental mean gain in the percentage diagnoses was 0.39% (95% CIs -2.73 to 3.51%), which equates to an additional 1 diagnosis per 256 patients tested. This cost-effectiveness study comparing these two strategies estimates that array-CGH first-line testing dominates second-line testing because it was both less costly and as effective. The sensitivity analyses conducted (adjusting both costs and effects) supported the dominance of the first-line testing strategy (i.e. lower cost and as effective). CONCLUSIONS The first-line testing strategy was estimated to dominate the second-line testing strategy because it was both less costly and as effective. These findings are relevant to the wider UK NHS clinical genetics service, with two key strengths of this study being the appropriateness of the comparator interventions and the direct applicability of the patient cohort within this study and the wider UK patient population.
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Affiliation(s)
- G S Sagoo
- PHG Foundation, 2 Worts Causeway, Cambridge, UK,
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Carlsten C, Sagoo GS, Frodsham AJ, Burke W, Higgins JPT. Glutathione S-transferase M1 (GSTM1) polymorphisms and lung cancer: a literature-based systematic HuGE review and meta-analysis. Am J Epidemiol 2008; 167:759-74. [PMID: 18270371 DOI: 10.1093/aje/kwm383] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [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: 12/21/2022] Open
Abstract
Multiple genes have been studied for potential associations with lung cancer. The gene most frequently associated with increased risk has been glutathione S-transferase M1 (GSTM1). The glutathione S-transferase enzyme family is known to catalyze detoxification of electrophilic compounds, including carcinogens, therapeutic drugs, environmental toxins, and products of oxidative stress. In this review, the authors summarize the available evidence associating lung cancer with the GSTM1 gene. They describe results from an updated meta-analysis of 98 published genetic association studies investigating the relation between the GSTM1 null variant and lung cancer risk including 19,638 lung cancer cases and 25,266 controls (counting cases and controls in each study only once). All studies considered, the GSTM1 null variant was associated with an increased risk of lung cancer (odds ratio (OR) = 1.22, 95% confidence interval (CI): 1.14, 1.30), but no increase in risk was seen (OR = 1.01, 95% CI: 0.91, 1.12) when only the five largest studies (>500 cases each) were considered. Furthermore, while GSTM1 null status conferred a significantly increased risk of lung cancer to East Asians (OR = 1.38, 95% CI: 1.24, 1.55), such a genotype did not confer increased risk to Caucasians. More data regarding the predictive value of GSTM1 genetic testing are needed before population-based testing may be reasonably considered.
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Affiliation(s)
- C Carlsten
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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