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Houlahan K, Schenkel FS, Miglior F, Jamrozik J, Stephansen RB, González-Recio O, Charfeddine N, Segelke D, Butty AM, Stratz P, VandeHaar MJ, Tempelman RJ, Weigel K, White H, Peñagaricano F, Koltes JE, Santos JEP, Baldwin RL, Baes CF. Estimation of genetic parameters for feed efficiency traits using random regression models in dairy cattle. J Dairy Sci 2024; 107:1523-1534. [PMID: 37690722 DOI: 10.3168/jds.2022-23124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/05/2023] [Indexed: 09/12/2023]
Abstract
Feed efficiency has become an increasingly important research topic in recent years. As feed costs rise and the environmental impacts of agriculture become more apparent, improving the efficiency with which dairy cows convert feed to milk is increasingly important. However, feed intake is expensive to measure accurately on large populations, making the inclusion of this trait in breeding programs difficult. Understanding how the genetic parameters of feed efficiency and traits related to feed efficiency vary throughout the lactation period is valuable to gain understanding into the genetic nature of feed efficiency. This study used 121,226 dry matter intake (DMI) records, 120,500 energy-corrected milk (ECM) records, and 98,975 metabolic body weight (MBW) records, collected on 7,440 first-lactation Holstein cows from 6 countries (Canada, Denmark, Germany, Spain, Switzerland, and the United States), from January 2003 to February 2022. Genetic parameters were estimated using a multiple-trait random regression model with a fourth-order Legendre polynomial for all traits. Weekly phenotypes for DMI were re-parameterized using linear regressions of DMI on ECM and MBW, creating a measure of feed efficiency that was genetically corrected for ECM and MBW, referred to as genomic residual feed intake (gRFI). Heritability (SE) estimates varied from 0.15 (0.03) to 0.29 (0.02) for DMI, 0.24 (0.01) to 0.29 (0.03) for ECM, 0.55 (0.03) to 0.83 (0.05) for MBW, and 0.12 (0.03) to 0.22 (0.06) for gRFI. In general, heritability estimates were lower in the first stage of lactation compared with the later stages of lactation. Additive genetic correlations between weeks of lactation varied, with stronger correlations between weeks of lactation that were close together. The results of this study contribute to a better understanding of the change in genetic parameters across the first lactation, providing insight into potential selection strategies to include feed efficiency in breeding programs.
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Affiliation(s)
- K Houlahan
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada, N1G 2W1
| | - F S Schenkel
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada, N1G 2W1
| | - F Miglior
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada, N1G 2W1; Lactanet, Guelph, ON, Canada, N1K 1E5
| | - J Jamrozik
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada, N1G 2W1; Lactanet, Guelph, ON, Canada, N1K 1E5
| | - R B Stephansen
- Center for Quantitative Genetics and Genomics, Aarhus University, Blichers Alle 20, 8830 Tjele, Denmark
| | - O González-Recio
- Departamento de Producción Animal, ETSI Agrónomos, Universidad Politécnica, Ciudad Universitaria s/n, 28040 Madrid, Spain
| | | | - D Segelke
- Vereinigte Informationssysteme Tierhaltung w.V. 27283 Verden/Aller
| | | | - P Stratz
- Qualitas AG, 6300 Zug, Switzerland
| | - M J VandeHaar
- Department of Animal Science, Michigan State University, East Lansing, MI 48824
| | - R J Tempelman
- Department of Animal Science, Michigan State University, East Lansing, MI 48824
| | - K Weigel
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706
| | - H White
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706
| | - F Peñagaricano
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706
| | - J E Koltes
- Department of Animal Science, Iowa State University, Ames, IA 50011
| | - J E P Santos
- Department of Animal Sciences, University of Florida, Gainesville, FL 32611
| | - R L Baldwin
- Animal Genomics and Improvement Laboratory, USDA, Beltsville, MD 20705
| | - C F Baes
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada, N1G 2W1; Institute of Genetics, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland.
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2
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Caley LR, Wood HM, Bottomley D, Fuentes Balaguer A, Wilkinson L, Dyson J, Young C, White H, Benton S, Brearley M, Quirke P, Peckham DG. The gut microbiota in adults with cystic fibrosis compared to colorectal cancer. J Cyst Fibros 2023:S1569-1993(23)01728-9. [PMID: 38104000 DOI: 10.1016/j.jcf.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Gut dysbiosis is implicated in colorectal cancer (CRC) pathogenesis. Cystic fibrosis (CF) is associated with both gut dysbiosis and increased CRC risk. We therefore compared the faecal microbiota from individuals with CF to CRC and screening samples. We also assessed changes in CRC-associated taxa before and after triple CF transmembrane conductance regulator (CFTR) modulator therapy. METHODS Bacterial DNA amplification comprising V4 16S rRNA analysis was conducted on 84 baseline and 53 matched follow-up stool samples from adults with CF. These data were compared to an existing cohort of 430 CRC and 491 control gFOBT samples from the NHS Bowel Cancer Screening Programme. Data were also compared to 26 previously identified CRC-associated taxa from a published meta-analysis. RESULTS Faecal CF samples had a lower alpha diversity and clustered distinctly from both CRC and control samples, with no clear clinical variables explaining the variation. Compared to controls, CF samples had an increased relative abundance in 6 of the 20 enriched CRC-associated taxa and depletion of 2 of the 6 taxa which have been reported as reduced in CRC. Commencing triple modulator therapy had subtle influence on the relative abundance of CRC-associated microbiota (n = 23 paired CF samples). CONCLUSIONS CF stool samples were clearly dysbiotic, clustering distinctly from both CRC and control samples. Several bacterial shifts in CF samples resembled those observed in CRC. Studies assessing the impact of dietary or other interventions and the longer-term use of CFTR modulators on reducing this potentially pro-oncogenic milieu are needed.
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Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research, Clinical Sciences Building, St James's University Hospital, University of Leeds, LS9 7TF, UK
| | - H M Wood
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - D Bottomley
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - A Fuentes Balaguer
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - L Wilkinson
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - J Dyson
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - C Young
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - H White
- Leeds Beckett University, Nutrition, Health & Environment, Leeds, LS1 3HE UK
| | - S Benton
- NHS Bowel Cancer Screening South of England Hub, Royal Surrey NHS Foundation Trust, Guildford, GU2 7YS, UK
| | - M Brearley
- NHS Bowel Cancer Screening South of England Hub, Royal Surrey NHS Foundation Trust, Guildford, GU2 7YS, UK
| | - P Quirke
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - D G Peckham
- Leeds Institute of Medical Research, Clinical Sciences Building, St James's University Hospital, University of Leeds, LS9 7TF, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.
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3
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Stadler E, Chai KL, Schlub TE, Cromer D, Khan SR, Polizzotto MN, Kent SJ, Beecher C, White H, Turner T, Skoetz N, Estcourt L, McQuilten ZK, Wood EM, Khoury DS, Davenport MP. Determinants of passive antibody efficacy in SARS-CoV-2 infection: a systematic review and meta-analysis. Lancet Microbe 2023; 4:e883-e892. [PMID: 37924835 DOI: 10.1016/s2666-5247(23)00194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 03/21/2023] [Accepted: 06/22/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Randomised controlled trials of passive antibodies as treatment and prophylaxis for COVID-19 have reported variable efficacy. However, the determinants of efficacy have not been identified. We aimed to assess how the dose and timing of administration affect treatment outcome. METHODS In this systematic review and meta-analysis, we extracted data from published studies of passive antibody treatment from Jan 1, 2019, to Jan 31, 2023, that were identified by searching multiple databases, including MEDLINE, PubMed, and ClinicalTrials.gov. We included only randomised controlled trials of passive antibody administration for the prevention or treatment of COVID-19. To compare administered antibody dose between different treatments, we used data on in-vitro neutralisation titres to normalise dose by antibody potency. We used mixed-effects regression and model fitting to analyse the relationship between timing, dose and efficacy. FINDINGS We found 58 randomised controlled trials that investigated passive antibody therapies for the treatment or prevention of COVID-19. Earlier clinical stage at treatment initiation was highly predictive of the efficacy of both monoclonal antibodies (p<0·0001) and convalescent plasma therapy (p=0·030) in preventing progression to subsequent stages, with either prophylaxis or treatment in outpatients showing the greatest effects. For the treatment of outpatients with COVID-19, we found a significant association between the dose administered and efficacy in preventing hospitalisation (relative risk 0·77; p<0·0001). Using this relationship, we predicted that no approved monoclonal antibody was expected to provide more than 30% efficacy against some omicron (B.1.1.529) subvariants, such as BQ.1.1. INTERPRETATION Early administration before hospitalisation and sufficient doses of passive antibody therapy are crucial to achieving high efficacy in preventing clinical progression. The relationship between dose and efficacy provides a framework for the rational assessment of future passive antibody prophylaxis and treatment strategies for COVID-19. FUNDING The Australian Government Department of Health, Medical Research Future Fund, National Health and Medical Research Council, the University of New South Wales, Monash University, Haematology Society of Australia and New Zealand, Leukaemia Foundation, and the Victorian Government.
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Affiliation(s)
- Eva Stadler
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Khai Li Chai
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Haematology, Monash Health, Clayton, VIC, Australia
| | - Timothy E Schlub
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Deborah Cromer
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Shanchita R Khan
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark N Polizzotto
- Clinical Hub for Interventional Research and John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia; Canberra Regional Cancer Centre, The Canberra Hospital, Canberra, ACT, Australia
| | - Stephen J Kent
- Melbourne Sexual Health Centre and Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Claire Beecher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Heath White
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nicole Skoetz
- Evidence-based Medicine, Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lise Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK; Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Zoe K McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Haematology, Monash Health, Clayton, VIC, Australia
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Haematology, Monash Health, Clayton, VIC, Australia
| | - David S Khoury
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Miles P Davenport
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Caley LR, Jarosz-Griffiths HH, Smith L, Gale L, Barrett J, Kinsey L, Davey V, Nash M, Jones AM, Whitehouse JL, Shimmin D, Floto RA, White H, Peckham DG. Body mass index and nutritional intake following Elexacaftor/Tezacaftor/Ivacaftor modulator therapy in adults with cystic fibrosis. J Cyst Fibros 2023; 22:1002-1009. [PMID: 37422432 DOI: 10.1016/j.jcf.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Elexacaftor/Tezacaftor/Ivacaftor (ETI) modulator therapy is often associated with increased body mass index (BMI) in people with cystic fibrosis (CF). This is thought to reflect improved clinical stability and increased appetite and nutritional intake. We explored the change in BMI and nutritional intake following ETI modulator therapy in adults with CF. METHODS Dietary intake, measured with myfood24®, and BMI were collected from adults with CF at baseline and follow-up as part of an observational study. Changes in BMI and nutritional intake in participants who commenced ETI therapy between time points were assessed. To contextualize findings, we also assessed changes in BMI and nutritional intake between study points in a group on no modulators. RESULTS In the pre and post ETI threapy group (n = 40), BMI significantly increased from 23.0 kg/m2 (IQR 21.4, 25.3) at baseline to 24.6 kg/m2 (IQR 23.0, 26.7) at follow-up (p<0.001), with a median of 68 weeks between time points (range 20-94 weeks) and median duration of ETI therapy was 23 weeks (range 7-72 weeks). There was a significant decrease in energy intake from 2551 kcal/day (IQR 2107, 3115) to 2153 kcal/day (IQR 1648, 2606), p<0.001. In the no modulator group (n = 10), BMI and energy intake did not significantly change between time points (p>0.05), a median of 28 weeks apart (range 20-76 weeks). CONCLUSIONS These findings tentatively suggest that the increase in BMI with ETI therapy may not simply be attributable to an increase in oral intake. Further exploration into the underlying aetiology of weight gain with ETI therapy is needed.
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Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - L Smith
- Leeds Institute of Health Sciences, University Hospital, University of Leeds, UK
| | - L Gale
- Cambridge Centre for Lung Infection, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - J Barrett
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - L Kinsey
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - V Davey
- Dietetic Department, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - M Nash
- North East Essex Community Services, East Suffolk and North Essex NHS Foundation Trust, UK
| | - A M Jones
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - J L Whitehouse
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - D Shimmin
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R A Floto
- Cambridge Centre for Lung Infection, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - H White
- Leeds Beckett University, Nutrition, Health & Environment, Leeds, UK
| | - D G Peckham
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Barber BE, White H, Poole AP, Davis JS, McGloughlin SA, Turner T. Australian National Clinical Evidence Taskforce COVID-19 drug treatment guidelines: challenges of producing a living guideline. Med J Aust 2023; 219:197-199. [PMID: 37516997 DOI: 10.5694/mja2.52044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Bridget E Barber
- QIMR Berghofer Medical Research Institute, Brisbane, QLD
- Royal Brisbane and Women's Hospital, Brisbane, QLD
| | | | - Alexis P Poole
- Monash University, Melbourne, VIC
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA
| | - Joshua S Davis
- John Hunter Hospital, Newcastle, NSW
- University of Newcastle, Newcastle, NSW
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Klarich S, White H. Can ultrasound strain elastography (USE) improve management of suspicious thyroid nodules measuring <10 mm? A systematic review. Radiography (Lond) 2023; 29:661-667. [PMID: 37148707 DOI: 10.1016/j.radi.2023.04.015] [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] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/08/2023] [Accepted: 04/17/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Current UK guidelines state that suspicious thyroid nodules <10 mm do not require FNA. These are often followed up with serial ultrasound scans. Ultrasound Strain Elastography (USE) could provide a more accurate alternative and preclude the need for follow-up. Can USE identify nodules at greater risk of malignancy and streamline patient management? METHODS Systematic review methodology used. Inclusion criteria are: - Population: patients with suspicious thyroid nodules <10 mm.- Intervention: USE.- Comparator: Ultrasound features of nodules.- Outcome measure: FNA or surgical removal of nodules. Searches performed on 6 commercial databases, along with grey literature anddissertation databases. The QUADAS-2 diagnostic study checklist used for quality assessment. RESULTS 8 studies included and a narrative analysis performed due to heterogeneity of results. The mean USE sensitivity is 74.3%, mean specificity 80.5%. Mean overall ultrasound sensitivity is 80.4%, specificity 71.0%. Results suggest that USE is not superior to ultrasound for detecting malignancy. Some study limitations, particularly the heterogeneity of reporting the ultrasound features preclude meaningful conclusion from being drawn. CONCLUSION USE is more accurate at identifying benign nodules than ultrasound. Nodules appearing benign on USE could be excluded from serial ultrasound follow-up. No significant difference was found between USE and ultrasound at identifying malignant nodules. IMPLICATIONS FOR PRACTICE As FNA is not recommended for suspicious thyroid nodules <10 mm, these are often followed up with multiple scans and clinician reviews. This increases pressure on healthcare systems and uncertainty for the patient. This review shows that USE is more accurate at identifying benign nodules than ultrasound alone, meaning that these nodules could potentially be excluded from serial follow up. This would streamline patient management, freeing-up vital resources in ENT and ultrasound departments.
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Affiliation(s)
- S Klarich
- Walsall Healthcare NHS Trust, Imaging Department, Walsall Manor Hospital, Moat Road, Walsall, WS2 9PS, United Kingdom.
| | - H White
- Department of Radiography, Birmingham City University, City South Campus, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom.
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7
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Gibbs KW, Ginde AA, Prekker ME, Seitz KP, Stempek SB, Taylor C, Gandotra S, White H, Resnick-Ault D, Khan A, Mohmed A, Brainard JC, Fein DG, Aggarwal NR, Whitson MR, Halliday SJ, Gaillard JP, Blinder V, Driver BE, Palakshappa JA, Lloyd BD, Wozniak JM, Exline MC, Russell DW, Ghamande S, Withers C, Hubel KA, Moskowitz A, Bastman J, Andrea L, Sottile PD, Page DB, Long MT, Goranson JK, Malhotra R, Long BJ, Schauer SG, Connor A, Anderson E, Maestas K, Rhoads JP, Womack K, Imhoff B, Janz DR, Trent SA, Self WH, Rice TW, Semler MW, Casey JD. Protocol and statistical analysis plan for the PREOXI trial of preoxygenation with noninvasive ventilation vs oxygen mask. medRxiv 2023:2023.03.23.23287539. [PMID: 36993496 PMCID: PMC10055579 DOI: 10.1101/2023.03.23.23287539] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Background Hypoxemia is a common and life-threatening complication during emergency tracheal intubation of critically ill adults. The administration of supplemental oxygen prior to the procedure ("preoxygenation") decreases the risk of hypoxemia during intubation. Research Question Whether preoxygenation with noninvasive ventilation prevents hypoxemia during tracheal intubation of critically ill adults, compared to preoxygenation with oxygen mask, remains uncertain. Study Design and Methods The PRagmatic trial Examining OXygenation prior to Intubation (PREOXI) is a prospective, multicenter, non-blinded randomized comparative effectiveness trial being conducted in 7 emergency departments and 17 intensive care units across the United States. The trial compares preoxygenation with noninvasive ventilation versus oxygen mask among 1300 critically ill adults undergoing emergency tracheal intubation. Eligible patients are randomized in a 1:1 ratio to receive either noninvasive ventilation or an oxygen mask prior to induction. The primary outcome is the incidence of hypoxemia, defined as a peripheral oxygen saturation <85% between induction and 2 minutes after intubation. The secondary outcome is the lowest oxygen saturation between induction and 2 minutes after intubation. Enrollment began on 10 March 2022 and is expected to conclude in 2023. Interpretation The PREOXI trial will provide important data on the effectiveness of noninvasive ventilation and oxygen mask preoxygenation for the prevention of hypoxemia during emergency tracheal intubation. Specifying the protocol and statistical analysis plan prior to the conclusion of enrollment increases the rigor, reproducibility, and interpretability of the trial. Clinical trial registration number NCT05267652.
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Affiliation(s)
- Kevin W. Gibbs
- Section on Pulmonary, Critical Care, Allergy, and immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adit A. Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine Aurora, CO, USA
| | - Matthew E. Prekker
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Kevin P. Seitz
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan B. Stempek
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Caleb Taylor
- Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Columbus, OH, USA
| | - Sheetal Gandotra
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine University of Alabama at Birmingham, Birmingham, AL, USA
| | - Heath White
- Department of Medicine, Division of pulmonary & Critical Care Medicine, Baylor Scott & White Medical Center, Temple, TX, USA
| | - Daniel Resnick-Ault
- Department of Emergency Medicine, University of Colorado School of Medicine Aurora, CO, USA
| | - Akram Khan
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amira Mohmed
- Division of Critical Care Medicine Montefiore Medical Center Bronx, NY, USA
| | - Jason C. Brainard
- Department of Anesthesiology University of Colorado School of Medicine Aurora, CO, USA
| | - Daniel G. Fein
- Division of Pulmonary Medicine Montefiore Medical Center Bronx, NY, USA
| | - Neil R. Aggarwal
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Micah R. Whitson
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen J. Halliday
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wi, USA
| | - John P. Gaillard
- Department of Anesthesiology, Section on Critical Care ,Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Veronika Blinder
- Division of Critical Care Medicine Montefiore Medical Center Bronx, NY, USA
| | - Brian E. Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jessica A. Palakshappa
- Section on Pulmonary, Critical Care, Allergy, and immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Bradley D. Lloyd
- Vanderbilt Institute for Clinical and Translational Research, and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joanne M. Wozniak
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Matthew C. Exline
- Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Columbus, OH, USA
| | - Derek W. Russell
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine University of Alabama at Birmingham, Birmingham, AL, USA
- Pulmonary Section, Birmingham VA medical Center, Birmingham, AL, USA
| | - Shekhar Ghamande
- Department of Medicine, Division of pulmonary & Critical Care Medicine, Baylor Scott & White Medical Center, Temple, TX, USA
| | - Cori Withers
- Department of Emergency Medicine, University of Colorado School of Medicine Aurora, CO, USA
| | - Kinsley A. Hubel
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Ari Moskowitz
- Division of Critical Care Medicine Montefiore Medical Center Bronx, NY, USA
| | - Jill Bastman
- Department of Emergency Medicine, University of Colorado School of Medicine Aurora, CO, USA
| | - Luke Andrea
- Division of Critical Care Medicine Montefiore Medical Center Bronx, NY, USA
| | - Peter D. Sottile
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - David B. Page
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine University of Alabama at Birmingham, Birmingham, AL, USA
| | - Micah T. Long
- Department of Anesthesiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Jordan Kugler Goranson
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rishi Malhotra
- Division of Critical Care Medicine Montefiore Medical Center Bronx, NY, USA
| | - Brit J. Long
- 59 Medical Wing, United States Air Force, Fort Sam Houston, San Antonio, TX, USA
| | - Steven G. Schauer
- United States Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antoni, TX, USA
| | - Andrew Connor
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Erin Anderson
- Department of Emergency Medicine, University of Colorado School of Medicine Aurora, CO, USA
| | - Kristin Maestas
- Department of Emergency Medicine, University of Colorado School of Medicine Aurora, CO, USA
| | - Jillian P. Rhoads
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelsey Womack
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brant Imhoff
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David R. Janz
- University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Stacy A. Trent
- Department of Emergency Medicine, University of Colorado School of Medicine Aurora, CO, USA
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Wesley H. Self
- Vanderbilt Institute for Clinical and Translational Research, and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd W. Rice
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew W. Semler
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D. Casey
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Hewitt J, McDonald S, Poole A, White H, Turner S, Turner T. Weekly updating of guideline recommendations was feasible: the Australian National COVID-19 clinical evidence Taskforce. J Clin Epidemiol 2023; 155:131-136. [PMID: 36813003 PMCID: PMC9939393 DOI: 10.1016/j.jclinepi.2023.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/21/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES To investigate how quickly evidence was incorporated into the Australian living guidelines for COVID-19 during the first 12 months of the pandemic. STUDY DESIGN AND SETTING For each study concerning drug therapies included in the guideline from April 3, 2020 to April 1, 2021, we extracted the publication date of the study, and the guideline version the study was included in. We analyzed two subgroups of studies as follows: those published in high impact factor journals and those with 100 or more participants. RESULTS In the first year, we published 37 major versions of the guidelines, incorporating 129 studies that investigated 48 drug therapies informing 115 recommendations. The median time from first publication of a study to incorporation in the guideline was 27 days (interquartile range [IQR], 16 to 44), ranging from 9 to 234 days. For the 53 studies in the highest impact factor journals, the median was 20 days (IQR 15 to 30), and for the 71 studies with 100 or more participants the median was 22 days (IQR 15 to 36). CONCLUSION Developing and sustaining living guidelines where evidence is rapidly incorporated is a resource- and time-intensive undertaking; however, this study demonstrates that it is feasible, even over a long period.
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Affiliation(s)
- Jessie Hewitt
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia
| | - Alex Poole
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA 5000, Australia
| | - Heath White
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia
| | - Simon Turner
- Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia.
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9
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Caley LR, Zagoya C, Duckstein F, White H, Shimmin D, Jones AM, Barrett J, Whitehouse JL, Floto RA, Mainz JG, Peckham DG. Diabetes is associated with increased burden of gastrointestinal symptoms in adults with cystic fibrosis. J Cyst Fibros 2023; 22:275-281. [PMID: 36710099 DOI: 10.1016/j.jcf.2023.01.010] [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] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/09/2022] [Accepted: 01/17/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Individuals with diabetes mellitus (DM) are known to frequently experience gastrointestinal (GI) symptoms. In contrast, the impact of cystic fibrosis-related diabetes (CFRD) on accentuating GI symptoms in people with cystic fibrosis (pwCF) is unknown. We sought to examine this. METHODS Abdominal symptoms were measured using the validated CF-specific GI symptom questionnaire - CFAbd-Score© - as part of a multicentre cohort study in pancreatic insufficient adults with CF, not on cystic fibrosis transmembrane conductance regulator (CFTR) modulators. The CFAbd-Score total score (0-100pts), its 5 domains, alongside nine specific GI symptoms associated with DM, were compared between the CFRD and non-CFRD groups. RESULTS 27 (31%) and 61 (69%) participants with CF were recruited in the CFRD and non-CFRD groups respectively. Total CFAbd-Score and the two domains: gastroesophageal reflux disease and disorders of appetite were significantly higher in the CFRD group compared to the non-CFRD group (p<0.05), with the mean total CFAbd-Score being 25.4 ± 2.5 and 18.4 ± 1.5 in the CFRD and non-CFRD groups respectively. Among the nine GI symptoms commonly reported as elevated in DM, bloating and nausea were significantly more common in individuals with CFRD compared to those without (p<0.05). CONCLUSIONS Individuals with CFRD overall, have a higher GI symptom burden, according to CFAbd-Scores. Specifically, they experience significantly more bloating and nausea. Close monitoring and further research is needed to better understand and manage GI symptoms in this group.
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Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research at St James's University Hospital, University of Leeds, Leeds, United Kingdom.
| | - C Zagoya
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - F Duckstein
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - H White
- Nutrition, Health & Environment, Leeds Beckett University, Leeds, United Kingdom
| | - D Shimmin
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A M Jones
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, United Kingdom
| | - J Barrett
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, United Kingdom
| | - J L Whitehouse
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, United Kingdom
| | - R A Floto
- MRC-Laboratory of Molecular Biology, Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, United Kingdom; Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, United Kingdom
| | - J G Mainz
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany; Faculty of Health Sciences Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Germany
| | - D G Peckham
- Leeds Institute of Medical Research at St James's University Hospital, University of Leeds, Leeds, United Kingdom; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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10
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Cheyne S, Fraile Navarro D, Hill K, McDonald S, Tunnicliffe D, White H, Whittle S, Karpusheff J, Mustafa R, Morgan RL, Sultan S, Turner T. Methods for living guidelines: early guidance based on practical experience. J Clin Epidemiol 2023; 155:84-96. [PMID: 36639038 DOI: 10.1016/j.jclinepi.2022.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To introduce methods for living guidelines based on practical experiences by the Australian Living Evidence Consortium (ALEC), the National Institute of Health and Care Excellence (NICE), and the Infectious Diseases Society of America (IDSA), with methodological support from the US Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Network. STUDY DESIGN AND SETTING Members of ALEC, NICE, and the US GRADE Network, convened a working group to share experiences of the methods used to develop living guidelines and outline the key differences between traditional and living guidelines methods. RESULTS The guidance includes the following steps: 1) deciding if the guideline is a priority for a living approach, 2) preparing for living guideline development, 3) literature surveillance and frequency of searching, 4) assessment and synthesis of the evidence, 5) publication and dissemination, and 6) transitioning recommendations out of living mode. CONCLUSION This paper introduces methods for living guidelines and provides examples of the similarities and differences in approach across multiple organizations conducting living guidelines. It also introduces a series of papers exploring methods for living guidelines based on our practical experiences, including consumer involvement, selecting and prioritizing questions, search decisions, and methods decisions.
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Affiliation(s)
- Saskia Cheyne
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.
| | - David Fraile Navarro
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Steve McDonald
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - David Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Heath White
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel Whittle
- Australia and New Zealand Musculoskeletal Clinical Trials Network, Melbourne, Australia; The Queen Elizabeth Hospital, South Australia, Australia; Department of Epidemiology and Preventive Medicine, School of Preventive Medicine and Public Health, Monash University, Melbourne, Australia
| | | | - Reem Mustafa
- University of Kansas Medical Center, KS, USA; The Evidence Foundation, Cleveland Heights, OH, USA
| | - Rebecca L Morgan
- The Evidence Foundation, Cleveland Heights, OH, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Shahnaz Sultan
- The Evidence Foundation, Cleveland Heights, OH, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Tari Turner
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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11
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Caley LR, White H, de Goffau MC, Floto RA, Parkhill J, Marsland B, Peckham DG. Cystic Fibrosis-Related Gut Dysbiosis: A Systematic Review. Dig Dis Sci 2023; 68:1797-1814. [PMID: 36600119 DOI: 10.1007/s10620-022-07812-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 10/17/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Cystic Fibrosis (CF) is associated with gut dysbiosis, local and systemic inflammation, and impaired immune function. Gut microbiota dysbiosis results from changes in the complex gut milieu in response to CF transmembrane conductance regulator (CFTR) dysfunction, pancreatic malabsorption, diet, medications, and environmental influences. In several diseases, alteration of the gut microbiota influences local and systemic inflammation and disease outcomes. We conducted a systematic review of the gut microbiota in CF and explored factors influencing dysbiosis. METHODS An electronic search of three databases was conducted in January 2019, and re-run in June 2021. Human, animal, and in vitro studies were included. The primary outcome was differences in the gut microbiota between people with CF (pwCF) and healthy controls. Secondary outcomes included the relationship between the gut microbiota and other factors, including diet, medication, inflammation, and pulmonary function in pwCF. RESULTS Thirty-eight studies were identified. The literature confirmed the presence of CF-related gut dysbiosis, characterized by reduced diversity and several taxonomic changes. There was a relative increase of bacteria associated with a pro-inflammatory response coupled with a reduction of those considered anti-inflammatory. However, studies linking gut dysbiosis to systemic and lung inflammation were limited. Causes of gut dysbiosis were multifactorial, and findings were variable. Data on the impact of CFTR modulators on the gut microbiota were limited. CONCLUSIONS CF-related gut dysbiosis is evident in pwCF. Whether this influences local and systemic disease and is amenable to interventions with diet and drugs, such as CFTR modulators, requires further investigation.
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Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research, St James's University Hospital, Clinical Sciences Building, Leeds, LS9 7TF, UK
| | - H White
- Nutrition, Health & Environment, Leeds Beckett University, Leeds, UK
| | - M C de Goffau
- Wellcome Sanger Institute, Cambridge, UK.,Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - R A Floto
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK
| | - J Parkhill
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - B Marsland
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia
| | - D G Peckham
- Leeds Institute of Medical Research, St James's University Hospital, Clinical Sciences Building, Leeds, LS9 7TF, UK. .,Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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12
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Fraile Navarro D, Cheyne S, Hill K, McFarlane E, Morgan RL, Murad MH, Mustafa RA, Sultan S, Tunnicliffe DJ, Vogel JP, White H, Turner T. Methods for living guidelines: early guidance based on practical experience. Article 5: decisions on methods for evidence synthesis and recommendation development for living guidelines. J Clin Epidemiol 2023; 155:118-128. [PMID: 36608720 DOI: 10.1016/j.jclinepi.2022.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 05/11/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Producing living guidelines requires making important decisions about methods for evidence identification, appraisal, and integration to allow the living mode to function. Clarifying what these decisions are and the trade-offs between options is necessary. This article provides living guideline developers with a framework to enable them to choose the most suitable model for their living guideline topic, question, or context. STUDY DESIGN AND SETTING We developed this guidance through an iterative process informed by interviews, feedback, and a consensus process with an international group of living guideline developers. RESULTS Several key decisions need to be made both before commencing and throughout the continual process of living guideline development and maintenance. These include deciding what approach is taken to the systematic review process; decisions about methods to be applied for the evidence appraisal process, including the use of unpublished data; and selection of "triggers" to incorporate new studies into living guideline recommendations. In each case, there are multiple options and trade-offs. CONCLUSION We identify trade-offs and important decisions to be considered throughout the living guideline development process. The most appropriate, and most sustainable, mode of development and updating will be dependent on the choices made in each of these areas.
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Affiliation(s)
- David Fraile Navarro
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Saskia Cheyne
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, Victoria, Australia
| | - Emma McFarlane
- National Institute for Health and care Excellence, Manchester, UK
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Reem A Mustafa
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Shahnaz Sultan
- University of Minnesota, Minneapolis Veterans Affairs Healthcare System, MN, USA
| | - David J Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Heath White
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tari Turner
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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13
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Cheyne S, Fraile Navarro D, Buttery AK, Chakraborty S, Crane O, Hill K, McFarlane E, Morgan RL, Mustafa RA, Poole A, Tunnicliffe D, Vogel JP, White H, Whittle S, Turner T. Methods for living guidelines: early guidance based on practical experience. Paper 3: selecting and prioritizing questions for living guidelines. J Clin Epidemiol 2023; 155:73-83. [PMID: 36603743 DOI: 10.1016/j.jclinepi.2022.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This article is part of a series on methods for living guidelines, consolidating practical experiences from developing living guidelines. It focuses on methods for identification, selection, and prioritization of clinical questions for a living approach to guideline development. STUDY DESIGN AND SETTING Members of the Australian Living Evidence Consortium, the National Institute of Health and Care Excellence and the US Grading of Recommendations, Assessment, Development and Evaluations Network, convened a working group. All members have expertize and practical experience in the development of living guidelines. We collated methods, documents on prioritization from each organization's living guidelines, conducted interviews and held working group discussions. We consolidated these to form best practice principles which were then edited and agreed on by the working group members. RESULTS We developed best practice principles for (1) identification, (2) selection, and (3) prioritization, of questions for a living approach to guideline development. Several different strategies for undertaking prioritizing questions are explored. CONCLUSION The article provides guidance for prioritizing questions in living guidelines. Subsequent articles in this series explore consumer involvement, search decisions, and methods decisions that are appropriate for questions with different priority levels.
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Affiliation(s)
- Saskia Cheyne
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.
| | - David Fraile Navarro
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Samantha Chakraborty
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Olivia Crane
- National Institute of Health and Care Excellence, Manchester, UK
| | | | - Emma McFarlane
- National Institute of Health and Care Excellence, Manchester, UK
| | - Rebecca L Morgan
- Evidence Foundation, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, McMaster, Canada
| | - Reem A Mustafa
- Evidence Foundation, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, McMaster, Canada; University of Kansas Medical Center, KS, USA
| | - Alex Poole
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - David Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Joshua P Vogel
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Maternal, Child and Adolescent Health Program, Burnet Institute, Australia
| | - Heath White
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel Whittle
- Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network, Melbourne, Australia; The Queen Elizabeth Hospital, South Australia, Australia; Department of Epidemiology and Preventive Medicine, School of Preventive Medicine and Public Health, Monash University, Melbourne, Australia
| | - Tari Turner
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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14
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Heffernan AJ, Talekar C, Henain M, Purcell L, Palmer M, White H. Comparison of continuous versus intermittent enteral feeding in critically ill patients: a systematic review and meta-analysis. Crit Care 2022; 26:325. [PMID: 36284334 PMCID: PMC9594889 DOI: 10.1186/s13054-022-04140-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background The enteral route is commonly utilised to support the nutritional requirements of critically ill patients. However, there is paucity of data guiding clinicians regarding the appropriate method of delivering the prescribed dose. Continuous enteral feeding is commonly used; however, a bolus or intermittent method of administration may provide several advantages such as minimising interruptions. The purpose of this meta-analysis is to compare a continuous versus an intermittent or bolus enteral nutrition administration method. Methods A systematic review and meta-analysis were performed with studies identified from the PubMed, EMBASE, Cochrane Library and Web of Science databases. Studies were included if they compared a continuous with either an intermittent or bolus administration method of enteral nutrition in adult patients admitted to the intensive care unit. Study quality was assessed using the PEDro and Newcastle–Ottawa scoring systems. Review Manager was used for performing the random-effects meta-analysis on the outcomes of mortality, constipation, diarrhoea, increased gastric residuals, pneumonia, and bacterial colonisation. Results A total of 5546 articles were identified, and 133 were included for full text review. Fourteen were included in the final analysis. There was an increased risk of constipation with patients receiving continuous enteral nutrition (relative risk 2.24, 95% confidence interval 1.01–4.97, p = 0.05). No difference was identified in other outcome measures. No appreciable bias was identified. Conclusion The current meta-analysis has not identified any clinically relevant difference in most outcome measures relevant to the care of critically ill patients. However, there is a paucity of high-quality randomised controlled clinical trials to guide this decision. Therefore, clinicians may consider either dosing regimen in the context of the patient’s care requirements.
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Affiliation(s)
- Aaron J. Heffernan
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia ,grid.1022.10000 0004 0437 5432School of Medicine and Dentistry, Griffith University, Southport, QLD Australia
| | - C. Talekar
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia ,grid.1022.10000 0004 0437 5432School of Medicine and Dentistry, Griffith University, Southport, QLD Australia
| | - M. Henain
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia ,grid.416100.20000 0001 0688 4634Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, QLD Australia
| | - L. Purcell
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia
| | - M. Palmer
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia
| | - H. White
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia ,grid.1022.10000 0004 0437 5432School of Medicine and Dentistry, Griffith University, Southport, QLD Australia
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15
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White H, McDonald SJ, Barber B, Davis J, Burr L, Nair P, Mukherjee S, Tendal B, Elliott J, McGloughlin S, Turner T. Care for adults with
COVID
‐19: living guidelines from the National
COVID
‐19 Clinical Evidence Taskforce. Med J Aust 2022; 217:368-378. [PMID: 36150213 PMCID: PMC9538623 DOI: 10.5694/mja2.51718] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 12/01/2022]
Abstract
Introduction The Australian National COVID‐19 Clinical Evidence Taskforce was established in March 2020 to maintain up‐to‐date recommendations for the treatment of people with coronavirus disease 2019 (COVID‐19). The original guideline (April 2020) has been continuously updated and expanded from nine to 176 recommendations, facilitated by the rapid identification, appraisal, and analysis of clinical trial findings and subsequent review by expert panels. Main recommendations In this article, we describe the recommendations for treating non‐pregnant adults with COVID‐19, as current on 1 August 2022 (version 61.0). The Taskforce has made specific recommendations for adults with severe/critical or mild disease, including definitions of disease severity, recommendations for therapy, COVID‐19 prophylaxis, respiratory support, and supportive care. Changes in management as a result of the guideline The Taskforce currently recommends eight drug treatments for people with COVID‐19 who do not require supplemental oxygen (inhaled corticosteroids, casirivimab/imdevimab, molnupiravir, nirmatrelvir/ritonavir, regdanvimab, remdesivir, sotrovimab, tixagevimab/cilgavimab) and six for those who require supplemental oxygen (systemic corticosteroids, remdesivir, tocilizumab, sarilumab, baricitinib, casirivimab/imdevimab). Based on evidence of their achieving no or only limited benefit, ten drug treatments or treatment combinations are not recommended; an additional 42 drug treatments should only be used in the context of randomised trials. Additional recommendations include support for the use of continuous positive airway pressure, prone positioning, and endotracheal intubation in patients whose condition is deteriorating, and prophylactic anticoagulation for preventing venous thromboembolism. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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Affiliation(s)
- Heath White
- Cochrane Australia Monash University Melbourne VIC
| | | | | | - Joshua Davis
- John Hunter Hospital Newcastle NSW
- The University of Newcastle Newcastle NSW
| | - Lucy Burr
- Mater Hospital Brisbane Brisbane QLD
- Mater Research Institute University of Queensland Brisbane QLD
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16
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Homer CSE, Roach V, Cusack L, Giles ML, Whitehead C, Burton W, Downton T, Gleeson G, Gordon A, Hose K, Hunt J, Kitschke J, McDonnell N, Middleton P, Oats JJN, Shand AW, Wilton K, Vogel J, Elliott J, McGloughlin S, McDonald SJ, White H, Cheyne S, Turner T. The National COVID-19 Clinical Evidence Taskforce: pregnancy and perinatal guidelines. Med J Aust 2022; 217 Suppl 9:S14-S19. [PMID: 36183307 PMCID: PMC9538383 DOI: 10.5694/mja2.51729] [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] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID-19) than non-pregnant women of a similar age. Early in the COVID-19 pandemic, it was clear that evidenced-based guidance was needed, and that it would need to be updated rapidly. The National COVID-19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID-19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice. MAIN RECOMMENDATIONS As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID-19-specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease-modifying treatments for the treatment of COVID-19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up-to-date guidance is available online (https://covid19evidence.net.au). CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINES The National COVID-19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID-19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.
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Affiliation(s)
- Caroline SE Homer
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVIC
| | - Vijay Roach
- Royal North Shore HospitalSydneyNSW,Mater HospitalSydneyNSW
| | | | | | - Clare Whitehead
- Royal Women’s HospitalMelbourneVIC,University of MelbourneMelbourneVIC
| | | | - Teena Downton
- Australian College of Rural and Remote MedicineBrisbaneQLD
| | - Glenda Gleeson
- CentralAustraliaHealth ServiceAlice SpringsNT,CRANAplusAdelaideSA
| | - Adrienne Gordon
- Sydney Local Health DistrictSydneyNSW,Sydney Institute for WomenChildren and their FamiliesSydneyNSW
| | | | - Jenny Hunt
- Victorian Aboriginal Health ServiceMelbourneVIC
| | | | - Nolan McDonnell
- King Edward Memorial HospitalPerthWA,University of Western AustraliaPerthWA
| | - Philippa Middleton
- SAHMRI, Women and Children's HospitalAdelaideSA,University of AdelaideAdelaideSA
| | | | - Antonia W Shand
- Royal Hospital for WomenSydneyNSW,University of NSWSydneyNSW
| | | | - Joshua Vogel
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVIC,CochraneAustraliaMonash UniversityMelbourneVIC
| | - Julian Elliott
- CochraneAustraliaMonash UniversityMelbourneVIC,Monash UniversityMelbourneVIC
| | | | | | - Heath White
- CochraneAustraliaMonash UniversityMelbourneVIC
| | - Saskia Cheyne
- CochraneAustraliaMonash UniversityMelbourneVIC,Australian College of MidwivesCanberraACT,NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
| | - Tari Turner
- CochraneAustraliaMonash UniversityMelbourneVIC
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17
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Cheyne S, Lindley RI, Smallwood N, Tendal B, Chapman M, Fraile Navarro D, Good PD, Jenkin P, McDonald S, Morgan D, Murano M, Millard T, Naganathan V, Srikanth V, Tuffin P, Vogel J, White H, Chakraborty SP, Whiting E, William L, Yates PM, Callary M, Elliott J, Agar MR. Care of older people and people requiring palliative care with COVID-19: guidance from the Australian National COVID-19 Clinical Evidence Taskforce. Med J Aust 2021; 216:203-208. [PMID: 34865227 PMCID: PMC9299653 DOI: 10.5694/mja2.51353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 12/26/2022]
Abstract
Introduction Older people living with frailty and/or cognitive impairment who have coronavirus disease 2019 (COVID‐19) experience higher rates of critical illness. There are also people who become critically ill with COVID‐19 for whom a decision is made to take a palliative approach to their care. The need for clinical guidance in these two populations resulted in the formation of the Care of Older People and Palliative Care Panel of the National COVID‐19 Clinical Evidence Taskforce in June 2020. This specialist panel consists of nursing, medical, pharmacy and allied health experts in geriatrics and palliative care from across Australia. Main recommendations The panel was tasked with developing two clinical flow charts for the management of people with COVID‐19 who are i) older and living with frailty and/or cognitive impairment, and ii) receiving palliative care for COVID‐19 or other underlying illnesses. The flow charts focus on goals of care, communication, medication management, escalation of care, active disease‐directed care, and managing symptoms such as delirium, anxiety, agitation, breathlessness or cough. The Taskforce also developed living guideline recommendations for the care of adults with COVID‐19, including a commentary to discuss special considerations when caring for older people and those requiring palliative care. Changes in management as result of the guideline The practice points in the flow charts emphasise quality clinical care, with a focus on addressing the most important challenges when caring for older individuals and people with COVID‐19 requiring palliative care. The adult recommendations contain additional considerations for the care of older people and those requiring palliative care.
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Affiliation(s)
- Saskia Cheyne
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW.,Cochrane Australia, Monash University, Melbourne, VIC
| | - Richard I Lindley
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW.,George Institute for Global Health, Sydney, NSW
| | | | - Britta Tendal
- Cochrane Australia, Monash University, Melbourne, VIC
| | | | | | | | | | | | - Deidre Morgan
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA.,Flinders University, Adelaide, SA
| | | | - Tanya Millard
- Cochrane Australia, Monash University, Melbourne, VIC
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CRGH), University of Sydney, Sydney, NSW
| | | | - Penelope Tuffin
- Royal Perth Hospital, Perth, WA.,Fiona Stanley Hospital, Perth, WA
| | - Joshua Vogel
- Cochrane Australia, Monash University, Melbourne, VIC.,Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC
| | - Heath White
- Cochrane Australia, Monash University, Melbourne, VIC
| | | | | | - Leeroy William
- Cochrane Australia, Monash University, Melbourne, VIC.,Eastern Health, Melbourne, VIC
| | - Patsy M Yates
- Centre for Cancer and Palliative Care Outcomes, Queensland University of Technology, Brisbane, QLD
| | | | | | - Meera R Agar
- IMPACCT Centre, University of Technology Sydney, Sydney, NSW
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18
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Fraile Navarro D, Tendal B, Tingay D, Vasilunas N, Anderson L, Best J, Burns P, Cheyne S, Craig SS, Erickson SJ, Fancourt NS, Goff Z, Kapuya V, Keyte C, Malyon L, McDonald S, White H, Wurzel D, Bowen AC, McMullan B. Clinical care of children and adolescents with COVID-19: recommendations from the National COVID-19 Clinical Evidence Taskforce. Med J Aust 2021; 216:255-263. [PMID: 34689329 PMCID: PMC8661691 DOI: 10.5694/mja2.51305] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS-TS). Recognising the distinct needs of this population, the National COVID-19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID-19 and COVID-19 complications. Living guidelines mean that these evidence-based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care. MAIN RECOMMENDATIONS To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID-19 and for the management of PIMS-TS. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES The Taskforce currently recommends corticosteroids as first line treatment for acute COVID-19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non-invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS-TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS-TS. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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Affiliation(s)
- David Fraile Navarro
- Cochrane Australia, Monash University, Melbourne, VIC.,Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Britta Tendal
- Cochrane Australia, Monash University, Melbourne, VIC
| | - David Tingay
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Nan Vasilunas
- Women's and Children's Health Network, Women's and Children's Hospital Adelaide, Adelaide, SA
| | - Lorraine Anderson
- Kimberley Aboriginal Medical Services Council, Broome, WA.,Junction Street Family Practice, Sydney, NSW
| | - James Best
- Junction Street Family Practice, Sydney, NSW
| | - Penelope Burns
- Australian National University, Canberra, ACT.,Northern Beaches Hospital, Sydney, NSW.,Western Sydney University, Sydney, NSW
| | - Saskia Cheyne
- Cochrane Australia, Monash University, Melbourne, VIC.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - Simon S Craig
- Monash University, Melbourne, VIC.,Monash Medical Centre, Monash Health, Melbourne, VIC
| | | | | | - Zoy Goff
- Perth Children's Hospital, Perth, WA
| | - Vimbai Kapuya
- Charles Darwin University, Darwin, NT.,Australian College of Rural and Remote Medicine, Brisbane, QLD
| | - Catherine Keyte
- Queensland Children's Hospital, Brisbane, QLD.,Australian College of Nursing, Canberra, ACT
| | - Lorelle Malyon
- College of Emergency Nursing Australasia, Melbourne, VIC
| | | | - Heath White
- Cochrane Australia, Monash University, Melbourne, VIC
| | - Danielle Wurzel
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Asha C Bowen
- Perth Children's Hospital, Perth, WA.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Brendan McMullan
- Sydney Children's Hospital, Randwick, Sydney, NSW.,University of New South Wales, Sydney, NSW
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19
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Holloway Z, Hawkey AB, Pippen E, White H, Katragadda V, Kenou B, Wells C, Murphy SK, Rezvani AH, Levin ED. Corrigendum to "Paternal cannabis extract exposure in rats: Preconception timing effects on neurobehavioral effects in offspring" [Neurotoxicology 81 (2020) 180-188]. Neurotoxicology 2021; 87:258. [PMID: 34483001 DOI: 10.1016/j.neuro.2021.08.009] [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: 10/20/2022]
Affiliation(s)
| | | | - E Pippen
- Duke University Medical Center, USA
| | - H White
- Duke University Medical Center, USA
| | | | - B Kenou
- Duke University Medical Center, USA
| | - C Wells
- Duke University Medical Center, USA
| | | | | | - E D Levin
- Duke University Medical Center, USA.
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20
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Han L, White H, Bosch K, Nair M. 708 Examining the Management of Acute Lower GI Bleeds in Order to Improve Policies and Reflect Safe and Updated Guidance. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.474] [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: 11/14/2022]
Abstract
Abstract
Introduction
Acute lower gastrointestinal bleeding (LGIB) tends to occur in elderly patients with complex comorbidities. At North Middlesex University Hospital (NMUH), LGIB patients are primarily managed by the surgical department. We amended local policies by integrating aspects of new guidelines published by the British Society of Gastroenterology (BSG).
Method
Handover documentation between November 2019 and January 2020 established patients admitted with LGIB (n = 45). Further data regarding the management of these patients was collated from clinical software and compared to standards set from BSG guidelines.
Results
We found NMUH to be efficient in ruling out upper GI bleeds via 24-hour OGDs and had low surgical intervention rates (0.02%). 40% of patients were transfused with an admission haemoglobin above suggested NICE thresholds, accounting for cardiovascular comorbidities. 56% of patients were discharged without a documented anticoagulation plan. Over 50% of patients did not have BSG recommended inpatient investigations.
Conclusions
Updated Trust guidelines aim to uphold areas that NMUH were shown to excel in, while reiterating NICE transfusion thresholds and include guidance regarding anticoagulant and antiplatelet medications. The Oakland score and shock index have been integrated into local protocols and will aid clinicians in making safe decisions in the management of LGIB patients.
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Affiliation(s)
- L Han
- North Middlesex University Hospital, London, United Kingdom
| | - H White
- North Middlesex University Hospital, London, United Kingdom
| | - K Bosch
- North Middlesex University Hospital, London, United Kingdom
| | - M Nair
- North Middlesex University Hospital, London, United Kingdom
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21
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White H, Stowe C. 134 Estimating the capacity of horse owners to absorb the surplus of wild horses. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Pyrke B, Abdalla B, Cartwright G, Figg K, Murphy E, Tuck A, White H. 140 Lessons From the Front Line: Communication is Key. Age Ageing 2021. [PMCID: PMC7989613 DOI: 10.1093/ageing/afab030.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction As junior doctors, we very rarely receive formal teaching on communication after medical school, with telephone encounters and difficult conversations over technology being a vital yet missing part of our education. The COVID-19 pandemic has required us to adapt how we communicate with patients’ families due to hospital visiting restrictions. In an era where tragically deterioration and death have been much more commonplace, we looked to identify areas where junior doctors felt their communication skills could be improved, and implemented a teaching programme to deliver this. Methods Pre-teaching questionnaires were distributed to a range of grades of junior doctors working in University Hospital of Llandough, Cardiff. The questionnaires were distributed at the beginning of June 2020, after 3 months of working in pandemic conditions. A teaching session on telephone and video communication skills was delivered by a local palliative care consultant. Post-teaching, a repeat questionnaire was undertaken to assess response and identify key learning points. Results Pre-teaching, 100% of the 22 respondents had had to participate in difficult conversations over the phone, 82% had had no formal phone based communication skills training and 81.82% felt some form of formal teaching would be helpful. Post-teaching, 12 junior doctors provided feedback with an average 37% increase in confidence to undertake difficult conversations. Key learning points from the session highlighted the importance of preparation, regularly updating the family to build trust and rapport, and integrating family updates via tele-communication into daily ward life. Conclusions Education around telephone communication skills is critical to enable us to adapt our skills in accordance with the demands of the pandemic, to continue to support relatives and to engage with technology with confidence. Increased preparation is required to navigate difficult conversations via technology, and successful communication requires clinicians to take responsibility for initiating regular family updates.
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Affiliation(s)
- B Pyrke
- University Hospital of Llandough, Cardiff, Wales
| | - B Abdalla
- University Hospital of Llandough, Cardiff, Wales
| | - G Cartwright
- University Hospital of Llandough, Cardiff, Wales
| | - K Figg
- University Hospital of Llandough, Cardiff, Wales
| | - E Murphy
- University Hospital of Llandough, Cardiff, Wales
| | - A Tuck
- University Hospital of Llandough, Cardiff, Wales
| | - H White
- University Hospital of Llandough, Cardiff, Wales
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23
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White H, Tuck A, Pyrke B, Murphy E, Figg K, Cartwright G, Abdalla B. 141 Face Time’ for the First Time: Patients, Families and Junior Doctors. Age Ageing 2021. [PMCID: PMC7989593 DOI: 10.1093/ageing/afab030.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Over the course of the COVID-19 pandemic, supporting effective communication between patients and their families has been a recognised challenge in the healthcare environment. Virtual communication via telecommunication and video-calling is more important than ever, but with minimal clinician education, preparation and relevant technological infrastructure available in the context of a global pandemic, we have recognised communication as an area for improvement as junior doctors working on a COVID-19 ward. Methods We interviewed via telephone 22 nominated next of kin relatives of patients admitted to a COVID-19 ward in the University Hospital of Llandough during May 2020 using a pre-prepared survey. We then provided relatives with the opportunity to engage with video-call updates from a doctor (with the patient’s permission). In appropriate scenarios, we used video calling to break bad news and to facilitate difficult communications with family members. These video calls were provided via Accurx, an NHS approved video communication system. Results Initial survey results showed an average understanding score of their relative’s current clinical plan of 5.5/10, with 63% of respondents saying they did not feel well informed. Nearly a quarter of respondents (22%) had received difficult news over the phone during the COVID-19 pandemic, and 86% said they would find video communication useful. Post-intervention survey results suggested a unanimous improvement in relative satisfaction, with relatives reporting an increased understanding around the admission, reassurance around the quality of care being given and less isolation from the patient. Conclusions The COVID-19 pandemic has provided novel communication challenges to physicians, promoting flexibility and adaptation to some of the core inter-personal skills we develop throughout training. Technology plays a huge role in this, and the use of video calling in particular can preserve non-verbal communication within the doctor-relative relationship and improve emotional connection between patients and their loved ones.
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Affiliation(s)
- H White
- University Hospital of Llandough, Wales
| | - A Tuck
- University Hospital of Llandough, Wales
| | - B Pyrke
- University Hospital of Llandough, Wales
| | - E Murphy
- University Hospital of Llandough, Wales
| | - K Figg
- University Hospital of Llandough, Wales
| | | | - B Abdalla
- University Hospital of Llandough, Wales
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24
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Salaami O, Salaami O, Pandey M, White H, Yanamadala M, Mohammed A. Improving Access of Advance Directives in a Skilled Nursing Facility. J Am Med Dir Assoc 2021; 22:B14. [PMID: 34287154 DOI: 10.1016/j.jamda.2021.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Palmer SC, Tendal B, Mustafa RA, Vandvik PO, Li S, Hao Q, Tunnicliffe D, Ruospo M, Natale P, Saglimbene V, Nicolucci A, Johnson DW, Tonelli M, Rossi MC, Badve SV, Cho Y, Nadeau-Fredette AC, Burke M, Faruque LI, Lloyd A, Ahmad N, Liu Y, Tiv S, Millard T, Gagliardi L, Kolanu N, Barmanray RD, McMorrow R, Raygoza Cortez AK, White H, Chen X, Zhou X, Liu J, Rodríguez AF, González-Colmenero AD, Wang Y, Li L, Sutanto S, Solis RC, Díaz González-Colmenero F, Rodriguez-Gutierrez R, Walsh M, Guyatt G, Strippoli GFM. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ 2021; 372:m4573. [PMID: 33441402 PMCID: PMC7804890 DOI: 10.1136/bmj.m4573] [Citation(s) in RCA: 275] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk. DESIGN Network meta-analysis. DATA SOURCES Medline, Embase, and Cochrane CENTRAL up to 11 August 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials comparing SGLT-2 inhibitors or GLP-1 receptor agonists with placebo, standard care, or other glucose lowering treatment in adults with type 2 diabetes with follow up of 24 weeks or longer. Studies were screened independently by two reviewers for eligibility, extracted data, and assessed risk of bias. MAIN OUTCOME MEASURES Frequentist random effects network meta-analysis was carried out and GRADE (grading of recommendations assessment, development, and evaluation) used to assess evidence certainty. Results included estimated absolute effects of treatment per 1000 patients treated for five years for patients at very low risk (no cardiovascular risk factors), low risk (three or more cardiovascular risk factors), moderate risk (cardiovascular disease), high risk (chronic kidney disease), and very high risk (cardiovascular disease and kidney disease). A guideline panel provided oversight of the systematic review. RESULTS 764 trials including 421 346 patients proved eligible. All results refer to the addition of SGLT-2 inhibitors and GLP-1 receptor agonists to existing diabetes treatment. Both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence). Notable differences were found between the two agents: SGLT-2 inhibitors reduced admission to hospital for heart failure more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect). SGLT-2 inhibitors caused genital infection (high certainty), whereas GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty). Low certainty evidence suggested that SGLT-2 inhibitors and GLP-1 receptor agonists might lower body weight. Little or no evidence was found for the effect of SGLT-2 inhibitors or GLP-1 receptor agonists on limb amputation, blindness, eye disease, neuropathic pain, or health related quality of life. The absolute benefits of these drugs vary substantially across patients from low to very high risk of cardiovascular and renal outcomes (eg, SGLT-2 inhibitors resulted in 3 to 40 fewer deaths in 1000 patients over five years; see interactive decision support tool (https://magicevidence.org/match-it/200820dist/#!/) for all outcomes. CONCLUSIONS In patients with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists reduced cardiovascular and renal outcomes, with some differences in benefits and harms. Absolute benefits are determined by individual risk profiles of patients, with clear implications for clinical practice, as reflected in the BMJ Rapid Recommendations directly informed by this systematic review. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019153180.
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Affiliation(s)
- Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Britta Tendal
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Reem A Mustafa
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas, Kansas City, KS, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Per Olav Vandvik
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Division of Population Health and Genomics, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Qiukui Hao
- Centre for Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - David Tunnicliffe
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio CESARE, 70124 Bari, Italy
| | - Patrizia Natale
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio CESARE, 70124 Bari, Italy
| | - Valeria Saglimbene
- Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio CESARE, 70124 Bari, Italy
| | - Antonio Nicolucci
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - David W Johnson
- Department of Nephrology, Division of Medicine, University of Queensland at Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maria Chiara Rossi
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Sunil V Badve
- George Institute for Global Health, Sydney, NSW, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Division of Medicine, University of Queensland at Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | | | | | - Labib I Faruque
- Department of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Anita Lloyd
- Department of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nasreen Ahmad
- Department of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Yuanchen Liu
- Department of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sophanny Tiv
- Department of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tanya Millard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lucia Gagliardi
- Endocrine and Diabetes Unit, Queen Elizabeth Hospital, Woodville, SA, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Nithin Kolanu
- Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Rahul D Barmanray
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Rita McMorrow
- Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, VIC, Australia
| | - Ana Karina Raygoza Cortez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Heath White
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Xiangyang Chen
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xu Zhou
- Evidence-based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jiali Liu
- Chinese Evidence-based Medicine Centre, Cochrane China Centre
| | - Andrea Flores Rodríguez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | - Yang Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Ling Li
- Chinese Evidence-based Medicine Centre, Cochrane China Centre
| | - Surya Sutanto
- Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Ricardo Cesar Solis
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | - René Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Michael Walsh
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio CESARE, 70124 Bari, Italy
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Chan D, Stewart R, Kerr A, Dicker B, Kyle C, Adamson P, Devlin G, Edmond J, El-Jack S, Elliott J, Fisher N, Flynn C, Lee M, Liao Y, Rhodes M, Scott T, Smith T, Stiles M, Swain A, Todd V, Webster M, Williams M, White H, Somaratne J. The Impact of a National COVID-19 Lockdown on Acute Coronary Syndrome Hospitalisations in New Zealand: an ANZACS-QI study. Heart Lung Circ 2021. [PMCID: PMC8203216 DOI: 10.1016/j.hlc.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Caley L, Smith L, White H, Peckham D. Average rate of lung function decline in adults with cystic fibrosis in the United Kingdom: Data from the UK CF registry. J Cyst Fibros 2021; 20:86-90. [DOI: 10.1016/j.jcf.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
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Vogel JP, Tendal B, Giles M, Whitehead C, Burton W, Chakraborty S, Cheyne S, Downton T, Fraile Navarro D, Gleeson G, Gordon A, Hunt J, Kitschke J, McDonald S, McDonnell N, Middleton P, Millard T, Murano M, Oats J, Tate R, White H, Elliott J, Roach V, Homer CS. Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce. Aust N Z J Obstet Gynaecol 2020; 60:840-851. [PMID: 33119139 PMCID: PMC7820999 DOI: 10.1111/ajo.13270] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates.
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Affiliation(s)
- Joshua P. Vogel
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVictoriaAustralia
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Britta Tendal
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Michelle Giles
- Alfred HospitalMelbourneVictoriaAustralia
- Monash HealthMelbourneVictoriaAustralia
- Royal Women’s HospitalMelbourneVictoriaAustralia
- Sunshine HospitalMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyMonash UniversityMelbourneVictoriaAustralia
| | - Clare Whitehead
- Royal Women’s HospitalMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Wendy Burton
- Morningside General Practice ClinicBrisbaneQueenslandAustralia
| | - Samantha Chakraborty
- Department of General PracticeSchool of Primary and Allied Health CareMonash UniversityMelbourneVictoriaAustralia
| | - Saskia Cheyne
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Teena Downton
- Australian College of Rural and Remote MedicineBrisbaneQueenslandAustralia
| | - David Fraile Navarro
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Glenda Gleeson
- Central Australia Primary and Public Health ‐ Midwifery and Women’s HealthAlice SpringsNorthern TerritoryAustralia
| | - Adrienne Gordon
- RPA Newborn CareSydney Local Health DistrictDiscipline of Obstetrics, Gynaecology and NeonatologyCentral Clinical SchoolFaculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- Sydney Institute for Women, Children and their FamiliesSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Jenny Hunt
- Victorian Aboriginal Health ServiceMelbourneVictoriaAustralia
| | - Jackie Kitschke
- Australian College of Midwives representative, Midwifery Group PracticeWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Steven McDonald
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Nolan McDonnell
- Faculty of Health and Medical SciencesObstetrics and GynaecologyUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Philippa Middleton
- SAHMRI, Women and Children’s HospitalAdelaideSouth AustraliaAustralia
- Faculty of Medical and Health SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Tanya Millard
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Melissa Murano
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jeremy Oats
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rhiannon Tate
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Heath White
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Julian Elliott
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Alfred HospitalMelbourneVictoriaAustralia
| | - Vijay Roach
- North Shore Private HospitalSydneyNew South WalesAustralia
| | - Caroline S.E. Homer
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVictoriaAustralia
- Centre for Midwifery, Child and Family Health in the Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
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29
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Tendal B, Vogel JP, McDonald S, Norris S, Cumpston M, White H, Leder K, Navarro DF, Cheyne S, Chakraborty S, Murano M, Millard T, Callesen HE, Islam RM, Elliott J, Turner T. Weekly updates of national living evidence-based guidelines: methods for the Australian living guidelines for care of people with COVID-19. J Clin Epidemiol 2020; 131:11-21. [PMID: 33188858 PMCID: PMC7657075 DOI: 10.1016/j.jclinepi.2020.11.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/06/2020] [Accepted: 11/04/2020] [Indexed: 01/06/2023]
Abstract
Background and Objectives The Australian National COVID-19 Clinical Evidence Taskforce is a consortium of 31 Australian health professional organisations developing living, evidence-based guidelines for care of people with COVID-19, which are updated weekly. This article describes the methods used to develop and maintain the guidelines. Methods The guidelines use the GRADE methods and are designed to meet Australian NHMRC standards. Each week, new evidence is reviewed, current recommendations are revised, and new recommendations made. These are published in MAGIC and disseminated through traditional and social media. Relevant new questions to be addressed are continually sought from stakeholders and practitioners. For prioritized questions, the evidence is actively monitored and updated. Evidence surveillance combines horizon scans and targeted searches. An evidence team appraises and synthesizes evidence and prepares evidence-to-decision frameworks to inform development of recommendations. A guidelines leadership group oversees the development of recommendations by multidisciplinary guidelines panels and is advised by a consumer panel. Results : The Taskforce formed in March 2020, and the first recommendations were published 2 weeks later. The guidelines have been revised and republished on a weekly basis for 24 weeks, and as of October 2020, contain over 90 treatment recommendations, suggesting that living methods are feasible in this context. Conclusions The Australian guidelines for care of people with COVID-19 provide an example of the feasibility of living guidelines and an opportunity to test and improve living evidence methods.
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Affiliation(s)
- Britta Tendal
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joshua P Vogel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sarah Norris
- School of Public Health, University of Sydney, Sydney, Australia
| | - Miranda Cumpston
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Heath White
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Fraile Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Saskia Cheyne
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Melissa Murano
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tanya Millard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Rakibul M Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Julian Elliott
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Infectious Diseases Unit, Alfred Health, Melbourne, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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30
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Wassberg C, Batra G, Hadziosmanovic N, Hagstrom E, White H, Stewart R, Siegbahn A, Wallentin L, Held C. Associations between psychosocial burden and prognostic biomarkers in patients with stable coronary heart disease – a STABILITY substudy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1505] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Psychosocial burden is associated with increased risk of cardiovascular (CV) events in patients with stable coronary heart disease (CHD). The underlying mechanisms linking psychosocial burden and CHD are unclear and might be explained by studying biomarkers known to be associated with CV risk.
Methods
15,608 patients in the STABILITY trial completed a questionnaire on to what extent they were feeling down, had loss of interest, experienced financial stress and if they were living alone. Levels of high-sensitivity (hs) C-reactive protein (hs-CRP), interleukin-6 (IL-6), hs-troponin T (hs-TnT) and N-terminal pro-B type natriuretic peptide (NT-proBNP) were assessed at baseline. Associations between levels of psychosocial burden (sometimes, often/always vs. never/rarely) and biomarkers were evaluated in a linear model where geometric mean ratio of the log-transformed biomarker were calculated.
Results
Adjusted associations (age, gender and established CV risk factors) are presented in the table.
Conclusion
Psychosocial burden in patients with stable CHD was independently associated with elevated biomarkers. The underlying association is likely to be complex and involve multiple pathways.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The STABILITY study was funded by GlaxoSmithKline. Roche Diagnostics, Rotkreuz, Switzerland, supported the research by providing the GDF-15 assay free of charge.
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Affiliation(s)
- C Wassberg
- Uppsala University, Dept. of Medical Sciences, Cardiology, Uppsala, Sweden
| | - G Batra
- Uppsala University, Dept. of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - E Hagstrom
- Uppsala University, Dept. of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala, Sweden
| | - H White
- Auckland City Hospital and University of Auckland, Green Lane Cardiovascular Service, Auckland, New Zealand
| | - R Stewart
- Auckland City Hospital and University of Auckland, Green Lane Cardiovascular Service, Auckland, New Zealand
| | - A Siegbahn
- Uppsala University, Dept. of Medical Sciences, Clinical Chemistry and Uppsala Clinical Research Center, Uppsala, Sweden
| | - L Wallentin
- Uppsala University, Dept. of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala, Sweden
| | - C Held
- Uppsala University, Dept. of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala, Sweden
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31
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Dunn C, Wong N, Griffin Y, White H, Wiselka M. Image challenge: A complex PUO. Clinical Infection in Practice 2020. [DOI: 10.1016/j.clinpr.2020.100023] [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: 10/24/2022] Open
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32
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Robinson D, Liou A, Rehman S, Darji H, White H, Mogri I, Sanchez J, Arroliga A, Ghamande S. ASSOCIATION BETWEEN BETA-AGONIST USE AND TAKOTSUBO CARDIOMYOPATHY IN HOSPITALIZED PATIENTS: A RETROSPECTIVE MULTI-CENTER REVIEW. Chest 2020. [DOI: 10.1016/j.chest.2020.08.055] [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: 11/26/2022] Open
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33
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Moslander C, Agrawal N, Afghani Z, Vazquez Sandoval A, White H, Rasmussen-Winkler J, Ghamande S. UTILITY OF PREDICTIVE SCORES FOR POST TPA INTRACRANIAL HEMORRHAGE IN ACUTE ISCHEMIC STROKES TO OPTIMIZE 24-HOUR POST TPA SCAN UTILIZATION. Chest 2020. [DOI: 10.1016/j.chest.2020.08.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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34
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Nathani A, OConnor S, White H. A CHALLENGING CASE OF DIFFUSE ALVEOLAR HEMORRHAGE. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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35
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Caley L, White H, Jaudszus A, Mainz J, Peckham D. ePS2.03 Prevalence of gastrointestinal symptoms in pancreatic insufficient adults with cystic fibrosis: a UK cohort study. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30293-9] [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: 10/24/2022]
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36
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Caley L, Smith L, White H, Peckham D. WS23.3 The average rate of lung function decline in adults with cystic fibrosis in the United Kingdom: data from the UK Cystic Fibrosis Registry. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30277-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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37
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White H, Tendal B, Elliott J, Turner T, Andrikopoulos S, Zoungas S. Breathing life into Australian diabetes clinical guidelines. Med J Aust 2020; 212:250-251.e1. [DOI: 10.5694/mja2.50509] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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38
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Liou A, Crowe M, Whitehurst C, Povian S, Zolfaghari K, White H, Arroliga A, Ghamande S. THE ROLE OF THE RAPID SCORE IN SURGICAL PLANNING FOR EMPYEMA. Chest 2019. [DOI: 10.1016/j.chest.2019.08.818] [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: 11/26/2022] Open
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39
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Swift SL, Lang SH, White H, Misso K, Kleijnen J, Quek RG. Effect of DNA damage response mutations on prostate cancer prognosis: a systematic review. Future Oncol 2019; 15:3283-3303. [PMID: 31535940 DOI: 10.2217/fon-2019-0298] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/18/2022] Open
Abstract
The prognosis of men with prostate cancer (PC) with mutations in DNA damage response (DDR) genes undergoing different treatments is unclear. This systematic review compared clinical outcomes in PC patients with DDR mutations (DDR+) versus no mutations (DDR-). 14 resources plus gray literature were searched for studies in PC and subgroups (castration-resistant PC, metastatic PC and metastatic castration-resistant PC) by DDR gene (ATM, ATR, BRCA1, BRCA2, CHEK2, FANCA, MLH1, MRE11A, NBN, PALB2, RAD51C) mutation status. From 11,648 records, 26 studies were included. For mCRPC, six studies reported comparative efficacy for key outcomes. Improvements in several clinical outcomes were observed for DDR+ (vs DDR-) after PARP inhibitor therapy or immunotherapy. DDR+ PC patients may have improved outcomes depending on the treatment they undergo.
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Affiliation(s)
| | - Shona H Lang
- Kleijnen Systematic Reviews Ltd, Escrick, York YO19 6FD, UK
| | - Heath White
- Kleijnen Systematic Reviews Ltd, Escrick, York YO19 6FD, UK
| | - Kate Misso
- Kleijnen Systematic Reviews Ltd, Escrick, York YO19 6FD, UK
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, Escrick, York YO19 6FD, UK.,School for Public Health & Primary Care, Maastricht University, Maastricht, 6211 LK, The Netherlands
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40
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Dhanda J, Gray J, White H. Bacterial cross-infection related to the use of bladeless fans in a clinical setting. J Hosp Infect 2019; 103:478-480. [PMID: 31491453 DOI: 10.1016/j.jhin.2019.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- J Dhanda
- Department of Microbiology, Birmingham Women's & Children's NHS Foundation Trust, Birmingham Children's Hospital, Birmingham, UK.
| | - J Gray
- Department of Microbiology, Birmingham Women's & Children's NHS Foundation Trust, Birmingham Children's Hospital, Birmingham, UK
| | - H White
- Department of Microbiology, Birmingham Women's & Children's NHS Foundation Trust, Birmingham Children's Hospital, Birmingham, UK
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41
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Lang SH, Swift SL, White H, Misso K, Kleijnen J, Quek RG. A systematic review of the prevalence of DNA damage response gene mutations in prostate cancer. Int J Oncol 2019; 55:597-616. [PMID: 31322208 PMCID: PMC6685596 DOI: 10.3892/ijo.2019.4842] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/28/2019] [Indexed: 02/06/2023] Open
Abstract
Several ongoing international prostate cancer (PC) clinical trials are exploring therapies that target the DNA damage response (DDR) pathway. This systematic review summarizes the prevalence of DDR mutation carriers in the unselected (general) PC and familial PC populations. A total of 11 electronic databases, 10 conference proceedings, and grey literature sources were searched from their inception to December 2017. Studies reporting the prevalence of somatic and/or germline DDR mutations were summarized. Metastatic PC (mPC), castration‑resistant PC (CRPC) and metastatic CRPC (mCRPC) subgroups were included. A total of 11,648 records were retrieved, and 80 studies (103 records) across all PC populations were included; 59 records were of unselected PC and 13 records of familial PC. Most data were available for DDR panels (n=12 studies), ataxia telangiectasia mutated (ATM; n=13), breast cancer susceptibility gene (BRCA)1 (n=14) and BRCA2 (n=20). ATM, BRCA2 and partner and localizer of BRCA2 (PALB2) had the highest mutation rates (≥4%). Median prevalence rates for DDR germline mutations were 18.6% in PC (range, 17.2‑19%; three studies, n=1,712), 11.6% in mPC (range, 11.4‑11.8%; two studies, n=1,261) and 8.3% in mCRPC (range, 7.5‑9.1%; two studies, n=738). Median prevalence rates for DDR somatic mutations were 10.7% in PC (range, 4.9‑22%; three studies, n=680), 13.2% in mPC (range, 10‑16.4%; two studies, n=105) and not reported (NR) in mCRPC. The prevalence of DDR germline and/or somatic mutations was 27% in PC (one study, n=221), 22.67% in mCRPC (one study, n=150) and NR in mPC. In familial PC, median mutation prevalence was 12.1% (range, 7.3‑16.9%) for germline DDR (two studies, n=315) and 3.7% (range, 1.3‑7.9%) for BRCA2 (six studies, n=945). In total, 88% of studies were at a high risk of bias. The prevalence of DDR gene mutations in PC varied widely within somatic subgroups depending on study size, genetic screening techniques, DDR mutation definition and PC diagnosis; somatic and/or germline DDR mutation prevalence was in the range of 23‑27% in PC. These findings support DDR mutation testing for all patients with PC (including those with mCRPC). With the advent of the latest clinical practice PC guidelines highlighting the importance of DDR mutation screening, and ongoing mCRPC clinical trials evaluating DDR mutation‑targeted drugs, future larger epidemiological studies are warranted to further quantify the international burden of DDR mutations in PC.
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Affiliation(s)
| | | | | | - Kate Misso
- Information Department, Kleijnen Systematic Reviews Ltd., Escrick, York YO19 6FD, UK
| | - Jos Kleijnen
- Reviews Department
- School for Public Health and Primary Care, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Ruben G.W. Quek
- Health Economics and Outcomes Research, Pfizer Inc., San Francisco, CA 94105, USA
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42
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Sawant A, Chadwick H, White H, Whitaker P, Etherington C, Clifton I, Peckham D. ePS5.02 The effect of providing patient online access to Electronic Health care Records (EHR) in cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30280-2] [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: 11/28/2022]
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43
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Olszowka M, Wallentin L, Eriksson N, Hagstrom E, Held C, Stewart R, White H, Siegbahn A. P625Screening multiple biomarkers for associations with major coronary events. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Olszowka
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - L Wallentin
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - N Eriksson
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - C Held
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - R Stewart
- The University of Auckland, Auckland, New Zealand
| | - H White
- The University of Auckland, Auckland, New Zealand
| | - A Siegbahn
- Uppsala University, Department of Medical Sciences, Clinical Chemistry, Uppsala, Sweden
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44
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Olszowka M, Siegbahn A, Eriksson N, Held C, Stewart R, White H, Wallentin L, Hagstrom E. P6249Screening multiple biomarkers for associations with acute ischemic stroke in patients with stable coronary heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Olszowka
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - A Siegbahn
- Uppsala University, Department of Medical Sciences, Clinical Chemistry, Uppsala, Sweden
| | - N Eriksson
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - C Held
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - R Stewart
- The University of Auckland, Auckland, New Zealand
| | - H White
- The University of Auckland, Auckland, New Zealand
| | - L Wallentin
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
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45
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Olszowka M, Wallentin L, Eriksson N, Hagstrom E, Stewart R, White H, Siegbahn A, Held C. 2170Screening multiple biomarkers for associations with cardiovascular death in patients with stable coronary heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Olszowka
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - L Wallentin
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - N Eriksson
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - R Stewart
- The University of Auckland, Auckland, New Zealand
| | - H White
- The University of Auckland, Auckland, New Zealand
| | - A Siegbahn
- Uppsala University, Department of Medical Sciences, Clinical Chemistry, Uppsala, Sweden
| | - C Held
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
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46
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Leadon M, White H, Lin B. A Surgical Career: The Medical Student Perspective. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.718] [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: 11/15/2022]
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47
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Sawant A, Chadwick H, White H, Spoletini G, Whitaker P, Etherington C, Clifton I, Lee T, Duff A, Peckham D. P237 Views of healthcare professionals on patients having access to their secondary care electronic healthcare record: results of a cross-sectional questionnaire. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30532-0] [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: 11/29/2022]
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48
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Sharda N, Sharda N, Genao L, Pavon J, White H, Orto V, Keith K, Johnson S. Improving Elder Care in a Community Based Hospital. J Am Med Dir Assoc 2018. [DOI: 10.1016/j.jamda.2017.12.060] [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: 10/18/2022]
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49
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Bergman C, Bergman C, Ewing C, Iloabuchi T, White H. Futures to CMD: 2017 Survey Results and Personal Reflections. J Am Med Dir Assoc 2018. [DOI: 10.1016/j.jamda.2017.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Affiliation(s)
- C Nally
- Department of Surgery, Royal Marsden Hospital, London
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