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Burton R, Fryers PT, Sharpe C, Clarke Z, Henn C, Hydes T, Marsden J, Pearce-Smith N, Sheron N. The independent and joint risks of alcohol consumption, smoking, and excess weight on morbidity and mortality: a systematic review and meta-analysis exploring synergistic associations. Public Health 2024; 226:39-52. [PMID: 38000113 DOI: 10.1016/j.puhe.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Alcohol consumption, smoking, and excess weight independently increase the risk of morbidity/mortality. Less is known about how they interact. This research aims to quantify the independent and joint associations of these exposures across health outcomes and identify whether these associations are synergistic. STUDY DESIGN The protocol for this systematic review and meta-analysis was pre-registered (PROSPERO CRD42021231443). METHODS Medline and Embase were searched between 1 January 2010 and 9 February 2022. Eligible peer-reviewed observational studies had to include adult participants from Organisation for Co-Operation and Development countries and report independent and joint associations between at least two eligible exposures (alcohol, smoking, and excess weight) and an ICD-10 outcome (or equivalent). For all estimates, we calculated the synergy index (SI) to identify whether joint associations were synergistic. Meta-analyses were conducted for outcomes with sufficiently homogenous data. RESULTS The search returned 26,290 studies, of which 98 were included. Based on 138,130 participants, the combined effect (SI) of alcohol and smoking on head and neck cancer death/disease was 3.78 times greater than the additive effect of each exposure (95% confidence interval [CI] = 2.61, 5.48). Based on 2,603,939 participants, the combined effect of alcohol and excess weight on liver disease/death was 1.55 times greater than the additive effect of each exposure (95% CI = 1.33, 1.82). CONCLUSION Synergistic associations suggest the true population-level risk may be underestimated. In the absence of bias, individuals with multiple risks would experience a greater absolute risk reduction from an intervention that targets a single exposure than individuals with a single risk.
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Affiliation(s)
- R Burton
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom; Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, England, United Kingdom.
| | - P T Fryers
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - C Sharpe
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - Z Clarke
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - C Henn
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - T Hydes
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University Hospital Aintree NHS Foundation Trust, University of Liverpool, Liverpool, England, United Kingdom
| | - J Marsden
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, England, United Kingdom
| | - N Pearce-Smith
- Knowledge and Library Services, UK Health Security Agency, London, England, United Kingdom
| | - N Sheron
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom; Institute of Liver Studies, Kings College London School of Medicine at King's College Hospital, London, England, United Kingdom
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Elarabi H, Marsden J, Alghafri H, Adem A, Lee A. Personalized Care in Opioid Use Disorder maintained on Buprenorphine. Eur Psychiatry 2022. [PMCID: PMC9567902 DOI: 10.1192/j.eurpsy.2022.2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Effectiveness of buprenorphine (BUP) is moderated by medication misuse diversion and non-adherence, and poor retention and high cost. Contingency Managment has added benefit to BUP with Take-home doses as the most preferred reward by Opioid Use Disorder patients. Objectives Examine the clinical effectiveness of a novel incentivised medication adherence and abstinence monitoring to enable contingent access to increasing BUP take-home doses.Explore associations with opioid use and retention. Contrast characteristics of polysubstance abusers (PSA) and response to BUP, with single opioid users. Methods Two-arm, pragmatic, 16-week outpatient RCT of BUP maintenance.Takehome doses were provided as stepped-approach upto 4-weeks contingent of abstinence (UDS) and adherence according to Therapeutic Drug Monitoring-TDM. Primary outcome and secondard outcomes were % negative UDS for opioids anx retention, respectively. - Results Opioid % negative UDS was 76.7% (SD 25.0%) in I-AAM versus 63.5% (SD 34.7%) in TAU (13.3%; 95% [CI] 3.2%–23.3%; Cohen’s d 0.44; 95% CI 0.10–0.87). In I-AAM, 40 participants (57.1%) were retained versus 33 (46.4%) in TAU [OR: 1.54; 95% CI 0.79–2.98). PSA (73.7%, n=104) and carisprodol use increases non-fatal overdose (OR) 3.83, 95% CI 1.25 to 11.71) and 5.31, 95% CI 1.92 to 14.65], respectively. Opioid and non-opioid UDS are positively associated. BUP elimination rate (BUP-EL.R) predicts 26.5% to 65% of negative opioid UDS [Beta - 89.95, 95% CIl -154.20 to -25.70, R2 0.22]. Family enagement increases retention by 3-fold. Conclusions BUP + incentivised TDM for contingent access to increasing take-home doses increased abstinence. BUP-EL.R seems promising in BUP treatment precision and BUP is clinically valuable in polysubstance abusers.Engaging family enhances retention. Disclosure No significant relationships.
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Rapson R, King T, Morris C, Jeffery R, Mellhuish J, Stephens C, Marsden J. Effect of different durations of using a standing frame on the rate of hip migration in children with moderate to severe cerebral palsy: a feasibility study for a randomised controlled trial. Physiotherapy 2022; 116:42-49. [DOI: 10.1016/j.physio.2022.01.001] [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] [Received: 09/07/2020] [Revised: 07/23/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Marsden J, Pavlou M, Dennett R, Gibbon A, Knight-Lozano R, Jeu L, Flavell C, Freeman J, Bamiou DE, Harris C, Hawton A, Goodwin E, Jones B, Creanor S. Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo. BMC Neurol 2020; 20:430. [PMID: 33243182 PMCID: PMC7694922 DOI: 10.1186/s12883-020-01983-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately. Methods/ design People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used. Discussion If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS. Trial registration ISRCTN Number: 27374299 Date of Registration 24/09/2018 Protocol Version 15 25/09/2019 Supplementary Information The online version contains supplementary material available at 10.1186/s12883-020-01983-y.
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Affiliation(s)
- J Marsden
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK.
| | - M Pavlou
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - R Dennett
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - A Gibbon
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - R Knight-Lozano
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - L Jeu
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - C Flavell
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - J Freeman
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - D E Bamiou
- EAR Institute University College London, 332 Gray's Inn Rd, London, WC1X 8EE, UK
| | - C Harris
- Royal Eye Infirmary, Derriford Hospital, Plymouth, PL6 8DH, UK.,School of Psychology, University of Plymouth, Drakes Circus, Plymouth, PL4 8AA, UK
| | - A Hawton
- Health Economics Group, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - E Goodwin
- Health Economics Group, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - B Jones
- Medical Statistics Group and Peninsula Clinical Trials Unit, Faculty of Health: Medicine, Dentistry and Human Science, Plymouth Science Park, 1 Davy Rd, Derriford, Plymouth, PL6 8BX, UK
| | - S Creanor
- Medical Statistics Group and Peninsula Clinical Trials Unit, Faculty of Health: Medicine, Dentistry and Human Science, Plymouth Science Park, 1 Davy Rd, Derriford, Plymouth, PL6 8BX, UK
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Durack A, Gran S, Gardiner MD, Jain A, Craythorne E, Proby CM, Marsden J, Harwood CA, Matin RN. A 10-year review of surgical management of dermatofibrosarcoma protuberans. Br J Dermatol 2020; 184:731-739. [PMID: 32599647 DOI: 10.1111/bjd.19346] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer. Standard treatment in the UK is either wide local excision (WLE) or Mohs micrographic surgery (MMS). It is unclear which approach has the lower recurrence rate. OBJECTIVES We undertook a retrospective comparative review of surgical management of DFSP in the UK National Health Service in order to define (i) current surgical practice for primary and recurrent DFSP, (ii) local recurrence rates for primary DFSP and (iii) survival outcomes for DFSP. METHODS A retrospective clinical case-note review of patients with histologically confirmed DFSP (January 2004 to December 2013) who have undergone surgical treatment. RESULTS The surgical management of 483 primary and 64 recurrent DFSP in 11 plastic surgery and 15 dermatology departments was analysed. Almost 75% of primary DFSP (n = 362) were treated with WLE and 20% (n = 97) with MMS. For recurrent DFSP, 69% (n = 44) and 23% (n = 15) of patients underwent WLE and MMS, respectively. Recurrent primary DFSP occurred in six patients after WLE and none after MMS. The median follow-up time was 25·5 months (interquartile range 6·8-45·1) for new and 19·8 (IQR 4·5-44·5) for recurrent DFSP [Correction added on 1 Feb 2021, after first online publication: 4.8 years (interquartile range 3.5-5.8) was incorrect], with eight reported deaths during the follow-up analysis period (one confirmed to be DFSP related). CONCLUSIONS WLE was the most common surgical modality used to treat DFSP across the UK. The local recurrence rate was very low, occurring only after WLE. Although a prospective randomized controlled trial may provide more definitive outcomes, in the absence of a clearly superior surgical modality, treatment decisions should be based on patient preference, clinical expertise and cost.
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Affiliation(s)
- A Durack
- Department of Dermatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Gran
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - M D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of Plastic and Reconstructive Surgery, Frimley Health Foundation NHS Trust, Frimley, UK
| | - A Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of Plastic and Reconstructive Surgery, Imperial College NHS Trust, London, UK
| | - E Craythorne
- Department of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C M Proby
- Department of Dermatology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - J Marsden
- Department of Dermatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Barts Health NHS Trust, Queen Mary University of London, London, UK
| | - R N Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Rogers A, Morrison SC, Gorst T, Paton J, Freeman J, Marsden J, Cramp MC. Repeatability of plantar pressure assessment during barefoot walking in people with stroke. J Foot Ankle Res 2020; 13:39. [PMID: 32600388 PMCID: PMC7325079 DOI: 10.1186/s13047-020-00407-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose Stroke-related changes in foot structure and function affect balance and mobility and quantifying foot function following stroke could offer clinically useful information to inform rehabilitation. The aim of this work was to explore the feasibility of undertaking plantar pressure assessment during barefoot walking in people with stroke, and evaluate the repeatability of the assessment protocol and regional footprint analysis as a measure of dynamic foot characteristics. Materials & methods Plantar pressure analysis was undertaken using a pressure platform (Tekscan HR Mat) on two test sessions, approximately two weeks apart (mean = 15.64 ± 11.64 days). Peak plantar pressure (kPa) and contact area (cm2) for foot regions were extracted and repeatability analysis undertaken. Descriptive evaluation of field notes and experiences of the participants was undertaken to inform the feasibility of the data collection protocol. Results Twenty-one participants (61.8 ± 9.2 years; 11 male, 10 female; 8 right-sided, 13 left-sided stroke) were recruited and 18 returned for retesting. Full data capture was achieved from 14 participants. Peak pressure and contact area demonstrated moderate to good repeatability for at the toes (ICC 0.76 and 0.58 respectively) and good to excellent repeatability for the other foot regions (ICC ≥ 0.82). Conclusion The protocol adopted in this study was feasible and yielded good to excellent repeatability for the foot regions, except the toes. The challenges with data collection in our study cohort could help inform future studies adopting similar protocols. This work also has relevance for use of pressure technology in clinical practice for assessing and monitoring foot function following stroke.
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Affiliation(s)
- A Rogers
- School of Health and Rehabilitation Sciences, Keele University, Keele, UK
| | - S C Morrison
- School of Health Sciences, University of Brighton, Darley Road, Eastbourne, BN20 7UR, UK.
| | - T Gorst
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - J Paton
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - J Freeman
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - J Marsden
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - M C Cramp
- School of Allied Health Professions, University of the West of England, Bristol, UK
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Rapson R, Marsden J, Latour J, Carter B. A comparison of dynamic balance during stepping between children with cerebral palsy and children with typical development. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.304] [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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Logan A, Freeman J, Pooler J, Kent B, Gunn H, Cork E, Billings S, Marsden J. The effectiveness of non-pharmacological interventions to treat orthostatic hypotension in people with stroke: a systematic review. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.052] [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: 11/24/2022]
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Rapson R, Marsden J, Jeffery R, Cox P, Morris C, King T. What is the effect of increased standing time in non-ambulant children with cerebral palsy? a feasibility study. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.098] [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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Peach H, Board R, Cook M, Corrie P, Ellis S, Geh J, King P, Laitung G, Larkin J, Marsden J, Middleton M, Moncrieff M, Nathan P, Powell B, Pritchard-Jones R, Rodwell S, Steven N, Lorigan P. Current role of sentinel lymph node biopsy in the management of cutaneous melanoma: A UK consensus statement. J Plast Reconstr Aesthet Surg 2020; 73:36-42. [DOI: 10.1016/j.bjps.2019.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
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Affiliation(s)
- J Marsden
- Departments of Breast Surgery, London, UK
| | - H Hamoda
- Women and Children, King's College Hospital NHS Foundation Trust, London, UK.
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Miura K, Olsen C, Rea S, Marsden J, Green A. 飞行员和空乘人员的黑色素瘤和皮肤癌. Br J Dermatol 2019. [DOI: 10.1111/bjd.18072] [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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Miura K, Olsen C, Rea S, Marsden J, Green A. Do airline pilots and cabin crew have raised risks of melanoma and other skin cancers? Systematic review and meta‐analysis. Br J Dermatol 2019; 181:55-64. [DOI: 10.1111/bjd.17586] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- K. Miura
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston QLD 4006 Australia
| | - C.M. Olsen
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston QLD 4006 Australia
| | - S. Rea
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston QLD 4006 Australia
| | - J. Marsden
- Queen Elizabeth Hospital Birmingham B15 2GW U.K
| | - A.C. Green
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston QLD 4006 Australia
- CRUK Manchester Institute and Faculty of Biology, Medicine and Health University of Manchester Manchester Academic Health Science Centre Manchester U.K
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Gunn H, Andrade J, Paul L, Miller L, Stevens K, Creanor S, Green C, Ewings P, Barton A, Berrow M, Vickery J, Marshall B, Marsden J, Freeman J. Balance Right in Multiple Sclerosis (BRiMS): Preliminary results of a randomised controlled feasibility trial. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.281] [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: 10/27/2022]
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Hendrie W, Dennett R, Jarrett L, Creanor S, Barton A, Hawton A, Marsden J, Freeman J. “I’m in a very good frame of mind”: the experience of standing frame use in people with progressive multiple sclerosis. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.282] [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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Freeman J, Hendrie W, Jarrett L, Hawton AM, Barton A, Dennett R, Jones B, Marsden J, Zajicek J, Creanor S. Standing up in people with progressive multiple sclerosis (SUMS): A multi-centre randomised controlled trial evaluating a home-based standing frame programme. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marsden J. Choice of Flattening Filter Free (FFF) Energy for Treating Lung SABR. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.077] [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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Bunn L, Brady D, Cattani A, Marsden J, Cowie D. Wee-Wii-validation: investigating the validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance in young children. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.172] [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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Haas B, Spicer N, Roberts E, Hawksley S, Bray T, Marsden J. Effects of different exercise modalities on cortical excitability and cognitive function in healthy participants. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.208] [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: 11/30/2022]
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Gorst T, Marsden J, Freeman J. The reliability and validity of three novel measures of lower limb somatosensory discrimination in chronic stroke. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.050] [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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Gunn H, Andrade J, Paul L, Miller L, Creanor S, Green C, Marsden J, Ewings P, Berrow M, Vickery J, Barton A, Marshall B, Zajicek J, Freeman JA. Balance Right in Multiple Sclerosis (BRiMS): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis: a protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2017; 4:26. [PMID: 28770099 PMCID: PMC5530568 DOI: 10.1186/s40814-017-0168-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/03/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Impaired mobility is a cardinal feature of multiple sclerosis (MS) and is rated by people with MS as their highest priority. By the secondary progressive phase, balance, mobility and physical activity levels are significantly compromised; an estimated 70% of people with secondary progressive MS fall regularly. Our ongoing research has systematically developed 'Balance Right in MS' (BRiMS), an innovative, manualised 13-week guided self-management programme tailored to the needs of people with MS, designed to improve safe mobility and minimise falls. Our eventual aim is to assess the clinical and cost effectiveness of BRiMS in people with secondary progressive MS by undertaking an appropriately statistically powered, multi-centre, assessor-blinded definitive, randomised controlled trial. This feasibility study will assess the acceptability of the intervention and test the achievability of running such a definitive trial. METHODS/DESIGN This is a pragmatic multi-centre feasibility randomised controlled trial with blinded outcome assessment. Sixty ambulant people with secondary progressive MS who self-report two or more falls in the previous 6 months will be randomly allocated (1:1) to either the BRiMS programme plus usual care or to usual care alone. All participants will be assessed at baseline and followed up at 15 weeks and 27 weeks post-randomisation. The outcomes of this feasibility trial include:Feasibility outcomes, including trial recruitment, retention and completionAssessment of the proposed outcome measures for the anticipated definitive trial (including measures of walking, quality of life, falls, balance and activity level)Measures of adherence to the BRiMS programmeData to inform the economic evaluation in a future trialProcess evaluation (assessment of treatment fidelity and qualitative evaluation of participant and treating therapist experience). DISCUSSION The BRiMS intervention aims to address a key concern for MS service users and providers. However, there are several uncertainties which need to be addressed prior to progressing to a full-scale trial, including acceptability of the BRiMS intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties and will enable a protocol to be finalised for use in the definitive trial. TRIAL REGISTRATION ISRCTN13587999.
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Affiliation(s)
- H. Gunn
- Faculty of Health and Human Sciences, School of Health Professions, Plymouth University, Peninsula Allied Health Centre, Derriford Rd, Plymouth, PL6 8BH UK
| | - J. Andrade
- Faculty of Health and Human Sciences, School of Psychology, Portland Square Building, Drake Circus Campus, Plymouth, PL4 8AA UK
| | - L. Paul
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - L. Miller
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
- Douglas Grant Rehabilitation Unit, Ayrshire Central Hospital, Kilwinning Road, Irvine, KA12 8SS UK
| | - S. Creanor
- Peninsula Schools of Medicine and Dentistry, Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Room N16, Plymouth Science Park, Plymouth, PL6 8BX UK
- Medical Statistics, Peninsula Schools of Medicine and Dentistry, Room N15, Plymouth Science Park, Plymouth, PL6 8BX UK
| | - C. Green
- University of Exeter Medical School, Health Economics Group, University of Exeter, St Luke’s Campus, Exeter, EX1 2 LU UK
| | - J. Marsden
- Faculty of Health and Human Sciences, School of Health Professions, Plymouth University, Peninsula Allied Health Centre, Derriford Rd, Plymouth, PL6 8BH UK
| | - P. Ewings
- NIHR Research Design Service (South West), Musgrove Park Hospital, Taunton, TA1 5DA UK
| | - M. Berrow
- Peninsula Schools of Medicine and Dentistry, Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Room N16, Plymouth Science Park, Plymouth, PL6 8BX UK
| | - J. Vickery
- Peninsula Schools of Medicine and Dentistry, Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Room N16, Plymouth Science Park, Plymouth, PL6 8BX UK
| | - A. Barton
- NIHR Research Design Service, Peninsula Schools of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX UK
| | | | - J. Zajicek
- School of Medicine, Medical and Biological Sciences, University of St Andrews, North Haugh, St Andrews, KY16 9TF UK
| | - J. A. Freeman
- Faculty of Health and Human Sciences, School of Health Professions, Plymouth University, Peninsula Allied Health Centre, Derriford Rd, Plymouth, PL6 8BH UK
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Nielsen G, Buszewicz M, Stevenson F, Hunter R, Holt K, Dudziec M, Ricciardi L, Marsden J, Joyce E, Edwards MJ. Randomised feasibility study of physiotherapy for patients with functional motor symptoms. J Neurol Neurosurg Psychiatry 2017; 88:484-490. [PMID: 27694498 DOI: 10.1136/jnnp-2016-314408] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/30/2016] [Accepted: 09/06/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the feasibility of conducting a randomised controlled trial of a specialist physiotherapy intervention for functional motor symptoms (FMS). METHODS A randomised feasibility study was conducted recruiting patients with a clinically established diagnosis of FMS from a tertiary neurology clinic in London, UK. Participants were randomised to the intervention or a treatment as usual control. Measures of feasibility and clinical outcome were collected and assessed at 6 months. RESULTS 60 individuals were recruited over a 9-month period. Three withdrew, leaving 29 intervention and 28 controls participants in the final analysis. 32% of patients with FMS met the inclusion criteria, of which 90% enrolled. Acceptability of the intervention was high and there were no adverse events. At 6 months, 72% of the intervention group rated their symptoms as improved, compared to 18% in the control group. There was a moderate to large treatment effect across a range of outcomes, including three of eight Short Form 36 (SF36) domains (d=0.46-0.79). The SF36 Physical function was found to be a suitable primary outcome measure for a future trial; adjusted mean difference 19.8 (95% CI 10.2 to 29.5). The additional quality adjusted life years (QALY) with intervention was 0.08 (95% CI 0.03 to 0.13), the mean incremental cost per QALY gained was £12 087. CONCLUSIONS This feasibility study demonstrated high rates of recruitment, retention and acceptability. Clinical effect size was moderate to large with high probability of being cost-effective. A randomised controlled trial is needed. TRIAL REGISTRATION NUMBER NCT02275000; Results.
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Affiliation(s)
- G Nielsen
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK.,Therapy Services Department, National Hospital for Neurology and Neurosurgery, London, UK
| | - M Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - F Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - R Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - K Holt
- Therapy Services Department, National Hospital for Neurology and Neurosurgery, London, UK.,Institute of Cardiovascular and Cell Sciences, St Georges University of London, London, UK
| | - M Dudziec
- Therapy Services Department, National Hospital for Neurology and Neurosurgery, London, UK
| | - L Ricciardi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - J Marsden
- School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - E Joyce
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - M J Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK.,Institute of Cardiovascular and Cell Sciences, St Georges University of London, London, UK
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Schwartz RP, McNeely J, Wu LT, Sharma G, Wahle A, Cushing C, Nordeck CD, Sharma A, O'Grady KE, Gryczynski J, Mitchell SG, Ali RL, Marsden J, Subramaniam GA. Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST. J Subst Abuse Treat 2017; 76:69-76. [PMID: 28159441 DOI: 10.1016/j.jsat.2017.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 10/07/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. METHODS Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. RESULTS The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. CONCLUSIONS The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.
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Affiliation(s)
- R P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - J McNeely
- New York University School of Medicine, Department of Population Health, 550 First Avenue, VZ30 6th floor, New York, NY 10016, USA.
| | - L T Wu
- Duke University, Department of Psychiatry and Behavioral Sciences and Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - G Sharma
- Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, USA.
| | - A Wahle
- Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, USA
| | - C Cushing
- National Institute on Drug Abuse, 6001 Executive Boulevard, Rockville, MD 20852, USA
| | - C D Nordeck
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - A Sharma
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - K E O'Grady
- University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742, USA
| | - J Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - S G Mitchell
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - R L Ali
- University of Adelaide, Department of Pharmacology, Frome Road, Level 5, Medical School North Bldg, The University of Adelaide, Adelaide, SA 5005, Australia.
| | - J Marsden
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, SE5 8BB London, United Kingdom.
| | - G A Subramaniam
- National Institute on Drug Abuse, 6001 Executive Boulevard, Rockville, MD 20852, USA.
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Denton A, Bunn L, Hough A, Bugmann G, Marsden J. Superficial warming and cooling of the leg affects walking speed and neuromuscular impairments in people with spastic paraparesis. Ann Phys Rehabil Med 2016; 59:326-332. [DOI: 10.1016/j.rehab.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 12/11/2022]
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Ofori J, Freeman J, Logan A, Rapson R, Zajieck J, Hobart J, Marsden J. An investigation of commonly prescribed stretches of the ankle plantarflexors in people with Multiple Sclerosis. Clin Biomech (Bristol, Avon) 2016; 37:22-26. [PMID: 27286554 DOI: 10.1016/j.clinbiomech.2016.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 04/04/2016] [Accepted: 05/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stretches are often prescribed to manage increased limb stiffness in people with Multiple Sclerosis. This study determined the ankle plantarflexor torque magnitude that people with Multiple Sclerosis can apply during four commonly prescribed stretches and determined the relationship between the applied torque and functional ability. METHODS People with Multiple Sclerosis (N=27) were compared to healthy control participants (n=15). Four stretches were investigated; stretching in step standing; using a step; pulling the ankle into dorsiflexion and standing in a frame. Joint position and forces were measured using 3D motion analysis and torque transducers. Baseline ankle strength and stiffness was measured using motor driven ankle perturbations. FINDINGS People with Multiple Sclerosis (N=27) had higher stretch reflex amplitudes and lower strength compared to the control group (n=15). People with Multiple Sclerosis achieved less lengthening of the plantarflexor muscle-tendon complex when stretching but similar ankle torques compared to controls. While stretching people with Multiple Sclerosis showed greater muscle activation in the ankle plantarflexors. Stretches in weight bearing positions produced higher plantarflexor torques. People with Multiple Sclerosis with lower functional ability preferred the more supported stretches (ankle pull and standing frame). INTERPRETATION Stretches in weight bearing positions achieve higher ankle torques but this is in part due to increased postural activity in people with Multiple Sclerosis. Functional ability may limit stretch effectiveness.
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Affiliation(s)
- J Ofori
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, PL6 8BH, UK
| | - J Freeman
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, PL6 8BH, UK
| | - A Logan
- Stroke Rehabilitation Unit, Camborne/Redruth Community Hospital, Barncoose Terrace, Redruth TR15 3ER, UK
| | - R Rapson
- Paediatrics and Learning Disabilities, South Devon Healthcare NHS Foundation Trust, Bidwell Brook School, Shinners Bridge, Dartington, TQ9 6JU, UK
| | - J Zajieck
- Peninsula College of Medicine and Dentistry University of Plymouth, PL6 8BH, UK
| | - J Hobart
- Peninsula College of Medicine and Dentistry University of Plymouth, PL6 8BH, UK
| | - J Marsden
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, PL6 8BH, UK.
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Freeman JA, Hendrie W, Creanor S, Jarrett L, Barton A, Green C, Marsden J, Rogers E, Zajicek J. Standing up in multiple sclerosis (SUMS): protocol for a multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis. BMC Neurol 2016; 16:62. [PMID: 27149954 PMCID: PMC4858871 DOI: 10.1186/s12883-016-0581-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 04/01/2016] [Accepted: 04/28/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is an incurable, unpredictable but typically progressive neurological condition. It is the most common cause of neurological disability in young adults. Within 15 years of diagnosis, approximately 50 % of affected people are unable to walk unaided, and over time an estimated 25 % depend on a wheelchair. Typically, people with such limited mobility are excluded from clinical trials. Severely impaired people with MS spend much of their day sitting, often with limited ability to change position. In response, secondary complications can occur including: muscle wasting, pain, reduced skin integrity, spasms, limb stiffness, constipation, and associated psychosocial problems such as depression and lowered self-esteem. Effective self-management strategies, which can be implemented relatively easily and cheaply within people's homes, are needed to improve or maintain mobility and reduce sedentary behaviour. However this is challenging, particularly in the latter stages of disease. Regular supported standing using standing frames is one potential option. METHODS/DESIGN SUMS is a pragmatic multi-centre randomised controlled trial evaluating use of Oswestry standing frames with blinded outcome assessment and full economic evaluation. Participants will be randomly allocated (1:1) to either a home-based, self-management standing programme (with advice and support) along with their usual care or to usual care alone. Those in the intervention group will be asked to stand for a minimum of 30 min three times weekly over 20 weeks. Each participant will be followed-up at 20 and 36 weeks post baseline. The primary clinical outcome is motor function, assessed using the Amended Motor Club Assessment. The primary economic endpoint is quality-adjusted life years. The secondary outcomes include measures of explanatory physical impairments, key clinical outcomes, and health-related quality of life. An embedded qualitative component will explore participant's and carer's experiences of the standing programme. DISCUSSION This is the first large scale multi-centre trial to assess the clinical and cost effectiveness of a home based standing frame programme for people who are severely impaired by MS. If demonstrated to be effective and cost-effective, we will use this evidence to develop recommendations for a health service delivery model which could be implemented across the United Kingdom. TRIAL REGISTRATION ISRCTN69614598 DATE OF REGISTRATION: 3.2.16 (retrospectively registered).
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Affiliation(s)
- J A Freeman
- Faculty of Health and Human Sciences, School of Health Professions, Plymouth University, Peninsula Allied Health Centre, Derriford Rd, Plymouth, PL6 8BH, England.
| | - W Hendrie
- Faculty of Health and Human Sciences, School of Health Professions, Plymouth University, Peninsula Allied Health Centre, Derriford Rd, Plymouth, PL6 8BH, England.,Norwich MS Centre, Alkmaar Way, Norwich, NR6 6BB, England
| | - S Creanor
- Centre for Health Statistics, Peninsula Schools of Medicine and Dentistry, Room 302, Tamar Science Park, Plymouth, PL68BX, England
| | - L Jarrett
- Faculty of Health and Human Sciences, School of Health Professions, Plymouth University, Peninsula Allied Health Centre, Derriford Rd, Plymouth, PL6 8BH, England.,Mardon Neurorehabilitation Centre, Royal Devon and Exeter NHS Foundation Trust, Wonford Rd, Exeter, EX2 4UD, England
| | - A Barton
- Research and Design Service, Peninsula Schools of Medicine and Dentistry, ITTC Building, Tamar Science Park, Plymouth, PL68BX, England
| | - C Green
- University of Exeter Medical School, Health Economics Group, University of Exeter, Veysey Building, Exeter, Devon, EX24SG, England
| | - J Marsden
- Faculty of Health and Human Sciences, School of Health Professions, Plymouth University, Peninsula Allied Health Centre, Derriford Rd, Plymouth, PL6 8BH, England
| | - E Rogers
- Faculty of Health and Human Sciences, School of Health Professions, Plymouth University, Peninsula Allied Health Centre, Derriford Rd, Plymouth, PL6 8BH, England
| | - J Zajicek
- School of Medicine, Medical and Biological Sciences, University of St Andrews, North Haugh, St Andrews, Scotland, KY169TF, UK
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Glasser S, Collings R, Paton J, Marsden J. Effect of experimentally reduced distal sensation on postural response to hip abductor/ankle evertor muscle vibration. Gait Posture 2015; 42:193-8. [PMID: 26153881 DOI: 10.1016/j.gaitpost.2015.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 05/06/2015] [Accepted: 05/14/2015] [Indexed: 02/02/2023]
Abstract
This study assessed whether postural responses induced by vibratory perturbations of the hip abductors and ankle evertors, were modified when distal tactile sensation was experimentally reduced through cooling. Sixteen healthy subjects were investigated pre and post cooling. Subjects stood with their eyes closed with a stance width of 4 cm. A 2s vibratory stimulus was applied to the left or right hip abductor or ankle evertor muscle. The order of the site and side of the stimulation was randomised. The postural response to hip abductor and ankle evertor vibration was recorded using 3D motion analysis (Codamotion, Leicestershire). Medio-lateral centre of pressure motion was simultaneously recorded during quiet standing via a force plate (Kistler, UK). Pre-cooling people responded to unilateral ankle vibration with an ipsilateral translation and tilt of the pelvis, and an ipsilateral tilt of the trunk. People responded to unilateral hip vibration with a contralateral translation and tilt of the pelvis, and an ipsilateral tilt of the trunk. Following an experimental reduction in distal tactile sensation there was a significant reduction in the amplitude of pelvic tilt in response to ankle vibration (F(6.2)=P<0.05) and a significant increase in amplitude of pelvic tilt in response to hip vibration (F(5.2)=P<0.05). This suggests that the sensitivity to artificial stimulation of hip proprioception increases with distal cooling, possibly indicating a change in the gain/weighting placed upon sensory information from the hips.
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Affiliation(s)
- S Glasser
- BEUP; School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.
| | - R Collings
- BEUP; Torbay and Southern Devon Health and Care NHS Trust, UK
| | - J Paton
- BEUP; School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - J Marsden
- BEUP; School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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30
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Goyale A, O'Shea J, Marsden J, Keep J, Vincent RP. Analysis of cerebrospinal fluid for xanthochromia versus modern computed tomography scanners in the diagnosis of subarachnoid haemorrhage: experience at a tertiary trauma referral centre. Ann Clin Biochem 2015; 53:150-4. [PMID: 25766384 DOI: 10.1177/0004563215579454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnosis of subarachnoid haemorrhage, a neurosurgical emergency in patients with headache remains a logistical challenge. The rationale of the traditional pathway of cerebrospinal fluid xanthochromia analysis following negative computed tomography head scans to exclude subarachnoid haemorrhage has been challenged by the increasing accuracy of modern computed tomography scanners. AIM We set out to establish whether our xanthochromia service was adding value to the diagnostic pathway for subarachnoid haemorrhage or whether it was acting merely as a supportive test. METHOD A retrospective audit of all cerebrospinal fluid requests received since the inception of Xanthochromia service at a tertiary trauma centre. Cases interpreted as being consistent with subarachnoid haemorrhage based on cerebrospinal fluid xanthochromia analysis were selected for in-depth review from the total number of cases. RESULTS In total 660 requests were received for cerebrospinal fluid xanthochromia between August 2009 and July 2012. A total 28 of these were interpreted as being consistent with subarachnoid haemorrhage. Only 18 (64.3%) of requests were deemed appropriate as the clinical presentation in the remaining 10 (35.7%) was strongly suggestive of other causes of headache. A final clinical diagnosis of subarachnoid haemorrhage was made in 11 of the 18 patients who had cerebrospinal fluid xanthochromia requested appropriately. From these 11, five (45%) were deemed initially computed tomography negative and cerebrospinal fluid analysis led to final correct diagnosis of subarachnoid haemorrhage and appropriate surgical management. CONCLUSION Despite improved computed tomography scanning technology, cerebrospinal fluid xanthochromia interpretation aids in the definitive diagnosis of subarachnoid haemorrhage. When requested appropriately cerebrospinal fluid xanthochromia analysis remains a vital service as results impact on clinical decision making, especially when computed tomography scan results are equivocal and is also important in later presenting patients when computed tomography accuracy decreases.
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Affiliation(s)
- A Goyale
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - J O'Shea
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - J Marsden
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - J Keep
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - R P Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
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Tantirangsee N, Assanangkornchai S, Marsden J. SY03-1-2 * ISAM FELLOWSHIP THE ASSOCIATION BETWEEN CLINICAL IMPROVEMENT IN SUBSTANCE-RELATED PROBLEMS AND PSYCHIATRIC SYMPTOMS IN PSYCHOSIS: A POST-HOC ANALYSIS. Alcohol Alcohol 2014. [DOI: 10.1093/alcalc/agu052.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Tantirangsee N, Assanangkornchai S, Marsden J. SY02-1 * THE ASSOCIATION BETWEEN CLINICAL IMPROVEMENT IN SUBSTANCE-RELATED PROBLEMS AND PSYCHIATRIC SYMPTOMS IN PSYCHOSIS: A POST-HOC ANALYSIS. Alcohol Alcohol 2014. [DOI: 10.1093/alcalc/agu052.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gonzalez D, Fearfield L, Nathan P, Tanière P, Wallace A, Brown E, Harwood C, Marsden J, Whittaker S. Concerns regarding BRAFtesting algorithm: reply from authors. Br J Dermatol 2013; 169:1168-70. [DOI: 10.1111/bjd.12509] [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: 11/29/2022]
Affiliation(s)
- D. Gonzalez
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Sutton Surrey SM2 5NG U.K
| | - L. Fearfield
- Royal Marsden NHS Foundation Trust; London SW3 6JJ U.K
| | - P. Nathan
- Mount Vernon Cancer Centre; Northwood Middlesex HA6 2RN U.K
| | - P. Tanière
- Queen Elizabeth Hospital; University Hospitals Birmingham NHS Trust; Birmingham B15 2WB U.K
| | - A. Wallace
- St Mary's Hospital; Central Manchester University Hospitals NHS Foundation Trust; Manchester M13 9WL U.K
| | - E. Brown
- Edinburgh Cancer Centre; NHS Lothian; Western General Hospital; Edinburgh EH4 2XU U.K
| | - C. Harwood
- Centre for Cutaneous Research; Blizard Institute; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London E1 2AT U.K
| | - J. Marsden
- Queen Elizabeth Hospital; University Hospitals Birmingham NHS Trust; Birmingham B15 2WB U.K
| | - S. Whittaker
- St John's Institute of Dermatology; Guy's and St Thomas' NHS Foundation Trust; London SE1 7EH U.K
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Gonzalez D, Fearfield L, Nathan P, Tanière P, Wallace A, Brown E, Harwood C, Marsden J, Whittaker S. BRAF mutation testing algorithm for vemurafenib treatment in melanoma: recommendations from an expert panel. Br J Dermatol 2013; 168:700-7. [PMID: 23360189 DOI: 10.1111/bjd.12248] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The incidence of melanoma has increased rapidly over the past 30 years, and the disease is now the sixth most common cancer among men and women in the U.K. Many patients are diagnosed with or develop metastatic disease, and survival is substantially reduced in these patients. Mutations in the BRAF gene have been identified as key drivers of melanoma cells and are found in around 50% of cutaneous melanomas. Vemurafenib (Zelboraf(®) ; Roche Molecular Systems Inc., Pleasanton, CA, U.S.A.) is the first licensed inhibitor of mutated BRAF, and offers a new first-line option for patients with unresectable or metastatic melanoma who harbour BRAF mutations. Vemurafenib was developed in conjunction with a companion diagnostic, the cobas(®) 4800 BRAF V600 Mutation Test. The purpose of this paper is to make evidence-based recommendations to facilitate the implementation of BRAF mutation testing and targeted therapy in patients with metastatic melanoma in the U.K. The recommendations are the result of a meeting of an expert panel and have been reviewed by melanoma specialists and representatives of the National Cancer Research Network Clinical Study Group on behalf of the wider melanoma community. This article is intended to be a starting point for practical advice and recommendations, which will no doubt be updated as we gain further experience in personalizing therapy for patients with melanoma.
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Affiliation(s)
- D Gonzalez
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5NG, UK.
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35
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McGarry S, Ward C, Garrod R, Marsden J. An exploratory study into the unmet supportive needs of breast cancer patients. Eur J Cancer Care (Engl) 2013; 22:673-83. [DOI: 10.1111/ecc.12076] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2013] [Indexed: 12/25/2022]
Affiliation(s)
- S. McGarry
- Kings Breast Care; Kings College Hospital NHS Foundation Trust; London; UK
| | - C. Ward
- Research and Development Department; Kings College Hospital NHS Foundation Trust; London; UK
| | - R. Garrod
- Pulmonary Rehabilitation; Kings College Hospital; London; UK
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Sturdee DW, Pines A, Archer DF, Baber RJ, Barlow D, Birkhäuser MH, Brincat M, Cardozo L, de Villiers TJ, Gambacciani M, Gompel AA, Henderson VW, Kluft C, Lobo RA, MacLennan AH, Marsden J, Nappi RE, Panay N, Pickar JH, Robinson D, Simon J, Sitruk-Ware RL, Stevenson JC. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric 2011; 14:302-20. [PMID: 21563996 DOI: 10.3109/13697137.2011.570590] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- D W Sturdee
- International Menopause Society, Wray, Lancaster, UK
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Eggermont AM, Suciu S, Santinami M, Kruit W, Testori A, Marsden J, Punt CJA, Gore ME, MacKie R, Dummer R, Schadendorf D, Patel P, Spatz A, Keilholz U. EORTC 18991 phase III trial: Long-term adjuvant pegylated interferon-α2b (PEG-IFN) versus observation in resected stage III melanoma: Long-term results at 7.6-years follow-up. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8506b] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Liney G, Bush M, Marsden J, Beavis A. 690 poster IMPLEMENTATION OF AN IMAGE GUIDED BRACHYTHERAPY (IGBT) SERVICE. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70812-x] [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: 11/24/2022]
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39
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Brown H, Marsden J. Why should mastectomy be an in-patient procedure? Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.085] [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] Open
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Samarasinghe V, Marsden J, Roberts C. Sebaceous carcinoma of the scalp presenting with nodal metastasis. J Plast Reconstr Aesthet Surg 2010; 63:2193-4. [DOI: 10.1016/j.bjps.2010.04.016] [Citation(s) in RCA: 4] [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] [Received: 01/10/2010] [Revised: 04/11/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
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Sawle L, Mathews M, Freeman J, Marsden J. Developing a dynamic elastomeric fabric orthosis to aid return to sport after lumbopelvic injury. Br J Sports Med 2010. [DOI: 10.1136/bjsm.2010.078972.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sawle L, Mathews M, Freeman J, Marsden J. Evaluation of customised dynamic elastomeric fabric orthoses for aiding return to sport after lumbopelvic injury. Br J Sports Med 2010. [DOI: 10.1136/bjsm.2010.078972.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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43
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Eggermont AM, Suciu S, Rutkowski P, Marsden J, Testori A, Corrie P, Aamdal S, Ascierto PA, Patel P, Spatz A. Randomized phase III trial comparing postoperative adjuvant ganglioside GM2-KLH/QS-21 vaccination versus observation in stage II (T3-T4N0M0) melanoma: Final results of study EORTC 18961. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8505] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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44
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Sutton CJ, Marsden J, Watkins CL, Leathley MJ, Dey P. Changing stroke mortality trends in middle-aged people: an age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England. J Epidemiol Community Health 2009; 64:523-9. [DOI: 10.1136/jech.2008.086785] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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45
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Eggermont AMM, Testori A, Marsden J, Hersey P, Quirt I, Petrella T, Gogas H, MacKie RM, Hauschild A. Utility of adjuvant systemic therapy in melanoma. Ann Oncol 2009; 20 Suppl 6:vi30-4. [PMID: 19617295 PMCID: PMC2712588 DOI: 10.1093/annonc/mdp250] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [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: 11/12/2022] Open
Abstract
The lack of effective drugs in stage IV melanoma has impacted the effectiveness of adjuvant therapies in stage II/III disease. To date, chemotherapy, immunostimulants and vaccines have been used with minimal success. Interferon (IFN) has shown an effect on relapse-free survival (RFS) in several clinical trials; however, without a clinically significant effect on overall survival (OS). A recently conducted meta-analysis demonstrated prolongation of disease-free survival (DFS) in 7% and OS benefit in 3% of IFN-treated patients when compared with observation-only patients. There were no clear differences for the dose and duration of treatment observed. Observation is still an appropriate control arm in adjuvant clinical trials. Regional differences exist in Europe in the adjuvant use of IFN. In Northwest Europe, IFN is infrequently prescribed. In Central and Mediterranean Europe, dermatologists commonly prescribe low-dose IFN therapy for AJCC stage II and III disease. High-dose IFN regimens are not commonly used. The population of patients that may benefit from IFN needs to be further characterised, potentially by finding biomarkers that can predict response. Such studies are ongoing.
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Affiliation(s)
- A M M Eggermont
- Department of Surgical Oncology, Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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Testori A, Rutkowski P, Marsden J, Bastholt L, Chiarion-Sileni V, Hauschild A, Eggermont AMM. Surgery and radiotherapy in the treatment of cutaneous melanoma. Ann Oncol 2009; 20 Suppl 6:vi22-9. [PMID: 19617294 PMCID: PMC2712595 DOI: 10.1093/annonc/mdp257] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [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: 01/13/2023] Open
Abstract
Adequate surgical management of primary melanoma and regional lymph node metastasis, and rarely distant metastasis, is the only established curative treatment. Surgical management of primary melanomas consists of excisions with 1–2 cm margins and primary closure. The recommended method of biopsy is excisional biopsy with a 2 mm margin and a small amount of subcutaneous fat. In specific situations (very large lesions or certain anatomical areas), full-thickness incisional or punch biopsy may be acceptable. Sentinel lymph node biopsy provides accurate staging information for patients with clinically unaffected regional nodes and without distant metastases, although survival benefit has not been proved. In cases of positive sentinel node biopsy or clinically detected regional nodal metastases (palpable, positive cytology or histopathology), radical removal of lymph nodes of the involved basin is indicated. For resectable local/in-transit recurrences, excision with a clear margin is recommended. For numerous or unresectable in-transit metastases of the extremities, isolated limb perfusion or infusion with melphalan should be considered. Decisions about surgery of distant metastases should be based on individual circumstances. Radiotherapy is indicated as a treatment option in select patients with lentigo maligna melanoma and as an adjuvant in select patients with regional metastatic disease. Radiotherapy is also indicated for palliation, especially in bone and brain metastases.
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Affiliation(s)
- A Testori
- European Institute of Oncology, Division of Melanoma, Milan, Italy.
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Sutton CJ, Marsden J, Watkins CL, Leathley MJ, Dey P. Stroke mortality trends for England: modelling the past to predict the future. Journal of Epidemiology & Community Health 2009. [DOI: 10.1136/jech.2009.096719c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Strang J, Bearn J, Farrell M, Finch E, Gossop M, Griffiths P, Marsden J, Wolff K. Route of drug use and its implications for drug effect, risk of dependence and health consequences. Drug Alcohol Rev 2009; 17:197-211. [PMID: 16203485 DOI: 10.1080/09595239800187001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Route of administration has a profound, but often overlooked, influence on the actual experience of the drug use itself, on the risk of resulting development of dependence, and on the nature of the harms to which drug users are exposing themselves. These three areas are reviewed. The influence of route of administration on drug effect is considered first with regard to overall effectiveness of absorption, and also with regard to speed of onset of effect. The implications for risk of dependence cover animal and human laboratory studies of reinforcement schedules, epidemiological studies, the attitudes of drug users themselves to the different routes of possible drug use and associated dependence risk and the postulated influences on progression to dependence. Finally, the relationship between route of drug use and health sequelae is explored for the three most widely used routes of administration of illicit drugs-snorting, smoking and injecting.
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Affiliation(s)
- J Strang
- National Addiction Centre, London, United Kingdom
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Abstract
This article discusses the visual acuity required by drivers in the UK to comply with the law, and sets out how these requirements will change over the next four years as driving licence regulations are harmonised across Europe. The article considers the advice nurses need to give patients who have temporary or permanent vision problems.
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Eggermont AM, Suciu S, Ruka W, Marsden J, Testori A, Corrie P, Aamdal S, Ascierto PA, Patel P, Spatz A. EORTC 18961: Post-operative adjuvant ganglioside GM2-KLH21 vaccination treatment vs observation in stage II (T3-T4N0M0) melanoma: 2nd interim analysis led to an early disclosure of the results. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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