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Spencer A, Nicholls I, Onianwa O, Furneaux J, Grieves J, Pottage T, Gould S, Fletcher T, Dunning J, Bennett AM, Atkinson B. Mpox virus DNA contamination can still be detected by qPCR analysis after autoclaving. J Hosp Infect 2023; 139:217-219. [PMID: 37459916 DOI: 10.1016/j.jhin.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A Spencer
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK.
| | - I Nicholls
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O Onianwa
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Grieves
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - T Pottage
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - A M Bennett
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - B Atkinson
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
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Dunn BD, Widnall E, Warbrick L, Warner F, Reed N, Price A, Kock M, Courboin C, Stevens R, Wright K, Moberly NJ, Geschwind N, Owens C, Spencer A, Campbell J, Kuyken W. Preliminary clinical and cost effectiveness of augmented depression therapy versus cognitive behavioural therapy for the treatment of anhedonic depression (ADepT): a single-centre, open-label, parallel-group, pilot, randomised, controlled trial. EClinicalMedicine 2023; 61:102084. [PMID: 37528846 PMCID: PMC10388573 DOI: 10.1016/j.eclinm.2023.102084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 08/03/2023] Open
Abstract
Background Anhedonia (reduced interest/pleasure) symptoms and wellbeing deficits are core to depression and predict a poor prognosis. Current depression psychotherapies fail to target these features adequately, contributing to sub-optimal outcomes. Augmented Depression Therapy (ADepT) has been developed to target anhedonia and wellbeing. We aimed to establish clinical and economic proof of concept for ADepT and to examine feasibility of a future definitive trial comparing ADepT to Cognitive Behavioural Therapy (CBT). Methods In this single-centre, open-label, parallel-group, pilot randomised controlled trial, adults meeting diagnostic criteria for a current major depressive episode, scoring ≥10 on the Patient Health Questionnaire (PHQ-9) and exhibiting anhedonic features (PHQ-9 item 1 ≥ 2) were recruited primarily from high intensity Improving Access to Psychological Therapy (IAPT) service waiting lists in Devon, UK. Participants were randomised to receive 20 sessions of CBT or ADepT, using a mimimisation algorithm to balance depression severity and antidepressant use between groups. Treatment was delivered in an out-patient university-based specialist mood disorder clinic. Researcher-blinded assessments were completed at intake and six, 12, and 18 months. Co-primary outcomes were depression (PHQ-9) and wellbeing (Warwick Edinburgh Mental Wellbeing Scale) at 6 months. Primary clinical proof-of-concept analyses were intention to treat. Feasibility (including safety) and health economic analyses used complete case data. This trial is registered at the ISRCTN registry, ISRCTN85278228. Findings Between 3/29/2017 and 7/31/2018, 82 individuals were recruited (102% of target sample) and 41 individuals were allocated to each arm. A minimum adequate treatment dose was completed by 36/41 (88%) of CBT and 35/41 (85%) of ADepT participants. There were two serious adverse events in each arm (primarily suicide attempts; none of which were judged to be trial- or treatment-related), with no other evidence of harms. Intake and six-month primary outcome data was available for 37/41 (90%) CBT participants and 32/41 (78%) ADepT participants. Between-group effects favoured ADepT over CBT for depression (meanΔ = -1.35, 95% CI = -3.70, 1.00, d = 0.23) and wellbeing (meanΔ = 2.64, 95% CI = -1.71, 6.99, d = 0.27). At 18 months, the advantage of ADepT over CBT was preserved and ADepT had a >80% probability of cost-effectiveness. Interpretation These findings provide proof of concept for ADepT and warrant continuation to definitive trial. Funding NIHR Career Development Fellowship.
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Affiliation(s)
- Barnaby D. Dunn
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Emily Widnall
- Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PN, UK
| | - Laura Warbrick
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Faith Warner
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Nigel Reed
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Alice Price
- School of Psychology, Cardiff University, 70 Park Place, Cardiff, CF10 3AT, UK
| | - Merle Kock
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Tiensetraat 102, Box 3712, 3000, Leuven, Belgium
| | - Clara Courboin
- Université libre de Bruxelles, Avenue Franklin Roosevelt 50, 1050, Bruxelles, Belgium
| | - Rosie Stevens
- Department of Health Sciences (MHARG), University of York, York, Y010 5DD, UK
| | - Kim Wright
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | | | - Nicole Geschwind
- Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Christabel Owens
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Anne Spencer
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - John Campbell
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Warneford Hospital Oxford, OX3 7JX, UK
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Turner R, Quach H, Horvath N, Kerridge I, Lee E, Morris E, Kalff A, Khong T, Reynolds J, Spencer A. Response adaptive salvage with KTd and ASCT for functional high-risk multiple myeloma-The Australasian Leukemia and Lymphoma Group (ALLG) MM17 Trial. Br J Haematol 2023. [PMID: 37332079 DOI: 10.1111/bjh.18914] [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: 01/25/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
We evaluated re-induction incorporating carfilzomib-thalidomide-dexamethasone (KTd) and autologous stem cell transplantation (ASCT) for newly diagnosed multiple myeloma (NDMM) refractory, or demonstrating a suboptimal response, to non-IMID bortezomib-based induction. KTd salvage consisted of thalidomide 100 mg daily and dexamethasone 20 mg orally combined with carfilzomib 56 mg/m2 days 1, 2, 8, 9, 15 and 16, of each 28-day cycle. Following four cycles, patients achieving a stringent complete response proceeded to ASCT whereas those who did not received a further two cycles then ASCT. Consolidation consisted of two cycles of KTd then Td to a total of 12 months post-ASCT therapy. Primary end-point was the overall response rate (ORR) with KTd prior to ASCT. Fifty patients were recruited. The ORR was 78% with EuroFlow MRD negativity of 34% in the intention-to-treat population and 65% in the evaluable population at 12 months post-ASCT. With follow-up >38 months median PFS and OS have not been reached with PFS and OS at 36 months of 64% and 80%, respectively. KTd was well tolerated with grade 3 and grade ≥4 adverse events rates of 32% and 10%, respectively. Response adaptive utilisation of KTd with ASCT is associated with both high-quality responses and durable disease control in functional high-risk NDMM.
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Affiliation(s)
- R Turner
- Alfred Health, Melbourne, Victoria, Australia
| | - H Quach
- St Vincent's Hospital, Melbourne, Victoria, Australia
- Melbourne University, Melbourne, Victoria, Australia
| | - N Horvath
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - I Kerridge
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - E Lee
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - E Morris
- Townsville Cancer Centre, Townsville, Queensland, Australia
| | - A Kalff
- Alfred Health, Melbourne, Victoria, Australia
| | - T Khong
- Alfred Health, Melbourne, Victoria, Australia
| | - J Reynolds
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - A Spencer
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
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Hamilton W, Mounce L, Abel GA, Dean SG, Campbell JL, Warren FC, Spencer A, Medina-Lara A, Pitt M, Shephard E, Shakespeare M, Fletcher E, Mercer A, Calitri R. Protocol for a pragmatic cluster randomised controlled trial assessing the clinical effectiveness and cost-effectiveness of Electronic RIsk-assessment for CAncer for patients in general practice (ERICA). BMJ Open 2023; 13:e065232. [PMID: 36940950 PMCID: PMC10030284 DOI: 10.1136/bmjopen-2022-065232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The UK has worse cancer outcomes than most comparable countries, with a large contribution attributed to diagnostic delay. Electronic risk assessment tools (eRATs) have been developed to identify primary care patients with a ≥2% risk of cancer using features recorded in the electronic record. METHODS AND ANALYSIS This is a pragmatic cluster randomised controlled trial in English primary care. Individual general practices will be randomised in a 1:1 ratio to intervention (provision of eRATs for six common cancer sites) or to usual care. The primary outcome is cancer stage at diagnosis, dichotomised to stage 1 or 2 (early) or stage 3 or 4 (advanced) for these six cancers, assessed from National Cancer Registry data. Secondary outcomes include stage at diagnosis for a further six cancers without eRATs, use of urgent referral cancer pathways, total practice cancer diagnoses, routes to cancer diagnosis and 30-day and 1-year cancer survival. Economic and process evaluations will be performed along with service delivery modelling. The primary analysis explores the proportion of patients with early-stage cancer at diagnosis. The sample size calculation used an OR of 0.8 for a cancer being diagnosed at an advanced stage in the intervention arm compared with the control arm, equating to an absolute reduction of 4.8% as an incidence-weighted figure across the six cancers. This requires 530 practices overall, with the intervention active from April 2022 for 2 years. ETHICS AND DISSEMINATION The trial has approval from London City and East Research Ethics Committee, reference number 19/LO/0615; protocol version 5.0, 9 May 2022. It is sponsored by the University of Exeter. Dissemination will be by journal publication, conferences, use of appropriate social media and direct sharing with cancer policymakers. TRIAL REGISTRATION NUMBER ISRCTN22560297.
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Affiliation(s)
- Willie Hamilton
- Primary Care Diagnostics, University of Exeter, EXETER, GB, UK
| | - Luke Mounce
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Gary A Abel
- University of Exeter Medical School (Primary Care), University of Exeter, Exeter, Essex, UK
| | | | | | - Fiona C Warren
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Anne Spencer
- Health Economics, University of Exeter Medical School, Exeter, UK
| | | | - Martin Pitt
- University of Exeter: Medical School, University of Exeter, Exeter, Essex, UK
| | | | | | - Emily Fletcher
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, UK
| | - Adrian Mercer
- Primary Care, University of Exeter Medical School, Exeter, UK
| | - Raff Calitri
- Primary Care, University of Exeter Medical School, Exeter, UK
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Atkinson B, Spencer A, Onianwa O, Furneaux J, Grieves J, Nicholls I, Gould S, Fletcher T, Dunning J, Bennett AM, Patel S, Asboe D, Whitlock G. Longitudinal mpox virus surface sampling in an outpatient setting. J Hosp Infect 2023; 135:196-198. [PMID: 36842538 DOI: 10.1016/j.jhin.2023.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Affiliation(s)
- B Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK.
| | - A Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O Onianwa
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Grieves
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - I Nicholls
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - A M Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Patel
- Chelsea & Westminster Hospital NHS Trust, London, UK
| | - D Asboe
- Chelsea & Westminster Hospital NHS Trust, London, UK
| | - G Whitlock
- Chelsea & Westminster Hospital NHS Trust, London, UK
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Atkinson B, Gould S, Spencer A, Onianwa O, Furneaux J, Grieves J, Summers S, Crocker-Buqué T, Fletcher T, Bennett A, Dunning J. Monkeypox virus contamination in an office-based workplace environment. J Hosp Infect 2022; 130:141-143. [PMID: 36055524 PMCID: PMC9428113 DOI: 10.1016/j.jhin.2022.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 10/25/2022]
Affiliation(s)
- B. Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK,Corresponding author. Address: Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - S. Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A. Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O. Onianwa
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Grieves
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S. Summers
- High Containment Microbiology, UK Health Security Agency, Porton Down, Salisbury, UK
| | - T. Crocker-Buqué
- Faculty of Public Health and Policy, London School Hygiene and Tropical Medicine, London, UK
| | - T. Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A.M. Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
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Wang J, Spencer A, Hulme C, Corbett A, Khan Z, Da Silva MV, O’Dwyer S, Wright N, Testad I, Ballard C, Creese B, Smith R. Healthcare utilisation, physical activity and mental health during COVID-19 lockdown: an interrupted time-series analysis of older adults in England. Eur J Ageing 2022; 19:1617-1630. [PMID: 36692792 PMCID: PMC9702630 DOI: 10.1007/s10433-022-00741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/29/2022] Open
Abstract
COVID-19 measures which reduce interpersonal contact may be effective in containing the transmission, but their impacts on peoples' well-being and daily lives overtime remain unclear. Older adults are more vulnerable to both the virus and social isolation. It is therefore imperative to understand how they were affected during this period. Major concerns arising from the pandemic cover the aspects of mental health, healthcare utilisation and individual behavioural changes. Complementing the existing before-and-after analyses, we explore the impacts of easing and re-introducing COVID-19 measures by using a time-series data in England. The data was collected between May and November 2020 from the monthly surveys of the Platform for Research Online to Investigate Genetics and Cognition in Aging (PROTECT). Chi-squared analysis and interrupted time-series analysis were conducted to examine impacts of easing and re-introducing COVID-19 measures. Overall, mental health improves overtime but at a decreasing rate. The use of telephone/video consultations with a doctor or health professional presented a decreasing trend during the pandemic, whilst that of in-person consultation was increasing overtime. We observed significant variations in the time trends of mental health measures, healthcare utilisation and physical activity following the ease but not the re-introduction of COVID-19 measures. Future research is required to understand if these asymmetric impacts were driven by adaption of the people or stringency of the measures. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-022-00741-y.
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Affiliation(s)
- Jiunn Wang
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Applied Health Research, University College London, London, UK
| | - Anne Spencer
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Claire Hulme
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anne Corbett
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Zunera Khan
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Miguel Vasconcelos Da Silva
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Siobhan O’Dwyer
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Natalie Wright
- Global Operations, UK Health Security Agency (UKHSA), London, UK
| | - Ingelin Testad
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Centre for Age-Related Medicine - SESAM, Stavanger University Hospital, Stavanger, Norway
| | - Clive Ballard
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Byron Creese
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Richard Smith
- Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Pentz B, Pilkington M, Daodu O, Lam J, Howlett A, Stephen L, Spencer A, Unrau J, Theam M, Brindle M. Implementation of a neonatal Enhanced Recovery After Surgery® (ERAS®) guideline and the effect on communication within the neonatal intensive care unit. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.075] [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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Pilkington M, Pentz B, Lam J, Howlett A, Stephen L, Spencer A, Brindle M. Small doses, big changes: Impact of neonatal Enhanced Recovery After Surgery® on opioid use. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.055] [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: 10/14/2022]
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Swancutt D, Tarrant M, Ingram W, Baldrey S, Burns L, Byng R, Calitri R, Creanor S, Dean S, Evans L, Gill L, Goodwin E, Hawkins L, Hayward C, Hind S, Hollands L, Hosking J, Lloyd J, Moghadam S, Neilens H, O’Kane M, Perry S, Sheaff R, Spencer A, Taylor A, Ward T, Watkins R, Wilding J, Pinkney J. A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol. Pilot Feasibility Stud 2022; 8:206. [PMID: 36088457 PMCID: PMC9463813 DOI: 10.1186/s40814-022-01167-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity. Methods This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted. Discussion This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients. Trial registration ISRCTN number 22088800. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01167-0.
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Hall R, Medina-Lara A, Hamilton W, Spencer A. Women's priorities towards ovarian cancer testing: a best-worst scaling study. BMJ Open 2022; 12:e061625. [PMID: 36581964 PMCID: PMC9438192 DOI: 10.1136/bmjopen-2022-061625] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate the importance of key characteristics relating to diagnostic testing for ovarian cancer and to understand how previous test experience influences priorities. DESIGN Case 1 best-worst scaling embedded in an online survey. SETTING Primary care diagnostic testing in England and Wales. PARTICIPANTS 150 women with ovaries over 40 years old living in England and Wales. METHODS We used best-worst scaling, a preference-based survey method, to elicit the relative importance of 25 characteristics relating to ovarian cancer testing following a systematic review. Responses were modelled using conditional logit regression. Subgroup analysis investigated variations based on testing history. MAIN OUTCOME MEASURES Relative importance scores. RESULTS 'Chance of dying from ovarian cancer' (0.380, 95% CI 0.26 to 0.49) was the most important factor to respondents, closely followed by 'test sensitivity' (0.308, 95% CI 0.21 to 0.40). In contrast, 'time away from usual activities' (-0.244, 95% CI -0.33 to -0.15) and 'gender of healthcare provider' (-0.243, 95% CI -0.35 to -0.14) were least important to respondents overall. Women who had previously undergone testing placed higher importance on certain characteristics including 'openness of healthcare providers' and 'chance of diagnosing another condition' at the expense of reduced emphasis on characteristics such as 'pain and discomfort' and 'time away from usual activities'. CONCLUSIONS The results clearly demonstrated items at the extreme, which were most and least important to women considering ovarian cancer testing. Differences in priorities by testing history demonstrate an experience effect, whereby preferences adapt over time based on evidence and experience. Acknowledging these differences helps to identify underlying barriers and facilitators for women with no test experience as well as shortcomings of current service based on women with experience.
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Affiliation(s)
- Rebekah Hall
- Health Economics Group, University of Exeter Medical School, Exeter, UK
| | | | - Willie Hamilton
- Primary Care Diagnostics, University of Exeter Medical School, Exeter, UK
| | - Anne Spencer
- Health Economics Group, University of Exeter Medical School, Exeter, UK
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Wang J, Spencer A, Hulme C, Corbett A, Khan Z, Vasconcelos Da Silva M, O'Dwyer S, Wright N, Testad I, Ballard C, Creese B, Smith R. Healthcare utilisation and physical activities for older adults with comorbidities in the UK during COVID-19. Health Soc Care Community 2022; 30:e2365-e2373. [PMID: 34888982 DOI: 10.1111/hsc.13675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 06/13/2023]
Abstract
A major concern with COVID-19 was the impact it would have on individual health, the routine use of healthcare services, and physical activities, especially for older adults with comorbidities. To address this, we studied the association between these variables for older adults during the pandemic. To explore what policy instruments might be effective in mitigating the negative impacts, we investigated the effects of a shielding notice for those identified as vulnerable by the government and social media given it has been an important source for disseminating information of COVID-19. We employed a UK sample with 3,807 participants aged ≥50 from an online survey administered during May and June 2020. Based on numbers of comorbidities, we separated the sample into a higher comorbidity group with those in the upper quartile of the sample (n = 829) and a lower comorbidity group with the remainder (n = 2,978). Statistical methods include chi-squared analyses and cross-sectional regressions. We found that individuals with higher comorbidities were more likely to have poorer self-reported health and mental health and to receive a shielding notice from the government compared to those without (p < 0.05). Decreases in physical activities were associated with poorer self-reported health and the increases were associated with better self-reported health; on the other hand, the decreases were associated with poorer mental health, but the increases did not link to better mental health. Examination of the effects of policy instruments shows that a shielding notice was positively associated with primary care use. The notice generated greater reliance on telephone/video consultations compared to in-person consultations, but the impacts were less strong for people with higher comorbidities. Frequent use of social media raised the probability of increasing physical activities and reduced that of decreasing physical activities, implying social media being an effective tool in promoting physical activities during the lockdown and subsequent restrictions.
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Affiliation(s)
- Jiunn Wang
- University of Exeter Medical School, Exeter, UK
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Price S, Landa P, Mujica-Mota R, Hamilton W, Spencer A. Revising the Suspected-Cancer Guidelines: Impacts on Patients' Primary Care Contacts and Costs. Value Health 2022:S1098-3015(22)02095-2. [PMID: 35953398 DOI: 10.1016/j.jval.2022.06.017] [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] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to explore the impact of revising suspected-cancer referral guidelines on primary care contacts and costs. METHODS Participants had incident cancer (colorectal, n = 2000; ovary, n = 763; and pancreas, n = 597) codes in the Clinical Practice Research Datalink or England cancer registry. Difference-in-differences analyses explored guideline impacts on contact days and nonzero costs between the first cancer feature and diagnosis. Participants were controls ("old National Institute for Health and Care Excellence [NICE]") or "new NICE" if their index feature was introduced during guideline revision. Model assumptions were inspected visually and by falsification tests. Sensitivity analyses reclassified participants who subsequently presented with features in the original guidelines as "old NICE." For colorectal cancer, sensitivity analysis (n = 3481) adjusted for multimorbidity burden. RESULTS Median contact days and costs were, respectively, 4 (interquartile range [IQR] 2-7) and £117.69 (IQR £53.23-£206.65) for colorectal, 5 (IQR 3-9) and £156.92 (IQR £78.46-£272.29) for ovary, and 7 (IQR 4-13) and £230.64 (IQR £120.78-£408.34) for pancreas. Revising ovary guidelines may have decreased contact days (incidence rate ratio [IRR] 0.74; 95% confidence interval 0.55-1.00; P = .05) with unchanged costs, but parallel trends assumptions were violated. Costs decreased by 13% (equivalent to -£28.05, -£50.43 to -£5.67) after colorectal guidance revision but only in sensitivity analyses adjusting for multimorbidity. Contact days and costs remained unchanged after pancreas guidance revision. CONCLUSIONS The main analyses of symptomatic patients suggested that prediagnosis primary care costs remained unchanged after guidance revision for pancreatic cancer. For colorectal cancer, contact days and costs decreased in analyses adjusting for multimorbidity. Revising ovarian cancer guidelines may have decreased primary care contact days but not costs, suggesting increased resource-use intensity; nevertheless, there is evidence of confounding.
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Affiliation(s)
- Sarah Price
- Discovery Unit, University of Exeter Medical School, University of Exeter, Exeter, England, UK.
| | - Paolo Landa
- Département d'opérations et systèmes de decision, Faculté des sciences de l'administration, Université Laval, Québec City, QC, Canada; Centre Hospitaliere Universitaire (CHU) de Québec - Université Laval, Québec City, QC, Canada
| | - Ruben Mujica-Mota
- Academic Unit of Health Economics, University of Leeds, Leeds, England, UK
| | - Willie Hamilton
- Discovery Unit, University of Exeter Medical School, University of Exeter, Exeter, England, UK
| | - Anne Spencer
- Health Economics Group, University of Exeter, Exeter, England, UK
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Spencer A, Watchorn RE, Kravvas G, Ben-Salha I, Haider A, Francis N, Freeman A, Alnajjar HM, Muneer A, Bunker CB. Pseudoepitheliomatous keratotic and micaceous balanitis: a series of eight cases. J Eur Acad Dermatol Venereol 2022; 36:1851-1856. [PMID: 35695159 DOI: 10.1111/jdv.18328] [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] [Received: 10/14/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pseudoepitheliomatous keratotic and micaceous balanitis (PEKMB) is a clinicopathological entity characterized clinically by micaceous scale on the glans, and histologically by acanthosis, hyperkeratosis and pseudoepitheliomatous hyperplasia. We present a series of eight cases of this rare condition, the first series of more than two cases to be reported. OBJECTIVES To determine the clinical and histological characteristics of cases of PEKMB, and evaluate treatments used and clinical course. METHODS This monocentric case series was conducted at the University College London Hospitals tertiary male genital dermatology clinic between April 2018 and August 2020. Eight patients with PEKMB were evaluated. Data were collected on demographics, clinical presentation, histological features, presence of human papilloma virus (HPV), history of lichen sclerosus, treatment of PEKMB and subsequent response, and presence or development of squamous cell carcinoma (SCC) or penile intraepithelial neoplasia (PeIN) during follow-up. RESULTS Eight Caucasian males presented with clinical and histological evidence of PEKMB. Seven had a background of lichen sclerosus; two had failed treatment with superpotent topical steroids and four had symptoms for three or more years prior to circumcision. There was no clinical or histological relationship with HPV infection, and p16 staining was negative. HPV PCR, performed in two cases, was negative. Basal atypia, insufficient to amount to PeIN, was present in six patients. One patient progressed to PeIN during follow-up, and no patient progressed to invasive malignancy. Five patients were treated successfully with glans resurfacing and split skin graft reconstruction. CONCLUSIONS Our observations demonstrate that PEKMB represents a form of chronic, undiagnosed or misdiagnosed, inadequately treated or treatment refractory, unstable lichen sclerosus. The significant potential for squamous carcinogenesis (differentiated PeIN and verrucous carcinoma) can be mitigated by timely diagnosis and treatment. Glans resurfacing and split skin graft reconstruction appears to be a successful treatment modality in patients with refractory disease.
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Affiliation(s)
- A Spencer
- Department of Dermatology, University College London Hospitals NHS Trust, London, UK.,Department of Dermatology, Imperial College Healthcare NHS Trust, London, UK
| | - R E Watchorn
- Department of Dermatology, University College London Hospitals NHS Trust, London, UK.,Department of Dermatology, Imperial College Healthcare NHS Trust, London, UK
| | - G Kravvas
- Department of Dermatology, University College London Hospitals NHS Trust, London, UK
| | - I Ben-Salha
- Department of Histopathology, University College London Hospitals NHS Trust, London, UK
| | - A Haider
- Department of Histopathology, University College London Hospitals NHS Trust, London, UK
| | - N Francis
- Department of Histopathology, Imperial College Healthcare NHS Trust, London, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals NHS Trust, London, UK
| | - H M Alnajjar
- Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - A Muneer
- Department of Urology, University College London Hospitals NHS Trust, London, UK.,National Institute of Health Research Centre, University College London Hospitals NHS Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - C B Bunker
- Department of Dermatology, University College London Hospitals NHS Trust, London, UK
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Sardinha M, Simão D, Gil L, Spencer A, Reis A, Leão J, Montenegro A, Ferreira R, Furtado I, Verdasca F, Escaleira R, Miguens M, Winckler P, Luz R. P-191 Ampullary neoplasms – how to treat in real-world practice? A retrospective study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.281] [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: 11/01/2022] Open
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16
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Liu X, Spencer A, Long Y, Greenhalgh C, Steeg S, Verma A. A systematic review and meta-analysis of disease burden of healthcare-associated infections in China: an economic burden perspective from general hospitals. J Hosp Infect 2022; 123:1-11. [PMID: 35182684 DOI: 10.1016/j.jhin.2022.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 09/20/2021] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a global public health issue. However, the economic burden attributable to HAIs at a national level is unknown in China. The aim of this systematic review was to estimate the direct economic burden caused by HAIs in China. METHODS Medline, EMBASE and Chinese Journals Online databases were searched, including studies published from 2009 to 2019. The pooled estimates with 95% Confidential Interval were calculated with Quantile Estimation. The random effect model of the DerSimonian-Laird method was used. The statistical significance was set as P<0.05. RESULTS 2,756 publications were identified; 6 studies were included in a meta-analysis to calculate the pooled estimates of direct economic burden, while 5 were included in the pooled estimates of the additional economic burden. The pooled median estimates of the total medical expenditure, the medicine expenditure and hospitalisation days per inpatient of patients with HAIs were ¥34,415.62, ¥20,065.21 and 34.01 days, respectively (P <0.0001). The pooled median estimates of the differences of the total medical expenditure, the medicine expenditure and hospitalisation days per inpatient between patients with HAIs and patients without HAIs were ¥24,881.37, ¥9,438.46 and 13.89 days, respectively (P < 0.01). CONCLUSIONS The cost of care for patients with HAIs was significantly higher than that for those without HAIs. This excess economic burden is likely to impact on patients and their families as well as health service providers and the health care system as a whole. Effective surveillance systems and cost-effective interventions are needed to control HAIs.
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Affiliation(s)
- X Liu
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
| | - A Spencer
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Y Long
- Global Health Institute/School of Health Sciences, Wuhan University, Wuhan, Hubei Province, China
| | - C Greenhalgh
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - S Steeg
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - A Verma
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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Merriel SWD, Pocock L, Gilbert E, Creavin S, Walter FM, Spencer A, Hamilton W. Systematic review and meta-analysis of the diagnostic accuracy of prostate-specific antigen (PSA) for the detection of prostate cancer in symptomatic patients. BMC Med 2022; 20:54. [PMID: 35125113 PMCID: PMC8819971 DOI: 10.1186/s12916-021-02230-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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: 09/30/2021] [Accepted: 12/30/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Prostate-specific antigen (PSA) is a commonly used test to detect prostate cancer. Attention has mostly focused on the use of PSA in screening asymptomatic patients, but the diagnostic accuracy of PSA for prostate cancer in patients with symptoms is less well understood. METHODS A systematic database search was conducted of Medline, EMBASE, Web of Science, and the Cochrane library. Studies reporting the diagnostic accuracy of PSA for prostate cancer in patients with symptoms were included. Two investigators independently assessed the titles and abstracts of all database search hits and full texts of potentially relevant studies against the inclusion criteria, and data extracted into a proforma. Study quality was assessed using the QUADAS-2 tool by two investigators independently. Summary estimates of diagnostic accuracy were calculated with meta-analysis using bivariate mixed effects regression. RESULTS Five hundred sixty-three search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. Nineteen studies met the inclusion criteria, 18 of which were conducted in secondary care settings with one from a screening study cohort. All studies used histology obtained by transrectal ultrasound-guided biopsy (TRUS) as a reference test; usually only for patients with elevated PSA or abnormal prostate examination. Pooled data from 14,489 patients found estimated sensitivity of PSA for prostate cancer was 0.93 (95% CI 0.88, 0.96) and specificity was 0.20 (95% CI 0.12, 0.33). The area under the hierarchical summary receiver operator characteristic curve was 0.72 (95% CI 0.68, 0.76). All studies were assessed as having a high risk of bias in at least one QUADAS-2 domain. CONCLUSIONS Currently available evidence suggests PSA is highly sensitive but poorly specific for prostate cancer detection in symptomatic patients. However, significant limitations in study design and reference test reduces the certainty of this estimate. There is very limited evidence for the performance of PSA in primary care, the healthcare setting where most PSA testing is performed.
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Affiliation(s)
- Samuel W D Merriel
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK.
| | - Lucy Pocock
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Emma Gilbert
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Sam Creavin
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Fiona M Walter
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Anne Spencer
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
| | - Willie Hamilton
- University of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK
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18
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Henstock L, Wong R, Tsuchiya A, Spencer A. Behavioral Theories That Have Influenced the Way Health State Preferences Are Elicited and Interpreted: A Bibliometric Mapping Analysis of the Time Trade-Off Method With VOSviewer Visualization. Front Health Serv 2022; 2:848087. [PMID: 36925791 PMCID: PMC10012726 DOI: 10.3389/frhs.2022.848087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022]
Abstract
Aim The aim of this paper is to develop an understanding of how behavioral theories have influenced the way preferences for health-related quality of life are elicited and interpreted. We focus on the Time Trade-off (TTO) method given it represents the quality-adjusted life-year (QALY) concept-that survival in less-than-full health can be deemed equivalent to a shorter survival in full health. To our knowledge this is the first review using a combination of systematic scoping review, bibliometrics and VOSviewer visualization to map the development of ideas in health economics. Methods A priori, we selected three behavioral theories to explore within our review, referred to here as Expected Utility Theory, Non-Expected Utility Theory and Probabilistic Choice Theory. A fourth topic, Order Effects, is defined broadly to encompass behavioral theories around timing/sequence of events. For the main search, Scopus was used to identify literature that had (a) elicited TTO values and/or (b) contributed to the way TTO values were elicited and interpreted, from inception to July 2021. Papers that focused on the latter category were given the label "behavioral" and underwent additional analyses. A two stage-screening was applied to assess eligibility. Co-citation, co-authorship and co-occurrence of keywords was used to chart the development of TTO over time. Results A total of 1,727 records were retrieved from Scopus and were supplemented by an additional 188 papers. There were 856 applied and 280 behavioral papers included in the final corpus, with the behavioral set split equally into four sets of 70 papers to chart the development of keywords over time: (1) 1972-1999; (2) 2000-2010, (3) 2010-2015 and (4) 2015-2021. Discussion The keyword analysis suggested that whilst some ideas transition quickly from economic theory to the TTO literature, such as the impact of Order Effects, others take longer to be assimilated, for example Non-Expected Utility models or failure of constant discounting. It is therefore important that researchers within health economics work more closely with those in mainstream economics and keep abreast of the wider economics and behavioral sciences to expedite the uptake of new and relevant ideas.
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Affiliation(s)
- Luke Henstock
- University of Birmingham, Birmingham, United Kingdom
| | - Ruth Wong
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Aki Tsuchiya
- Department of Economics and School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Anne Spencer
- Department of Health and Community Sciences, University of Exeter, Exeter, United Kingdom
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Spencer A, Rivero-Arias O, Wong R, Tsuchiya A, Bleichrodt H, Edward R, Norman R, Lloyd A, Clarke P. The QALY at 50: One story many voices. Soc Sci Med 2021; 296:114653. [DOI: 10.1016/j.socscimed.2021.114653] [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: 05/28/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
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20
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Kikhtyanin O, Korolova V, Spencer A, Dubnová L, Shumeiko B, Kubička D. On the influence of acidic admixtures in furfural on the performance of MgAl mixed oxide catalysts in aldol condensation of furfural and acetone. Catal Today 2021. [DOI: 10.1016/j.cattod.2020.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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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21
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Hussey P, Das S, Farrell S, Ledger L, Spencer A. A Knowledge Graph to Understand Nursing Big Data: Case Example for Guidance. J Nurs Scholarsh 2021; 53:323-332. [PMID: 33811733 DOI: 10.1111/jnu.12650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To provide a summary of research on ontology development in the Centre of eIntegrated Care at Dublin City University, Ireland. DESIGN Design science methods using Open Innovation 2.0. METHODS This was a co-participatory study focusing on adoption of health informatics standards and translation of nursing knowledge to advance nursing theory through a nursing knowledge graph (NKG). In this article we outline groundwork research conducted through a focused analysis to advance structural interoperability and to inform integrated care in Ireland. We provide illustrated details on a simple example of initial research available through open access. FINDINGS For this phase of development, the initial completed research is presented and discussed. CONCLUSIONS We conclude by promoting the use of knowledge graphs for visualization of diverse knowledge translation, which can be used as a primer to gain valuable insights into nursing interventions to inform big data science in the future. CLINICAL RELEVANCE In line with stated global policy, the uptake and use of health informatics standards in design science within the profession of nursing is a priority. Nursing leaders should initially focus on health informatics standards relating to structural interoperability to inform development of NKGs. This will provide a robust foundation to gain valuable insights into articulating the nursing contribution in relation to the design of digital health and progress the nursing contribution to targeted data sources for the advancement of United Nations Sustainable Development Goal Three.
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Affiliation(s)
- Pamela Hussey
- Associate Professor in Health Informatics and Nursing, Center for eIntegrated Care, School of Nursing Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Subhashis Das
- MSCA ELITE-S Fellow, Centre for eIntegrated Care, Adapt Research Center, Dublin City University, Dublin, Ireland
| | - Sharon Farrell
- CeIC Project Co-Ordinator, Center for eIntegrated Care School of Nursing Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Lorraine Ledger
- ADON/Nurse Manager on Call, St Michael's House, Ballymun Road, Dublin, Ireland
| | - Anne Spencer
- Clinical Nurse Manager CNM1, St Michael's House, Ballymun Road, Dublin, Ireland
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22
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Moore G, Rickard H, Stevenson D, Aranega-Bou P, Pitman J, Crook A, Davies K, Spencer A, Burton C, Easterbrook L, Love HE, Summers S, Welch SR, Wand N, Thompson KA, Pottage T, Richards KS, Dunning J, Bennett A. Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England. J Hosp Infect 2021; 108:189-196. [PMID: 33259882 PMCID: PMC7831847 DOI: 10.1016/j.jhin.2020.11.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control measures, and prevent nosocomial transmission. METHODS The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays. FINDINGS SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m3 air. Infectious virus was not recovered from any of the PCR-positive samples analysed. CONCLUSIONS Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.
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Affiliation(s)
- G Moore
- National Infection Service, Public Health England, Porton Down, Salisbury, UK.
| | - H Rickard
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - D Stevenson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - P Aranega-Bou
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Pitman
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Crook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K Davies
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Spencer
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - C Burton
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - L Easterbrook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - H E Love
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S Summers
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S R Welch
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - N Wand
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K-A Thompson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - T Pottage
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K S Richards
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Dunning
- Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, Colindale, London, UK; NIHR Health Protection Research Unit in Emerging Infections and Zoonoses, Liverpool, UK
| | - A Bennett
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
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Tarrant M, Carter M, Dean SG, Taylor R, Warren FC, Spencer A, Adamson J, Landa P, Code C, Backhouse A, Lamont RA, Calitri R. Singing for people with aphasia (SPA): results of a pilot feasibility randomised controlled trial of a group singing intervention investigating acceptability and feasibility. BMJ Open 2021; 11:e040544. [PMID: 33441355 PMCID: PMC7812101 DOI: 10.1136/bmjopen-2020-040544] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Pilot feasibility randomised controlled trial (RCT) for the singing groups for people with aphasia (SPA) intervention to assess: (1) the acceptability and feasibility of participant recruitment, randomisation and allocation concealment; (2) retention rates; (3) variance of continuous outcome measures; (4) outcome measure completion and participant burden; (5) fidelity of intervention delivery; (6) SPA intervention costs; (7) acceptability and feasibility of trial and intervention to participants and others involved. DESIGN A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. SETTING Three community-based cohorts in the South-West of England. PARTICIPANTS Eligible participants with post-stroke aphasia were randomised 1:1 to SPA or control. INTERVENTION The manualised SPA intervention was delivered over 10 weekly singing group sessions, led by a music facilitator and assisted by an individual with post-stroke aphasia. The intervention was developed using the Information-Motivation-Behavioural skills model of behaviour change and targeted psychosocial outcomes. Control and intervention participants all received an aphasia information resource pack. OUTCOME MEASURES Collected at baseline, 3 and 6 months post-randomisation, candidate primary outcomes were measured (well-being, quality of life and social participation) as well as additional clinical outcomes. Feasibility, acceptability and process outcomes included recruitment and retention rates, and measurement burden; and trial experiences were explored in qualitative interviews. RESULTS Of 87 individuals screened, 42 participants were recruited and 41 randomised (SPA=20, control=21); 36 participants (SPA=17, control=19) completed 3-month follow-up, 34 (SPA=18, control=16) completed 6-month follow-up. Recruitment and retention (83%) were acceptable for a definitive RCT, and participants did not find the study requirements burdensome. High fidelity of the intervention delivery was shown by high attendance rates and facilitator adherence to the manual, and participants found SPA acceptable. Sample size estimates for a definitive RCT and primary/secondary outcomes were identified. CONCLUSIONS The SPA pilot RCT fulfilled its objectives, and demonstrated that a definitive RCT of the intervention would be both feasible and acceptable. TRIAL REGISTRATION NUMBER NCT03076736.
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Affiliation(s)
- Mark Tarrant
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Mary Carter
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah Gerard Dean
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rod Taylor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fiona C Warren
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Spencer
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jane Adamson
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Paolo Landa
- Département d'opérations et systèmes de décision, Université Laval, Québec, Québec, Canada
| | - Chris Code
- Department of Psychology, University of Exeter, Exeter, UK
| | - Amy Backhouse
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ruth A Lamont
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Raff Calitri
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
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Bunker CB, Kravvas G, Watchorn R, Spencer A, Ong E, Haider A, Freeman A, Francis NA, Alnajjar H, Muneer A, Dinneen M. Reply to: ‘Does routine histology alter management post-circumcision?’. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415820982755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- CB Bunker
- Department of Dermatology, University College London Hospitals, UK
| | - G Kravvas
- Department of Dermatology, University College London Hospitals, UK
| | - R Watchorn
- Department of Dermatology, Imperial College Healthcare, UK
| | - A Spencer
- Department of Dermatology, Imperial College Healthcare, UK
| | - E Ong
- Department of Dermatology, University College London Hospitals, UK
| | - A Haider
- Department of Histopathology, University College London Hospitals, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals, UK
| | - NA Francis
- Department of Histopathology, Chelsea and Westminster Hospital, UK
| | - H Alnajjar
- Department of Urology, University College London Hospitals, UK
| | - A Muneer
- Department of Urology, University College London Hospitals, UK
| | - M Dinneen
- Department of Urology, Chelsea and Westminster Hospital, UK
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25
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Price S, Spencer A, Zhang X, Ball S, Lyratzopoulos G, Mujica-Mota R, Stapley S, Ukoumunne OC, Hamilton W. Trends in time to cancer diagnosis around the period of changing national guidance on referral of symptomatic patients: A serial cross-sectional study using UK electronic healthcare records from 2006-17. Cancer Epidemiol 2020; 69:101805. [PMID: 32919226 PMCID: PMC7480981 DOI: 10.1016/j.canep.2020.101805] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/24/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND UK primary-care referral guidance describes the signs, symptoms, and test results ("features") of undiagnosed cancer. Guidance revision in 2015 liberalised investigation by introducing more low-risk features. We studied adults with cancer whose features were in the 2005 guidance ("Old-NICE") or were introduced in the revision ("New-NICE"). We compared time to diagnosis between the groups, and its trend over 2006-2017. METHODS Clinical Practice Research Datalink records were analysed for adults with incident myeloma, breast, bladder, colorectal, lung, oesophageal, ovarian, pancreatic, prostate, stomach or uterine cancers in 1/1/2006-31/12/2017. Cancer-specific features in the year before diagnosis were used to create New-NICE and Old-NICE groups. Diagnostic interval was time between the index feature and diagnosis. Semiparametric varying-coefficient analyses compared diagnostic intervals between New-NICE and Old-NICE groups over 1/1/2006-31/12/2017. RESULTS Over all cancers (N = 83,935), median (interquartile range) Old-NICE diagnostic interval rose over 2006-2017, from 51 (20-132) to 64 (30-148) days, with increases in breast (15 vs 25 days), lung (103 vs 135 days), ovarian (65·5 vs 100 days), prostate (80 vs 93 days) and stomach (72·5 vs 102 days) cancers. Median New-NICE values were consistently longer (99, 40-212 in 2006 vs 103, 42-236 days in 2017) than Old-NICE values over all cancers. After guidance revision, New-NICE diagnostic intervals became shorter than Old-NICE values for colorectal cancer. CONCLUSIONS Despite improvements for colorectal cancer, scope remains to reduce diagnostic intervals for most cancers. Liberalised investigation requires protecting and enhancing cancer-diagnostic services to avoid their becoming a rate-limiting step in the diagnostic pathway.
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Affiliation(s)
- Sarah Price
- University of Exeter Medical School, Room 1.20 College House, St Luke's Campus, University of Exeter, Exeter, Devon, EX1 2LU, UK.
| | - Anne Spencer
- Health Economics Group, University of Exeter, Exeter, UK.
| | - Xiaohui Zhang
- University of Exeter Business School, University of Exeter, Exeter, UK.
| | - Susan Ball
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula, University of Exeter, Exeter, UK.
| | | | | | - Sal Stapley
- University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - Obioha C Ukoumunne
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula, University of Exeter, Exeter, UK.
| | - Willie Hamilton
- University of Exeter Medical School, University of Exeter, Exeter, UK.
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Quach H, Nooka A, Samoylova O, Venner C, Facon T, Spencer A, Usmani S, Weisel K, Mateos M, Kim K, Grosicki S, Suzuki K, Delimpasi S, Obreja M, Zahlten-Kumeli A. CARFILZOMIB, DEXAMETHASONE, AND DARATUMUMAB VERSUS CARFILZOMIB AND DEXAMETHASONE IN RELAPSED OR REFRACTORY MULTIPLE MYELOMA: SUBGROUP ANALYSIS OF THE PHASE 3 CANDOR STUDY BY NUMBER OF PRIOR LINES OFTHERAPY AND PRIOR THERAPIES. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.425] [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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Price S, Zhang X, Spencer A. Measuring the impact of national guidelines: What methods can be used to uncover time-varying effects for healthcare evaluations? Soc Sci Med 2020; 258:113021. [PMID: 32502834 DOI: 10.1016/j.socscimed.2020.113021] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/08/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
We examine the suitability of three methods using patient-level data to evaluate the time-varying impacts of national healthcare guidelines. Such guidelines often codify progressive change and are implemented gradually; for example, National Institute for Health and Care Excellence (NICE) suspected-cancer referral guidelines. These were revised on June 23, 2015, to include more cancer symptoms and test results ("features"), partly reflecting changing practice. We explore the time-varying impact of guideline revision on time to colorectal cancer diagnosis, which is linked to improved outcomes in decision-analytic models. We included 11,842 patients diagnosed in 01/01/2006-31/12/2017 in the Clinical Practice Research Datalink with England cancer registry data linkage. Patients were classified by whether their first pre-diagnostic cancer feature was in the original guidelines (NICE-2005) or was added during the revision (NICE-2015-only). Outcome was diagnostic interval: time from first cancer feature to diagnosis. All analyses adjusted for age and sex. Two difference-in-differences analyses used either a Pre (01/08/2012-31/12/2014, n = 2243) and Post (01/08/2015-31/12/2017, n = 1017) design, or event-study cohorts (2006-2017 vs 2015) to estimate change in diagnostic interval attributable to official implementation of the revised guidelines. A semiparametric varying-coefficient model analysed the difference in diagnostic interval between the NICE groups over time. After model estimation, primary and broader treatment effects of guideline content and implementation were measured. The event-study difference-in-differences and the semiparametric varying-coefficient methods showed that shorter diagnostic intervals were attributable to official implementation of the revised guidelines. This impact was only detectable by pre-to-post difference-in-differences when the pre/post periods were selected according to the estimation results from the varying-coefficient model. Formal tests of the parametric models, which are special cases of the semiparametric model, suggest that they are misspecified. We conclude that the semiparametric method is well suited to explore the time-varying impacts of guidelines codifying progressive change.
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Affiliation(s)
- Sarah Price
- Cancer Diagnosis (DISCO) Group, College of Medicine and Health, St Luke's Campus, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK.
| | - Xiaohui Zhang
- Department of Economics, Exeter Business School, University of Exeter, Rennes Drives, Exeter, Devon, EX4 4PU, UK
| | - Anne Spencer
- Health Economics Group, College of Medicine and Health, St Luke's Campus, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK
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Tomás T, Nogueira-Costa G, Eiriz I, Vitorino M, Vicente R, Oliveira A, Luz P, Baleiras M, Spencer A, Costa LLD, Liu P, Cadavez E, Correia M, Atalaia G, Silva M, Fiúza T. P-278 Neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios as predictive markers of pathological response to FLOT neoadjuvant strategy in locally advanced gastric/gastroesophageal junction cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.360] [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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29
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Simão D, Parmanande A, Barreira J, Sardinha M, Reis A, Spencer A, Oliveira S, Luz RD. P-95 Non-metastatic anal cancer outcomes: A single-center experience. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.177] [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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30
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Mújica-Mota RE, Landa P, Pitt M, Allen M, Spencer A. The heterogeneous causal effects of neonatal care: a model of endogenous demand for multiple treatment options based on geographical access to care. Health Econ 2020; 29:46-60. [PMID: 31746059 DOI: 10.1002/hec.3970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/14/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
Neonatal units in the UK are organised into three levels, from highest Neonatal Intensive Care Unit (NICU), to Local Neonatal Unit (LNU) to lowest Special Care Unit (SCU). We model the endogenous treatment selection of neonatal care unit of birth to estimate the average and marginal treatment effects of different neonatal designations on infant mortality, length of stay and hospital costs. We use prognostic factors, survival and hospital care use data on all preterm births in England for 2014-2015, supplemented by national reimbursement tariffs and instrumental variables of travel time from a geographic information system. The data were consistent with a model of demand for preterm birth care driven by physical access. In-hospital mortality of infants born before 32 weeks was 8.5% overall, and 1.2 (95% CI: -0.7, 3.2) percentage points lower for live births in hospitals with NICU or SCU compared to those with an LNU according to instrumental variable estimates. We find imprecise differences in average total hospital costs by unit designation, with positive unobserved selection of those with higher unexplained absolute and incremental costs into NICU. Our results suggest a limited scope for improvement in infant mortality by increasing in-utero transfers based on unit designation alone.
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Affiliation(s)
- Rubén E Mújica-Mota
- University of Leeds Medical School, Leeds Institute of Health Sciences, Leeds, UK
| | - Paolo Landa
- Department of Economics, University of Genoa, Genoa, Italy
| | - Martin Pitt
- University of Exeter Medical School, Institute of Health Research, Exeter, UK
| | - Mike Allen
- University of Exeter Medical School, Institute of Health Research, Exeter, UK
| | - Anne Spencer
- University of Exeter Medical School, Institute of Health Research, Exeter, UK
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Walter FM, Thompson MJ, Wellwood I, Abel GA, Hamilton W, Johnson M, Lyratzopoulos G, Messenger MP, Neal RD, Rubin G, Singh H, Spencer A, Sutton S, Vedsted P, Emery JD. Evaluating diagnostic strategies for early detection of cancer: the CanTest framework. BMC Cancer 2019; 19:586. [PMID: 31200676 PMCID: PMC6570853 DOI: 10.1186/s12885-019-5746-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 05/23/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Novel diagnostic triage and testing strategies to support early detection of cancer could improve clinical outcomes. Most apparently promising diagnostic tests ultimately fail because of inadequate performance in real-world, low prevalence populations such as primary care or general community populations. They should therefore be systematically evaluated before implementation to determine whether they lead to earlier detection, are cost-effective, and improve patient safety and quality of care, while minimising over-investigation and over-diagnosis. METHODS We performed a systematic scoping review of frameworks for the evaluation of tests and diagnostic approaches. RESULTS We identified 16 frameworks: none addressed the entire continuum from test development to impact on diagnosis and patient outcomes in the intended population, nor the way in which tests may be used for triage purposes as part of a wider diagnostic strategy. Informed by these findings, we developed a new framework, the 'CanTest Framework', which proposes five iterative research phases forming a clear translational pathway from new test development to health system implementation and evaluation. CONCLUSION This framework is suitable for testing in low prevalence populations, where tests are often applied for triage testing and incorporated into a wider diagnostic strategy. It has relevance for a wide range of stakeholders including patients, policymakers, purchasers, healthcare providers and industry.
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Affiliation(s)
- Fiona M. Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB1 8RN UK
| | | | - Ian Wellwood
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB1 8RN UK
| | - Gary A. Abel
- University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | | | - Margaret Johnson
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB1 8RN UK
| | - Georgios Lyratzopoulos
- Department of Behavioural Science and Health, Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, University College London, London, UK
| | - Michael P. Messenger
- National Institute of Health Research (NIHR) Leeds In Vitro Diagnostic Cooperative (IVDC), Leeds Centre for Personalised Medicine and Health, University of Leeds, Leeds, UK
| | - Richard D. Neal
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Greg Rubin
- Institute of Health and Society, University of Newcastle, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle, NE1 4LP UK
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX USA
| | - Anne Spencer
- Health Economics Group, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU Devon UK
| | - Stephen Sutton
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB1 8RN UK
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis – CaP, The Research Unit for General Practice and Research Clinic for Innovative Health Care Delivery, Department of Clinical Medicine, Aarhus University, Bartholins Alle 2, 8000 Aarhus, Denmark
| | - Jon D. Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne, 10th floor, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, VIC 3010 Australia
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Spencer A, Tomeny E, Mujica-Mota RE, Robinson A, Covey J, Pinto-Prades JL. Do time trade-off values fully capture attitudes that are relevant to health-related choices? Eur J Health Econ 2019; 20:559-568. [PMID: 30596209 PMCID: PMC6517563 DOI: 10.1007/s10198-018-1017-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
Previous research has shown that demographics, beliefs, and self-reported own health influence TTO values. Our hypothesis is that attitudes towards length and quality of life influence TTO values, but should no longer affect a set of related choices that are based on respondents' own TTO scores. A representative sample of 1339 respondents was asked their level of agreement to four statements relating to the importance of quality and length of life. Respondents then went on to value 4 EQ-5D 5L states using an online interactive survey and a related set of 6 pairwise health-related choice questions, set up, so that respondents should be indifferent between choice options. We explored the impact of attitudes using regression analysis for TTO values and a logit model for choices. TTO values were correlated with the attitudes and were found to have a residual impact on the choices. In particular, those respondents who preferred quality of life over length of life gave less weight to the differences in years and more weight to differences in quality of life in these choice. We conclude that although the TTO responses reflect attitudes, these attitudes continue to affect health-related choices.
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Affiliation(s)
- Anne Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK.
| | - Ewan Tomeny
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Ruben E Mujica-Mota
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Angela Robinson
- Norwich Medical School, University of East Anglia, Earlham Road, Norwich, NR4 7TJ, UK
| | - Judith Covey
- Department of Psychology, Durham University, Stockton Road, Durham, DH1 3LE, UK
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Dunn BD, Widnall E, Reed N, Taylor R, Owens C, Spencer A, Kraag G, Kok G, Geschwind N, Wright K, Moberly NJ, Moulds ML, MacLeod AK, Handley R, Richards D, Campbell J, Kuyken W. Evaluating Augmented Depression Therapy (ADepT): study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2019; 5:63. [PMID: 31061718 PMCID: PMC6486988 DOI: 10.1186/s40814-019-0438-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While existing psychological treatments for depression are effective for many, a significant proportion of depressed individuals do not respond to current approaches and few remain well over the long-term. Anhedonia (a loss of interest or pleasure) is a core symptom of depression which predicts a poor prognosis but has been neglected by existing treatments. Augmented Depression Therapy (ADepT) has been co-designed with service users to better target anhedonia alongside other features of depression. This mixed methods pilot trial aims to establish proof of concept for ADepT and to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost-effectiveness of ADepT, compared to an evidence-based mainstream therapy (Cognitive Behavioural Therapy; CBT) in the acute treatment of depression, the prevention of subsequent depressive relapse, and the enhancement of wellbeing. METHODS We aim to recruit 80 depressed participants and randomise them 1:1 to receive ADepT (15 weekly acute and 5 booster sessions in following year) or CBT (20 weekly acute sessions). Clinical and health economic assessments will take place at intake and at 6-, 12-, and 18-month follow-up. Reductions in PHQ-9 depression severity and increases in WEMWBS wellbeing at 6-month assessment (when acute treatment should be completed) are the co-primary outcomes. Quantitative and qualitative process evaluation will assess mechanism of action, implementation issues, and contextual moderating factors. To evaluate proof of concept, intake-post effect sizes and the proportion of individuals showing reliable and clinically significant change on outcome measures in each arm at each follow-up will be reported. To evaluate feasibility and acceptability, we will examine recruitment, retention, treatment completion, and data completeness rates and feedback from patients and therapists about their experience of study participation and therapy. Additionally, we will establish the cost of delivery of ADepT. DISCUSSION We will proceed to definitive trial if any concerns about the safety, acceptability, feasibility, and proof of concept of ADepT and trial procedures can be rectified, and we recruit, retain, and collect follow-up data on at least 60% of the target sample. TRIAL REGISTRATION ISCRTN85278228, registered 27/03/2017.
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Affiliation(s)
| | - Emily Widnall
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | - Nigel Reed
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | - Rod Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Christabel Owens
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Spencer
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Gerda Kraag
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Gerjo Kok
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Nicole Geschwind
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Kim Wright
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | | | - Michelle L. Moulds
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Andrew K. MacLeod
- Department of Psychology, Royal Holloway University of London, London, UK
| | | | - David Richards
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - John Campbell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
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Villeneuve E, Landa P, Allen M, Spencer A, Prosser S, Gibson A, Kelsey K, Mujica-Mota R, Manktelow B, Modi N, Thornton S, Pitt M. A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study. Health Serv Deliv Res 2018. [DOI: 10.3310/hsdr06350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BackgroundThere is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale.Objectives(1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives.Main outcome measuresThe ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents.DesignDescriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study.SettingNHS neonatal services across England.DataNeonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey.ResultsLocation analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling > 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families.LimitationsThe following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface.ConclusionsAn evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents.Future workTo extend the modelling to encompass the interface between maternity and neonatal services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Villeneuve
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Paolo Landa
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Michael Allen
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anne Spencer
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sue Prosser
- Neonatal Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Katie Kelsey
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruben Mujica-Mota
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Brad Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Steve Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Pitt
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Tarrant M, Carter M, Dean SG, Taylor RS, Warren FC, Spencer A, Adamson J, Landa P, Code C, Calitri R. Singing for people with aphasia (SPA): a protocol for a pilot randomised controlled trial of a group singing intervention to improve well-being. BMJ Open 2018; 8:e025167. [PMID: 30206095 PMCID: PMC6144319 DOI: 10.1136/bmjopen-2018-025167] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The singing for people with aphasia (SPA) intervention aims to improve quality of life and well-being for people with poststroke aphasia. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost effectiveness of SPA. The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design. METHODS AND ANALYSIS A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. Forty-eight participants discharged from clinical speech and language therapy will be individually randomised 1:1 to SPA (10 group sessions plus a resource booklet) or control (resource booklet only). Outcome assessment at baseline, 3 and 6 months postrandomisation include: ICEpop CAPability measure for adults, Stroke and Aphasia Quality of Life, EQ-5D-5L, modified Reintegration into Normal Living Index, Communication Outcome After Stroke, Very Short Version of the Minnesota Aphasia Test, Service Receipt Inventory and Care Related Quality of Life. Feasibility, acceptability and process outcomes include recruitment and retention rates, with measurement burden and trial experiences being explored in qualitative interviews (15 participants, 2 music facilitators and 2 music champions). Analyses include: descriptive statistics, with 95% CIs where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis. ETHICS AND DISSEMINATION NHS National Research Ethics Service and the Health Research Authority confirmed approval in April 2017; recruitment commenced in June 2017. Outputs will include: pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised intervention manual for multicentre replication of SPA; presentations at conferences, public involvement events; internationally recognised peer reviewed journal publications, open access sources and media releases. TRIAL REGISTRATION NUMBER NCT03076736.
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Affiliation(s)
- Mark Tarrant
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Mary Carter
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Sarah Gerard Dean
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Rod S Taylor
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Fiona C Warren
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Anne Spencer
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Jane Adamson
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Paolo Landa
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Chris Code
- Department of Psychology, University of Exeter, Exeter, UK
| | - Raff Calitri
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
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Barbosa EC, Verhoef TI, Morris S, Solmi F, Johnson M, Sohal A, El-Shogri F, Dowrick S, Ronalds C, Griffiths C, Eldridge S, Lewis NV, Devine A, Spencer A, Feder G. Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study. BMJ Open 2018; 8:e021256. [PMID: 30158224 PMCID: PMC6119435 DOI: 10.1136/bmjopen-2017-021256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/03/2018] [Accepted: 07/31/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon. DESIGN AND SETTING Cost-utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England. PARTICIPANTS Based on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older. INTERVENTIONS The IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context. RESULTS The IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval -£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval -0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence. CONCLUSION The IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.
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Affiliation(s)
| | | | - Steve Morris
- University College London, Department of Applied Health Research, London, UK
| | - Francesca Solmi
- Division of Psychiatry, University College London, London, UK
| | | | - Alex Sohal
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Farah El-Shogri
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Susanna Dowrick
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Clare Ronalds
- Pankhurst Trust Incorporating, Manchester Women's Aid, Manchester, UK
| | - Chris Griffiths
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Natalia V Lewis
- NIHR CLAHRC North Thames at Bart's Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Angela Devine
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Anne Spencer
- University of Exeter Medical School, Exeter, Devon, UK
| | - Gene Feder
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Ashaye T, Hounsome N, Carnes D, Taylor SJC, Homer K, Eldridge S, Spencer A, Rahman A, Foell J, Underwood MR. Opioid prescribing for chronic musculoskeletal pain in UK primary care: results from a cohort analysis of the COPERS trial. BMJ Open 2018; 8:e019491. [PMID: 29880563 PMCID: PMC6009475 DOI: 10.1136/bmjopen-2017-019491] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To establish the level of opioid prescribing for patients with chronic musculoskeletal pain in a sample of patients from primary care and to estimate prescription costs. DESIGN Secondary data analyses from a two-arm pragmatic randomised controlled trial (COPERS) testing the effectiveness of group self-management course and usual care against relaxation and usual care for patients with chronic musculoskeletal pain (ISRCTN 24426731). SETTING 25 general practices and two community musculoskeletal services in the UK (London and Midlands). PARTICIPANTS 703 chronic pain participants; 81% white, 67% female, enrolled in the COPERS trial. MAIN OUTCOME MEASURES Anonymised prescribing data over 12 months extracted from GP electronic records. RESULTS Of the 703 trial participants with chronic musculoskeletal pain, 413 (59%) patients were prescribed opioids. Among those prescribed an opioid, the number of opioid prescriptions varied from 1 to 52 per year. A total of 3319 opioid prescriptions were issued over the study period, of which 53% (1768/3319) were for strong opioids (tramadol, buprenorphine, morphine, oxycodone, fentanyl and tapentadol). The mean number of opioid prescriptions per patient prescribed any opioid was 8.0 (SD=7.9). A third of patients on opioids were prescribed more than one type of opioid; the most frequent combinations were: codeine plus tramadol and codeine plus morphine. The cost of opioid prescriptions per patient per year varied from £3 to £4844. The average annual prescription cost was £24 (SD=29) for patients prescribed weak opioids and £174 (SD=421) for patients prescribed strong opioids. Approximately 40% of patients received >3 prescriptions of strong opioids per year, with an annual cost of £236 per person. CONCLUSIONS Long-term prescribing of opioids for chronic musculoskeletal pain is common in primary care. For over a quarter of patients receiving strong opioids, these drugs may have been overprescribed according to national guidelines. TRIAL REGISTRATION NUMBER ISRCTN24426731; Post-results.
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Affiliation(s)
- Tomi Ashaye
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Anne Spencer
- Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Anisur Rahman
- Centre for Rheumatology Research, University College London, London, UK
| | - Jens Foell
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Shepherd AI, Pulsford R, Poltawski L, Forster A, Taylor RS, Spencer A, Hollands L, James M, Allison R, Norris M, Calitri R, Dean SG. Physical activity, sleep, and fatigue in community dwelling Stroke Survivors. Sci Rep 2018; 8:7900. [PMID: 29785009 PMCID: PMC5962574 DOI: 10.1038/s41598-018-26279-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/30/2018] [Indexed: 11/09/2022] Open
Abstract
Stroke can lead to physiological and psychological impairments and impact individuals' physical activity (PA), fatigue and sleep patterns. We analysed wrist-worn accelerometry data and the Fatigue Assessment Scale from 41 stroke survivors following a physical rehabilitation programme, to examine relationships between PA levels, fatigue and sleep. Validated acceleration thresholds were used to quantify time spent in each PA intensity/sleep category. Stroke survivors performed less moderate to vigorous PA (MVPA) in 10 minute bouts than the National Stroke guidelines recommend. Regression analysis revealed associations at baseline between light PA and fatigue (p = 0.02) and MVPA and sleep efficiency (p = 0.04). Light PA was positively associated with fatigue at 6 months (p = 0.03), whilst sleep efficiency and fatigue were associated at 9 months (p = 0.02). No other effects were shown at baseline, 6 or 9 months. The magnitude of these associations were small and are unlikely to be clinically meaningful. Larger trials need to examine the efficacy and utility of accelerometry to assess PA and sleep in stroke survivors.
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Affiliation(s)
- Anthony I Shepherd
- University of Portsmouth, Sport and Exercise Science, Portsmouth, PO1 2ER, UK.
| | - Richard Pulsford
- University of Exeter, Sport and Health Sciences, Exeter, EX1 2LU, UK
| | - Leon Poltawski
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Anne Forster
- Academic Unit of Elderly Care, University of Leeds, Leeds, LS2 9LJ, UK
| | - Rod S Taylor
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Anne Spencer
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Laura Hollands
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Martin James
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK.,Royal Devon & Exeter Hospital, Exeter, EX2 5DW, UK
| | - Rhoda Allison
- Torbay and Southern Devon Health and Care Trust, Torquay, TQ2 7TD, UK
| | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, London, Uxbridge, UB8 3PH, UK
| | - Raff Calitri
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Sarah G Dean
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
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Dean SG, Poltawski L, Forster A, Taylor RS, Spencer A, James M, Allison R, Stevens S, Norris M, Shepherd AI, Landa P, Pulsford RM, Hollands L, Calitri R. Community-based rehabilitation training after stroke: results of a pilot randomised controlled trial (ReTrain) investigating acceptability and feasibility. BMJ Open 2018; 8:e018409. [PMID: 29449290 PMCID: PMC5829775 DOI: 10.1136/bmjopen-2017-018409] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/20/2017] [Accepted: 09/29/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To assess acceptability and feasibility of trial processes and the Rehabilitation Training (ReTrain) intervention including an assessment of intervention fidelity. DESIGN A two-group, assessor-blinded, randomised controlled trial with parallel mixed methods process and economic evaluations. SETTING Community settings across two sites in Devon. PARTICIPANTS Eligible participants were: 18 years old or over, with a diagnosis of stroke and with self-reported mobility issues, no contraindications to physical activity, discharged from National Health Service or any other formal rehabilitation programme at least 1 month before, willing to be randomised to either control or ReTrain and attend the training venue, possessing cognitive capacity and communication ability sufficient to participate. Participants were individually randomised (1:1) via a computer-generated randomisation sequence minimised for time since stroke and level of functional disability. Only outcome assessors independent of the research team were blinded to group allocation. INTERVENTIONS ReTrain comprised (1) an introductory one-to-one session; (2) ten, twice-weekly group classes with up to two trainers and eight clients; (3) a closing one-to-one session, followed by three drop-in sessions over the subsequent 3 months. Participants received a bespoke home-based training programme. All participants received treatment as usual. The control group received an exercise after stroke advice booklet. OUTCOME MEASURES Candidate primary outcomes included functional mobility and physical activity. RESULTS Forty-five participants were randomised (ReTrain=23; Control=22); data were available from 40 participants at 6 months of follow-up (ReTrain=21; Control=19) and 41 at 9 months of follow-up (ReTrain=21; Control=20). We demonstrated ability to recruit and retain participants. Participants were not burdened by the requirements of the study. We were able to calculate sample estimates for candidate primary outcomes and test procedures for process and health economic evaluations. CONCLUSIONS All objectives were fulfilled and indicated that a definitive trial of ReTrain is feasible and acceptable. TRIAL REGISTRATION NUMBER NCT02429180; Results.
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Affiliation(s)
| | | | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | | | | | - Martin James
- University of Exeter Medical School, Exeter, UK
- Royal Devon and Exeter NHS Foundation Trust
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Rhoda Allison
- Torbay and Southern Devon NHS Foundation Trust, Torquay, UK
| | | | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Anthony I Shepherd
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Paolo Landa
- University of Exeter Medical School, Exeter, UK
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Spencer A, Gazzani P, Gadvi R, Hughes S, Stevens A, Shah F, Scarisbrick J. Computed tomography scanning in mycosis fungoides: optimizing the balance between benefit and harm. Br J Dermatol 2017; 178:563-564. [DOI: 10.1111/bjd.15657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- A. Spencer
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - P. Gazzani
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - R. Gadvi
- Department of Radiology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - S.J. Hughes
- Department of Radiology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - A. Stevens
- Department of Oncology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - F. Shah
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - J. Scarisbrick
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
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Spencer A, Hanson J. Associations between Apolipoprotein B and Disease Risk Factors among Worksite Wellness Participants. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.347] [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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Lentzsch S, Weisel K, Mateos M, Hungria V, Munder M, Nooka A, Mark T, Quach H, Scott E, Lee J, Sonneveld P, Casneuf T, Chiu C, Qin X, Amin H, Thiyagarajah P, Schecter J, Qi M, Spencer A. DARATUMUMAB, BORTEZOMIB AND DEXAMETHASONE (DVD) VS BORTEZOMIB AND DEXAMETHASONE (VD) IN RELAPSED OR REFRACTORY MULTIPLE MYELOMA (RRMM): EFFICACY AND SAFETY UPDATE (CASTOR). Hematol Oncol 2017. [DOI: 10.1002/hon.2439_152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. Lentzsch
- Division of Hematology/Oncology; Columbia University; New York NY USA
| | - K. Weisel
- Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmonologie; Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II; Tuebingen Germany
| | - M.V. Mateos
- Department of Haematology; University Hospital of Salamanca/IBSAL; Salamanca Spain
| | - V. Hungria
- Department Hematology and Oncology; Irmandade Da Santa Casa De Misericordia De São Paulo; São Paulo Brazil
| | - M. Munder
- Third Department of Medicine (Hematology, Oncology, and Pneumology); University Medical Center of the Johannes Gutenberg-University; Mainz Germany
| | - A. Nooka
- Division of Bone Marrow Transplant, Winship Cancer Institute; Emory University; Atlanta GA USA
| | - T. Mark
- Department of Medicine; Weill Cornell Medical College; New York NY USA
| | - H. Quach
- Department of Haematology; University of Melbourne, St. Vincent's Hospital; Victoria Australia
| | - E. Scott
- Division of Hematology and Medical Oncology, Knight Cancer Institute; Oregon Health and Science University; Portland OR USA
| | - J. Lee
- Department of Hematology-Oncology; Chonnam National University Hwasun Hospital, Hwasun Jeollanamdo; Republic of Korea
| | - P. Sonneveld
- Department of Hematology, Erasmus MC; Rotterdam The Netherlands
| | - T. Casneuf
- Research & Development, Janssen; Beerse Belgium
| | - C. Chiu
- Research & Development, Janssen; Spring House PA USA
| | - X. Qin
- Research & Development, Janssen; Spring House PA USA
| | - H. Amin
- Research & Development, Janssen; Raritan NJ USA
| | | | - J. Schecter
- Research & Development, Janssen; Raritan NJ USA
| | - M. Qi
- Research & Development, Janssen; Spring House PA USA
| | - A. Spencer
- Division of Blood Cancers, Malignant Haematology and Stem Cell Transplantation Service; Alfred Health-Monash University; Melbourne Australia
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Fowler N, Gopal A, Schuster S, Trotman J, Hess G, Hou J, Yacoub A, Lill M, Martin P, Vitolo U, Spencer A, Radford J, Jurczak W, Morton J, Osmanov D, Caballero D, Deshpande S, Vermeulen J, Damle R, Schaffer M, Balasubramanian S, Cheson B, Salles G. Biomarker analysis of patients with follicular lymphoma treated with ibrutinib in the phase 2 DAWN study. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_75] [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: 11/12/2022]
Affiliation(s)
- N. Fowler
- Department of Lymphoma/Myeloma; The University of Texas MD Anderson Cancer Center; Houston USA
| | - A.K. Gopal
- Seattle Cancer Care Alliance; The University of Washington/Fred Hutchison Cancer Research Center; Seattle USA
| | - S.J. Schuster
- Lymphoma Program; Abramson Cancer Center of the University of Pennsylvania; Philadelphia USA
| | - J. Trotman
- Concord Hospital; University of Sydney, Haematology Department; Sydney Australia
| | - G. Hess
- Department of Hematology/Oncology; Johannes Gutenberg University; Mainz Germany
| | - J. Hou
- Division of Hematology/Oncology; University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute; Pittsburgh USA
| | - A. Yacoub
- Hematologic Malignancies and Cellular Therapeutics; University of Kansas Medical Center; Kansas City USA
| | - M. Lill
- Stem Cell and Bone Marrow Transplant Program, Cedars-Sinai Medical Center; Los Angeles USA
| | - P. Martin
- Weill Cornell Medical College; Cornell University; New York USA
| | - U. Vitolo
- Hematology; Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino; Turin Italy
| | - A. Spencer
- Central Clinical School; Alfred Hospital-Monash University; Melbourne Australia
| | - J. Radford
- University of Manchester and the Christie NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
| | - W. Jurczak
- Department of Hematology; Jagiellonian University; Krakow Poland
| | - J. Morton
- Clinical Haemato-Oncology; Haematology and Oncology Clinics of Australia; Milton Australia
| | - D. Osmanov
- Blokhin Cancer Research Center; Russian Academy of Medical Sciences; Moscow Russian Federation
| | - D. Caballero
- Instituto Biosanitario de Salamanca; Hospital Clínico Universitario; Salamanca Spain
| | | | - J. Vermeulen
- Research & Development, Janssen; Leiden The Netherlands
| | - R. Damle
- Research & Development, Janssen; Raritan USA
| | - M. Schaffer
- Research & Development, Janssen; Raritan USA
| | | | - B. Cheson
- Lombardi Comprehensive Cancer Center; Georgetown University Hospital; Washington District of Columbia USA
| | - G. Salles
- Haematology Department; Hospices Civils de Lyon-Université de Lyon; Lyon France
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Woolcott CG, Giguère Y, Weiler HA, Spencer A, Forest JC, Armson BA, Dodds L. Determinants of vitamin D status in pregnant women and neonates. Can J Public Health 2016; 107:e410-e416. [PMID: 28026707 DOI: 10.17269/cjph.107.5629] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/16/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Evidence suggests a beneficial effect of vitamin D on perinatal health; however, low vitamin D status is prevalent in pregnant women and neonates. The objective was to determine factors that are associated with vitamin D status of mothers in early pregnancy and neonates. METHODS The study comprised 1,635 pregnant women from Quebec City and Halifax, Canada, 2002-2010. Vitamin D status was based on the concentration of 25-hydroxy-vitamin D [25(OH)D] determined with a chemiluminescence immunoassay in maternal sera collected at a median of 15 weeks' gestation and in neonatal cord sera at delivery. A questionnaire with information on potential determinants was completed midpregnancy. RESULTS A total of 44.8% of mothers and 24.4% of neonates had 25(OH)D concentrations <50 nmol/L. Adjusted mean (95% confidence interval) maternal 25(OH)D levels were higher in summer than in winter by 16.1 nmol/L (13.6-18.7), and in those in the highest versus the lowest category of education by 6.1 nmol/L (0.5-11.8), in BMI <25 kg/m2 versus BMI ≥35 kg/m2 by 8.2 nmol/L (4.0-12.3), and in the highest versus the lowest physical activity category by up to 9.5 nmol/L (2.9-16.1). Determinants of neonatal 25(OH)D levels were similar but also included maternal age, dairy intake, supplement use and 25(OH)D level. CONCLUSION This study suggests that vitamin D status of pregnant women and/or neonates might be improved through supplementation, adequate dairy intake, a move towards a healthy pre-pregnancy body weight, and participation in physical activity. Controlled studies are needed to determine the effectiveness of interventions aimed at these factors.
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Affiliation(s)
- Christy G Woolcott
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University and IWK Health Centre, Halifax, NS.
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Gay F, Oliva S, Petrucci MT, Montefusco V, Conticello C, Musto P, Catalano L, Evangelista A, Spada S, Campbell P, Ria R, Salvini M, Offidani M, Carella AM, Omedé P, Liberati AM, Troia R, Cafro AM, Malfitano A, Falcone AP, Caravita T, Patriarca F, Nagler A, Spencer A, Hajek R, Palumbo A, Boccadoro M. Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis. Leukemia 2016; 31:1727-1734. [PMID: 28008174 DOI: 10.1038/leu.2016.381] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.
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Affiliation(s)
- F Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - S Oliva
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Roma, Roma, Italy
| | - V Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - C Conticello
- Division of Hematology, Azienda Policlinico 'Vittorio Emanuele', University of Catania, Catania, Italy
| | - P Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - L Catalano
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Napoli, Italy
| | - A Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - S Spada
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - P Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, Australia
| | - R Ria
- Department of Biomedical Science, University of Bari 'Aldo Moro' Medical School, Internal Medicine 'G. Baccelli' Policlinico, Bari, Italy
| | - M Salvini
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Offidani
- Hematology Department, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A M Carella
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Martino-Ist, Genova, Italy
| | - P Omedé
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Liberati
- Department of Oncohematology, AO S.Maria di Terni, Terni, Italy
| | - R Troia
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Cafro
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - A Malfitano
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A P Falcone
- Division of Hematology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - T Caravita
- UOC Ematologia S. Eugenio ASL RM2 Roma, Roma, Italy
| | - F Patriarca
- Department of Hematology, Azienda Ospedaliera-Universitaria di Udine, DISM, Università di Udine, Udine, Italy
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - R Hajek
- Blood Cancer Research Group, Department of Haematooncology, Faculty Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - A Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Mithraprabhu S, Khong T, Ramachandran M, Chow A, Klarica D, Mai L, Walsh S, Broemeling D, Marziali A, Wiggin M, Hocking J, Kalff A, Durie B, Spencer A. Circulating tumour DNA analysis demonstrates spatial mutational heterogeneity that coincides with disease relapse in myeloma. Leukemia 2016; 31:1695-1705. [DOI: 10.1038/leu.2016.366] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/05/2016] [Accepted: 11/18/2016] [Indexed: 02/06/2023]
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Dean SG, Poltawski L, Forster A, Taylor RS, Spencer A, James M, Allison R, Stevens S, Norris M, Shepherd AI, Calitri R. Community-based Rehabilitation Training after stroke: protocol of a pilot randomised controlled trial (ReTrain). BMJ Open 2016; 6:e012375. [PMID: 27697876 PMCID: PMC5073546 DOI: 10.1136/bmjopen-2016-012375] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The Rehabilitation Training (ReTrain) intervention aims to improve functional mobility, adherence to poststroke exercise guidelines and quality of life for people after stroke. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost-effectiveness of ReTrain, which is based on Action for Rehabilitation from Neurological Injury (ARNI). The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design. METHODS AND ANALYSIS A 2-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed-methods process evaluation and economic evaluation. 48 participants discharged from clinical rehabilitation despite residual physical disability will be individually randomised 1:1 to ReTrain (25 sessions) or control (exercise advice booklet). Outcome assessment at baseline, 6 and 9 months include Rivermead Mobility Index; Timed Up and Go Test; modified Patient-Specific Functional Scale; 7-day accelerometry; Stroke Self-efficacy Questionnaire, exercise diary, Fatigue Assessment Scale, exercise beliefs and self-efficacy questionnaires, SF-12, EQ-5D-5L, Stroke Quality of Life, Carer Burden Index and Service Receipt Inventory. Feasibility, acceptability and process outcomes include recruitment and retention rates; with measurement burden and trial experiences being explored in qualitative interviews (20 participants, 3 intervention providers). Analyses include descriptive statistics, with 95% CI where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis. ETHICS AND DISSEMINATION National Health Service (NHS) National Research Ethics Service approval granted in April 2015; recruitment started in June. Preliminary studies suggested low risk of serious adverse events; however (minor) falls, transitory muscle soreness and high levels of postexercise fatigue are expected. Outputs include pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised Trainer and Intervention Delivery manuals for multicentre replication of ReTrain; presentations at conferences, public involvement events; internationally recognised peer-reviewed journal publications, open access sources and media releases. TRIAL REGISTRATION NUMBER NCT02429180; Pre-results.
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Affiliation(s)
- Sarah G Dean
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Leon Poltawski
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Anne Forster
- ResearchAcademic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Rod S Taylor
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Anne Spencer
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Martin James
- University of Exeter Medical School & PenCLAHRC, Exeter, UK Royal Devon & Exeter Hospital, Exeter, UK
| | - Rhoda Allison
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | | | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, Middlesex, UK
| | - Anthony I Shepherd
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Raff Calitri
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
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von Moos R, Costa L, Scagliotti G, Sleeboom H, Goldwasser F, Hirsh V, Spencer A, Radcliffe HS, Niepel D, Henry D. Symptomatic skeletal events (SSEs) versus skeletal-related events (SREs) in patients with advanced cancer and bone metastases treated with denosumab or zoledronic acid. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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White MP, Elliott LR, Taylor T, Wheeler BW, Spencer A, Bone A, Depledge MH, Fleming LE. Recreational physical activity in natural environments and implications for health: A population based cross-sectional study in England. Prev Med 2016; 91:383-388. [PMID: 27658650 DOI: 10.1016/j.ypmed.2016.08.023] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/25/2016] [Accepted: 08/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Building on evidence that natural environments (e.g. parks, woodlands, beaches) are key locations for physical activity, we estimated the total annual amount of adult recreational physical activity in England's natural environments, and assessed implications for population health. METHODS A cross-sectional analysis of six waves (2009/10-2014/5) of the nationally representative, Monitor of Engagement with the Natural Environment survey (n=280,790). The survey uses a weekly quota sample, and population weights, to estimate nature visit frequency across England, and provides details on a single, randomly selected visit (n=112,422), including: a) duration; b) activity; and c) environment type. RESULTS Approximately 8.23 million (95% CIs: 7.93, 8.54) adults (19.5% of the population) made at least one 'active visit' (i.e. ≥30min, ≥3 METs) to natural environments in the previous week, resulting in 1.23 billion (1.14, 1.32) 'active visits' annually. An estimated 3.20 million (3.05, 3.35) of these also reported meeting recommended physical activity guidelines (i.e. ≥5×30min a week) fully, or in part, through such visits. Active visits by this group were associated with an estimated 109,164 (101,736, 116,592) Quality Adjusted Life Years (QALYs) annually. Assuming the social value of a QALY to be £20,000, the annual value of these visits was approximately £2.18 billion (£2.03, £2.33). Results for walking were replicated using WHO's Health Economic Assessment Tool. CONCLUSIONS Natural environments provide the context for a large proportion of England's recreational physical activity and highlight the need to protect and manage such environments for health purposes.
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Affiliation(s)
- M P White
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - L R Elliott
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - T Taylor
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - B W Wheeler
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - A Spencer
- Health Economics Group, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter EX1 2LU, United Kingdom.
| | - A Bone
- Public Health England, Environmental Change Department, 133-135 Waterloo Road, London SE1 8UG, United Kingdom.
| | - M H Depledge
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - L E Fleming
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
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Weisel K, Palumbo A, Chanan-Khan A, Nooka A, Spicka I, Masszi T, Beksac M, Hungria V, Munder M, Mateos MV, Mark T, Spencer A, Qi M, Schecter J, Amin H, Qin X, Deraedt W, Ahmadi T, Sonneveld P. Phase 3 randomised study of daratumumab, bortezomib and dexamethasone (DVd) vs bortezomib and dexamethasone (Vd) in patients (pts) with relapsed or refractory multiple myeloma (RRMM): CASTOR. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw375.01] [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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