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Walsh TS, Aitken LM, McKenzie CA, Boyd J, Macdonald A, Giddings A, Hope D, Norrie J, Weir C, Parker RA, Lone NI, Emerson L, Kydonaki K, Creagh-Brown B, Morris S, McAuley DF, Dark P, Wise MP, Gordon AC, Perkins G, Reade M, Blackwood B, MacLullich A, Glen R, Page VJ. Alpha 2 agonists for sedation to produce better outcomes from critical illness (A2B Trial): protocol for a multicentre phase 3 pragmatic clinical and cost-effectiveness randomised trial in the UK. BMJ Open 2023; 13:e078645. [PMID: 38072483 PMCID: PMC10729141 DOI: 10.1136/bmjopen-2023-078645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Almost all patients receiving mechanical ventilation (MV) in intensive care units (ICUs) require analgesia and sedation. The most widely used sedative drug is propofol, but there is uncertainty whether alpha2-agonists are superior. The alpha 2 agonists for sedation to produce better outcomes from critical illness (A2B) trial aims to determine whether clonidine or dexmedetomidine (or both) are clinically and cost-effective in MV ICU patients compared with usual care. METHODS AND ANALYSIS Adult ICU patients within 48 hours of starting MV, expected to require at least 24 hours further MV, are randomised in an open-label three arm trial to receive propofol (usual care) or clonidine or dexmedetomidine as primary sedative, plus analgesia according to local practice. Exclusions include patients with primary brain injury; postcardiac arrest; other neurological conditions; or bradycardia. Unless clinically contraindicated, sedation is titrated using weight-based dosing guidance to achieve a Richmond-Agitation-Sedation score of -2 or greater as early as considered safe by clinicians. The primary outcome is time to successful extubation. Secondary ICU outcomes include delirium and coma incidence/duration, sedation quality, predefined adverse events, mortality and ICU length of stay. Post-ICU outcomes include mortality, anxiety and depression, post-traumatic stress, cognitive function and health-related quality of life at 6-month follow-up. A process evaluation and health economic evaluation are embedded in the trial.The analytic framework uses a hierarchical approach to maximise efficiency and control type I error. Stage 1 tests whether each alpha2-agonist is superior to propofol. If either/both interventions are superior, stages 2 and 3 testing explores which alpha2-agonist is more effective. To detect a mean difference of 2 days in MV duration, we aim to recruit 1437 patients (479 per group) in 40-50 UK ICUs. ETHICS AND DISSEMINATION The Scotland A REC approved the trial (18/SS/0085). We use a surrogate decision-maker or deferred consent model consistent with UK law. Dissemination will be via publications, presentations and updated guidelines. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03653832.
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Affiliation(s)
- Timothy Simon Walsh
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | | | - Julia Boyd
- Edinburgh Clinical Trials Unit, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Alix Macdonald
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Annabel Giddings
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - John Norrie
- Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh No. 9, Bioquarter, Edinburgh, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Nazir I Lone
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | | | - Benedict Creagh-Brown
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Intensive Care Unit, Royal Surrey County Hospital, Guildford, UK
| | - Stephen Morris
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | | | - Paul Dark
- Intensive Care Unit, University of Manchester, Greater Manchester, UK
| | - Matt P Wise
- Department of Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Anthony C Gordon
- Section of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
| | - Gavin Perkins
- Clinical Trials Unit, University of Warwick, Birmingham, UK
| | - Michael Reade
- University of Queensland, Brisbane, Queensland, Australia
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | | | - Valerie J Page
- Intensive Care, West Hertfordshire Hospitals NHS Trust, Watford, UK
- Faculty of Medicine, Imperial College London, London, UK
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Krasauskaite J, Conway B, Weir C, Huang Z, Price J. Exploration of Metabolomic Markers Associated With Declining Kidney Function in People With Type 2 Diabetes Mellitus. J Endocr Soc 2023; 8:bvad166. [PMID: 38174155 PMCID: PMC10763986 DOI: 10.1210/jendso/bvad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Indexed: 01/05/2024] Open
Abstract
Background Metabolomics, the study of small molecules in biological systems, can provide valuable insights into kidney dysfunction in people with type 2 diabetes mellitus (T2DM), but prospective studies are scarce. We investigated the association between metabolites and kidney function decline in people with T2DM. Methods The Edinburgh Type 2 Diabetes Study, a population-based cohort of 1066 men and women aged 60 to 75 years with T2DM. We measured 149 serum metabolites at baseline and investigated individual associations with baseline estimated glomerular filtration rate (eGFR), incident chronic kidney disease [CKD; eGFR <60 mL/min/(1.73 m)2], and decliner status (5% eGFR decline per year). Results At baseline, mean eGFR was 77.5 mL/min/(1.73 m)2 (n = 1058), and 216 individuals had evidence of CKD. Of those without CKD, 155 developed CKD over a median 7-year follow-up. Eighty-eight metabolites were significantly associated with baseline eGFR (β range -4.08 to 3.92; PFDR < 0.001). Very low density lipoproteins, triglycerides, amino acids (AAs), glycoprotein acetyls, and fatty acids showed inverse associations, while cholesterol and phospholipids in high-density lipoproteins exhibited positive associations. AA isoleucine, apolipoprotein A1, and total cholines were not only associated with baseline kidney measures (PFDR < 0.05) but also showed stable, nominally significant association with incident CKD and decline. Conclusion Our study revealed widespread changes within the metabolomic profile of CKD, particularly in lipoproteins and their lipid compounds. We identified a smaller number of individual metabolites that are specifically associated with kidney function decline. Replication studies are needed to confirm the longitudinal findings and explore if metabolic signals at baseline can predict kidney decline.
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Affiliation(s)
| | - Bryan Conway
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, EH16 4TJ, Edinburgh, UK
| | - Christopher Weir
- Usher Institute, University of Edinburgh, EH8 9AG, Edinburgh, UK
| | - Zhe Huang
- Usher Institute, University of Edinburgh, EH8 9AG, Edinburgh, UK
| | - Jackie Price
- Usher Institute, University of Edinburgh, EH8 9AG, Edinburgh, UK
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Espinasse A, Solovyeva O, Dimairo M, Weir C, Jaki T, Mander A, Kightley A, Evans J, Lee S, Bedding A, Hopewell S, Rantell K, Liu R, Chan AW, De Bono J, Yap C. SPIRIT and CONSORT extensions for early phase dose-finding clinical trials: the DEFINE (DosE-FIndiNg Extensions) study protocol. BMJ Open 2023; 13:e068173. [PMID: 36990492 PMCID: PMC10069529 DOI: 10.1136/bmjopen-2022-068173] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Early phase dose-finding (EPDF) studies are critical for the development of new treatments, directly influencing whether compounds or interventions can be investigated in further trials to confirm their safety and efficacy. There exists guidance for clinical trial protocols and reporting of completed trials in the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 and CONsolidated Standards Of Reporting Randomised Trials (CONSORT) 2010 statements. However, neither the original statements nor their extensions adequately cover the specific features of EPDF trials. The DEFINE (DosE-FIndiNg Extensions) study aims to enhance transparency, completeness, reproducibility and interpretation of EPDF trial protocols (SPIRIT-DEFINE) and their reports once completed (CONSORT-DEFINE), across all disease areas, building on the original SPIRIT 2013 and CONSORT 2010 statements. METHODS AND ANALYSIS A methodological review of published EPDF trials will be conducted to identify features and deficiencies in reporting and inform the initial generation of the candidate items. The early draft checklists will be enriched through a review of published and grey literature, real-world examples analysis, citation and reference searches and consultation with international experts, including regulators and journal editors. Development of CONSORT-DEFINE commenced in March 2021, followed by SPIRIT-DEFINE from January 2022. A modified Delphi process, involving worldwide, multidisciplinary and cross-sector key stakeholders, will be run to refine the checklists. An international consensus meeting in autumn 2022 will finalise the list of items to be included in both guidance extensions. ETHICS AND DISSEMINATION This project was approved by ICR's Committee for Clinical Research. The Health Research Authority confirmed Research Ethics Approval is not required. The dissemination strategy aims to maximise guideline awareness and uptake, including but not limited to dissemination in stakeholder meetings, conferences, peer-reviewed publications and on the EQUATOR Network and DEFINE study websites. REGISTRATION DETAILS SPIRIT-DEFINE and CONSORT-DEFINE are registered with the EQUATOR Network.
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Affiliation(s)
- Aude Espinasse
- Clinical Trial and Statistical Unit, Institute of Cancer Research Sutton, London, UK
| | - Olga Solovyeva
- Clinical Trial and Statistical Unit, Institute of Cancer Research Sutton, London, UK
| | - Munyaradzi Dimairo
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, University of Edinburgh, Usher Institute, Edinburgh, UK
| | - Thomas Jaki
- Computational Statistics Group, Department of Informatics and Data Science, University of Regensburg, Regensburg, Germany
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Adrian Mander
- Cardiff University Centre for Trials Research, Cardiff, UK
| | | | - Jeffry Evans
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Shing Lee
- Columbia University, New York, New York, USA
| | - Alun Bedding
- Data and Statistical Sciences Department, Roche Products Ltd, Welwyn Garden City, UK
| | - Sally Hopewell
- Centre for Statistics in Medicine, Oxford Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Khadija Rantell
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Rong Liu
- Biostatistics Department, Bristol-Myers Squibb Co, New York, New York, USA
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Johann De Bono
- Institute of Cancer Research, London, UK
- Royal Marsden Hospital, London, UK
| | - Christina Yap
- Clinical Trial and Statistical Unit, Institute of Cancer Research Sutton, London, UK
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Solovyeva O, Dimairo M, Weir C, de Bono J, Bedding A, Chan AW, Espinasse A, Evans T, Hee S, Hopewell S, Hughes S, Jaki T, Kightley A, Lee S, Mander A, Patel D, Rantell K, Rekowski J, Ursino M, Yap C. 79MO Developing international consensus-driven SPIRIT and CONSORT extensions for early phase dose-finding clinical trials: The DEFINE (DosE FIndiNg Extensions) study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100937] [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: 04/05/2023] Open
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Trotter NE, Slight SP, Karimi R, Bates DW, Sheikh A, Weir C, Tolley CL. The effect of digital antimicrobial stewardship programmes on antimicrobial usage, length of stay, mortality and cost. Informatics in Medicine Unlocked 2023. [DOI: 10.1016/j.imu.2023.101183] [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: 02/01/2023] Open
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Manyara AM, Davies P, Stewart D, Wells V, Weir C, Young A, Taylor R, Ciani O. Scoping and targeted reviews to support development of SPIRIT and CONSORT extensions for randomised controlled trials with surrogate primary endpoints: protocol. BMJ Open 2022; 12:e062798. [PMID: 36229145 PMCID: PMC9562307 DOI: 10.1136/bmjopen-2022-062798] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Using a surrogate endpoint as a substitute for a primary patient-relevant outcome enables randomised controlled trials (RCTs) to be conducted more efficiently, that is, with shorter time, smaller sample size and lower cost. However, there is currently no consensus-driven guideline for the reporting of RCTs using a surrogate endpoint as a primary outcome; therefore, we seek to develop SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) extensions to improve the design and reporting of these trials. As an initial step, scoping and targeted reviews will identify potential items for inclusion in the extensions and participants to contribute to a Delphi consensus process. METHODS AND ANALYSIS The scoping review will search and include literature reporting on the current understanding, limitations and guidance on using surrogate endpoints in trials. Relevant literature will be identified through: (1) bibliographic databases; (2) grey literature; (3) handsearching of reference lists and (4) solicitation from experts. Data from eligible records will be thematically analysed into potential items for inclusion in extensions. The targeted review will search for RCT reports and protocols published from 2017 to 2021 in six high impact general medical journals. Trial corresponding author contacts will be listed as potential participants for the Delphi exercise. ETHICS AND DISSEMINATION Ethical approval is not required. The reviews will support the development of SPIRIT and CONSORT extensions for reporting surrogate primary endpoints (surrogate endpoint as the primary outcome). The findings will be published in open-access publications.This review has been prospectively registered in the OSF Registration DOI: 10.17605/OSF.IO/WP3QH.
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Affiliation(s)
- Anthony Muchai Manyara
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Philippa Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Valerie Wells
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Amber Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rod Taylor
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Poon MTC, Keni S, Vimalan V, Ip C, Smith C, Erridge S, Weir C, Brennan P. Extent of MGMT Promoter Methylation Modifies the Effect of Temozolomide on Overall Survival in Patients with Glioblastoma: A Regional Cohort Study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
AIMS
MGMT methylation in glioblastoma predicts response to temozolomide but dichotomizing methylation status may mask the true prognostic value of quantitative MGMT methylation. This study evaluated whether extent of MGMT methylation interacts with the effect of temozolomide on overall survival.
METHOD
We included consecutive glioblastoma patients aged ≥16 years diagnosed (April 2012–May 2020) at a neuro-oncology center. All patients had quantitative MGMT methylation measured using pyrosequencing. Those with MGMT methylated tumors were stratified into high and low methylation groups based on a cut-off using Youden index on 2-year survival. Our accelerated failure time survival models included extent of MGMT methylation, age, postoperative Karnofsky performance score, extent of resection, temozolomide regimen, and radiotherapy.
RESULTS
There were 414 patients. Optimal cut-off point using Youden index was 25.9% MGMT methylation. The number of patients in the unmethylated, low and high methylation groups was 223 (53.9%), 81 (19.6%), and 110 (26.6%), respectively. In the adjusted model, high (hazard ratio [HR] 0.60, 95% confidence intervals [CI] 0.46– 0.79, P=0.005) and low (HR 0.67, 95% CI 0.50–0.89, P<0.001) methylation groups had better survival compared to unmethylated group. There was no evidence for interaction between MGMT methylation and completed temozolomide regimen (interaction term for low methylation P=0.097; high methylation P=0.071). This suggests no strong effect of MGMT status on survival in patients completing temozolomide regimen. In patients not completing the temozolomide regimen, higher MGMT methylation predicted better survival (interaction terms P<0.001).
CONCLUSION
Quantitative MGMT methylation may provide additional prognostic value. This is important when assessing clinical and research therapies.
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Wong C, Dakin R, Chataway J, Swingler R, Weir C, Stallard N, Parmar M, Macleod M, Pal S, Chandran S. 090 Clinical trials in amyotrophic lateral sclerosis: a systematic review. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.127] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAmyotrophic lateral sclerosis (ALS) is a rapidly fatal neurodegenerative disease. Despite decades of clinical trials, there remains a pressing unmet need for effective treatments. We reviewed past and present ALS clinical trials to understand the methodological challenges in trial design and delivery.MethodsTrial registry databases including clinicaltrials. gov, International Clinical Trials Registry Platform, European Union Clinical Trials Register, and PubMed were systematically searched to identify Phase II, Phase II/III and Phase III Clinical Trials of Investigational Medicinal Products (CTIMPs) assessing potential disease modifying treatments in ALS. Trials registered, completed or published during 2008–2019 were included.Results125 CTIMPs, evaluating 76 drugs, involving 15647 people with ALS (pwALS) were reviewed. Ten drugs were tested in three or more trials. Trials employed predominantly traditional two-arm designs; only 12 used novel designs. Median number of participants was 86. 40% of trials had an attrition rate ≥ 20%. There was a wide variation of primary outcome measures and primary endpoints used.ConclusionHistorically, limited participation of pwALS in trials, resources and outcome measures hindered definitive and timely evaluation of drugs in two-arm trials. We propose that future trials will need to be more flexible, scalable and acceptable to all stakeholders.charis.wong@ed.ac.uk
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Ware J, Boughton CK, Allen JM, Wilinska ME, Tauschmann M, Denvir L, Thankamony A, Campbell FM, Wadwa RP, Buckingham BA, Davis N, DiMeglio LA, Mauras N, Besser REJ, Ghatak A, Weinzimer SA, Hood KK, Fox DS, Kanapka L, Kollman C, Sibayan J, Beck RW, Hovorka R, Hovorka R, Acerini CL, Thankamony A, Allen JM, Boughton CK, Dovc K, Dunger DB, Ware J, Musolino G, Tauschmann M, Wilinska ME, Hayes JF, Hartnell S, Slegtenhorst S, Ruan Y, Haydock M, Mangat J, Denvir L, Kanthagnany SK, Law J, Randell T, Sachdev P, Saxton M, Coupe A, Stafford S, Ball A, Keeton R, Cresswell R, Crate L, Cripps H, Fazackerley H, Looby L, Navarra H, Saddington C, Smith V, Verhoeven V, Bratt S, Khan N, Moyes L, Sandhu K, West C, Wadwa RP, Alonso G, Forlenza G, Slover R, Towers L, Berget C, Coakley A, Escobar E, Jost E, Lange S, Messer L, Thivener K, Campbell FM, Yong J, Metcalfe E, Allen M, Ambler S, Waheed S, Exall J, Tulip J, Buckingham BA, Ekhlaspour L, Maahs D, Norlander L, Jacobson T, Twon M, Weir C, Leverenz B, Keller J, Davis N, Kumaran A, Trevelyan N, Dewar H, Price G, Crouch G, Ensom R, Haskell L, Lueddeke LM, Mauras N, Benson M, Bird K, Englert K, Permuy J, Ponthieux K, Marrero-Hernandez J, DiMeglio LA, Ismail H, Jolivette H, Sanchez J, Woerner S, Kirchner M, Mullen M, Tebbe M, Besser REJ, Basu S, London R, Makaya T, Ryan F, Megson C, Bowen-Morris J, Haest J, Law R, Stamford I, Ghatak A, Deakin M, Phelan K, Thornborough K, Shakeshaft J, Weinzimer SA, Cengiz E, Sherr JL, Van Name M, Weyman K, Carria L, Steffen A, Zgorski M, Sibayan J, Beck RW, Borgman S, Davis J, Rusnak J, Hellman A, Cheng P, Kanapka L, Kollman C, McCarthy C, Chalasani S, Hood KK, Hanes S, Viana J, Lanning M, Fox DS, Arreaza-Rubin G, Eggerman T, Green N, Janicek R, Gabrielson D, Belle SH, Castle J, Green J, Legault L, Willi SM, Wysham C. Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial. Lancet Digit Health 2022; 4:e245-e255. [PMID: 35272971 DOI: 10.1016/s2589-7500(22)00020-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/10/2021] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population. METHODS In a multicentre, multinational, parallel randomised controlled trial, participants aged 6-18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbA1c levels between 53 and 86 mmol/mol (7·0-10·0%). Using block randomisation and central randomisation software, we randomly assigned participants to either closed-loop insulin delivery (closed-loop group) or to usual care with insulin pump therapy (control group) for 6 months. Randomisation was stratified at each centre by local baseline HbA1c. The Cambridge closed-loop algorithm running on a smartphone was used with either (1) a modified Medtronic 640G pump, Medtronic Guardian 3 sensor, and Medtronic prototype phone enclosure (FlorenceM configuration), or (2) a Sooil Dana RS pump and Dexcom G6 sensor (CamAPS FX configuration). The primary endpoint was change in HbA1c at 6 months combining data from both configurations. The primary analysis was done in all randomised patients (intention to treat). Trial registration ClinicalTrials.gov, NCT02925299. FINDINGS Of 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbA1c was 8·2% (SD 0·7) in the closed-loop group and 8·3% (0·7) in the control group. At 6 months, HbA1c was lower in the closed-loop group than in the control group (between-group difference -3·5 mmol/mol (95% CI -6·5 to -0·5 [-0·32 percentage points, -0·59 to -0·04]; p=0·023). Closed-loop usage was low with FlorenceM due to failing phone enclosures (median 40% [IQR 26-53]), but consistently high with CamAPS FX (93% [88-96]), impacting efficacy. A total of 155 adverse events occurred after randomisation (67 in the closed-loop group, 88 in the control group), including seven severe hypoglycaemia events (four in the closed-loop group, three in the control group), two diabetic ketoacidosis events (both in the closed-loop group), and two non-treatment-related serious adverse events. There were 23 reportable hyperglycaemia events (11 in the closed-loop group, 12 in the control group), which did not meet criteria for diabetic ketoacidosis. INTERPRETATION The Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX. FUNDING National Institute of Diabetes and Digestive and Kidney Diseases.
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Walsh TS, Pauley E, Donaghy E, Thompson J, Barclay L, Parker RA, Weir C, Marple J. Does a screening checklist for complex health and social care needs have potential clinical usefulness for predicting unplanned hospital readmissions in intensive care survivors: development and prospective cohort study. BMJ Open 2022; 12:e056524. [PMID: 35321894 PMCID: PMC8943772 DOI: 10.1136/bmjopen-2021-056524] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Intensive care (ICU) survivors are at high risk of long-term physical and psychosocial problems. Unplanned hospital readmission rates are high, but the best way to triage patients for interventions is uncertain. We aimed to develop and evaluate a screening checklist to help predict subsequent readmissions or deaths. DESIGN A checklist for complex health and social care needs (CHSCNs) was developed based on previous research, comprising six items: multimorbidity; polypharmacy; frequent previous hospitalisations; mental health issues; fragile social circumstances and impaired activities of daily living. Patients were considered to have CHSCNs if two or more were present. We prospectively screened all ICU discharges for CHSCNs for 12 months. SETTING ICU, Royal Infirmary, Edinburgh, UK. PARTICIPANTS ICU survivors over a 12-month period (1 June 2018 and 31 May 2019). INTERVENTIONS None. OUTCOME MEASURE Readmission or death in the community within 3 months postindex hospital discharge. RESULTS Of 1174 ICU survivors, 937 were discharged alive from the hospital. Of these 253 (27%) were classified as having CHSCNs. In total 28% (266/937) patients were readmitted (N=238) or died (N=28) within 3 months. Among CHSCNs patients 45% (n=115) patients were readmitted (N=105) or died (N=10). Patients without CHSCNs had a 22% readmission (N=133) or death (N=18) rate. The checklist had: sensitivity 43% (95% CI 37% to 49%), specificity 79% (95% CI 76% to 82%), positive predictive value 45% (95% CI 41% to 51%), and negative predictive value 78% (95% CI 76% to 80%). Relative risk of readmission/death for patients with CHSCNs was 2.06 (95% CI 1.69 to 2.50), indicating a pretest to post-test probability change of 28%-45%. The checklist demonstrated high inter-rater reliability (percentage agreement ≥87% for all domains; overall kappa, 0.84). CONCLUSIONS Early evaluation of a screening checklist for CHSCNs at ICU discharge suggests potential clinical usefulness, but this requires further evaluation as part of a care pathway.
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Affiliation(s)
- Timothy Simon Walsh
- Critical Care Medicine; Usher Institute of Population Health Sciences, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Ellen Pauley
- Department of Anaesthesia, Critical Care & Pain Medicine, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Eddie Donaghy
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| | - Joanne Thompson
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| | - Lucy Barclay
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| | | | - Christopher Weir
- Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - James Marple
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
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Yap C, Solovyeva O, Yin Z, Martin J, Manickavasagar T, Weir C, Lee S, Dimairo M, Liu R, Kightley A, de Bono J. 53P Assessing the reporting quality of early phase dose-finding trials. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.01.018] [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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12
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Sutton K, Weir C, Lewis N, Meulman A, Toon C, Boyle T, Fernando SL. Linear immunoglobulin A bullous dermatosis with severe ocular and oropharyngeal involvement. Pathology 2022. [DOI: 10.1016/j.pathol.2021.12.268] [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: 11/16/2022]
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13
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Foley P, Kong Y, Dirvanskiene R, Valdes-Hernandez M, Bastiani M, Murnane J, Sellar R, Roberts N, Pernet C, Weir C, Bak T, Colvin L, Chandran S, Fallon M, Tracey I. Coupling cognitive and brainstem dysfunction in multiple sclerosis-related chronic neuropathic limb pain. Brain Commun 2022; 4:fcac124. [PMID: 35663383 PMCID: PMC9155950 DOI: 10.1093/braincomms/fcac124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/01/2022] [Accepted: 05/13/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic pain in multiple sclerosis is common and difficult to treat. Its mechanisms remain incompletely understood. Dysfunction of the descending pain modulatory system is known to contribute to human chronic pain conditions. However, it is not clear how alterations in executive function influence this network, despite healthy volunteer studies linking function of the descending pain modulatory system, to cognition. In adults with multiple sclerosis-associated chronic neuropathic limb pain, compared to those without pain, we hypothesized altered functional connectivity of the descending pain modulatory system, coupled to executive dysfunction. Specifically we hypothesized reduced mental flexibility, because of potential importance in stimulus reappraisal. To investigate these hypotheses, we conducted a case-control cross-sectional study of 47 adults with relapsing remitting multiple sclerosis (31 with chronic neuropathic limb pain, 16 without pain), employing clinical, neuropsychological, structural, and functional MRI measures. We measured brain lesions and atrophy affecting descending pain modulatory system structures. Both cognitive and affective dysfunctions were confirmed in the chronic neuropathic limb pain group, including reduced mental flexibility (Delis Kaplan Executive Function System card sorting tests P < 0.001). Functional connectivity of rostral anterior cingulate and ventrolateral periaqueductal gray, key structures of the descending pain modulatory system, was significantly lower in the group experiencing chronic neuropathic pain. There was no significant between-group difference in whole-brain grey matter or lesion volumes, nor lesion volume affecting white matter tracts between rostral anterior cingulate and periaqueductal gray. Brainstem-specific lesion volume was higher in the chronic neuropathic limb pain group (P = 0.0017). Differential functional connectivity remained after correction for brainstem-specific lesion volume. Gabapentinoid medications were more frequently used in the chronic pain group. We describe executive dysfunction in people with multiple sclerosis affected by chronic neuropathic pain, along with functional and structural MRI evidence compatible with dysfunction of the descending pain modulatory system. These findings extend understanding of close inter-relationships between cognition, function of the descending pain modulatory system, and chronic pain, both in multiple sclerosis and more generally in human chronic pain conditions. These findings could support application of pharmacological and cognitive interventions in chronic neuropathic pain associated with multiple sclerosis.
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Affiliation(s)
- Peter Foley
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Yazhuo Kong
- CAS Key Laboratory of Behavioural Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ramune Dirvanskiene
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Maria Valdes-Hernandez
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Matteo Bastiani
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK.,Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Jonathan Murnane
- Clinical Research Imaging Centre, Edinburgh University, Edinburgh, UK
| | - Robin Sellar
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Neil Roberts
- Clinical Research Imaging Centre, Edinburgh University, Edinburgh, UK
| | - Cyril Pernet
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas Bak
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Lesley Colvin
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.,Dementia Research Institute, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Marie Fallon
- Department of Palliative Medicine, University of Edinburgh, Edinburgh, UK
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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14
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Li J, Weir C, Fernando S. Combining skin testing and basophil activation testing is useful for evaluation of life-threatening radiocontrast media anaphylaxis. Br J Anaesth 2021; 128:e16-e18. [PMID: 34772498 DOI: 10.1016/j.bja.2021.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/01/2021] [Accepted: 09/20/2021] [Indexed: 01/14/2023] Open
Affiliation(s)
- Jamma Li
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Medicine (Immunology & Infectious Diseases), University of Sydney, Sydney, Australia.
| | - Christopher Weir
- Medicine (Immunology & Infectious Diseases), University of Sydney, Sydney, Australia
| | - Suran Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Medicine (Immunology & Infectious Diseases), University of Sydney, Sydney, Australia
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15
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Armstrong L, O'Brien S, Weir C. 756 Adapting Undergraduate Teaching in the COVID 19 Era. Br J Surg 2021. [PMCID: PMC8524509 DOI: 10.1093/bjs/znab259.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
The COVID-19 pandemic has drastically impacted medical education, particularly in terms of content delivery and clinical placement efficacy. The initial suspension of placements was devised to limit exposure and redirect medical staff to critical areas. Nevertheless, clinical placements are an important pillar of the undergraduate curriculum and new techniques must be developed to better facilitate its delivery. Our aim was to create a programme that effectively met the required curriculum learning outcomes for medical students.
Method
In September 2020, students from Queen’s University, Belfast, returned to placement following months of online and distance learning. Having previously focused on bedside and case-based teaching, our priority remained with patient and student safety. Complimentary non-clinical and simulation methods were introduced including laparoscopic skills, suture and knot tying sessions and foundation competencies. Rating scale questionnaires were distributed over a four-week period following each session.
Results
32 sessions were carried out and 53 questionnaires returned. Three key areas were reviewed; teaching delivery, usefulness of session and content/relevance, with each area scored out of 10. Collectively across all sessions, 94.3%, 92.4% and 88.7% respectively were scored 9 or greater for each key area.
Conclusions
The COVID-19 crisis has led to the development of alternative methods of undergraduate teaching. The insurance of patient safety whilst preparing students for their future career is a priority. We have successfully developed an effective and useful placement that blends clinical knowledge and skill-based learning. Given the ongoing pandemic and redirection of resources, further novel ways of teaching should be considered.
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Affiliation(s)
- L Armstrong
- Craigavon Area Hospital, Portadown, United Kingdom
| | - S O'Brien
- Craigavon Area Hospital, Portadown, United Kingdom
| | - C Weir
- Craigavon Area Hospital, Portadown, United Kingdom
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16
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MacLullich AM, Shenkin SD, Goodacre S, Godfrey M, Hanley J, Stíobhairt A, Lavender E, Boyd J, Stephen J, Weir C, MacRaild A, Steven J, Black P, Diernberger K, Hall P, Tieges Z, Fox C, Anand A, Young J, Siddiqi N, Gray A. The 4 'A's test for detecting delirium in acute medical patients: a diagnostic accuracy study. Health Technol Assess 2020; 23:1-194. [PMID: 31397263 DOI: 10.3310/hta23400] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Delirium is a common and serious neuropsychiatric syndrome, usually triggered by illness or drugs. It remains underdetected. One reason for this is a lack of brief, pragmatic assessment tools. The 4 'A's test (Arousal, Attention, Abbreviated Mental Test - 4, Acute change) (4AT) is a screening tool designed for routine use. This project evaluated its usability, diagnostic accuracy and cost. METHODS Phase 1 - the usability of the 4AT in routine practice was measured with two surveys and two qualitative studies of health-care professionals, and a review of current clinical use of the 4AT as well as its presence in guidelines and reports. Phase 2 - the 4AT's diagnostic accuracy was assessed in newly admitted acute medical patients aged ≥ 70 years. Its performance was compared with that of the Confusion Assessment Method (CAM; a longer screening tool). The performance of individual 4AT test items was related to cognitive status, length of stay, new institutionalisation, mortality at 12 weeks and outcomes. The method used was a prospective, double-blind diagnostic test accuracy study in emergency departments or in acute general medical wards in three UK sites. Each patient underwent a reference standard delirium assessment and was also randomised to receive an assessment with either the 4AT (n = 421) or the CAM (n = 420). A health economics analysis was also conducted. RESULTS Phase 1 found evidence that delirium awareness is increasing, but also that there is a need for education on delirium in general and on the 4AT in particular. Most users reported that the 4AT was useful, and it was in widespread use both in the UK and beyond. No changes to the 4AT were considered necessary. Phase 2 involved 785 individuals who had data for analysis; their mean age was 81.4 (standard deviation 6.4) years, 45% were male, 99% were white and 9% had a known dementia diagnosis. The 4AT (n = 392) had an area under the receiver operating characteristic curve of 0.90. A positive 4AT score (> 3) had a specificity of 95% [95% confidence interval (CI) 92% to 97%] and a sensitivity of 76% (95% CI 61% to 87%) for reference standard delirium. The CAM (n = 382) had a specificity of 100% (95% CI 98% to 100%) and a sensitivity of 40% (95% CI 26% to 57%) in the subset of participants whom it was possible to assess using this. Patients with positive 4AT scores had longer lengths of stay (median 5 days, interquartile range 2.0-14.0 days) than did those with negative 4AT scores (median 2 days, interquartile range 1.0-6.0 days), and they had a higher 12-week mortality rate (16.1% and 9.2%, respectively). The estimated 12-week costs of an initial inpatient stay for patients with delirium were more than double the costs of an inpatient stay for patients without delirium (e.g. in Scotland, £7559, 95% CI £7362 to £7755, vs. £4215, 95% CI £4175 to £4254). The estimated cost of false-positive cases was £4653, of false-negative cases was £8956, and of a missed diagnosis was £2067. LIMITATIONS Patients were aged ≥ 70 years and were assessed soon after they were admitted, limiting generalisability. The treatment of patients in accordance with reference standard diagnosis limited the ability to assess comparative cost-effectiveness. CONCLUSIONS These findings support the use of the 4AT as a rapid delirium assessment instrument. The 4AT has acceptable diagnostic accuracy for acute older patients aged > 70 years. FUTURE WORK Further research should address the real-world implementation of delirium assessment. The 4AT should be tested in other populations. TRIAL REGISTRATION Current Controlled Trials ISRCTN53388093. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 40. See the NIHR Journals Library website for further project information. The funder specified that any new delirium assessment tool should be compared against the CAM, but had no other role in the study design or conduct of the study.
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Affiliation(s)
| | - Susan D Shenkin
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Steve Goodacre
- Emergency Medicine, University of Sheffield, Sheffield, UK
| | - Mary Godfrey
- Health and Social Care, Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Janet Hanley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Antaine Stíobhairt
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Elizabeth Lavender
- Health and Social Care, Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Julia Boyd
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Jacqueline Stephen
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Allan MacRaild
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Jill Steven
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Polly Black
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Katharina Diernberger
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Peter Hall
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Zoë Tieges
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Christopher Fox
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Atul Anand
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - John Young
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Najma Siddiqi
- Psychiatry, University of York, York.,Hull York Medical School, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Alasdair Gray
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
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17
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Fernando SL, Li J, Jain A, Weir C, Boyle T. Mixed drug reaction to amiodarone characterized by sequential immediate, immune complex, and delayed hypersensitivity. Ann Allergy Asthma Immunol 2020; 125:102-103. [PMID: 32283252 DOI: 10.1016/j.anai.2020.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Suran L Fernando
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - Jamma Li
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Arunima Jain
- Department of Cardiology, Gosford Hospital, Gosford, Australia
| | - Christopher Weir
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
| | - Therese Boyle
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
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18
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McGarry K, Mark D, McGarry C, Mackle E, Lewis A, Weir C. Porcine RESusitation and its Effect on the Nature of Taste (PResENT) Trial. Ir Med J 2019; 112:1024. [PMID: 32311249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- K McGarry
- Craigavon Area Hospital, 68 Lurgan Road, Portadown, Craigavon, BT63 5QQ
| | - D Mark
- Craigavon Area Hospital, 68 Lurgan Road, Portadown, Craigavon, BT63 5QQ
| | - C McGarry
- Craigavon Area Hospital, 68 Lurgan Road, Portadown, Craigavon, BT63 5QQ
| | - E Mackle
- Craigavon Area Hospital, 68 Lurgan Road, Portadown, Craigavon, BT63 5QQ
| | - A Lewis
- Craigavon Area Hospital, 68 Lurgan Road, Portadown, Craigavon, BT63 5QQ
| | - C Weir
- Craigavon Area Hospital, 68 Lurgan Road, Portadown, Craigavon, BT63 5QQ
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19
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Chapman AR, Adamson PD, Anand A, Shah ASV, Lee KK, Strachan FE, Ferry ASV, Sandeman DE, Berry C, Gray AJ, Tuck C, Fox KAA, Newby DE, Weir C, Mills NL. 249High-sensitivity cardiac troponin and the universal definition of myocardial infarction: a randomised controlled trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Universal Definition of Myocardial Infarction recommends the 99th centile diagnostic threshold using a high-sensitivity cardiac troponin (hs-cTn) assay and the classification of patients by the etiology of myocardial injury. Whether implementation of this definition improves risk stratification, treatment or outcomes is unknown.
Methods
In a stepped-wedge cluster randomized controlled trial, we implemented a high-sensitivity troponin assay and the recommendations of the Universal Definition in 48,282 consecutive patients with suspected acute coronary syndrome across ten hospitals. In a pre-specified secondary analysis, we compared the primary outcome of myocardial infarction or cardiovascular death, and secondary outcome of non-cardiovascular death at one year across diagnostic categories as per the Fourth Universal Definition. We applied competing risks methodology in all analyses, using a cumulative incidence function and determining the cause-specific hazard ratio (csHR) for competing outcomes.
Results
Cardiac troponin concentrations were elevated in 21.5% (10,360/48,282) of all trial participants. Implementation increased the diagnosis of type 1 myocardial infarction by 11% (510/4,471), type 2 myocardial infarction by 22% (205/916), acute myocardial injury by 36% (443/1,233) and chronic myocardial injury by 43% (389/898). The risk and rate of the primary outcome was highest in those with type 1 myocardial infarction, whereas the risk and rate of non-cardiovascular death was highest in those with acute myocardial injury (Table, Figure). Despite increases in anti-platelet therapy and coronary revascularization after implementation, the primary outcome was unchanged in patients with type 1 myocardial infarction (csHR 1.00, 95% CI 0.82 to 1.21), or in any other category.
Adjusted csHR for competing outcomes Myocardial infarction or cardiovascular death Non-cardiovascular death Adjusted csHR (95% CI) Adjusted csHR (95% CI) Type 1 myocardial infarction 5.64 (5.12 to 6.22) 0.83 (0.72 to 0.96) Type 2 myocardial infarction 3.50 (2.94 to 4.15) 1.72 (1.44 to 2.06) Acute myocardial injury 4.38 (3.80 to 5.05) 2.65 (2.33 to 3.00) Chronic myocardial injury 3.88 (3.31 to 4.55) 2.06 (1.77 to 2.40) Cox regression models adjusted for age, sex, diabetes, ischaemic heart disease, season, days since trial onset and site of recruitment (as a random effect).
Cumulative incidence and number at risk
Conclusions
Implementation of the recommendations of the Universal Definition identified patients with different risks of future cardiovascular and non-cardiovascular events, but did not improve outcomes. Greater understanding of the underlying mechanisms and effective strategies for the investigation and treatment of patients with myocardial injury and infarction are required if we are to improve outcomes.
Acknowledgement/Funding
British Heart Foundation
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Affiliation(s)
- A R Chapman
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - P D Adamson
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A Anand
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A S V Shah
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - K K Lee
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - F E Strachan
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A S V Ferry
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D E Sandeman
- Victoria Hospital, Cardiology, Kirkcaldy, United Kingdom
| | - C Berry
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | - A J Gray
- Royal Infirmary of Edinburgh, Department of Emergency Medicine, Edinburgh, United Kingdom
| | - C Tuck
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - K A A Fox
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D E Newby
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - C Weir
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - N L Mills
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
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20
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Healer J, Wong W, Thompson JK, He W, Birkinshaw RW, Miura K, Long CA, Soroka V, Søgaard TMM, Jørgensen T, de Jongh WA, Weir C, Svahn E, Czabotar PE, Tham W, Mueller I, Barlow PN, Cowman AF. Neutralising antibodies block the function of Rh5/Ripr/CyRPA complex during invasion of Plasmodium falciparum into human erythrocytes. Cell Microbiol 2019; 21:e13030. [PMID: 30965383 PMCID: PMC6594224 DOI: 10.1111/cmi.13030] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 01/19/2023]
Abstract
An effective vaccine is a priority for malaria control and elimination. The leading candidate in the Plasmodium falciparum blood stage is PfRh5. PfRh5 assembles into trimeric complex with PfRipr and PfCyRPA in the parasite, and this complex is essential for erythrocyte invasion. In this study, we show that antibodies specific for PfRh5 and PfCyRPA prevent trimeric complex formation. We identify the EGF-7 domain on PfRipr as a neutralising epitope and demonstrate that antibodies against this region act downstream of complex formation to prevent merozoite invasion. Antibodies against the C-terminal region of PfRipr were more inhibitory than those against either PfRh5 or PfCyRPA alone, and a combination of antibodies against PfCyRPA and PfRipr acted synergistically to reduce invasion. This study supports prioritisation of PfRipr for development as part of a next-generation antimalarial vaccine.
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Affiliation(s)
- Julie Healer
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Wilson Wong
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Jennifer K. Thompson
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
| | - Wengqiang He
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Richard W. Birkinshaw
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Kazutoyo Miura
- Laboratory of Malaria and Vector ResearchNational Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaMarylandUSA
| | - Carol A. Long
- Laboratory of Malaria and Vector ResearchNational Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaMarylandUSA
| | | | | | | | | | - Christopher Weir
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneMelbourneVictoriaAustralia
- Schools of Chemistry and Biological SciencesUniversity of EdinburghEdinburghScotland, UK
| | - Ella Svahn
- Schools of Chemistry and Biological SciencesUniversity of EdinburghEdinburghScotland, UK
| | - Peter E. Czabotar
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Wai‐Hong Tham
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Ivo Mueller
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Paul N. Barlow
- Schools of Chemistry and Biological SciencesUniversity of EdinburghEdinburghScotland, UK
| | - Alan F. Cowman
- Infection and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneMelbourneVictoriaAustralia
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21
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Rath EM, Cheng YY, Pinese M, Sarun KH, Hudson AL, Weir C, Wang YD, Håkansson AP, Howell VM, Liu GJ, Reid G, Knott RB, Duff AP, Church WB. BAMLET kills chemotherapy-resistant mesothelioma cells, holding oleic acid in an activated cytotoxic state. PLoS One 2018; 13:e0203003. [PMID: 30157247 PMCID: PMC6114908 DOI: 10.1371/journal.pone.0203003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/13/2018] [Indexed: 12/29/2022] Open
Abstract
Malignant pleural mesothelioma is an aggressive cancer with poor prognosis. Here we have investigated in vitro efficacy of BAMLET and BLAGLET complexes (anti-cancer complexes consisting of oleic acid and bovine α-lactalbumin or β-lactoglobulin respectively) in killing mesothelioma cells, determined BAMLET and BLAGLET structures, and investigated possible biological mechanisms. We performed cell viability assays on 16 mesothelioma cell lines. BAMLET and BLAGLET having increasing oleic acid content inhibited human and rat mesothelioma cell line proliferation at decreasing doses. Most of the non-cancer primary human fibroblasts were more resistant to BAMLET than were human mesothelioma cells. BAMLET showed similar cytotoxicity to cisplatin-resistant, pemetrexed-resistant, vinorelbine-resistant, and parental rat mesothelioma cells, indicating the BAMLET anti-cancer mechanism may be different to drugs currently used to treat mesothelioma. Cisplatin, pemetrexed, gemcitabine, vinorelbine, and BAMLET, did not demonstrate a therapeutic window for mesothelioma compared with immortalised non-cancer mesothelial cells. We demonstrated by quantitative PCR that ATP synthase is downregulated in mesothelioma cells in response to regular dosing with BAMLET. We sought structural insight for BAMLET and BLAGLET activity by performing small angle X-ray scattering, circular dichroism, and scanning electron microscopy. Our results indicate the structural mechanism by which BAMLET and BLAGLET achieve increased cytotoxicity by holding increasing amounts of oleic acid in an active cytotoxic state encapsulated in increasingly unfolded protein. Our structural studies revealed similarity in the molecular structure of the protein components of these two complexes and in their encapsulation of the fatty acid, and differences in the microscopic structure and structural stability. BAMLET forms rounded aggregates and BLAGLET forms long fibre-like aggregates whose aggregation is more stable than that of BAMLET due to intermolecular disulphide bonds. The results reported here indicate that BAMLET and BLAGLET may be effective second-line treatment options for mesothelioma.
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Affiliation(s)
- Emma M. Rath
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Yuen Yee Cheng
- Asbestos Diseases Research Institute (ADRI), Concord, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Mark Pinese
- Kinghorn Cancer Centre and Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Kadir H. Sarun
- Asbestos Diseases Research Institute (ADRI), Concord, NSW, Australia
| | - Amanda L. Hudson
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Christopher Weir
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Yiwei D. Wang
- Burns Research, ANZAC Research Institute, Concord Hospital, University of Sydney, Concord, NSW, Australia
| | | | - Viive M. Howell
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Guo Jun Liu
- Australian Nuclear Science and Technology Organisation (ANSTO), New Illawarra Rd, Lucas Heights, NSW, Australia
- Brain and Mind Centre and Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Glen Reid
- Asbestos Diseases Research Institute (ADRI), Concord, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Robert B. Knott
- Australian Nuclear Science and Technology Organisation (ANSTO), New Illawarra Rd, Lucas Heights, NSW, Australia
| | - Anthony P. Duff
- Australian Nuclear Science and Technology Organisation (ANSTO), New Illawarra Rd, Lucas Heights, NSW, Australia
| | - W. Bret Church
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
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Dichgans M, Wardlaw J, Smith E, Zietemann V, Seshadri S, Sachdev P, Biessels GJ, Fazekas F, Benavente O, Pantoni L, De Leeuw F, Norrving B, Matthews P, Chen C, Mok V, Düring M, Whiteley W, Shuler K, Alonso A, Black SE, Brayne C, Chabriat H, Cordonnier C, Doubal F, Duzel E, Ewers M, Frayne R, Hachinski V, Ikram MA, Jessen F, Jouvent E, Linn J, O'Brien J, van Oostenbrugge R, Malik R, Mazoyer B, Schmidt R, Sposato LA, Stephan B, Swartz RH, Vernooij M, Viswanathan A, Werring D, Abe K, Allan L, Arba F, Diener H, Davis S, Hankey G, Lees K, Ovbiagele B, Weir C, Bae H, Bath PMW, Bordet R, Breteler M, Choi S, Deary I, DeCarli C, Ebmeier K, Feng L, Greenberg SM, Ihara M, Kalaria R, Kim S, Lim J, Lindley RI, Mead G, Murray A, Quinn T, Ritchie C, Sacco R, Al‐Shahi Salman R, Sprigg N, Sudlow C, Thomas A, van Boxtel M, van der Grond J, van der Lugt A, Yang Y. METACOHORTS for the study of vascular disease and its contribution to cognitive decline and neurodegeneration: An initiative of the Joint Programme for Neurodegenerative Disease Research. Alzheimers Dement 2016; 12:1235-1249. [PMID: 27490018 PMCID: PMC5399602 DOI: 10.1016/j.jalz.2016.06.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 06/09/2016] [Indexed: 12/18/2022]
Abstract
Dementia is a global problem and major target for health care providers. Although up to 45% of cases are primarily or partly due to cerebrovascular disease, little is known of these mechanisms or treatments because most dementia research still focuses on pure Alzheimer's disease. An improved understanding of the vascular contributions to neurodegeneration and dementia, particularly by small vessel disease, is hampered by imprecise data, including the incidence and prevalence of symptomatic and clinically "silent" cerebrovascular disease, long-term outcomes (cognitive, stroke, or functional), and risk factors. New large collaborative studies with long follow-up are expensive and time consuming, yet substantial data to advance the field are available. In an initiative funded by the Joint Programme for Neurodegenerative Disease Research, 55 international experts surveyed and assessed available data, starting with European cohorts, to promote data sharing to advance understanding of how vascular disease affects brain structure and function, optimize methods for cerebrovascular disease in neurodegeneration research, and focus future research on gaps in knowledge. Here, we summarize the results and recommendations from this initiative. We identified data from over 90 studies, including over 660,000 participants, many being additional to neurodegeneration data initiatives. The enthusiastic response means that cohorts from North America, Australasia, and the Asia Pacific Region are included, creating a truly global, collaborative, data sharing platform, linked to major national dementia initiatives. Furthermore, the revised World Health Organization International Classification of Diseases version 11 should facilitate recognition of vascular-related brain damage by creating one category for all cerebrovascular disease presentations and thus accelerate identification of targets for dementia prevention.
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Weir C. Book Review: Total Intravenous Anaesthesia. Scott Med J 2016. [DOI: 10.1177/003693309804300522] [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: 11/16/2022]
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Jones M, Butler J, Graber C, Glassman P, Samore MH, Weir C, Goetz MB. A cognitive perspective of an antibiotic timeout program. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475166 DOI: 10.1186/2047-2994-4-s1-p187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Islam R, Weir C, Del Fiol G. Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity. Methods Inf Med 2015; 55:14-22. [PMID: 26404626 DOI: 10.3414/me15-01-0031] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/25/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine. OBJECTIVE The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on the infectious disease domain. The measurement model was adapted and modified for the healthcare domain. METHODS Three clinical infectious disease teams were observed, audio-recorded and transcribed. Each team included an infectious diseases expert, one infectious diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding processes and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen's kappa. RESULTS The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions. CONCLUSION The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare.
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Affiliation(s)
- R Islam
- Roosan Islam, PharmD, University of Utah, Department of Biomedical Informatics, 421 Wakara Way, Ste 140, Salt Lake City, UT 84108-3514, USA, E-mail:
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Denvir MA, Highet G, Boyd K, Robertson S, Cudmore S, Donald L, Haga K, Weir C, Murray SA. O-96 Phase 2 randomised controlled trial of future care planning in patients with advanced heart disease. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lim NTY, Harder MJ, Kennedy AT, Lin CS, Weir C, Cowman AF, Call MJ, Schmidt CQ, Tham WH. Characterization of Inhibitors and Monoclonal Antibodies That Modulate the Interaction between Plasmodium falciparum Adhesin PfRh4 with Its Erythrocyte Receptor Complement Receptor 1. J Biol Chem 2015; 290:25307-21. [PMID: 26324715 DOI: 10.1074/jbc.m115.657171] [Citation(s) in RCA: 9] [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] [Received: 04/08/2015] [Indexed: 11/06/2022] Open
Abstract
Plasmodium falciparum parasites must invade red blood cells to survive within humans. Entry into red blood cells is governed by interactions between parasite adhesins and red blood cell receptors. Previously we identified that P. falciparum reticulocyte binding protein-like homologue 4 (PfRh4) binds to complement receptor 1 (CR1) to mediate entry of malaria parasites into human red blood cells. In this report we characterize a collection of anti-PfRh4 monoclonal antibodies and CR1 protein fragments that modulate the interaction between PfRh4 and CR1. We identify an anti-PfRh4 monoclonal that blocks PfRh4-CR1 interaction in vitro, inhibits PfRh4 binding to red blood cells, and as a result abolishes the PfRh4-CR1 invasion pathway in P. falciparum. Epitope mapping of anti-PfRh4 monoclonal antibodies identified distinct functional regions within PfRh4 involved in modulating its interaction with CR1. Furthermore, we designed a set of protein fragments based on extensive mutagenesis analyses of the PfRh4 binding site on CR1 and determined their interaction affinities using surface plasmon resonance. These CR1 protein fragments bind tightly to PfRh4 and also function as soluble inhibitors to block PfRh4 binding to red blood cells and to inhibit the PfRh4-CR1 invasion pathway. Our findings can aid future efforts in designing specific single epitope antibodies to block P. falciparum invasion via complement receptor 1.
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Affiliation(s)
- Nicholas T Y Lim
- From the Walter and Eliza Hall Institute, Parkville, Victoria 3052, Australia
| | - Markus J Harder
- the Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University, Helmholtzstrasse 20, D-89081 Ulm, Germany
| | - Alexander T Kennedy
- From the Walter and Eliza Hall Institute, Parkville, Victoria 3052, Australia, the Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia, and
| | - Clara S Lin
- From the Walter and Eliza Hall Institute, Parkville, Victoria 3052, Australia, the Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia, and
| | - Christopher Weir
- From the Walter and Eliza Hall Institute, Parkville, Victoria 3052, Australia, the Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia, and the School of Chemistry, University of Edinburgh, Edinburgh EH93JJ, Scotland, United Kingdom
| | - Alan F Cowman
- From the Walter and Eliza Hall Institute, Parkville, Victoria 3052, Australia, the Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia, and
| | - Melissa J Call
- From the Walter and Eliza Hall Institute, Parkville, Victoria 3052, Australia, the Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia, and
| | - Christoph Q Schmidt
- the Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University, Helmholtzstrasse 20, D-89081 Ulm, Germany
| | - Wai-Hong Tham
- From the Walter and Eliza Hall Institute, Parkville, Victoria 3052, Australia, the Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia, and
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Denvir MA, Highet G, Boyd K, Robertson S, Cudmore S, Donald L, Haga K, Weir C, Murray S. PHASE 2 RANDOMISED CONTROLLED TRIAL OF FUTURE CARE PLANNING IN PATIENTS WITH ADVANCED HEART DISEASE. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jacobs J, Weir C, Evans RS, Staes C. Assessment of readiness for clinical decision support to aid laboratory monitoring of immunosuppressive care at U.S. liver transplant centers. Appl Clin Inform 2014; 5:988-1004. [PMID: 25589912 DOI: 10.4338/aci-2014-08-ra-0060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 11/16/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Following liver transplantation, patients require lifelong immunosuppressive care and monitoring. Computerized clinical decision support (CDS) has been shown to improve post-transplant immunosuppressive care processes and outcomes. The readiness of transplant information systems to implement computerized CDS to support post-transplant care is unknown. OBJECTIVES a) Describe the current clinical information system functionality and manual and automated processes for laboratory monitoring of immunosuppressive care, b) describe the use of guidelines that may be used to produce computable logic and the use of computerized alerts to support guideline adherence, and c) explore barriers to implementation of CDS in U.S. liver transplant centers. METHODS We developed a web-based survey using cognitive interviewing techniques. We surveyed 119 U.S. transplant programs that performed at least five liver transplantations per year during 2010-2012. Responses were summarized using descriptive analyses; barriers were identified using qualitative methods. RESULTS Respondents from 80 programs (67% response rate) completed the survey. While 98% of programs reported having an electronic health record (EHR), all programs used paper-based manual processes to receive or track immunosuppressive laboratory results. Most programs (85%) reported that 30% or more of their patients used external laboratories for routine testing. Few programs (19%) received most external laboratory results as discrete data via electronic interfaces while most (80%) manually entered laboratory results into the EHR; less than half (42%) could integrate internal and external laboratory results. Nearly all programs had guidelines regarding pre-specified target ranges (92%) or testing schedules (97%) for managing immunosuppressive care. Few programs used computerized alerting to notify transplant coordinators of out-of-range (27%) or overdue laboratory results (20%). CONCLUSIONS Use of EHRs is common, yet all liver transplant programs were largely dependent on manual paper-based processes to monitor immunosuppression for post-liver transplant patients. Similar immunosuppression guidelines provide opportunities for sharing CDS once integrated laboratory data are available.
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Affiliation(s)
- J Jacobs
- Department of Biomedical Informatics, University of Utah , Salt Lake City, Utah, USA
| | - C Weir
- Department of Biomedical Informatics, University of Utah , Salt Lake City, Utah, USA
| | - R S Evans
- Department of Biomedical Informatics, University of Utah , Salt Lake City, Utah, USA ; Medical Informatics, Intermountain Healthcare , Salt Lake City, Utah, USA
| | - C Staes
- Department of Biomedical Informatics, University of Utah , Salt Lake City, Utah, USA
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Rubio N, McKinstry B, Parker R, Pinnock H, Weir C, Hanley J, Yerramasu C, Cruz-Mantoani L, MacNee W, Rabinovich RA. M146 Validation Of Five Non-invasive Respiratory Rate Monitors In Patients With Copd In A Laboratory Setting. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Denvir MA, Highet G, Robertson S, Cudmore S, Reid J, Ness A, Hogg K, Weir C, Murray S, Boyd K. Future Care Planning for patients approaching end-of-life with advanced heart disease: an interview study with patients, carers and healthcare professionals exploring the content, rationale and design of a randomised clinical trial. BMJ Open 2014; 4:e005021. [PMID: 25023130 PMCID: PMC4120336 DOI: 10.1136/bmjopen-2014-005021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the optimal content and design of a clinical trial of an end-of-life intervention for advanced heart disease with patients, carers and healthcare professionals. DESIGN Qualitative interview and focus group study. SETTING Community and hospital-based focus groups and interviews. PARTICIPANTS Stable community-dwelling patients, informal carers (PC, n=15) and primary and secondary care based healthcare professionals (HCP, n=11). RESULTS PC highlighted fragmentation of services and difficulty in accessing specialist care as key barriers to good care. They felt that time for discussion with HCP was inadequate within current National Health Service (NHS) healthcare systems. HCP highlighted uncertainty of prognosis, explaining mortality risk to patients and switching from curative to palliative approaches as key challenges. Patient selection, nature of the intervention and relevance of trial outcomes were identified by HCP as key challenges in the design of a clinical trial. CONCLUSIONS PC and HCP expressed a number of concerns relevant to the nature and content of an end-of-life intervention for patients with advanced heart disease. The findings of this study are being used to support a phase II randomised clinical trial of Future Care Planning in advanced heart disease.
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Affiliation(s)
- Martin A Denvir
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gill Highet
- Department of Palliative Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shirley Robertson
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sarah Cudmore
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Janet Reid
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrea Ness
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Karen Hogg
- Cardiology Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Christopher Weir
- Edinburgh Health Services Research Unit, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Scott Murray
- Primary Palliative Care Research Group, Community Health Sciences—General Practice, University of Edinburgh, Edinburgh, UK
| | - Kirsty Boyd
- Department of Palliative Care, Royal Infirmary of Edinburgh, Edinburgh, UK
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Chandrasekaran NC, Weir C, Alfraji S, Grice J, Roberts MS, Barnard RT. Effects of magnesium deficiency--more than skin deep. Exp Biol Med (Maywood) 2014; 239:1280-91. [PMID: 24928863 DOI: 10.1177/1535370214537745] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Dead Sea and magnesium salt therapy are two of the oldest forms of treatment for skin disease and several other disorders, supported by a body of largely anecdotal evidence. In this paper we review possible pathways for penetration of magnesium ions through the epidermis to reach the circulation, in turn replenishing cellular magnesium levels. We also discuss mechanisms for intercellular movement of magnesium ions and possible mechanisms for the interaction between magnesium ions and inflammatory mediators. Upon addition of magnesium ions in vitro, the expression of inflammatory mediators such as tumour necrosis factor α (TNFα) and nuclear factor κβ (NFκβ) is down regulated. Dysregulation of these and other inflammatory mediators has been linked to several inflammatory disorders, including asthma, arthritis, atherosclerosis and neuroinflammation.
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Affiliation(s)
- Navin Chandrakanth Chandrasekaran
- School of Chemistry and Molecular Biosciences, Australian Infectious Diseases Research Centre, The University of Queensland, Queensland 4072, Australia School of Medicine, Translational Research Institute, The University of Queensland, Wooloongabba, Queensland 4102, Australia
| | - Christopher Weir
- Walter and Eliza Hall Institute of Medical Research and Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Sumaya Alfraji
- School of Chemistry and Molecular Biosciences, Australian Infectious Diseases Research Centre, The University of Queensland, Queensland 4072, Australia
| | - Jeff Grice
- School of Medicine, Translational Research Institute, The University of Queensland, Wooloongabba, Queensland 4102, Australia
| | - Michael S Roberts
- School of Medicine, Translational Research Institute, The University of Queensland, Wooloongabba, Queensland 4102, Australia
| | - Ross T Barnard
- School of Chemistry and Molecular Biosciences, Australian Infectious Diseases Research Centre, The University of Queensland, Queensland 4072, Australia
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Hudson SF, Colclough R, Campbell F, Pereira B, Leek J, Sullivan A, Davies C, Weir C. M21 Space to breathe: A new hospice based palliative care, respiratory and psychology programme for patients with severe COPD and their carers. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rodriguez A, Lewis S, Murray G, Krishan A, Butcher I, Weir C. Statistical analysis plans (SAPS) for academic clinical trials at the edinburgh clinical trials unit: what should they contain? Trials 2013. [PMCID: PMC3981655 DOI: 10.1186/1745-6215-14-s1-o102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Hansen CH, Weir C, Warner P, Critchley H. An integrated approach to the development of a Bayesian response-adaptive dose-finding study using sas and winbugs. Trials 2013. [PMCID: PMC3981579 DOI: 10.1186/1745-6215-14-s1-o74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wardlaw JM, Muir KW, Macleod MJ, Weir C, McVerry F, Carpenter T, Shuler K, Thomas R, Acheampong P, Dani K, Murray A. Clinical relevance and practical implications of trials of perfusion and angiographic imaging in patients with acute ischaemic stroke: a multicentre cohort imaging study. J Neurol Neurosurg Psychiatry 2013; 84:1001-7. [PMID: 23644501 PMCID: PMC3756443 DOI: 10.1136/jnnp-2012-304807] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In randomised trials testing treatments for acute ischaemic stroke, imaging markers of tissue reperfusion and arterial recanalisation may provide early response indicators. OBJECTIVE To determine the predictive value of structural, perfusion and angiographic imaging for early and late clinical outcomes and assess practicalities in three comprehensive stroke centres. METHODS We recruited patients with potentially disabling stroke in three stroke centres, performed magnetic resonance (MR) or CT, including perfusion and angiography imaging, within 6 h, at 72 h and 1 month after stroke. We assessed the National Institutes of Health Stroke Scale (NIHSS) score serially and functional outcome at 3 months, tested associations between clinical variables and structural imaging, several perfusion parameters and angiography. RESULTS Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1-30), 38 (46%) received alteplase, 41 (49%) had died or were dependent at 3 months. Most baseline imaging was CT (76%); follow-up was MR (79%) despite both being available acutely. At presentation, perfusion lesion size varied considerably between parameters (p<0.0001); 40 (48%) had arterial occlusion. Arterial occlusion and baseline perfusion lesion extent were both associated with baseline NIHSS (p<0.0001). Recanalisation by 72 h was associated with 1 month NIHSS (p=0.0007) and 3 month functional outcome (p=0.048), whereas tissue reperfusion, using even the best perfusion parameter, was not (p=0.11, p=0.08, respectively). CONCLUSION Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion. Acute assessment with CT and follow-up with MR was practical and feasible, did not preclude image analysis, and would enhance trial recruitment and generalisability of results.
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Affiliation(s)
- Joanna M Wardlaw
- Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK.
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Edwards D, Fletcher K, Deller R, McManus R, Lasserson D, Giles M, Sims D, Norrie J, McGuire G, Cohn S, Whittle F, Hobbs V, Weir C, Mant J. RApid Primary care Initiation of Drug treatment for Transient Ischaemic Attack (RAPID-TIA): study protocol for a pilot randomised controlled trial. Trials 2013; 14:194. [PMID: 23819476 PMCID: PMC3716929 DOI: 10.1186/1745-6215-14-194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/28/2012] [Accepted: 06/14/2013] [Indexed: 11/23/2022] Open
Abstract
Background People who have a transient ischaemic attack (TIA) or minor stroke are at high risk of a recurrent stroke, particularly in the first week after the event. Early initiation of secondary prevention drugs is associated with an 80% reduction in risk of stroke recurrence. This raises the question as to whether these drugs should be given before being seen by a specialist – that is, in primary care or in the emergency department. The aims of the RAPID-TIA pilot trial are to determine the feasibility of a randomised controlled trial, to analyse cost effectiveness and to ask: Should general practitioners and emergency doctors (primary care physicians) initiate secondary preventative measures in addition to aspirin in people they see with suspected TIA or minor stroke at the time of referral to a specialist? Methods/Design This is a pilot randomised controlled trial with a sub-study of accuracy of primary care physician diagnosis of TIA. In the pilot trial, we aim to recruit 100 patients from 30 general practices (including out-of-hours general practice centres) and 1 emergency department whom the primary care physician diagnoses with TIA or minor stroke and randomly assign them to usual care (that is, initiation of aspirin and referral to a TIA clinic) or usual care plus additional early initiation of secondary prevention drugs (a blood-pressure lowering protocol, simvastatin 40 mg and dipyridamole 200 mg m/r bd). The primary outcome of the main study will be the number of strokes at 90 days. The diagnostic accuracy sub-study will include these 100 patients and an additional 70 patients in whom the primary care physician thinks the diagnosis of TIA is possible, rather than probable. For the pilot trial, we will report recruitment rate, follow-up rate, a preliminary estimate of the primary event rate and occurrence of any adverse events. For the diagnostic study, we will calculate sensitivity and specificity of primary care physician diagnosis using the final TIA clinic diagnosis as the reference standard. Discussion This pilot study will be used to estimate key parameters that are needed to design the main study and to estimate the accuracy of primary care diagnosis of TIA. The planned follow-on trial will have important implications for the initial management of people with suspected TIA. Trial registration ISRCTN62019087
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Affiliation(s)
- Duncan Edwards
- General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
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Lockington D, MacDonald R, King S, Weir C, Winter A, Aitken C. Multiplex PCR testing requires a robust multi-disciplinary strategy to effectively manage identified cases of chlamydial conjunctivitis. Scott Med J 2013; 58:77-82. [DOI: 10.1177/0036933013482635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction Implementation of an in-house polymerase chain reaction (PCR) multiplex assay by West of Scotland Specialist Virology Centre to improve sample processing means all viral eye swabs are now routinely tested for Adenovirus, Herpes simplex, Varicella and Chlamydia. Concern was raised regarding subsequent management and sexual health attendance for Chlamydia-positive patients identified in eye casualty. Methods A retrospective review of virology results identified 76 Chlamydia-positive patients from 1914 eye swabs (4%) from May 2007 to April 2008. Of these results, 12 originated from Glasgow eye casualty and available clinical notes were cross-referenced with the sexual health network (Sandyford). Results Identified issues included no documentation of implications of testing, poor communication of positive results and poor referral pathways to sexual health for assessment; all leading to inadequate management. A shared care network was created to address these issues. A designated sexual health advisor was identified to improve sexual health referral, specialist assessment, standardised management and contact tracing. Re-audit showed more consistent follow-up. Conclusion New PCR technology has resulted in a shared care approach to address corresponding implications of testing. Effective communication with a structured protocol and a central point of contact has improved follow-up and ensures appropriate best practice management of chlamydial conjunctivitis.
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Affiliation(s)
- D Lockington
- ST6 Ophthalmology, Tennent Institute of Ophthalmology, Gartnavel General Hospital, UK
| | - R MacDonald
- SpR Genito-Urinary Medicine, Sandyford Initiative, UK
| | - S King
- Sexual Health Advisor, Sandyford Initiative, UK
| | - C Weir
- Consultant Ophthalmologist, Tennent Institute of Ophthalmology, Gartnavel General Hospital, UK
| | - A Winter
- Consultant, Genito-Urinary Medicine, Sandyford Initiative, UK
| | - C Aitken
- Consultant Virologist, Regional Virology Department, Gartnavel General Hospital, UK
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Thompson R, Lewis A, Weir C. Patient-reported quality-of-life after radiofrequency ablation of varicose veins compared to conventional surgery. Ir J Med Sci 2013; 182:639-42. [PMID: 23543415 DOI: 10.1007/s11845-013-0944-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/18/2013] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to compare patient-reported quality-of-life scores after radiofrequency ablation (RFA) compared to conventional surgery using the Aberdeen Varicose Vein Questionnaire (AVVQ). METHODS A postal questionnaire based on the AVVQ was sent out to 105 patients who underwent RFA and 50 patients who underwent surgery for varicose veins in our unit over a 14-month period. Responses were analysed according to sex and compared between the two groups to determine if there is a difference in the patient-reported quality-of-life scores. The mean AVVQ was calculated for both groups. RESULTS Responses were received from 57 patients who underwent RFA and 27 patients who had surgery. In the domains of itch, discolouration, analgesia use, ankle swelling, cosmetic concern due to their varicose veins and reporting that their varicose veins affect their choice of clothing, there was a statistically significant difference favouring RFA in female patients. Conversely, in men, there was a statistically significant difference in favour of conventional surgery in the domains of pain, itch, analgesia use, cosmetic concern, affecting choice of clothing and affecting daily activities. There was no statistically significant difference in the mean AVVQ scores. CONCLUSIONS This study has shown that for the female patients in our patient population, RFA results in generally better quality-of-life scores than conventional surgery when assessed using the disease-specific AVVQ. In this cohort, there was a statistically significant difference favouring conventional surgery in men. A number of potentially confounding variables have been discussed.
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Affiliation(s)
- R Thompson
- Craigavon Area Hospital, 68 Lurgan Road, Portadown, BT63 5QQ, Craigavon, Northern Ireland,
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Abstract
The pathophysiology of atopic diseases, including asthma and allergy, is the result of complex gene-environment interactions. Since European colonization the Indigenous population of Australia has undergone significant changes with respect to their lifestyle as hunter-gatherers. These changes have had a detrimental effect on Aboriginal health, in part due to immunological modification. This review provides a comparative look at both the traditional Aboriginal/Indigenous diet and modern Western diets, examines some common allergies increasingly reported in contemporary Indigenous populations, and reviews concepts such the effect of vitamin deficiencies and changes in gut microbiota on immune function.
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Affiliation(s)
- Shelley F Walton
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.
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Weir C, Yeatts K, Vizuete W, London S, Salo P, Jaramillo R, Zeldin D. 1. Ambient Air Pollution and Allergic Sensitization: Results from the National Health and Examination Survey (NHANES) 2005-2006. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Christopher Weir
- Associate Director (Statistics) of the MRC Edinburgh HTMR and the Edinburgh Health Services Research Unit
| | - Gordon Murray
- Professor of Medical Statistics at the University of Edinburgh and Director of the MRC Edinburgh Hub for Trials Methodology Research (HTMR)
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Abstract
OBJECTIVE To systematically review and summarize the current available literature on prognostic variables relating to upper limb recovery following stroke. To identify which, if any variables predict upper limb recovery following stroke. DATA SOURCES We completed searches in MEDLINE, EMBASE, AMED, CINAHL and Cochrane CENTRAL databases. Searches were completed in November 2010. REVIEW METHODS Studies were included if predictor variables were measured at baseline and linked to an outcome of upper limb recovery at a future time point. Exclusion criteria included predictor variables relating to response to treatment and outcome measurements of very specific upper limb impairments such as spasticity or pain. Two independent reviewers completed data extraction and assessed study quality. RESULTS Fifty-eight studies met the inclusion criteria. Predictor variables which have been considered within these studies include; age, sex, lesion site, initial motor impairment, motor-evoked potentials and somatosensory-evoked potentials. Initial measures of upper limb impairment and function were found to be the most significant predictors of upper limb recovery; odds ratio 14.84 (95% confidence intervals (CI) 9.08-24.25) and 38.62 (95% CI 8.40-177.53), respectively. CONCLUSIONS Interpretation of these results is complicated by methodological factors including variations in study populations, upper limb motor outcome scales, timing of baseline and outcome assessments and predictors selected. The most important predictive factors for upper limb recovery following stroke appears to the initial severity of motor impairment or function.
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Affiliation(s)
- Fiona Coupar
- Glasgow University, Academic Section of Geriatric Medicine, Glasgow, UK.
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Stephens-Stidham S, Trudeau J, Istre G, Weir C, Johnson U, Anderson R. Using lay home educators to provide safety messages in Dallas, TX, USA. Inj Prev 2011. [DOI: 10.1136/ip.2010.029215.261] [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: 11/04/2022]
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Affiliation(s)
- Ebube E Obi
- Gartnavel General Hospital, Glasgow G12 0YN, UK.
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Legg LA, Langhorne P, Tierney J, Stott DJ, Weir C, Smith LN. Non-pharmacological interventions for caregivers of stroke survivors. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Weir C, Morel-Kopp MC, Gill A, Tinworth K, Ladd L, Hunyor SN, Ward C. Mesenchymal stem cells: isolation, characterisation and in vivo fluorescent dye tracking. Heart Lung Circ 2008; 17:395-403. [PMID: 18396458 DOI: 10.1016/j.hlc.2008.01.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 01/15/2008] [Accepted: 01/20/2008] [Indexed: 10/22/2022]
Abstract
Cell therapies have been used to regenerate the heart by direct myocardial delivery, by coronary infusion and by surface attached scaffolds. Multipotent mesenchymal stem cells (MSC) with capacity to differentiate into cardiomyocytes and other cell lines have been predominantly trialled in rodents. However, large animal models are increasingly needed to translate basic research into new, safe regenerative therapies. Understanding the mode of action of cell therapies in the mammalian heart has been limited by cell tracking capability. This study examined the ability to track the fate of allogeneic MSC in sheep using various fluorescent dyes. MSC isolated from sheep bone marrow were grown in culture following extraction and flow cytometric characterisation. After labelling with fluorescent tracking dyes (e.g. CFSE and DiI) cells were tested for in vitro and in vivo signal up to six weeks. Labelling effect on cell division and differentiation was studied. Several dyes lost fluorescence and slowed cell division. However, the thiol reactive dye CM-DiI showed detectable in vivo fluorescence in labelled MSC six weeks after injection into sheep skeletal muscle and two weeks after implantation of an MSC coated biomaterial scaffold. CM-DiI labelled MSC differentiated in vitro showed label retention over four weeks. The fluorescent membrane dye CM-DiI tracks implanted sheep MSC and provides an alternative to traditional cell markers such as gene modified GFP.
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Affiliation(s)
- Christopher Weir
- Cardiac Technology Centre & Kolling Institute, Sydney, Australia
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Bloor M, Neale J, Weir C, Robertson M, McKeganey N. Severity of drug dependence does not predict changes in drug users’ behaviour over time. Critical Public Health 2008. [DOI: 10.1080/09581590802070845] [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: 10/21/2022]
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Dawson J, Weir C, Wright F, Bryden C, Aslanyan S, Lees K, Bird W, Walters M. Associations between meteorological variables and acute stroke hospital admissions in the west of Scotland. Acta Neurol Scand 2008; 117:85-9. [PMID: 18184342 DOI: 10.1111/j.1600-0404.2007.00916.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We combined a large clinical stroke registry with the UK Met Office database to assess the association between meteorological variables and specific clinical subtypes of acute stroke. METHODS We used negative binomial regression and Poisson regression techniques to explore the effect of meteorological values to hospital with acute stroke. Differential effects of atmospheric conditions upon stroke subtypes were also investigated. RESULTS Data from 6389 patients with acute stroke were examined. The mean age (SD) was 71.2 (13.0) years. About 5723 (90%) patients suffered ischaemic stroke of which 1943 (34%) were lacunar. Six hundred and sixty-six patients (10%) had haemorrhagic stroke. Every 1 degrees C increase in mean temperature during the preceding 24 h was associated with a 2.1% increase in ischaemic stroke admissions (P = 0.004). A fall in atmospheric pressure over the preceding 48 h was associated with increased rate of haemorrhagic stroke admissions (P = 0.045). Higher maximum daily temperature gave a greater increase in lacunar stroke admissions than in other ischaemic strokes (P = 0.035). CONCLUSION We report a measurable effect of atmospheric conditions upon stroke incidence in a temperate climate.
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Affiliation(s)
- J Dawson
- Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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