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Pryjmachuk S, Kirk S, Fraser C, Evans N, Lane R, Crooks J, McGowan R, Naughton G, Neill L, Camacho E, Bower P, Bee P, McDougall T. A collaboratively produced model of service design for children and young people with common mental health problems. BMC Health Serv Res 2024; 24:133. [PMID: 38268003 PMCID: PMC10809440 DOI: 10.1186/s12913-024-10562-7] [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] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Little is known about the effectiveness of, and implementation complexities associated with, service delivery models for children and young people (CYP) experiencing 'common' mental health problems such as anxiety, depression, behavioural difficulties and self-harm. This paper outlines how a model for high-quality service design for this population group was developed by identifying available services, their effectiveness, cost-effectiveness and acceptability, and the barriers and enablers to access. METHODS Sequential, mixed-methods design, combining evidence syntheses (scoping and integrative reviews of the international literature) with primary research (a collective case study in England and Wales). Data from these two elements were collaboratively synthesised in a subsequent model-building phase. RESULTS The scoping review yielded a service model typology. The integrative review found effectiveness evidence only for four models: collaborative care (the only service model to also have cost-effectiveness evidence), outreach approaches, brief intervention services and an organisational framework called 'Availability, Responsiveness and Continuity'. No service model seemed more acceptable than others. Three case study themes were identified: pathways to support; service engagement; and learning and understanding. The model-building phase identified rapid access, learning self-care skills, individualised support, clear information, compassionate and competent staff and aftercare planning as core characteristics of high-quality services. These characteristics were underpinned by four organisational qualities: values that respect confidentiality; engagement and involvement; collaborative relationships; and a learning culture. CONCLUSIONS A consistent organisational evidence-base for service design and delivery in CYP's mental health spanning many years appears to have had little impact on service provision in England and Wales. Rather than impose - often inflexible and untested - specific local or national models or frameworks, those commissioning, designing and delivering mental health services for CYP should (re)focus on already known, fundamental components necessary for high-quality services. These fundamental components have been integrated into a collaboratively produced general model of service design for CYP with common mental health problems. While this general model is primarily focused on British service provision, it is broad enough to have utility for international audiences.
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Affiliation(s)
- Steven Pryjmachuk
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
- Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - Susan Kirk
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Claire Fraser
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Nicola Evans
- School of Healthcare Studies, Cardiff University, Cardiff, UK
| | - Rhiannon Lane
- School of Healthcare Studies, Cardiff University, Cardiff, UK
| | | | | | | | | | | | - Peter Bower
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Penny Bee
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
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Jokl E, Mullan AF, Simpson K, Birchall L, Pearmain L, Martin K, Pritchett J, Raza S, Shah R, Hodson NW, Williams CJ, Camacho E, Zeef L, Donaldson I, Athwal VS, Hanley NA, Piper Hanley K. PAK1-dependent mechanotransduction enables myofibroblast nuclear adaptation and chromatin organization during fibrosis. Cell Rep 2023; 42:113414. [PMID: 37967011 DOI: 10.1016/j.celrep.2023.113414] [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] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023] Open
Abstract
Myofibroblasts are responsible for scarring during fibrosis. The scar propagates mechanical signals inducing a radical transformation in myofibroblast cell state and increasing profibrotic phenotype. Here, we show mechanical stress from progressive scarring induces nuclear softening and de-repression of heterochromatin. The parallel loss of H3K9Me3 enables a permissive state for distinct chromatin accessibility and profibrotic gene regulation. Integrating chromatin accessibility profiles with RNA expression provides insight into the transcription network underlying the switch in profibrotic myofibroblast states, emphasizing mechanoadaptive regulation of PAK1 as key drivers. Through genetic manipulation in liver and lung fibrosis, loss of PAK1-dependent signaling impairs the mechanoadaptive response in vitro and dramatically improves fibrosis in vivo. Moreover, we provide human validation for mechanisms underpinning PAK1-mediated mechanotransduction in liver and lung fibrosis. Collectively, these observations provide insight into the nuclear mechanics driving the profibrotic chromatin landscape in fibrosis, highlighting actomyosin-dependent mechanisms as potential therapeutic targets in fibrosis.
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Affiliation(s)
- Elliot Jokl
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Aoibheann F Mullan
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Kara Simpson
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Lindsay Birchall
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Laurence Pearmain
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Katherine Martin
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - James Pritchett
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Sayyid Raza
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Rajesh Shah
- Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Nigel W Hodson
- Core Facilities, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Craig J Williams
- Department of Materials, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Leo Zeef
- Core Facilities, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ian Donaldson
- Core Facilities, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Varinder S Athwal
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK; Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Neil A Hanley
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK; Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK; College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karen Piper Hanley
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK.
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Hayes D, Hunter-Brown H, Camacho E, McPhilbin M, Elliott RA, Ronaldson A, Bakolis I, Repper J, Meddings S, Stergiopoulos V, Brophy L, Miyamoto Y, Castelein S, Klevan TG, Elton D, Grant-Rowles J, Kotera Y, Henderson C, Slade M. Organisational and student characteristics, fidelity, funding models, and unit costs of recovery colleges in 28 countries: a cross-sectional survey. Lancet Psychiatry 2023; 10:768-779. [PMID: 37739003 DOI: 10.1016/s2215-0366(23)00229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Recovery colleges were developed in England to support the recovery of individuals who have mental health symptoms or mental illness. They have been founded in many countries but there has been little international research on recovery colleges and no studies investigating their staffing, fidelity, or costs. We aimed to characterise recovery colleges internationally, to understand organisational and student characteristics, fidelity, and budget. METHODS In this cross-sectional study, we identified all countries in which recovery colleges exist. We repeated a cross-sectional survey done in England for recovery colleges in 28 countries. In both surveys, recovery colleges were defined as services that supported personal recovery, that were coproduced with students and staff, and where students learned collaboratively with trainers. Recovery college managers completed the survey. The survey included questions about organisational and student characteristics, fidelity to the RECOLLECT Fidelity Measure, funding models, and unit costs. Recovery colleges were grouped by country and continent and presented descriptively. We used regression models to explore continental differences in fidelity, using England as the reference group. FINDINGS We identified 221 recovery colleges operating across 28 countries, in five continents. Overall, 174 (79%) of 221 recovery colleges participated. Most recovery colleges scored highly on fidelity. Overall scores for fidelity (β=-2·88, 95% CI 4·44 to -1·32; p=0·0001), coproduction (odds ratio [OR] 0·10, 95% CI 0·03 to 0·33; p<0·0001), and being tailored to the student (OR 0·10, 0·02 to 0·39; p=0·0010), were lower for recovery colleges in Asia than in England. No other significant differences were identified between recovery colleges in England, and those in other continents where recovery colleges were present. 133 recovery colleges provided data on annual budgets, which ranged from €0 to €2 550 000, varying extensively within and between continents. From included data, all annual budgets reported by the college added up to €30 million, providing 19 864 courses for 55 161 students. INTERPRETATION Recovery colleges exist in many countries. There is an international consensus on key operating principles, especially equality and a commitment to recovery, and most recovery colleges achieve moderate to high fidelity to the original model, irrespective of the income band of their country. Cultural differences need to be considered in assessing coproduction and approaches to individualising support. FUNDING National Institute for Health and Care Research.
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Affiliation(s)
- Daniel Hayes
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK; Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Holly Hunter-Brown
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Elizabeth Camacho
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Merly McPhilbin
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Rachel A Elliott
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Amy Ronaldson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Julie Repper
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sara Meddings
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia; Melbourne School of Public and Global Health, University of Melbourne, VIC, Australia
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, wGraduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Stynke Castelein
- Lentis Psychiatric Institute, Lentis Research, Groningen, Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Trude Gøril Klevan
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Kongsberg, Norway
| | - Dan Elton
- RECOLLECT Lived Experience Advisory Panel, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Jason Grant-Rowles
- RECOLLECT Lived Experience Advisory Panel, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Claire Henderson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK; Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
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Paat YF, Torres-Hostos LR, Garcia Tovar D, Camacho E, Zamora H, Myers NW. An integrated ecological approach to countering targeted violence on the U.S.-Mexico border: Insights and lessons learned. J Prev Interv Community 2023; 51:375-395. [PMID: 38236583 DOI: 10.1080/10852352.2023.2297096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Well-integrated and productive communities are an asset to the development and advancement of our nation, and they have an important role to play in planning, learning, and enforcing safety to enhance national and border security. REACH (Resilience, Education, Action, Commitment, and Humanity) is a community-based project housed at The University of Texas at El Paso that aims to prevent targeted violence and domestic terrorism in El Paso County. We integrated three frameworks (i.e., Whole Community Preparedness, Socio-Ecological Model, and Global Citizen Education) to involve local residents in efforts to combat and mitigate targeted violence. REACH had two goals: to (1) prevent targeted violence and domestic terrorism through education, outreach, and community capacity-building aimed at identifying and deterring radicalization (primary prevention) and (2) reduce the short-term and long-term impact and prevent re-occurrence of targeted violence and domestic terrorism (secondary and tertiary prevention). Overall, our project served 8,934 participants directly and reached many more through our media cavmpaigns and outreach efforts during our 2 years of project implementation (2021-2023). Our project design may serve as an implementation model for other community-based projects on the U.S.-Mexico border and can be replicated with other target populations in the U.S. Insights and lessons learned from this project are discussed.
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Affiliation(s)
- Yok-Fong Paat
- The University of Texas at El Paso, El Paso, Texas, USA
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Camacho E, Shields G, Eisner E, Chew-Graham C, Gilbody S, Littlewood E, McMillan D, Watson K. Exploring the cost-effectiveness of case-finding for antenatal depression: an economic modelling study. Br J Gen Pract 2023; 73:bjgp23X733977. [PMID: 37479293 DOI: 10.3399/bjgp23x733977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The NHS has limited human and financial resources, with particular pressures in primary care. The National Institute for Health and Care Excellence (NICE) makes decisions on which services can be commissioned within the NHS. Many women experiencing antenatal depression are not identified as such in routine care and so may not access support. Current NICE guidance does not recommend universal case-finding for antenatal depression; however, a programme targeted towards pregnant women with risk factors (for example, previous mental illness, traumatic life events) has not been considered. AIM To explore the cost-effectiveness of case-finding for antenatal depression: targeted vs. universal vs. no case-finding. METHOD The following case-finding tools were evaluated: Edinburgh Postnatal Depression Scale, Whooley questions, PHQ-9. One- and two-stage strategies were considered (second tool administered following positive response to Whooley questions). A decision tree model of costs and health outcomes from 20-40 weeks' gestation was developed. Health was measured as quality-adjusted-life-years (QALYs). Costs included case-finding and treatment for depression. RESULTS The two-stage Whooley/PHQ-9 option was the most cost-effective case-finding strategy. Implementing a universal case-finding strategy was associated with lower costs than no case-finding (£52 vs £61) and more QALYs (0.3458 vs 0.3455). Targeted case-finding has similar costs to no case-finding and more QALYs (0.3459), requiring a spend of £1775 to improve health by 1 QALY. CONCLUSION Universal case-finding for antenatal depression is cost-saving and improves health compared with no case-finding. It should be considered by policymakers to improve the identification and support of women experiencing antenatal depression in primary and maternity care.
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Dave RV, Bromley H, Taxiarchi VP, Camacho E, Chatterjee S, Barnes N, Hutchison G, Bishop P, Kirwan CC, Gandhi A. No association between breast pain and breast cancer. Breast 2023. [DOI: 10.1016/j.breast.2022.12.016] [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: 03/19/2023] Open
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Leroi I, Camacho E, Chaghil‐Boissier N, Charalambous AP, Conelly JP, Constantinidou F, David R, Elliott R, Frison E, Hann M, Holden A, Kennelly S, Lawlor B, Longobardi J, Politis A, Kontogianni E, Rao VS, Reeves D, Termote M, Thodi C, Worthington M, Yeung W. A Europe‐wide randomized controlled trial of hearing and vision rehabilitation in dementia: Results from the SENSE‐Cog trial. Alzheimers Dement 2022. [DOI: 10.1002/alz.062722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Nathalie Chaghil‐Boissier
- INSERM, EUCLID/F‐CRIN Clinical Trials Platform, Bordeaux Population Health Center, CHU Bordeaux, University of Bordeaux Bordeaux France
| | | | - JP Conelly
- Trinity College Dublin AND St James Hospital Dublin Ireland
| | | | - Renaud David
- CoBTeK “Cognition Behaviour Technology”, Côte d'Azur University Nice France
- Institut Claude Pompidou Nice France
| | | | - Eric Frison
- EUCLID/F‐CRIN Clinical Trials Platform, University of Bordeaux, Inserm Bordeaux France
- University of Bordeaux Bordeaux France
| | - Mark Hann
- University of Manchester Manchester United Kingdom
| | - Alison Holden
- Lancashire & South Cumbria NHS Foundation Trust Preston United Kingdom
| | - Sean Kennelly
- Trinity Centre for Health Sciences, Tallaght Hospital Dublin Ireland
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin Dublin Ireland
| | - Julie Longobardi
- INSERM, EUCLID/F‐CRIN Clinical Trials Platform, Bordeaux Population Health Center, CHU Bordeaux, University of Bordeaux Bordeaux France
| | - Antonis Politis
- Eginition Hospital, National and Kapodistrian University, Athens Medical School Athens Greece
| | - Evangelia Kontogianni
- 1st Department of Psychiatry, School of Medicine, National and Kapodestrian University of Athens Athens Greece
| | | | - David Reeves
- University of Manchester Manchester United Kingdom
| | - Monique Termote
- INSERM, EUCLID/F‐CRIN Clinical Trials Platform Bordeaux France
| | | | - Mark Worthington
- Lancashire & South Cumbria NHS Foundation Trust Preston United Kingdom
| | - Wai Yeung
- University of Manchester Manchester United Kingdom
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Estevinho F, Figueiredo A, Teixeira E, Oliveira J, Pego A, Barroso A, Faria A, Fernandes A, Chaves A, Araújo A, Meleiro A, Parente B, Matos C, Canário D, Camacho E, Barata F, Câmara G, Queiroga H, Lopes J, Mellidez J, Barradas L, Ferreira L, Ferreira L, Felizardo M, Figueiredo M, Soares M, Lopes M, Gil N, Fidalgo P, Gomes R, Vitorino R, Valente S, Silva S, Cardoso T, Brito U, Almodovar T. EP04.01-011 Diagnostic Approach and Treatment of Lung Cancer Patients in Portugal: Portuguese Lung Cancer Study Group Survey. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mills TA, Roberts SA, Camacho E, Heazell AEP, Massey RN, Melvin C, Newport R, Smith DM, Storey CO, Taylor W, Lavender T. Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study. BMC Pregnancy Childbirth 2022; 22:634. [PMID: 35948884 PMCID: PMC9363262 DOI: 10.1186/s12884-022-04925-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Around 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS). Methods A prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks’ gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8). Results Overall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited. Conclusions Women and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities. Trial registration ISRCTN17447733 first registration 13/02/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04925-3.
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Affiliation(s)
- Tracey A Mills
- Department of International Public Health, Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine. Pembroke Place, Liverpool, L3 5QA, UK.
| | - Stephen A Roberts
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Elizabeth Camacho
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Alexander E P Heazell
- Division of Developmental Biology and Medicine, School of Medical Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Rachael N Massey
- East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, BB2 3HH, England
| | - Cathie Melvin
- East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, BB2 3HH, England
| | - Rachel Newport
- Northern Care Alliance NHS Trust, Royal Oldham Hospital, Oldham, OL1 2JH, England
| | - Debbie M Smith
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | | | - Wendy Taylor
- Division of Nursing Midwifery and Social Work, School of Health Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Tina Lavender
- Department of International Public Health, Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine. Pembroke Place, Liverpool, L3 5QA, UK
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Wittkowski A, Emsley R, Bee PE, Camacho E, Calam R, Abel KM, Duxbury P, Gomez P, Cartwright K, Reid HE. A Feasibility Randomized Controlled Trial of a Parenting Intervention Offered to Women With Severe Mental Health Problems and Delivered in a Mother and Baby Unit Setting: The IMAgINE Study Outcomes. Front Psychiatry 2022; 13:815018. [PMID: 35651824 PMCID: PMC9149174 DOI: 10.3389/fpsyt.2022.815018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Approximately 1-2% of mothers may experience severe mental illness (SMI) requiring admission to an inpatient Mother and Baby Unit (MBU). MBUs aim to provide mental health assessment and treatment and strengthen the mother-infant relationship, essential for infant development. Whilst MBUs offer various interventions, they do not routinely offer structured parenting interventions. The Baby Triple P Positive Parenting Program (BTP) was developed to enhance parenting competence, psychological coping and the quality of partner and other social support. Guided by lived experience consultation, we aimed to determine the feasibility and acceptability of delivering BTP plus Treatment as Usual (TAU) in this setting. Method A multi-site, parallel-group, single-blind pilot randomized controlled trial (registration: ISRCTN12765736) comparing BTP+TAU to TAU in participants, recruited from two MBUs in England. The Baby Triple P intervention consisted of eight parenting sessions, with the final four being delivered over the telephone following MBU discharge. Feasibility outcomes were participant intervention engagement and study retention. Clinical outcomes including maternal parenting competence, bonding and mental health outcomes were assessed at baseline, post-baseline/intervention (10 weeks) and six-month follow-up. Data were analyzed using descriptive statistics and linear regression models. An economic feasibility analysis was also conducted. Results Thirty-seven of the 67 eligible participants consented; 34 were randomized (16 to BTP+TAU and 18 to TAU), of whom 20 were retained at post-intervention data collection and 21 at six-month follow-up. Twelve participants (75%) completed the intervention, which was rated as highly acceptable. Clinical outcomes signaled potential improvements in maternal parenting competence, bonding, mood and mental health symptomatology in participants who received the intervention. Healthcare resource use and EQ-5D-5L questionnaires were well-completed by participants. Delivering BTP in this setting is estimated to cost £443-822 per participant. Conclusions This is the first trial of a parenting intervention in a MBU setting. BTP is feasible and acceptable to mothers with SMI, with a promising signal for treatment efficacy. Although minor modifications may be required for the collection of observer-rated measures post-MBU discharge, the findings indicate that a larger, definitive trial could be conducted, especially if the setting is extended to include perinatal mental health community settings.
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Affiliation(s)
- Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Clinical Psychology, Laureate House, Wythenshawe Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Penny E. Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Elizabeth Camacho
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Kathryn M. Abel
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Paula Duxbury
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Paula Gomez
- Department of Clinical Psychology, Laureate House, Wythenshawe Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Cartwright
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Holly E. Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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11
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Shields GE, Camacho E, Farragher T, Clarkson P, Verma A, Davies LM. Acknowledging Patient Heterogeneity in Economic Evaluations in Schizophrenia: A Systematic Review. Value Health 2022; 25:147-156. [PMID: 35031093 DOI: 10.1016/j.jval.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/28/2021] [Accepted: 07/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Schizophrenia is a severe mental illness with heterogeneous etiology, range of symptoms, and course of illness. Cost-effectiveness analysis often applies averages from populations, which disregards patient heterogeneity even though there are a range of methods available to acknowledge patient heterogeneity. This review evaluates existing economic evaluations of interventions in schizophrenia to understand how patient heterogeneity is currently reflected in economic evaluation. METHODS Electronic searches of MEDLINE, Embase, and PsycINFO via Ovid and the Health Technology Assessment database were run to identify full economic evaluations of interventions aiming to reduce the symptoms associated with schizophrenia. Two levels of screening were used, and explicit inclusion criteria were applied. Prespecified data extraction and critical appraisal were performed. RESULTS Seventy-six relevant studies were identified. More than half (41 of 76) of the articles acknowledged patient heterogeneity in some way through discussion or methods. There was a range of patient characteristics considered, including demographics and socioeconomic factors (eg, age, educational level, ethnicity), clinical characteristics (eg, symptom severity, comorbidities), and preferences (eg, preferences related to outcomes or symptoms). Subgroup analyses were rarely reported (8 of 76). CONCLUSIONS Patient heterogeneity was frequently mentioned in studies but was rarely thoroughly investigated in the identified economic evaluations. When investigated, included patient characteristics and methods were found to be heterogeneous. Understanding and acknowledging patient heterogeneity may alter the conclusions of cost-effectiveness evaluations; subsequently, we would encourage further research in this area.
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Affiliation(s)
- Gemma E Shields
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK.
| | - Elizabeth Camacho
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
| | - Tracey Farragher
- The Epidemiology and Public Health Group, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
| | - Paul Clarkson
- Social Care and Society, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
| | - Arpana Verma
- The Epidemiology and Public Health Group, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK; Manchester Academic Health Science Centre, The University of Manchester, Manchester, England, UK
| | - Linda M Davies
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
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12
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Patchwood E, Woodward-Nutt K, Rhodes SA, Batistatou E, Camacho E, Knowles S, Darley S, Grande G, Ewing G, Bowen A. Organising Support for Carers of Stroke Survivors (OSCARSS): a cluster randomised controlled trial with economic evaluation. BMJ Open 2021; 11:e038777. [PMID: 33436463 PMCID: PMC7805348 DOI: 10.1136/bmjopen-2020-038777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Investigated clinical effectiveness and cost-effectiveness of a person-centred intervention for informal carers/caregivers of stroke survivors. DESIGN Pragmatic cluster randomised controlled trial (cRCT) with economic and process evaluation. SETTING Clusters were services, from a UK voluntary sector specialist provider, delivering support primarily in the homes of stroke survivors and informal carers. PARTICIPANTS Adult carers in participating clusters were referred to the study by cluster staff following initial support contact. INTERVENTIONS Intervention was the Carer Support Needs Assessment Tool for Stroke: a staff-facilitated, carer-led approach to help identify, prioritise and address the specific support needs of carers. It required at least one face-to-face support contact dedicated to carers, with reviews as required. Control was usual care, which included carer support (unstructured and variable). OUTCOME MEASURES Participants provided study entry and self-reported outcome data by postal questionnaires, 3 and 6 months after first contact by cluster staff. PRIMARY OUTCOME 3-month caregiver strain (Family Appraisal of Caregiving Questionnaire, FACQ). SECONDARY OUTCOMES FACQ subscales of caregiver distress and positive appraisals of caregiving, mood (Hospital Anxiety and Depression Scale) and satisfaction with stroke services (Pound). The economic evaluation included self-reported healthcare utilisation, intervention costs and EQ-5D-5L. RANDOMISATION AND MASKING Clusters were recruited before randomisation to intervention or control, with stratification for size of service. Cluster staff could not be masked as training was required for participation. Carer research participants provided self-reported outcome data unaware of allocation; they consented to follow-up data collection only. RESULTS Between 1 February 2017 and 31 July 2018, 35 randomised clusters (18 intervention; 17 control) recruited 414 cRCT carers (208 intervention; 206 control). Study entry characteristics were well balanced. PRIMARY OUTCOME MEASURE intention-to-treat analysis for 84% retained participants (175 intervention; 174 control) found mean (SD) FACQ carer strain at 3 months to be 3.11 (0.87) in the control group compared with 3.03 (0.90) in the intervention group, adjusted mean difference of -0.04 (95% CI -0.20 to 0.13). Secondary outcomes had similarly small differences and tight CIs. Sensitivity analyses suggested robust findings. Intervention fidelity was not achieved. Intervention-related group costs were marginally higher with no additional health benefit observed on EQ-5D-5L. No adverse events were related to the intervention. CONCLUSIONS The intervention was not fully implemented in this pragmatic trial. As delivered, it conferred no clinical benefits and is unlikely to be cost-effective compared with usual care from a stroke specialist provider organisation. It remains unclear how best to support carers of stroke survivors. To overcome the implementation challenges of person-centred care in carers' research and service development, staff training and organisational support would need to be enhanced. TRIAL REGISTRATION NUMBER ISRCTN58414120.
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Affiliation(s)
- Emma Patchwood
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
| | - Kate Woodward-Nutt
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
| | - Sarah A Rhodes
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Evridiki Batistatou
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Knowles
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Darley
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Gunn Grande
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Division of Nursing Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Gail Ewing
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
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Martins JNR, Silva EJNL, Marques D, Belladonna F, Simões-Carvalho M, Camacho E, Braz Fernandes FM, Versiani MA. Comparison of design, metallurgy, mechanical performance and shaping ability of replica-like and counterfeit instruments of the ProTaper Next system. Int Endod J 2021; 54:780-792. [PMID: 33300121 DOI: 10.1111/iej.13463] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
AIM To compare the ProTaper Next (PTN) system with a replica-like and a counterfeit system regarding design, metallurgy, mechanical performance and shaping ability. METHODOLOGY Replica-like (X-File) and counterfeit (PTN-CF) instruments were compared to the PTN system regarding design (microscopy), phase transformation temperatures (differential scanning calorimetry), nickel-titanium ratio (energy-dispersive X-ray spectroscopy), cyclic fatigue, torsional resistance, bending strength, and untouched canal areas in extracted mandibular molars (micro-CT). anova, post hoc Tukey's and Kruskal-Wallis tests were used according to normality assessment (Shapiro-Wilk test) with the significance level set at 5%. RESULTS Overall similarities in design and nickel-titanium (Ni/Ti) ratio were observed amongst instruments with the X-File having a smoother surface finish. PTN and PTN-CF had mixed austenite plus R-phase (R-phase start approximately at 45 ºC and near 30 ºC, respectively), whilst X-File instruments were austenitic (R-phase started at approximately at 17 ºC) at room temperature (20 ºC). PTN-CF had the greatest inconsistency in the phase transformation temperatures. Time to fracture of PTN-CF X2 and X3 was significantly shorter than PTN and X-File instruments (P < 0.05), whilst no difference was noted in maximum torque to fracture amongst the tested systems (P > 0.05). X-Files and PTN-CF had a stress-induced phase change during bending load. Mean unprepared surface areas of root canals were 25.8% (PTN), 31.1% (X-File) and 32.5% (PTN-CF) with no significant difference amongst groups (P > 0.05). CONCLUSION Similarities amongst the systems were noted in the Ni/Ti ratio and maximum torque to fracture, whilst differences were observed in the design, phase transformation temperatures and mechanical behaviour. The ProTaper Next counterfeit instruments could be considered as the less secure system considering its low-cyclic fatigue resistance. Apart from these differences, the unprepared canal surface areas, obtained with the tested systems, were similar.
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Affiliation(s)
- J N R Martins
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal.,Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - E J N L Silva
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Endodontics, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
| | - D Marques
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal.,LIBPhys-FCT UID/FIS/04559/2013, Lisboa, Portugal
| | - F Belladonna
- Department of Endodontics, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
| | - M Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
| | - E Camacho
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
| | - F M Braz Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
| | - M A Versiani
- Dental Specialty Center, Brazilian Military Police, Minas Gerais, Brazil
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14
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Hammond A, Prior Y, Cotterill S, Sutton C, Camacho E, Heal C, Adams J, Hough Y, O'Neill TW, Firth J. Clinical and cost effectiveness of arthritis gloves in rheumatoid arthritis (A-GLOVES): randomised controlled trial with economic analysis. BMC Musculoskelet Disord 2021; 22:47. [PMID: 33419426 PMCID: PMC7792116 DOI: 10.1186/s12891-020-03917-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arthritis (or compression) gloves are widely prescribed to people with rheumatoid arthritis and other forms of hand arthritis. They are prescribed for daytime wear to reduce hand pain and improve hand function, and/or night-time wear to reduce pain, improve sleep and reduce morning stiffness. However, evidence for their effectiveness is limited. The aims of this study were to investigate the clinical and cost effectiveness of arthritis gloves compared to placebo gloves on hand pain, stiffness and function in people with rheumatoid arthritis and persistent hand pain. METHODS A parallel randomised controlled trial, in adults (≥ 18 years) with rheumatoid or undifferentiated inflammatory arthritis at 16 National Health Service sites in the UK. Patients with persistent hand pain affecting function and/or sleep were eligible. Randomisation (1:1) was stratified by recent change (or not) in medication, using permuted blocks of random sizes. Three-quarter-finger length arthritis gloves (Isotoner®: applying 23-32 mmHg pressure) (intervention) were compared to loose-fitting placebo gloves (Jobskin® classic: providing no/minimal pressure) (control). Both gloves (considered to have similar thermal qualities) were provided by occupational therapists. Patients and outcome assessors were blinded; clinicians were not. The primary outcome was dominant hand pain on activity (0-10) at 12 weeks, analysed using linear regression and intention to treat principles. RESULTS Two hundred six participants were randomly assigned (103 per arm) and 163 (84 intervention: 79 control) completed 12-week follow-up. Hand pain improved by 1.0 (intervention) and 1.2 (control), an adjusted mean difference of 0.10 (95% CI: - 0.47 to 0.67; p = 0.72). Adverse events were reported by 51% of intervention and 36% of control group participants; with 6 and 7% respectively, discontinuing glove wear. Provision of arthritis gloves cost £129, with no additional benefit. CONCLUSION The trial provides evidence of no clinically important effect of arthritis gloves on any of the trial outcomes (hand pain, function and stiffness) and arthritis gloves are not cost-effective. The clinical and cost-effectiveness results support ceasing provision of arthritis gloves in routine clinical practice. FUNDING National Institute for Health Research. TRIAL REGISTRATION ISRCTN, ISRCTN25892131 ; Registered 05/09/2016: retrospectively registered.
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Affiliation(s)
- Alison Hammond
- Centre for Health Sciences Research, School of Health and Society, University of Salford, Allerton Building, Frederick Road, Salford, M6 6PU, UK.
| | - Yeliz Prior
- Centre for Health Sciences Research, School of Health and Society, University of Salford, Allerton Building, Frederick Road, Salford, M6 6PU, UK
| | - Sarah Cotterill
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Chris Sutton
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Calvin Heal
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jo Adams
- Health Sciences, University of Southampton, Southampton, UK
| | - Yvonne Hough
- Rheumatology Occupational Therapy, St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jill Firth
- Pennine MSK Partnership, Oldham, Manchester, UK
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15
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Rodrigues PF, Fernandes FB, Magalhães R, Camacho E, Lopes A, Paula A, Basu R, Schell N. Thermo-mechanical characterization of NiTi orthodontic archwires with graded actuating forces. J Mech Behav Biomed Mater 2020; 107:103747. [DOI: 10.1016/j.jmbbm.2020.103747] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 11/26/2022]
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16
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Elliott RA, Camacho E, Jankovic D, Sculpher MJ, Faria R. Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Qual Saf 2020; 30:96-105. [PMID: 32527980 DOI: 10.1136/bmjqs-2019-010206] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [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: 08/10/2019] [Revised: 03/03/2020] [Accepted: 03/07/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To provide national estimates of the number and clinical and economic burden of medication errors in the National Health Service (NHS) in England. METHODS We used UK-based prevalence of medication errors (in prescribing, dispensing, administration and monitoring) in primary care, secondary care and care home settings, and associated healthcare resource use, to estimate annual number and burden of errors to the NHS. Burden (healthcare resource use and deaths) was estimated from harm associated with avoidable adverse drug events (ADEs). RESULTS We estimated that 237 million medication errors occur at some point in the medication process in England annually, 38.4% occurring in primary care; 72% have little/no potential for harm and 66 million are potentially clinically significant. Prescribing in primary care accounts for 34% of all potentially clinically significant errors. Definitely avoidable ADEs are estimated to cost the NHS £98 462 582 per year, consuming 181 626 bed-days, and causing/contributing to 1708 deaths. This comprises primary care ADEs leading to hospital admission (£83.7 million; causing 627 deaths), and secondary care ADEs leading to longer hospital stay (£14.8 million; causing or contributing to 1081 deaths). CONCLUSIONS Ubiquitous medicines use in health care leads unsurprisingly to high numbers of medication errors, although most are not clinically important. There is significant uncertainty around estimates due to the assumption that avoidable ADEs correspond to medication errors, data quality, and lack of data around longer-term impacts of errors. Data linkage between errors and patient outcomes is essential to progress understanding in this area.
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Affiliation(s)
- Rachel Ann Elliott
- Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Dina Jankovic
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Mark J Sculpher
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Rita Faria
- University of York, Centre for Health Economics, York, UK
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17
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Leroi I, Simkin Z, Hooper E, Wolski L, Abrams H, Armitage CJ, Camacho E, Charalambous AP, Collin F, Constantinidou F, Dawes P, Elliott R, Falkingham S, Frison E, Hann M, Helmer C, Himmelsbach I, Hussain H, Marié S, Montecelo S, Thodi C, Yeung WK. Impact of an intervention to support hearing and vision in dementia: The SENSE-Cog Field Trial. Int J Geriatr Psychiatry 2020; 35:348-357. [PMID: 31713262 PMCID: PMC7079053 DOI: 10.1002/gps.5231] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/07/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Hearing, vision, and cognitive impairment commonly co-occur in older adults. Improving sensory function may positively impact outcomes in people with dementia (PwD). We developed a "sensory intervention" (SI) to support hearing and vision in PwD. Here, we report the findings of an international open-label field trial, and nested case series, to explore the impact of the SI on dementia-related outcomes. METHODS This was a home-based trial conducted in France, England, and Cyprus. Participants were people with mild-to-moderate dementia and hearing and/or vision impairment (n = 19) and their study partners (unpaid carers; n = 19). The "basic" SI included a hearing and vision assessment and provision of glasses and/or hearing aids. A subsample received the "extended" SI with additional weekly visits from a sensory support therapist (SST). Exploratory analyses of dementia-related, health utility and resource utilisation outcomes were performed. RESULTS Quality of life (QoL) and sensory functional ability improved. Change in QoL exceeded the threshold for a minimum clinically important difference. There was a modest improvement (in absolute terms) post intervention in behavioural disturbance, self-efficacy, and relationship satisfaction. Study partner time assisting instrumental activities of daily living (iADL) and supervision decreased by about 22 and 38 hours per month, respectively, although time for personal ADL support increased. Qualitative data supported effectiveness of the intervention: PwD were more socially engaged, less isolated, less dependent on study partners, and had improved functional ability and communication. CONCLUSIONS These findings support the need for a definitive randomised controlled trial (RCT) to evaluate the effectiveness of the intervention.
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Affiliation(s)
- Iracema Leroi
- Global Brain Health InstituteTrinity College DublinDublinIreland
- Division of Neuroscience and Experimental PsychologyUniversity of ManchesterManchesterUK
| | - Zoe Simkin
- Division of Neuroscience and Experimental PsychologyUniversity of ManchesterManchesterUK
| | - Emma Hooper
- Division of Neuroscience and Experimental PsychologyUniversity of ManchesterManchesterUK
| | - Lucas Wolski
- Institute of Applied Research, Development and Further EducationCatholic University of Applied Sciences FreiburgFreiburgGermany
| | - Harvey Abrams
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFL
| | | | - Elizabeth Camacho
- Manchester Centre for Health EconomicsUniversity of ManchesterManchesterUK
| | | | - Fideline Collin
- INSERM, EUCLID/F‐CRIN Clinical Trials PlatformUniversity of BordeauxTalenceAquitaineFrance
| | | | - Piers Dawes
- Manchester Centre for Audiology and DeafnessUniversity of ManchesterManchesterUK
| | - Rachel Elliott
- Manchester Centre for Health EconomicsUniversity of ManchesterManchesterUK
| | - Sue Falkingham
- Department of AudiologyStarkey Hearing TechnologiesStockportUK
| | - Eric Frison
- INSERM, EUCLID/F‐CRIN Clinical Trials PlatformUniversity of BordeauxTalenceAquitaineFrance
| | - Mark Hann
- Centre for BiostatisticsUniversity of ManchesterManchesterUK
| | - Catherine Helmer
- INSERM, Bordeaux Population Health Research Center, Team LEHAUniversity of BordeauxTalenceAquitaineFrance
| | - Ines Himmelsbach
- Institute of Applied Research, Development and Further EducationCatholic University of Applied Sciences FreiburgFreiburgGermany
| | - Hannah Hussain
- Manchester Centre for Health EconomicsUniversity of ManchesterManchesterUK
| | - Sarah Marié
- Research and DevelopmentEssilor InternationalParisFrance
| | | | - Chryssoula Thodi
- Department of Health SciencesEuropean University CyprusNicosiaCyprus
| | - Wai Kent Yeung
- Division of Neuroscience and Experimental PsychologyUniversity of ManchesterManchesterUK
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Figueiredo A, Almeida M, Almodovar M, Alves P, Araújo A, Araújo D, Barata F, Barradas L, Barroso A, Brito U, Camacho E, Canário D, Cardoso T, Chaves A, Costa L, Cunha J, Duarte J, Estevinho F, Felizardo M, Fernandes J, Ferreira L, Ferreira L, Fidalgo P, Freitas C, Garrido P, Gil N, Hasmucrai D, Jesus E, Lopes J, de Macedo J, Meleiro A, Neveda R, Nogueira F, Pantorotto M, Parente B, Pego A, Rocha M, Roque J, Santos C, Saraiva J, Silva E, Silva S, Simões S, Soares M, Teixeira E, Timóteo T, Hespanhol V. Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC). Pulmonology 2020; 26:10-17. [DOI: 10.1016/j.pulmoe.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022] Open
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19
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Canales A, Landi V, Martínez A, Macri M, Pizarro G, Delgado JV, Cervantes P, Hernández A, Camacho E. Caracterización genética del pavo domestico de traspatio mexicano. ARCH ZOOTEC 2019. [DOI: 10.21071/az.v68i264.4986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
El pavo de traspatio mexicano es una raza autóctona en peligro de extinción, ya que en la actualidad se ha perdido la costumbre de conservar los recursos genéticos autóctonos de cada población, procurando el cruzamiento con animales de líneas comerciales para la producción de carne de pavo, dañando y perdiendo el acervo genético de los pavos autóctonos de México. El objetivo del presente trabajo es realizar la caracterización genética del pavo de traspatio mexicano mediante el uso de microsatélites y estudiar la posible estructura genética de esta población. Se analiza un panel de 38 microsatélites en 51 muestras de pavo de traspatio, tomadas de diferentes zonas de la ciudad de Veracruz, México. Se han evaluado los principales parámetros de diversidad genética: heterocigosidad esperada y observada, número de alelos, estadísticos F y Análisis Factorial de Correspondencia mediante el programa informático GENETIX. Se calculan las distancias genéticas entre individuos (DSA) con las que se ha construido un dendrograma utilizando el programa POPULATIONS. El árbol se visualiza con el programa TREEVIEW. Se estudia la estructura genética con el programa STRUCTURE. Todos los microsatélites utilizados han resultado polimórficos, encontrándose un mínimo de 2 alelos en el microsatélite MNT 264 y un máximo de 14 alelos en los marcadores MNT274 y RHT024, con un número medio de alelos de 6.79. Los valores medios de HE y HO son 0.619 y 0.620 respectivamente. Los estadísticos F muestran los siguientes valores en el total de la muestra: FIS 0.128 (P
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20
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Hooper E, Simkin Z, Abrams H, Camacho E, Charalambous AP, Collin F, Constantinidou F, Dawes P, Elliott R, Falkingham S, Frison E, Hann M, Helmer C, Himmelsbach I, Hussain H, Marié S, Montecelo S, Reeves D, Regan J, Thodi C, Wolski L, Leroi I. Feasibility of an Intervention to Support Hearing and Vision in Dementia: The SENSE-Cog Field Trial. J Am Geriatr Soc 2019; 67:1472-1477. [PMID: 31034588 DOI: 10.1111/jgs.15936] [Citation(s) in RCA: 17] [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: 01/25/2019] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES People with dementia (PwD) frequently experience hearing and vision impairment that is underrecognized and undertreated, resulting in reduced quality of life. Managing these impairments may be an important strategy to improve outcomes in PwD. Our objective was to field-trial a multifaceted sensory intervention (SI) to enhance hearing and vision in PwD. DESIGN An international single-arm open-label feasibility, acceptability, and tolerability study. SETTING Home-based setting in the United Kingdom, France, and Cyprus. PARTICIPANTS Adults aged 60 years and older with mild-to-moderate dementia and uncorrected or suboptimally corrected hearing and/or vision impairment, and their study partners (n = 19 dyads). INTERVENTION A sensory intervention (SI), comprising assessment of hearing and vision, fitting of corrective devices (glasses, hearing aids), and home-based support from a sensory support therapist for device adherence and maintenance, communication training, referral to support services, environmental sensory modification, and optimization of social inclusion. MEASUREMENTS Ratings of study procedure feasibility, and intervention acceptability/tolerability, ascertained through questionnaires, participant diaries, therapist logbooks, and semistructured interviews. RESULTS We successfully delivered all intervention components, and these were received and enacted as intended in all those who completed the intervention. No serious adverse events were reported. Acceptability (ie, understanding, motivation, sense of achievement) and tolerability (ie, effort, fatigue) ratings of the intervention were within a priori target ranges. We met recruitment and retention (93.8%) targets in two of the three sites. Participants completed more than 95% of diary entries, representing minimal missing data. Delays in the logistics circuit for the assessment and delivery of hearing aids and glasses were identified, requiring modification. The need for minor modifications to some outcome measures and the inclusion criteria were identified. CONCLUSION This is the first study combining home-based hearing and vision remediation in PwD. The positive feasibility, acceptability, and tolerability findings suggest that a full-scale efficacy trial, with certain modifications, is achievable.
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Affiliation(s)
- Emma Hooper
- Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Zoe Simkin
- Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | | | - Elizabeth Camacho
- Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Fideline Collin
- INSERM, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux Population Health Center, CHU Bordeaux, F-33000, University of Bordeaux, Bordeaux, France
| | - Fofi Constantinidou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
| | - Rachel Elliott
- Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Eric Frison
- INSERM, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux Population Health Center, CHU Bordeaux, F-33000, University of Bordeaux, Bordeaux, France
| | - Mark Hann
- Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Catherine Helmer
- INSERM, Bordeaux Population Health Research Center, Team LEHA, University of Bordeaux, Bordeaux, France
| | - Ines Himmelsbach
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany
| | - Hannah Hussain
- Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah Marié
- Essilor International, Research & Development, Paris, France
| | | | - David Reeves
- Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Jemma Regan
- University of Manchester, Manchester, United Kingdom
| | - Chryssoula Thodi
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Lucas Wolski
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany
| | - Iracema Leroi
- Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Greater Manchester Mental Health Foundation Trust, Manchester, United Kingdom
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21
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Wittkowski A, Cartwright K, Emsley R, Bee P, Camacho E, Calam R, Cross C, Abel KM, Reid H. Correction to: Enhancing maternal and infant wellbeing: study protocol for a feasibility trial of the Baby Triple P Positive Parenting programme for mothers with severe mental health difficulties (the IMAGINE study). Trials 2018; 19:516. [PMID: 30241568 PMCID: PMC6151026 DOI: 10.1186/s13063-018-2918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK. .,Department of Clinical Psychology, Greater Manchester Mental Health NHS Foundation Trust, Laureate House, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LK, UK.
| | - Kim Cartwright
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.,Department of Clinical Psychology, Greater Manchester Mental Health NHS Foundation Trust, Laureate House, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LK, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Penny Bee
- Division of Nursing, Midwifery & Social Work, The University of Manchester, Jean MacFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Elizabeth Camacho
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, The University of Manchester, Jean Macfarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - Catherine Cross
- Department of Clinical Psychology, Greater Manchester Mental Health NHS Foundation Trust, Laureate House, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LK, UK
| | - Kathryn M Abel
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - Holly Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.,Department of Clinical Psychology, Greater Manchester Mental Health NHS Foundation Trust, Laureate House, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LK, UK
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22
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Jones S, Riste L, Barrowclough C, Bartlett P, Clements C, Davies L, Holland F, Kapur N, Lobban F, Long R, Morriss R, Peters S, Roberts C, Camacho E, Gregg L, Ntais D. Reducing relapse and suicide in bipolar disorder: practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care – the PARADES (Psychoeducation, Anxiety, Relapse, Advance Directive Evaluation and Suicidality) programme. Programme Grants Appl Res 2018. [DOI: 10.3310/pgfar06060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment.ObjectivesA programme of linked studies to reduce relapse and suicide in BD.DesignThere were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5).SettingParticipants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)].ParticipantsAged ≥ 18 years. In WS1–3, participants had their diagnosis of BD confirmed by the Structural Clinical Interview for theDiagnostic and Statistical Manual of Mental Disorders.InterventionsIn WS1, group PEd/PS; in WS3 and WS4, individual psychological therapy for comorbid anxiety and alcohol use, respectively.Main outcome measuresIn WS1, time to relapse of bipolar episode; in WS2 and WS3, feasibility and acceptability of interventions; in WS4, prevalence and determinants of suicide and self-harm; and in WS5, professional training and support of advance planning in MCA, and SU awareness and implementation.ResultsGroup PEd and PS could be routinely delivered in the NHS. The estimated median time to first bipolar relapse was 67.1 [95% confidence interval (CI) 37.3 to 90.9] weeks in PEd, compared with 48.0 (95% CI 30.6 to 65.9) weeks in PS. The adjusted hazard ratio was 0.83 (95% CI 0.62 to 1.11; likelihood ratio testp = 0.217). The interaction between the number of previous bipolar episodes (1–7 and 8–19, relative to 20+) and treatment arm was significant (χ2 = 6.80, degrees of freedom = 2;p = 0.034): PEd with one to seven episodes showed the greatest delay in time to episode. A primary economic analysis indicates that PEd is not cost-effective compared with PS. A sensitivity analysis suggests potential cost-effectiveness if decision-makers accept a cost of £37,500 per quality-adjusted life-year. AIBD and motivational interviewing (MI) cognitive–behavioural therapy (CBT) trials were feasible and acceptable in achieving recruitment and retention targets (AIBD:n = 72, 72% retention to follow-up; MI-CBT:n = 44, 75% retention) and in-depth qualitative interviews. There were no significant differences in clinical outcomes for either trial overall. The factors associated with risk of suicide and self-harm (longer duration of illness, large number of periods of inpatient care, and problems establishing diagnosis) could inform improved clinical care and specific interventions. Qualitative interviews suggested that suicide risk had been underestimated, that care needs to be more collaborative and that people need fast access to good-quality care. Despite SUs supporting advance planning and psychiatrists being trained in MCA, the use of MCA planning provisions was low, with confusion over informal and legally binding plans.LimitationsInferences for routine clinical practice from WS1 were limited by the absence of a ‘treatment as usual’ group.ConclusionThe programme has contributed significantly to understanding how to improve outcomes in BD. Group PEd is being implemented in the NHS influenced by SU support.Future workFuture work is needed to evaluate optimal approaches to psychological treatment of comorbidity in BD. In addition, work in improved risk detection in relation to suicide and self-harm in clinical services and improved training in MCA are indicated.Trial registrationCurrent Controlled Trials ISRCTN62761948, ISRCTN84288072 and ISRCTN14774583.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lisa Riste
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Peter Bartlett
- School of Law and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline Clements
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Fiona Holland
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Manchester Mental Health & Social Care NHS Trust, Manchester, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Rita Long
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Chris Roberts
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Lynsey Gregg
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Institute of Population Health, University of Manchester, Manchester, UK
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23
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Athwal VS, Pritchett J, Llewellyn J, Martin K, Camacho E, Raza SM, Phythian-Adams A, Birchall LJ, Mullan AF, Su K, Pearmain L, Dolman G, Zaitoun AM, Friedman SL, MacDonald A, Irving WL, Guha IN, Hanley NA, Piper Hanley K. SOX9 predicts progression toward cirrhosis in patients while its loss protects against liver fibrosis. EMBO Mol Med 2018; 9:1696-1710. [PMID: 29109128 PMCID: PMC5709769 DOI: 10.15252/emmm.201707860] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Fibrosis and organ failure is a common endpoint for many chronic liver diseases. Much is known about the upstream inflammatory mechanisms provoking fibrosis and downstream potential for tissue remodeling. However, less is known about the transcriptional regulation in vivo governing fibrotic matrix deposition by liver myofibroblasts. This gap in understanding has hampered molecular predictions of disease severity and clinical progression and restricted targets for antifibrotic drug development. In this study, we show the prevalence of SOX9 in biopsies from patients with chronic liver disease correlated with fibrosis severity and accurately predicted disease progression toward cirrhosis. Inactivation of Sox9 in mice protected against both parenchymal and biliary fibrosis, and improved liver function and ameliorated chronic inflammation. SOX9 was downstream of mechanosignaling factor, YAP1. These data demonstrate a role for SOX9 in liver fibrosis and open the way for the transcription factor and its dependent pathways as new diagnostic, prognostic, and therapeutic targets in patients with liver fibrosis.
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Affiliation(s)
- Varinder S Athwal
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research & Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - James Pritchett
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Jessica Llewellyn
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Katherine Martin
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research & Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Elizabeth Camacho
- Centre for Health Economics, Institute of Population Health, Faculty of Medical & Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sayyid Ma Raza
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research & Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Alexander Phythian-Adams
- Manchester Centre for Collaborative Inflammation Research, Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Lindsay J Birchall
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research & Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Aoibheann F Mullan
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research & Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Kim Su
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research & Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Laurence Pearmain
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research & Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Grace Dolman
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Abed M Zaitoun
- Department of Cellular Pathology, Nottingham Digestive Diseases Centre and National Institute of Health Research Biomedical Research Unit in Gastroenterology and Liver Disease, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Scott L Friedman
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew MacDonald
- Manchester Centre for Collaborative Inflammation Research, Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - William L Irving
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.,School of Life Sciences, Nottingham Digestive Diseases Centre and National Institute of Health Research Biomedical Research Unit in Gastroenterology and Liver Disease, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Indra N Guha
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Neil A Hanley
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research & Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Karen Piper Hanley
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK .,Research & Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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24
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Guthrie E, Afzal C, Blakeley C, Blakemore A, Byford R, Camacho E, Chan T, Chew-Graham C, Davies L, de Lusignan S, Dickens C, Drinkwater J, Dunn G, Hunter C, Joy M, Kapur N, Langer S, Lovell K, Macklin J, Mackway-Jones K, Ntais D, Salmon P, Tomenson B, Watson J. CHOICE: Choosing Health Options In Chronic Care Emergencies. Programme Grants Appl Res 2017. [DOI: 10.3310/pgfar05130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cara Afzal
- Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
- Greater Manchester Academic Health Science Network (GM AHSN), Manchester, UK
| | - Claire Blakeley
- Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Blakemore
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Rachel Byford
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Elizabeth Camacho
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Health Economics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Tom Chan
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Linda Davies
- Centre for Health Economics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Simon de Lusignan
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Chris Dickens
- Institute of Health Research, Medical School, University of Exeter, Exeter, UK
- Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), University of Exeter, Exeter, UK
| | | | - Graham Dunn
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Cheryl Hunter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mark Joy
- Faculty of Science, Engineering and Computing, Kingston University, London, UK
| | - Navneet Kapur
- Manchester Academic Health Science Centre, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Susanne Langer
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Karina Lovell
- Manchester Academic Health Science Centre, Manchester, UK
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Kevin Mackway-Jones
- Manchester Academic Health Science Centre, Manchester, UK
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Dionysios Ntais
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Health Economics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Barbara Tomenson
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Jennifer Watson
- Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
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Prior Y, Sutton C, Cotterill S, Adams J, Camacho E, Arafin N, Firth J, O'Neill T, Hough Y, Jones W, Hammond A. The effects of arthritis gloves on people with Rheumatoid Arthritis or Inflammatory Arthritis with hand pain: a study protocol for a multi-centre randomised controlled trial (the A-GLOVES trial). BMC Musculoskelet Disord 2017; 18:224. [PMID: 28558734 PMCID: PMC5450242 DOI: 10.1186/s12891-017-1583-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 12/03/2022] Open
Abstract
Background Arthritis gloves are regularly provided as part of the management of people with rheumatoid arthritis (RA) and undifferentiated (early) inflammatory arthritis (IA). Usually made of nylon and elastane (i.e. Lycra®), these arthritis gloves apply pressure with the aims of relieving hand pain, stiffness and improving hand function. However, a systematic review identified little evidence supporting their use. We therefore designed a trial to compare the effectiveness of the commonest type of arthritis glove provided in the United Kingdom (Isotoner gloves) (intervention) with placebo (control) gloves (i.e. larger arthritis gloves providing similar warmth to the intervention gloves but minimal pressure only) in people with these conditions. Methods Participants aged 18 years and over with RA or IA and persistent hand pain will be recruited from National Health Service Trusts in the United Kingdom. Following consent, participants will complete a questionnaire booklet, then be randomly allocated to receive intervention or placebo arthritis gloves. Within three weeks, they will be fitted with the allocated gloves by clinical specialist rheumatology occupational therapists. Twelve weeks (i.e. the primary endpoint) after completing the baseline questionnaire, participants will complete a second questionnaire, including the same measures plus additional questions to explore adherence, benefits and problems with glove-wear. A sub-sample of participants from each group will be interviewed at the end of their participation to explore their views of the gloves received. The clinical effectiveness and cost-effectiveness of the intervention, compared to placebo gloves, will be evaluated over 12 weeks. The primary outcome measure is hand pain during activity. Qualitative interviews will be thematically analysed. Discussion This study will evaluate the commonest type of arthritis glove (Isotoner) provided in the NHS (i.e. the intervention) compared to a placebo glove. The results will help occupational therapists, occupational therapy services and people with arthritis make informed choices as to the value of arthritis gloves. If effective, arthritis gloves should become more widely available in the NHS to help people with RA and IA manage hand symptoms and improve performance of daily activities, work and leisure. If not, services can determine whether to cease supplying these to reduce service costs. Trial registration ISRCTN Registry: ISRCTN25892131 Registered 05/09/2016 Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1583-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yeliz Prior
- Centre for Health Sciences Research (OT), University of Salford, Frederick Road, L701 Allerton Building, Salford, Greater Manchester, M6 6PU, UK.,Mid Cheshire NHS Trust, Leighton Hospital, Leighton, Crewe, UK
| | - Chris Sutton
- Lancashire Clinical Trials Unit, UCLAN, Preston, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jo Adams
- Health Sciences, University of Southampton, Southampton, UK
| | - Elizabeth Camacho
- Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nazina Arafin
- Centre for Health Sciences Research (OT), University of Salford, Frederick Road, L701 Allerton Building, Salford, Greater Manchester, M6 6PU, UK
| | - Jill Firth
- Pennine Musculoskeletal Partnership Ltd, Oldham, UK
| | - Terence O'Neill
- Arthritis Research UK Centre for Epidemiology, University of Manchester & NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Yvonne Hough
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens Hospital, St Helens, UK
| | | | - Alison Hammond
- Centre for Health Sciences Research (OT), University of Salford, Frederick Road, L701 Allerton Building, Salford, Greater Manchester, M6 6PU, UK.
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Weinstein C, Jordan K, Green S, Camacho E, Khanani S, Beckford-Brathwaite E, Vallejos W, Liang L, Noga S, Rapoport B. Exploration of the heterogeneity of moderately emetogenic chemotherapy on response to fosaprepitant in a randomized phase 3 trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.03] [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: 11/13/2022] Open
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Domínguez DC, Camacho E, Antony S. The Role of Molecular Technology and Prolonged Cultures in the Diagnosis of Fungal Prosthetic Joint Infections and Orthopedic-Related Devices. Infect Dis Clin Pract 2016. [DOI: 10.1097/ipc.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Weinstein C, Jordan K, Green SA, Camacho E, Khanani S, Beckford-Brathwaite E, Vallejos W, Liang LW, Noga SJ, Rapoport BL. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with moderately emetogenic chemotherapy: results of a randomized, double-blind phase III trial. Ann Oncol 2016; 27:172-8. [PMID: 26449391 PMCID: PMC4684151 DOI: 10.1093/annonc/mdv482] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/01/2015] [Accepted: 09/23/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To establish the role of antiemetic therapy with neurokinin-1 (NK1) receptor antagonists (RAs) in nonanthracycline and cyclophosphamide (AC)-based moderately emetogenic chemotherapy (MEC) regimens, this study evaluated single-dose intravenous (i.v.) fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with non-AC MEC. PATIENTS AND METHODS In this international, phase III, double-blind trial, adult cancer subjects scheduled to receive ≥1 non-AC MEC on day 1 were randomized to a regimen comprising single-dose i.v. fosaprepitant 150 mg or placebo along with ondansetron and dexamethasone on day 1; control regimen recipients received ondansetron on days 2 and 3. Primary end points were the proportion of subjects achieving a complete response (CR; no vomiting and no use of rescue medication) in the delayed phase (25-120 h after MEC initiation) and safety. Secondary end points included CR in the overall and acute phases (0-120 and 0-24 h after MEC initiation, respectively) and no vomiting in the overall phase. Nausea and the Functional Living Index-Emesis were assessed as exploratory end points. RESULTS The fosaprepitant regimen improved CR significantly in the delayed (78.9% versus 68.5%; P < 0.001) and overall (77.1% versus 66.9%; P < 0.001) phases, but not in the acute phase (93.2% versus 91.0%; P = 0.184), versus control. In the overall phase, the proportion of subjects with no vomiting (82.7% versus 72.9%; P < 0.001) and no significant nausea (83.2% versus 77.9%; P = 0.030) was also significantly improved with the fosaprepitant regimen. The fosaprepitant regimen was generally well tolerated. CONCLUSION Single-dose fosaprepitant added to a 5-HT3 RA and dexamethasone was well tolerated and demonstrated superior control of CINV (primary end point achieved) associated with non-AC MEC. This is the first study to evaluate NK1 RA therapy as an i.v. formulation in a well-defined non-AC MEC population. CLINICALTRIALSGOV NCT01594749 (https://clinicaltrials.gov/ct2/show/NCT01594749).
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Affiliation(s)
| | - K Jordan
- Department of Hematology/Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - S A Green
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - E Camacho
- Department of Hematology and Medical Oncology, Comprehensive Cancer Center at the Desert Regional Medical Center, Palm Springs, CA
| | - S Khanani
- Department of Hematology/Oncology, Reliant Medical Group, Worcester, MA
| | | | | | - L W Liang
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - S J Noga
- Department of Oncology, Weinberg Cancer Institute, Baltimore, MD, USA
| | - B L Rapoport
- Department of Medical Oncology, Medical Oncology Center of Rosebank, Johannesburg, South Africa
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Nieves E, Ramírez M, Fajardo E, Camacho E, Giraldo Ó. Tratamiento de la úlcera venosa con escleroespuma frente a un método convencional. Ensayo clínico, prospectivo y aleatorizado. Angiología 2015. [DOI: 10.1016/j.angio.2014.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Casas D, Rodríguez A, Tapia E, Camacho E, Rodríguez R. Aptitud clínica en médicos familiares apegada a guías de práctica clínica. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/s2214-3106(15)30005-4] [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: 10/23/2022]
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Delgado JV, Martínez AM, Acosta A, Alvarez LA, Armstrong E, Camacho E, Cañón J, Cortés O, Dunner S, Landi V, Marques JR, Martín-Burriel I, Martínez OR, Martínez RD, Melucci L, Muñoz JE, Penedo MCT, Postiglioni A, Quiróz J, Rodellar C, Sponenberg P, Uffo O, Ulloa-Arvizu R, Vega-Pla JL, Villalobos A, Zambrano D, Zaragoza P, Gama LT, Ginja C. Genetic characterization of Latin-American Creole cattle using microsatellite markers. Anim Genet 2011; 43:2-10. [PMID: 22221019 DOI: 10.1111/j.1365-2052.2011.02207.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Genetic diversity in and relationships among 26 Creole cattle breeds from 10 American countries were assessed using 19 microsatellites. Heterozygosities, F-statistics estimates, genetic distances, multivariate analyses and assignment tests were performed. The levels of within-breed diversity detected in Creole cattle were considerable and higher than those previously reported for European breeds, but similar to those found in other Latin American breeds. Differences among breeds accounted for 8.4% of the total genetic variability. Most breeds clustered separately when the number of pre-defined populations was 21 (the most probable K value), with the exception of some closely related breeds that shared the same cluster and others that were admixed. Despite the high genetic diversity detected, significant inbreeding was also observed within some breeds, and heterozygote excess was detected in others. These results indicate that Creoles represent important reservoirs of cattle genetic diversity and that appropriate conservation measures should be implemented for these native breeds in order to minimize inbreeding and uncontrolled crossbreeding.
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Affiliation(s)
- J V Delgado
- Departamento de Genética, Universidad de Córdoba, Campus Rabanales Edificio Gregor Mendel, Córdoba, Spain
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Vílchez F, Camacho E, Alcaraz I, López N, Herrera E. Dermatomyositis and Livedoid Vasculopathy as the Initial Manifestation of a Tumor. Actas Dermo-Sifiliográficas (English Edition) 2011. [DOI: 10.1016/s1578-2190(11)70777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Aamodt K, Abel N, Abeysekara U, Abrahantes Quintana A, Abramyan A, Adamová D, Aggarwal MM, Aglieri Rinella G, Agocs AG, Aguilar Salazar S, Ahammed Z, Ahmad A, Ahmad N, Ahn SU, Akimoto R, Akindinov A, Aleksandrov D, Alessandro B, Alfaro Molina R, Alici A, Almaráz Aviña E, Alme J, Alt T, Altini V, Altinpinar S, Andrei C, Andronic A, Anelli G, Angelov V, Anson C, Anticić T, Antinori F, Antinori S, Antipin K, Antończyk D, Antonioli P, Anzo A, Aphecetche L, Appelshäuser H, Arcelli S, Arceo R, Arend A, Armesto N, Arnaldi R, Aronsson T, Arsene IC, Asryan A, Augustinus A, Averbeck R, Awes TC, Aystö J, Azmi MD, Bablok S, Bach M, Badalà A, Baek YW, Bagnasco S, Bailhache R, Bala R, Baldisseri A, Baldit A, Bán J, Barbera R, Barnaföldi GG, Barnby LS, Barret V, Bartke J, Barile F, Basile M, Basmanov V, Bastid N, Bathen B, Batigne G, Batyunya B, Baumann C, Bearden IG, Becker B, Belikov I, Bellwied R, Belmont-Moreno E, Belogianni A, Benhabib L, Beole S, Berceanu I, Bercuci A, Berdermann E, Berdnikov Y, Betev L, Bhasin A, Bhati AK, Bianchi L, Bianchi N, Bianchin C, Bielcík J, Bielcíková J, Bilandzic A, Bimbot L, Biolcati E, Blanc A, Blanco F, Blanco F, Blau D, Blume C, Boccioli M, Bock N, Bogdanov A, Bøggild H, Bogolyubsky M, Bohm J, Boldizsár L, Bombara M, Bombonati C, Bondila M, Borel H, Borisov A, Bortolin C, Bose S, Bosisio L, Bossú F, Botje M, Böttger S, Bourdaud G, Boyer B, Braun M, Braun-Munzinger P, Bravina L, Bregant M, Breitner T, Bruckner G, Brun R, Bruna E, Bruno GE, Budnikov D, Buesching H, Buncic P, Busch O, Buthelezi Z, Caffarri D, Cai X, Caines H, Calvo E, Camacho E, Camerini P, Campbell M, Canoa Roman V, Capitani GP, Cara Romeo G, Carena F, Carena W, Carminati F, Casanova Díaz A, Caselle M, Castillo Castellanos J, Castillo Hernandez JF, Catanescu V, Cattaruzza E, Cavicchioli C, Cerello P, Chambert V, Chang B, Chapeland S, Charpy A, Charvet JL, Chattopadhyay S, Chattopadhyay S, Cherney M, Cheshkov C, Cheynis B, Chiavassa E, Chibante Barroso V, Chinellato DD, Chochula P, Choi K, Chojnacki M, Christakoglou P, Christensen CH, Christiansen P, Chujo T, Chuman F, Cicalo C, Cifarelli L, Cindolo F, Cleymans J, Cobanoglu O, Coffin JP, Coli S, Colla A, Conesa Balbastre G, Conesa Del Valle Z, Conner ES, Constantin P, Contin G, Contreras JG, Corrales Morales Y, Cormier TM, Cortese P, Cortés Maldonado I, Cosentino MR, Costa F, Cotallo ME, Crescio E, Crochet P, Cuautle E, Cunqueiro L, Cussonneau J, Dainese A, Dalsgaard HH, Danu A, Das I, Dash A, Dash S, de Barros GOV, De Caro A, de Cataldo G, de Cuveland J, De Falco A, De Gaspari M, de Groot J, De Gruttola D, De Marco N, De Pasquale S, De Remigis R, de Rooij R, de Vaux G, Delagrange H, Delgado Y, Dellacasa G, Deloff A, Demanov V, Dénes E, Deppman A, D'Erasmo G, Derkach D, Devaux A, Di Bari D, Di Giglio C, Di Liberto S, Di Mauro A, Di Nezza P, Dialinas M, Díaz L, Díaz R, Dietel T, Divià R, Djuvsland O, Dobretsov V, Dobrin A, Dobrowolski T, Dönigus B, Domínguez I, Don DMM, Dordic O, Dubey AK, Dubuisson J, Ducroux L, Dupieux P, Dutta Majumdar AK, Dutta Majumdar MR, Elia D, Emschermann D, Enokizono A, Espagnon B, Estienne M, Esumi S, Evans D, Evrard S, Eyyubova G, Fabjan CW, Fabris D, Faivre J, Falchieri D, Fantoni A, Fasel M, Fateev O, Fearick R, Fedunov A, Fehlker D, Fekete V, Felea D, Fenton-Olsen B, Feofilov G, Fernández Téllez A, Ferreiro EG, Ferretti A, Ferretti R, Figueredo MAS, Filchagin S, Fini R, Fionda FM, Fiore EM, Floris M, Fodor Z, Foertsch S, Foka P, Fokin S, Formenti F, Fragiacomo E, Fragkiadakis M, Frankenfeld U, Frolov A, Fuchs U, Furano F, Furget C, Fusco Girard M, Gaardhøje JJ, Gadrat S, Gagliardi M, Gago A, Gallio M, Ganoti P, Ganti MS, Garabatos C, García Trapaga C, Gebelein J, Gemme R, Germain M, Gheata A, Gheata M, Ghidini B, Ghosh P, Giraudo G, Giubellino P, Gladysz-Dziadus E, Glasow R, Glässel P, Glenn A, Gómez Jiménez R, González Santos H, González-Trueba LH, González-Zamora P, Gorbunov S, Gorbunov Y, Gotovac S, Gottschlag H, Grabski V, Grajcarek R, Grelli A, Grigoras A, Grigoras C, Grigoriev V, Grigoryan A, Grigoryan S, Grinyov B, Grion N, Gros P, Grosse-Oetringhaus JF, Grossiord JY, Grosso R, Guber F, Guernane R, Guerra C, Guerzoni B, Gulbrandsen K, Gulkanyan H, Gunji T, Gupta A, Gupta R, Gustafsson HA, Gutbrod H, Haaland O, Hadjidakis C, Haiduc M, Hamagaki H, Hamar G, Hamblen J, Han BH, Harris JW, Hartig M, Harutyunyan A, Hasch D, Hasegan D, Hatzifotiadou D, Hayrapetyan A, Heide M, Heinz M, Helstrup H, Herghelegiu A, Hernández C, Herrera Corral G, Herrmann N, Hetland KF, Hicks B, Hiei A, Hille PT, Hippolyte B, Horaguchi T, Hori Y, Hristov P, Hrivnácová I, Hu S, Huang M, Huber S, Humanic TJ, Hutter D, Hwang DS, Ichou R, Ilkaev R, Ilkiv I, Inaba M, Innocenti PG, Ippolitov M, Irfan M, Ivan C, Ivanov A, Ivanov M, Ivanov V, Iwasaki T, Jachołkowski A, Jacobs P, Jancurová L, Jangal S, Janik R, Jena C, Jena S, Jirden L, Jones GT, Jones PG, Jovanović P, Jung H, Jung W, Jusko A, Kaidalov AB, Kalcher S, Kalinák P, Kalisky M, Kalliokoski T, Kalweit A, Kamal A, Kamermans R, Kanaki K, Kang E, Kang JH, Kapitan J, Kaplin V, Kapusta S, Karavichev O, Karavicheva T, Karpechev E, Kazantsev A, Kebschull U, Keidel R, Khan MM, Khan SA, Khanzadeev A, Kharlov Y, Kikola D, Kileng B, Kim DJ, Kim DS, Kim DW, Kim HN, Kim J, Kim JH, Kim JS, Kim M, Kim M, Kim SH, Kim S, Kim Y, Kirsch S, Kisel I, Kiselev S, Kisiel A, Klay JL, Klein J, Klein-Bösing C, Kliemant M, Klovning A, Kluge A, Knichel ML, Kniege S, Koch K, Kolevatov R, Kolojvari A, Kondratiev V, Kondratyeva N, Konevskih A, Kornaś E, Kour R, Kowalski M, Kox S, Kozlov K, Kral J, Králik I, Kramer F, Kraus I, Kravcáková A, Krawutschke T, Krivda M, Krumbhorn D, Krus M, Kryshen E, Krzewicki M, Kucheriaev Y, Kuhn C, Kuijer PG, Kumar L, Kumar N, Kupczak R, Kurashvili P, Kurepin A, Kurepin AN, Kuryakin A, Kushpil S, Kushpil V, Kutouski M, Kvaerno H, Kweon MJ, Kwon Y, La Rocca P, Lackner F, Ladrón de Guevara P, Lafage V, Lal C, Lara C, Larsen DT, Laurenti G, Lazzeroni C, Le Bornec Y, Le Bris N, Lee H, Lee KS, Lee SC, Lefèvre F, Lenhardt M, Leistam L, Lehnert J, Lenti V, León H, León Monzón I, León Vargas H, Lévai P, Li X, Li Y, Lietava R, Lindal S, Lindenstruth V, Lippmann C, Lisa MA, Liu L, Loginov V, Lohn S, Lopez X, López Noriega M, López-Ramírez R, López Torres E, Løvhøiden G, Lozea Feijo Soares A, Lu S, Lunardon M, Luparello G, Luquin L, Lutz JR, Ma K, Ma R, Madagodahettige-Don DM, Maevskaya A, Mager M, Mahapatra DP, Maire A, Makhlyueva I, Mal'kevich D, Malaev M, Malagalage KJ, Maldonado Cervantes I, Malek M, Malkiewicz T, Malzacher P, Mamonov A, Manceau L, Mangotra L, Manko V, Manso F, Manzari V, Mao Y, Mares J, Margagliotti GV, Margotti A, Marín A, Martashvili I, Martinengo P, Martínez Hernández MI, Martínez Davalos A, Martínez García G, Maruyama Y, Marzari Chiesa A, Masciocchi S, Masera M, Masetti M, Masoni A, Massacrier L, Mastromarco M, Mastroserio A, Matthews ZL, Matyja A, Mayani D, Mazza G, Mazzoni MA, Meddi F, Menchaca-Rocha A, Mendez Lorenzo P, Meoni M, Mercado Pérez J, Mereu P, Miake Y, Michalon A, Miftakhov N, Milano L, Milosevic J, Minafra F, Mischke A, Miśkowiec D, Mitu C, Mizoguchi K, Mlynarz J, Mohanty B, Molnar L, Mondal MM, Montaño Zetina L, Monteno M, Montes E, Morando M, Moretto S, Morsch A, Moukhanova T, Muccifora V, Mudnic E, Muhuri S, Müller H, Munhoz MG, Munoz J, Musa L, Musso A, Nandi BK, Nania R, Nappi E, Navach F, Navin S, Nayak TK, Nazarenko S, Nazarov G, Nedosekin A, Nendaz F, Newby J, Nianine A, Nicassio M, Nielsen BS, Nikolaev S, Nikolic V, Nikulin S, Nikulin V, Nilsen BS, Nilsson MS, Noferini F, Nomokonov P, Nooren G, Novitzky N, Nyatha A, Nygaard C, Nyiri A, Nystrand J, Ochirov A, Odyniec G, Oeschler H, Oinonen M, Okada K, Okada Y, Oldenburg M, Oleniacz J, Oppedisano C, Orsini F, Ortiz Velasquez A, Ortona G, Oskarsson A, Osmic F, Osterman L, Ostrowski P, Otterlund I, Otwinowski J, Ovrebekk G, Oyama K, Ozawa K, Pachmayer Y, Pachr M, Padilla F, Pagano P, Paić G, Painke F, Pajares C, Pal S, Pal SK, Palaha A, Palmeri A, Panse R, Papikyan V, Pappalardo GS, Park WJ, Pastircák B, Pastore C, Paticchio V, Pavlinov A, Pawlak T, Peitzmann T, Pepato A, Pereira H, Peressounko D, Pérez C, Perini D, Perrino D, Peryt W, Peschek J, Pesci A, Peskov V, Pestov Y, Peters AJ, Petrácek V, Petridis A, Petris M, Petrov P, Petrovici M, Petta C, Peyré J, Piano S, Piccotti A, Pikna M, Pillot P, Pinazza O, Pinsky L, Pitz N, Piuz F, Platt R, Płoskoń M, Pluta J, Pocheptsov T, Pochybova S, Podesta Lerma PLM, Poggio F, Poghosyan MG, Polák K, Polichtchouk B, Polozov P, Polyakov V, Pommeresch B, Pop A, Posa F, Pospísil V, Potukuchi B, Pouthas J, Prasad SK, Preghenella R, Prino F, Pruneau CA, Pshenichnov I, Puddu G, Pujahari P, Pulvirenti A, Punin A, Punin V, Putis M, Putschke J, Quercigh E, Rachevski A, Rademakers A, Radomski S, Räihä TS, Rak J, Rakotozafindrabe A, Ramello L, Ramírez Reyes A, Rammler M, Raniwala R, Raniwala S, Räsänen SS, Rashevskaya I, Rath S, Read KF, Real JS, Redlich K, Renfordt R, Reolon AR, Reshetin A, Rettig F, Revol JP, Reygers K, Ricaud H, Riccati L, Ricci RA, Richter M, Riedler P, Riegler W, Riggi F, Rivetti A, Rodriguez Cahuantzi M, Røed K, Röhrich D, Román López S, Romita R, Ronchetti F, Rosinský P, Rosnet P, Rossegger S, Rossi A, Roukoutakis F, Rousseau S, Roy C, Roy P, Rubio-Montero AJ, Rui R, Rusanov I, Russo G, Ryabinkin E, Rybicki A, Sadovsky S, Safarík K, Sahoo R, Saini J, Saiz P, Sakata D, Salgado CA, Salgueiro Domingues da Silva R, Salur S, Samanta T, Sambyal S, Samsonov V, Sándor L, Sandoval A, Sano M, Sano S, Santo R, Santoro R, Sarkamo J, Saturnini P, Scapparone E, Scarlassara F, Scharenberg RP, Schiaua C, Schicker R, Schindler H, Schmidt C, Schmidt HR, Schossmaier K, Schreiner S, Schuchmann S, Schukraft J, Schutz Y, Schwarz K, Schweda K, Scioli G, Scomparin E, Scott PA, Segato G, Semenov D, Senyukov S, Seo J, Serci S, Serkin L, Serradilla E, Sevcenco A, Sgura I, Shabratova G, Shahoyan R, Sharkov G, Sharma N, Sharma S, Shigaki K, Shimomura M, Shtejer K, Sibiriak Y, Siciliano M, Sicking E, Siddi E, Siemiarczuk T, Silenzi A, Silvermyr D, Simili E, Simonetti G, Singaraju R, Singh R, Singhal V, Sinha BC, Sinha T, Sitar B, Sitta M, Skaali TB, Skjerdal K, Smakal R, Smirnov N, Snellings R, Snow H, Søgaard C, Soloviev A, Soltveit HK, Soltz R, Sommer W, Son CW, Son H, Song M, Soos C, Soramel F, Soyk D, Spyropoulou-Stassinaki M, Srivastava BK, Stachel J, Staley F, Stan E, Stefanek G, Stefanini G, Steinbeck T, Stenlund E, Steyn G, Stocco D, Stock R, Stolpovsky P, Strmen P, Suaide AAP, Subieta Vásquez MA, Sugitate T, Suire C, Sumbera M, Susa T, Swoboda D, Symons J, Szanto de Toledo A, Szarka I, Szostak A, Szuba M, Tadel M, Tagridis C, Takahara A, Takahashi J, Tanabe R, Tapia Takaki JD, Taureg H, Tauro A, Tavlet M, Tejeda Muñoz G, Telesca A, Terrevoli C, Thäder J, Tieulent R, Tlusty D, Toia A, Tolyhy T, Torcato de Matos C, Torii H, Torralba G, Toscano L, Tosello F, Tournaire A, Traczyk T, Tribedy P, Tröger G, Truesdale D, Trzaska WH, Tsiledakis G, Tsilis E, Tsuji T, Tumkin A, Turrisi R, Turvey A, Tveter TS, Tydesjö H, Tywoniuk K, Ulery J, Ullaland K, Uras A, Urbán J, Urciuoli GM, Usai GL, Vacchi A, Vala M, Valencia Palomo L, Vallero S, van der Kolk N, Vande Vyvre P, van Leeuwen M, Vannucci L, Vargas A, Varma R, Vasiliev A, Vassiliev I, Vasileiou M, Vechernin V, Venaruzzo M, Vercellin E, Vergara S, Vernet R, Verweij M, Vetlitskiy I, Vickovic L, Viesti G, Vikhlyantsev O, Vilakazi Z, Villalobos Baillie O, Vinogradov A, Vinogradov L, Vinogradov Y, Virgili T, Viyogi YP, Vodopianov A, Voloshin K, Voloshin S, Volpe G, von Haller B, Vranic D, Vrláková J, Vulpescu B, Wagner B, Wagner V, Wallet L, Wan R, Wang D, Wang Y, Wang Y, Watanabe K, Wen Q, Wessels J, Westerhoff U, Wiechula J, Wikne J, Wilk A, Wilk G, Williams MCS, Willis N, Windelband B, Xu C, Yang C, Yang H, Yasnopolskiy S, Yermia F, Yi J, Yin Z, Yokoyama H, Yoo IK, Yuan X, Yurevich V, Yushmanov I, Zabrodin E, Zagreev B, Zalite A, Zampolli C, Zanevsky Y, Zaporozhets S, Zarochentsev A, Závada P, Zbroszczyk H, Zelnicek P, Zenin A, Zepeda A, Zgura I, Zhalov M, Zhang X, Zhou D, Zhou S, Zhu J, Zichichi A, Zinchenko A, Zinovjev G, Zoccarato Y, Zychácek V, Zynovyev M. Midrapidity antiproton-to-proton ratio in pp collisons at sqrt[s]=0.9 and 7 TeV measured by the ALICE experiment. Phys Rev Lett 2010; 105:072002. [PMID: 20868032 DOI: 10.1103/physrevlett.105.072002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Indexed: 05/29/2023]
Abstract
The ratio of the yields of antiprotons to protons in pp collisions has been measured by the ALICE experiment at sqrt[s]=0.9 and 7 TeV during the initial running periods of the Large Hadron Collider. The measurement covers the transverse momentum interval 0.45<p_{t}<1.05 GeV/c and rapidity |y|<0.5. The ratio is measured to be R_{|y|<0.5}=0.957±0.006(stat)±0.014(syst) at 0.9 TeV and R_{|y|<0.5}=0.991±0.005(stat)±0.014(syst) at 7 TeV and it is independent of both rapidity and transverse momentum. The results are consistent with the conventional model of baryon-number transport and set stringent limits on any additional contributions to baryon-number transfer over very large rapidity intervals in pp collisions.
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Affiliation(s)
- K Aamodt
- Department of Physics, University of Oslo, Oslo, Norway
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Holliday KL, McBeth J, Thomson W, Goodson NJ, Smith BH, Goebel A, Goulston LM, Soni A, White KM, Kiran A, Javaid MK, Hart DJ, Spector TD, Arden NK, Stahl E, Eyre S, Hinks A, Barton A, Flynn E, Lee A, Coblyn J, Xie G, Padyukov L, Chen R, Siminovitch K, Klareskog L, Raychaudhuri S, Gregersen P, Plenge R, Worthington J, Chen Y, Dawes PT, Mattey DL, Camacho E, Farragher T, Lunt M, Verstappen S, Bunn D, Symmons D, Mirjafari H, Farragher T, Verstappen SM, Charlton-Menys V, Bunn D, Marshall T, Edlin H, Wilson P, Symmons DP, Bruce IN, Hinks A, Moncrieffe H, Martin P, Lal SD, Ursu S, Kassoumeri L, Wedderburn LR, Thomson W. Concurrent Oral 3 - Genetics and Epidemiology [OP16-OP23]: OP16. Genetic Variation in the Dream Pain Modulation Pathway is Associated with the Extent of Musculoskeletal Pain. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq703] [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: 11/12/2022] Open
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Diéguez MC, Cerecedo I, Muriel A, Zamora J, Abraira V, Camacho E, Antón M, de la Hoz B. Utility of diagnostic tests in the follow-up of egg-allergic children. Clin Exp Allergy 2009; 39:1575-84. [DOI: 10.1111/j.1365-2222.2009.03299.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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López N, Alcaraz I, Cid-Mañas J, Camacho E, Herrera-Acosta E, Matilla A, Herrera E. Wolf's isotopic response: zosteriform morphea appearing at the site of healed herpes zoster in a HIV patient. J Eur Acad Dermatol Venereol 2009; 23:90-2. [DOI: 10.1111/j.1468-3083.2008.02711.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Urbano M, Rosa A, Gomes D, Camacho E, Calhau CA, Leitão M. Team approach to ERCP-directed single-brush cytology for the diagnosis of malignancy. Rev esp enferm dig 2008; 100:462-5. [DOI: 10.4321/s1130-01082008000800003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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García CM, Carmena R, García R, Berges P, Camacho E, Cotter MP, De La Hoz B. Fixed drug eruption from ticlopidine, with positive lesional patch test. Contact Dermatitis 2008. [DOI: 10.1034/j.1600-0536.2001.440107-7.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- M Areia
- Department of Gastroenterology, Coimbra University Hospital, Coimbra, Portugal.
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Cuatrecasas M, Santamaria G, Velasco M, Camacho E, Hernandez L, Sanchez M, Orrit C, Murcia C, Cardesa A, Campo E, Fernandez PL. ATM gene expression is associated with differentiation and angiogenesis in infiltrating breast carcinomas. Histol Histopathol 2006; 21:149-56. [PMID: 16329039 DOI: 10.14670/hh-21.149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The product of the ATM gene, mutated in the human genetic disorder ataxia-telangiectasia (A-T) plays a key role in the detection and repair of DNA double-strand breaks. A-T is defined by progressive cerebellar ataxia, telangiectasia, sensitivity to ionising radiation and genomic instability with cancer predisposition. On the other hand, increased angiogenesis is essential for tumor growth and metastasis. The aim of this study was to investigate ATM expression in breast carcinomas and its relationship to neoangiogenesis. METHODS AND RESULTS Fifty-two breast tumors from 51 patients, 38 of them with concomitant in situ component (CIS), were analyzed by immunohistochemistry for the expression of ATM. CD34 expression was used for the morphometric evaluation of vasculature. ATM was positive in 1 to 10% of normal epithelial cells. ATM expression was reduced in 55.8% of infiltrating carcinomas, non-reduced in 34.6%, and increased in 9.6%. Expression of ATM in CIS was similar to the infiltrating component in 71% of cases and reduced in 23.7% of them. High-grade ductal infiltrating carcinomas showed lower ATM expression than low-grade ones. Reduced ATM expression also correlated with increased microvascular area. CONCLUSIONS Reduced ATM expression in breast carcinomas correlated with tumor differentiation and increased microvascular parameters, supporting its role in neoangiogenesis and tumor progression in breast carcinogenesis.
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MESH Headings
- Antigens, CD34/analysis
- Ataxia Telangiectasia Mutated Proteins
- Breast Neoplasms/blood supply
- Breast Neoplasms/chemistry
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/blood supply
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/physiology
- Cell Differentiation
- DNA Damage
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/physiology
- Disease Progression
- Down-Regulation
- Female
- Gene Expression Regulation, Neoplastic/physiology
- Humans
- Immunohistochemistry
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/physiopathology
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/physiology
- Tumor Suppressor Proteins/genetics
- Tumor Suppressor Proteins/physiology
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Affiliation(s)
- M Cuatrecasas
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain.
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Neves P, Leitão M, Portela F, Pontes JM, Areia M, Brito D, Sousa HT, Souto P, Camacho E, Andrade P, Gouveia H, Freitas D. Endoscopic resection of ampullary carcinoma. Endoscopy 2006; 38:101. [PMID: 16429371 DOI: 10.1055/s-2006-925039] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- P Neves
- Dept. of Gastroenterology, University Hospitals of Coimbra, Coimbra, Portugal.
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Miranda C, Camacho E, Reina G, Turiño J, Rodríguez-Granger J, Yeste R, Bautista MF, García M, Alados JC, De la Rosa M. Isolation of Mycoplasma hominis from extragenital cultures. Eur J Clin Microbiol Infect Dis 2005; 24:334-7. [PMID: 15868155 DOI: 10.1007/s10096-005-1326-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 10/25/2022]
Abstract
In order to document the characteristics of extragenital Mycoplasma hominis infections, the clinical features of 36 cases in which M. hominis was isolated from extragenital sites of adult patients were reviewed. In most cases, the organism was detected in conventional bacterial cultures (from specimens obtained from surgical and immunosuppressed patients) that had been incubated for at least 72 h. The results indicate that in cases in which M. hominis involvement is suspected, prolonged incubation or specialized microbiological techniques for detecting Mycoplasma spp. should be employed.
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Affiliation(s)
- C Miranda
- Department of Microbiology, Virgen de las Nieves University Hospital, Avenida Fuerzas Armadas 2, 18014 Granada, Spain.
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Barata F, Camacho E, Sousa A, Costa M, Resende R, Meleiro A, Nogueira F, Pereira A, Canário D. P-449 Docetaxel in combination carboplatin as first-line treatment of patients with inoperable, locally advanced or metastatic non-small cell lung cancer. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80942-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tort F, Hernández S, Beà S, Camacho E, Fernández V, Esteller M, Fraga MF, Burek C, Rosenwald A, Hernández L, Campo E. Checkpoint kinase 1 (CHK1) protein and mRNA expression is downregulated in aggressive variants of human lymphoid neoplasms. Leukemia 2005; 19:112-7. [PMID: 15526025 DOI: 10.1038/sj.leu.2403571] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [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: 11/08/2022]
Abstract
CHK1: gene encodes for a serine/threonine kinase involved in the regulation of cell cycle progression and DNA damage checkpoints. To determine the role of CHK1 in the pathogenesis of lymphoid neoplasms and its relationship to other DNA damage response genes, we have analyzed the gene status, protein, and mRNA expression in a series of tumors and nonneoplastic lymphoid tissues. CHK1 protein and mRNA expression levels were very low in both reactive tissues and resting lymphoid cells, whereas tumor samples showed a variable pattern of expression related to their proliferative activity. However, seven aggressive tumors showed a dissociate pattern of extremely low or negative protein expression in spite of a high proliferative activity. Four of these tumors were diffuse large B-cell lymphomas (DLCLs) with concordant reduced levels of mRNA, whereas one blastoid mantle cell lymphoma (B-MCL) and two DLCLs had relatively normal levels of mRNA. No gene mutations, deletions, or hypermethylation of the promoter region were detected in any of these cases. In all these tumors ATM, CHK2, and p53 genes were wild type. These findings suggest that CHK1 inactivation in NHLs occurs by loss of protein expression in a subset of aggressive variants alternatively to ATM, CHK2, and p53 alterations.
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Affiliation(s)
- F Tort
- Laboratory of Pathology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villaroel 170, 08036 Barcelona, Spain
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Jagannath S, Durie B, Wolf J, Camacho E, Irwin D, Lutzky J, McKinley M, Gabayan E, Crowley J, Schenkein DP. First-line therapy with bortezomib (formerly PS-341) in patients with multiple myeloma (MM). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Jagannath
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - B. Durie
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - J. Wolf
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - E. Camacho
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - D. Irwin
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - J. Lutzky
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - M. McKinley
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - E. Gabayan
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - J. Crowley
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - D. P. Schenkein
- St. Vincent's Comprehensive Cancer Center, New York, NY; Salick Health Care Research Network, Los Angeles, CA; Cancer Research and Biostatistics, Seattle, WA; Millennium Pharmaceuticals, Inc., Cambridge, MA
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Martín-García C, Hinojosa M, Berges P, Camacho E, García-Rodriguez R, Alfaya T. Celecoxib, a highly selective COX-2 inhibitor, is safe in aspirin-induced asthma patients. J Investig Allergol Clin Immunol 2003; 13:20-5. [PMID: 12861847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND In 5-10% of adult patients with asthma, aspirin and most other nonsteroidal anti-inflammatory drugs (NSAIDs) precipitate acute asthmatic attacks. Therefore, choosing an alternative anti-inflammatory agent for patients who have suffered adverse reactions to a nonsteroidal anti-inflammatory agent is a common problem in clinical practice. The discoveries that cyclooxygenase COX-2 is an inducible form of COX involved in inflammation and COX-1 is the major isoform responsible for the production of prostaglandins have provided a reasonable basis for the development of specific COX-2 inhibitors as a new class of anti-inflammatory agents. OBJECTIVE The purpose of this study is to demonstrate that celecoxib, a specific inhibitor of COX-2, does not cause asthmatic attacks in patients with aspirin and/or other nonsteroidal anti-inflammatory drug-induced asthma. METHODS We studied 33 patients, all of whom suffered from asthma induced by at least two different NSAID drugs. They were challenged in a single-blind manner with different doses of celecoxib on three different days, until either the therapeutic dose of 200 mg or intolerance was reached. Each patient was rechallenged with 200 mg celecoxib seven days later if no evidence of intolerance was previously observed. RESULTS Celecoxib 200 mg was proven to be well tolerated in all 30 three aspirin- and NSAID-induced asthma patients. CONCLUSION Our study appears to demonstrate that celecoxib is a suitable NSAID in aspirin-induced and/or nonsteroidal anti-inflammatory drug-induced asthma patients.
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Affiliation(s)
- C Martín-García
- Department of Allergy, Hospital Ramón y Cajal, Madrid, Spain
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Moreno C, Fernández-Távora L, Acero S, Alonso MD, Barasona MJ, Blanco R, Cisteró A, Conde J, Fernández J, Fernández S, Fernández-Rivas M, García BE, García-Rodríguez R, Camacho E, González-Quevedo T, Gonzalo A, Guardia P, Sánchez-Cano M, Tabar AI, de la Torre F. Tolerance of a cluster schedule on the treatment of seasonal allergic respiratory disease with pollen extracts quantified in mass units. J Investig Allergol Clin Immunol 2003; 13:221-7. [PMID: 14989109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
In order to evaluate the tolerance of a cluster schedule on specific immunotherapy (SIT), 306 patients were included in a multicenter study. The patients were suffering from rhinoconjunctivitis with/without asthma, caused by sensitization to olive and/or grass pollen. SIT was administered subcutaneously according to a cluster schedule in which the maintenance dose is reached after four visits (3 weeks). The extracts were biologically standardized with major allergens quantified in mass units. Local reactions appeared in 7.2% of the patients and 1.3% of the doses. Systemic reactions (SR) were recorded in 1.2% of the doses administered to 9.5% of the patients. No anaphylactic shock was registered, and all the SR responded fully and rapidly to treatment. There was no difference in SR according to diagnosis or allergen extract used. The majority of SR occurred with the administration of vial of higher concentration (Vial 2: 7 SR (22%), Vial 3: 32 SR (78%), p < 0.05). Of the 32 SR recorded with Vial 3, 13 (41%) were immediate, with no existing association between dose administered and appearance of SR. However, of the 18 delayed SR (56%), 14 occurred after the administration of the first two doses of Vial 3 and four occurred after administration of the second two doses (78% vs 22%, p < 0.05). On the other hand, this regime realized an important saving in cost and time compared to the conventional schedule (1581 fewer doses and 2754 fewer visits were necessary to reach the optimal dose). Considering all these factors, the clinical profile of the proposed regime may be qualified as good. However, future studies are necessary in order to better adjust the schedule to avoid the delayed SR that occurred after the administration of the first two doses of Vial 3.
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Affiliation(s)
- C Moreno
- Hospital Reina Sofía, Córdoba, Spain
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Espinosa A, Entrena A, Gallo MA, Campos J, Dominguez JF, Camacho E, Garrido R. Conformational analysis of some 1,4-dioxepane systems. 2. Methoxy-1,4-dioxepanes. J Org Chem 2002. [DOI: 10.1021/jo00311a020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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García CM, Carmena R, García R, Berges P, Camacho E, Cotter MP, de la Hoz B. Fixed drug eruption from ticlopidine, with positive lesional patch test. Contact Dermatitis 2001; 44:40-1. [PMID: 11156015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- C M García
- Department of Allergy, Hospital Ramón y Cajal, Madrid, Spain
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