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Farmer AJ, Allen J, Bartlett YK, Bower P, Chi Y, French DP, Gudgin B, Holmes E, Horne R, Hughes DA, Jones L, Kenning C, Locock L, McSharry J, Miles L, Newhouse N, Rea R, Robinson S, Tarassenko L, Velardo C, Williams N, Yu LM. Supporting people with type 2 diabetes in effective use of their medicine through mobile health technology integrated with clinical care (SuMMiT-D pilot): results of a feasibility randomised trial. Pilot Feasibility Stud 2024; 10:15. [PMID: 38273420 PMCID: PMC10809651 DOI: 10.1186/s40814-023-01429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The purpose of this 6-month intervention pilot feasibility randomised trial was to test sending brief messages using mobile phones to promote self-management through taking medication as prescribed to people with type 2 diabetes. This was to inform the design and conduct of a future large-scale United Kingdom-based clinical trial and establish the feasibility of recruitment, the technology used, follow-up, and data collection. METHODS A multicentre individually randomised, controlled parallel group trial in primary care, recruiting adults (≥ 35 years) with type 2 diabetes in England. Consenting participants were randomly allocated to receive short message system text messages up to four times a week, or usual care, for a period of 6 months; messages contained behavioural change techniques targeting medication use. The primary outcome was the rate of recruitment to randomisation of participants to the trial with a planned rate of 22 participants randomised per month. The study also aimed to establish the feasibility of follow-up at 6 months, with an aim of retaining more than 80% of participants. Data, including patient-reported measures, were collected at baseline and the end of the 6-month follow-up period, and a notes review was completed at 24 months. RESULTS The trial took place between 26 November 2018 and 30 September 2019. In total 209 participants were randomly allocated to intervention (n = 103) or usual care (n = 106). The maximum rate of monthly recruitment to the trial was 60-80 participants per month. In total, 12,734 messages were sent to participants. Of these messages, 47 were identified as having failed to be sent by the service provider. Participants sent 2,864 messages to the automated messaging system. Baseline data from medical records were available for > 90% of participants with the exception of cholesterol (78.9%). At 6 months, a further HbA1c measurement was reported for 67% of participants. In total medical record data were available at 6 months for 207 (99.0%) of participants and completed self-report data were available for 177 (84.7%) of participants. CONCLUSION The feasibility of a large-scale randomised evaluation of brief message intervention for people with type 2 diabetes appears to be high using this efficient design. Failure rate of sending messages is low, rapid recruitment was achieved among people with type 2 diabetes, clinical data is available on participants from routine medical records and self-report of economic measures was acceptable. TRIAL REGISTRATION ISCTRN ISRCTN13404264. Registered on 10 October 2018.
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Affiliation(s)
- Andrew J Farmer
- University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, Woodstock Road, Oxford, OX2 6GG, UK.
| | | | | | | | - Yuan Chi
- University of Oxford, Oxford, UK
| | | | | | | | | | | | | | | | | | | | - Lisa Miles
- University of Manchester, Manchester, UK
| | | | - Rustam Rea
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Suffridge CP, Shannon KC, Matthews H, Johnson RC, Jeffres C, Mantua N, Ward AE, Holmes E, Kindopp J, Aidoo M, Colwell FS. Connecting thiamine availability to the microbial community composition in Chinook salmon spawning habitats of the Sacramento River basin. Appl Environ Microbiol 2024; 90:e0176023. [PMID: 38084986 PMCID: PMC10807462 DOI: 10.1128/aem.01760-23] [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: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 01/25/2024] Open
Abstract
Thiamine deficiency complex (TDC) is a major emerging threat to global populations of culturally and economically important populations of salmonids. Salmonid eggs and embryos can assimilate exogenous thiamine, and evidence suggests that microbial communities in benthic environments can produce substantial amounts of thiamine. We therefore hypothesize that natural dissolved pools of thiamine exist in the surface water and hyporheic zones of riverine habitats where salmonids with TDC migrate, spawn, and begin their lives. To examine the relationship between dissolved thiamine-related compounds (dTRCs) and their microbial source, we determined the concentrations of these metabolites and the compositions of microbial communities in surface and hyporheic waters of the Sacramento River, California and its tributaries. Here we determine that all dTRCs are present in femto-picomolar concentrations in a range of critically important salmon spawning habitats. We observed that thiamine concentrations in the Sacramento River system are orders of magnitude lower than those of marine waters, indicating substantial differences in thiamine cycling between these two environments. Our data suggest that the hyporheic zone is likely the source of thiamine to the overlying surface water. Temporal variations in dTRC concentrations were observed where the highest concentrations existed when Chinook salmon were actively spawning. Significant correlations were seen between the richness of microbial taxa and dTRC concentrations, particularly in the hyporheic zone, which would influence the conditions where embryonic salmon incubate. Together, these results indicate a connection between microbial communities in freshwater habitats and the availability of thiamine to spawning TDC-impacted California Central Valley Chinook salmon.IMPORTANCEPacific salmon are keystone species with considerable economic importance and immeasurable cultural significance to Pacific Northwest indigenous peoples. Thiamine deficiency complex has recently been diagnosed as an emerging threat to the health and stability of multiple populations of salmonids ranging from California to Alaska. Microbial biosynthesis is the major source of thiamine in marine and aquatic environments. Despite this importance, the concentrations of thiamine and the identities of the microbial communities that cycle it are largely unknown. Here we investigate microbial communities and their relationship to thiamine in Chinook salmon spawning habitats in California's Sacramento River system to gain an understanding of how thiamine availability impacts salmonids suffering from thiamine deficiency complex.
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Affiliation(s)
| | - Kelly C. Shannon
- Department of Microbiology, Oregon State University, Corvallis, Oregon, USA
| | - H. Matthews
- Department of Microbiology, Oregon State University, Corvallis, Oregon, USA
| | - R. C. Johnson
- Fisheries Ecology Division, NOAA Fisheries, Southwest Fisheries Science Center, Santa Cruz, California, USA
- University of California, Center for Watershed Sciences, Davis, California, USA
| | - C. Jeffres
- University of California, Center for Watershed Sciences, Davis, California, USA
| | - N. Mantua
- Fisheries Ecology Division, NOAA Fisheries, Southwest Fisheries Science Center, Santa Cruz, California, USA
| | - A. E. Ward
- University of California, Center for Watershed Sciences, Davis, California, USA
| | - E. Holmes
- University of California, Center for Watershed Sciences, Davis, California, USA
- California Department of Water Resources, West Sacramento, California, USA
| | - J. Kindopp
- California Department of Water Resources, Division of Integrated Science and Engineering, Oroville, California, USA
| | - M. Aidoo
- Bronx Community College, Bronx, New York, USA
| | - F. S. Colwell
- Department of Microbiology, Oregon State University, Corvallis, Oregon, USA
- College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, Oregon, USA
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Jaydev F, Gavin W, Russ J, Holmes E, Kumar V, Sadowski J, Kara A. Discharges against medical advice: time to take another look. A retrospective review of discharges against medical advice focused on prevention. Hosp Pract (1995) 2023; 51:288-294. [PMID: 37994412 DOI: 10.1080/21548331.2023.2287431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/21/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Discharges against medical advice (DAMA) increase the risk of death. METHODS We retrieved DAMA from five hospitals within a large health system and reviewed 10% of DAMA from the academic site between 2016 and 2021. RESULTS DAMA increased at the onset of the pandemic. Patients who discharged AMA multiple times accounted for a third of all DAMA. Detailed review was completed for 278 patients who discharged AMA from the academic site. In this sample, women comprised 52% of those who discharged AMA multiple times. Relative to the proportion of all discharges from the academic site during the study period, Black patients were overrepresented among DAMA (21% vs. 34%, p < .05). Patients with multiple AMA discharges were younger, more likely to be unmarried, or have substance use disorders (SUD) than those who discharged AMA once. The most common reason for requesting premature discharge noted in n = 77, 28% of instances was related to patient obligations outside the hospital. Hospital policies and procedures contributed in n = 29, 10% of instances. Reasons for requesting premature discharge and documentation of key safety processes were similar by gender and race however the sample may be underpowered to detect differences. Capacity was evaluated in 109 (39%). Among those who consumed alcohol (n = 81 (29%)) or had SUDs (n = 112 (40%)), information on the amount or timing of last use was missing in n = 39 (48%) and n = 74 (66%), respectively. Critical tools to manage illness were provided in 45 (16%) of DAMA reviewed. CONCLUSIONS Drivers of AMA discharge may differ by AMA discharge frequency. Recognition of the common reasons for requesting premature discharge may help destigmatize AMA discharges and also identifies early assessments by social work colleagues as an important prevention strategy. Opportunities also exist in anticipating and preventing withdrawal symptoms and in revising hospital practices that contribute to DAMA.
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Affiliation(s)
- Fnu Jaydev
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Warren Gavin
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Jason Russ
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Emily Holmes
- Department of Pscyhiatry, Indiana University School of Medicine, Indianapolis, USA
| | - Vinod Kumar
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Joshua Sadowski
- Infection Prevention, Indiana University Health, Indianapolis, USA
| | - Areeba Kara
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, USA
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Tseng ZJ, Garcia-Lara S, Flynn JJ, Holmes E, Rowe TB, Dickson BV. A switch in jaw form-function coupling during the evolution of mammals. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220091. [PMID: 37183899 PMCID: PMC10184249 DOI: 10.1098/rstb.2022.0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The evolutionary shift from a single-element ear, multi-element jaw to a multi-element ear, single-element jaw during the transition to crown mammals marks one of the most dramatic structural transformations in vertebrates. Research on this transformation has focused on mammalian middle-ear evolution, but a mandible comprising only the dentary is equally emblematic of this evolutionary radiation. Here, we show that the remarkably diverse jaw shapes of crown mammals are coupled with surprisingly stereotyped jaw stiffness. This strength-based morphofunctional regime has a genetic basis and allowed mammalian jaws to effectively resist deformation as they radiated into highly disparate forms with markedly distinct diets. The main functional consequences for the mandible of decoupling hearing and mastication were a trade-off between higher jaw stiffness versus decreased mechanical efficiency and speed compared with non-mammals. This fundamental and consequential shift in jaw form-function underpins the ecological and taxonomic diversification of crown mammals. This article is part of the theme issue 'The mammalian skull: development, structure and function'.
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Affiliation(s)
- Z Jack Tseng
- Department of Integrative Biology, University of California, Berkeley, CA 94720, USA
- Museum of Paleontology, University of California, Berkeley, CA 94720, USA
- Division of Paleontology, American Museum of Natural History, New York, NY 10024, USA
| | - Sergio Garcia-Lara
- Department of Integrative Biology, University of California, Berkeley, CA 94720, USA
- Museum of Paleontology, University of California, Berkeley, CA 94720, USA
| | - John J Flynn
- Division of Paleontology, American Museum of Natural History, New York, NY 10024, USA
- Richard Gilder Graduate School, American Museum of Natural History, New York, NY 10024, USA
| | - Emily Holmes
- Department of Integrative Biology, University of California, Berkeley, CA 94720, USA
| | - Timothy B Rowe
- Jackson School of Geological Sciences, University of Texas, Austin, TX 78712, USA
| | - Blake V Dickson
- Department of Evolutionary Anthropology, Duke University, Durham, NC 27708, USA
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Hartwell JL, Barach P, Gunter TD, Reed K, Kelker H, Welch J, Olson K, Harry E, Meltzer-Brody S, Quinn M, Ferrand J, Kiely SC, Hartsock J, Holmes E, Schroeder K, Ahmed R. Navigating Work-Life Integration, Legal Issues, Patient Safety: Lessons for Work-Life Wellness in Academic Medicine: Part 1 of 3. Kans J Med 2023; 16:153-158. [PMID: 37377624 PMCID: PMC10291991 DOI: 10.17161/kjm.vol16.19952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
In this series of three manuscripts, we will explore real-life scenarios encountered by clinicians, learners, and researchers in healthcare, which challenge our assumptions and our understanding of how to navigate issues as diverse as mental health, racial diversity, gender discrimination, imposter syndrome, and substance use disorder.
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Affiliation(s)
| | - Paul Barach
- Thomas Jefferson School of Medicine, Philadelphia, PA
| | - Tracy D Gunter
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kyra Reed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Heather Kelker
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Julie Welch
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Kristine Olson
- Department of Medicine, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT
| | - Elizabeth Harry
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mariah Quinn
- Department of Medicine, University of Wisconsin School of Medicine and Public Health Madison, Madison, WI
| | | | | | - Jane Hartsock
- Center for Bioethics, Indiana University, Indianapolis, IN
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kristin Schroeder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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Ahmed R, Hartwell JL, Farley H, MacRae J, Rogers DA, Lawrence EC, Brazeau CM, Park EM, Cassidy A, Hartsock J, Holmes E, Schroeder K, Barach P. Navigating Minority and Gender Discrimination, Substance Use Disorder, Financial Distress, and Workplace Politics: Lessons for Work-Life Wellness in Academic Medicine: Part 2 of 3. Kans J Med 2023; 16:159-164. [PMID: 37377619 PMCID: PMC10291990 DOI: 10.17161/kjm.vol16.19953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
In this second of three manuscripts addressing a range of complex work and personal issues, the authors explore case scenarios with characters who work in the fields of general surgery, orthopedic surgery, anesthesiology, neurology, radiology, and otolaryngology. The medical specialty identifiers help inform some baseline understanding of the demands of that particular profession but are less pertinent than the specifics of each case. In this manuscript, the authors dive into the topics of navigating a lawsuit and professional burnout, personal finances, substance use disorder, demands of clinical work and workplace politics, diversity and inclusion, and dealing with major personal illness. The authors provide practical steps to help the readers deal with similar situations and provide insight to support persons on how to improve support structures.
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Affiliation(s)
- Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | | | | | | | - Elizabeth C Lawrence
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM
| | - Chantal Mlr Brazeau
- Department of Family Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Eliza M Park
- Departments of Psychiatry and Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Anna Cassidy
- University of North Carolina, School of Medicine, Chapel Hill, NC
| | - Jane Hartsock
- Center for Bioethics, Indiana University, Indianapolis, IN
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kristen Schroeder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Paul Barach
- Thomas Jefferson School of Medicine, Philadelphia, PA
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Barach P, Ahmed R, Agarwal G, Olson K, Welch J, Chernoby K, Hein CL, Anand T, Joseph B, Rosenstein DL, Sotto-Santiago S, Hartsock J, Holmes E, Schroeder K, Hartwell JL. Navigating Personal Health Crises, Imposter Syndrome, Sexual Harassment, Clinical Mistakes, and Leadership Challenges: Lessons for Work-Life Wellness in Academic Medicine: Part 3 of 3. Kans J Med 2023; 16:165-171. [PMID: 37377621 PMCID: PMC10291980 DOI: 10.17161/kjm.vol16.19954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
In this final manuscript of the three-part series, the authors address issues of imposter syndrome, pregnancy, and parental leave, second victim phenomenon, sexual harassment, response to suicide, and managing a budget while advancing diversity, equity, and inclusion. The case scenarios have learners and non-clinicians as their main characters, bringing attention to the cross-cutting nature of the complex issues we see both in and around a career in medicine.
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Affiliation(s)
- Paul Barach
- Thomas Jefferson School of Medicine, Philadelphia, PA
| | - Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Gaurava Agarwal
- Departments of Medical Education and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kristine Olson
- Department of Medicine, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT
| | - Julie Welch
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Kimberly Chernoby
- Department of Emergency Medicine, National Women's Law Center and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Christine L Hein
- Department of Emergency Medicine, Tufts University School of Medicine, Maine Medical Center, Portland, ME
| | - Tanya Anand
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ
| | - Bellal Joseph
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sylk Sotto-Santiago
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Jane Hartsock
- Center for Bioethics, Indiana University, Indianapolis, IN
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kristen Schroeder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
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Chebib N, Holmes E, Maniewicz S, Abou-Ayash S, Srinivasan M, McKenna G, Kossioni A, Schimmel M, Müller F, Brocklehurst P. Exploring preferences of older adults for dental services: A pilot multi-national discrete choice experiment. Gerodontology 2023. [PMID: 37309614 DOI: 10.1111/ger.12696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel. BACKGROUND The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge. MATERIALS AND METHODS Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random-effects logit model. RESULTS Two hundred and forty-six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: β = 0.944, Switzerland: β = 0.260, UK β = 0.791), rather than a medical doctor (Greece: β = -0.556, Switzerland: β = -0.4690, UK: β = -0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: β = 0.220, UK: β = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (β = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (β = 0.365) in their home (β = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: β = -0.387; UK: β = -0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: β = 0.454, UK: β = 0.695). CONCLUSION Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence.
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Affiliation(s)
- Najla Chebib
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, Bangor University, Bangor, UK
| | - Sabrina Maniewicz
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Samir Abou-Ayash
- Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Murali Srinivasan
- Clinic of General- Special care- and Geriatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Gerald McKenna
- Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Anastasia Kossioni
- Division of Gerodontology, Department of Prosthodontics, Dental School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Martin Schimmel
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, Bangor University, Bangor, UK
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Johnson S, Marshall A, Hughes D, Holmes E, Henrich F, Nurmikko T, Sharma M, Frank B, Bassett P, Marshall A, Magerl W, Goebel A. Correction: Mechanistically informed non-invasive peripheral nerve stimulation for peripheral neuropathic pain: a randomised double-blind sham-controlled trial. J Transl Med 2023; 21:289. [PMID: 37120561 PMCID: PMC10148541 DOI: 10.1186/s12967-023-04131-5] [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: 05/01/2023] Open
Affiliation(s)
- Selina Johnson
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK.
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | - Anne Marshall
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation (CHEME) Department, Bangor University, Bangor, Wales, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation (CHEME) Department, Bangor University, Bangor, Wales, UK
| | - Florian Henrich
- Department of Neurophysiology, Mannheim Centre for Translational Neurosciences, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Heidelberg, Germany
| | - Turo Nurmikko
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
| | - Manohar Sharma
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
| | - Bernhard Frank
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Andrew Marshall
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Walter Magerl
- Department of Neurophysiology, Mannheim Centre for Translational Neurosciences, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Heidelberg, Germany
| | - Andreas Goebel
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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Asselbergs J, van Bentum J, Riper H, Cuijpers P, Holmes E, Sijbrandij M. A systematic review and meta-analysis of the effect of cognitive interventions to prevent intrusive memories using the trauma film paradigm. J Psychiatr Res 2023; 159:116-129. [PMID: 36708636 DOI: 10.1016/j.jpsychires.2023.01.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
There is an unmet need for effective early interventions that can relieve initial trauma symptoms and reduce symptoms of posttraumatic stress disorder (PTSD). We evaluated the efficacy of cognitive interventions compared to control in reducing intrusion frequency and PTSD symptoms in healthy individuals using the trauma film paradigm, in which participants view a film with aversive content as an experimental analogue of trauma exposure. A systematic literature search identified 41 experiments of different cognitive interventions targeting intrusions. In the meta-analysis, the pooled effect size of 52 comparisons comparing cognitive interventions to no-intervention controls on intrusions was moderate (g = -0.46, 95% CI [-0.61 to -0.32], p < .001). The pooled effect size of 16 comparisons on PTSD symptoms was also moderate (g = -0.31, 95% CI [-0.46 to -0.17], p < .001). Both visuospatial interference and imagery rescripting tasks were associated with significantly fewer intrusions than controls, whereas verbal interference and meta-cognitive processing tasks showed nonsignificant effect sizes. Interventions administered after viewing the trauma film showed significantly fewer intrusions than controls, whereas interventions administered during film viewing did not. No experiments had low risk of bias (ROB), 37 experiments had some concerns of ROB, while the remaining four experiments had high ROB. To the best of our knowledge, this is the first meta-analysis investigating the efficacy of cognitive interventions targeting intrusions in non-clinical samples. Results seem to be in favour of visuospatial interference tasks rather than verbal tasks. More research is needed to develop an evidence base on the efficacy of various cognitive interventions and test their clinical translation to reduce intrusive memories of real trauma.
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Affiliation(s)
- Joost Asselbergs
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands
| | - Jaёl van Bentum
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Faculty of Social and Behavioural Sciences, Dept. of Clinical Psychology, Universiteit Utrecht, Heidelberglaan 1, 3584 CS, Utrecht, Netherlands.
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Medical Centre, VUmc, Dept. of Psychiatry, Amsterdam, the Netherlands; Research Unit for Telepsychiatry and E-Mental Health, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark
| | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, the Netherlands
| | - Emily Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, the Netherlands
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11
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Connors JN, Kroenke K, Monahan P, Chernyak Y, Pettit K, Hayden J, Montgomery C, Brenner G, Millard M, Holmes E, Musey P. Comparing the effectiveness of existing anxiety treatment options among patients evaluated for chest pain and anxiety in the emergency department setting: Study protocol for the PACER pragmatic randomized comparative effectiveness trial. Contemp Clin Trials 2023; 124:107020. [PMID: 36423863 DOI: 10.1016/j.cct.2022.107020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anxiety disorders are a common underlying cause of symptoms among low-risk chest pain patients evaluated in the emergency department setting. However, anxiety is often undiagnosed and undertreated in any setting, and causes considerable functional impairment to work, family, and social life. OBJECTIVES The Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) study is a pragmatic randomized trial to test the comparative effectiveness of existing anxiety treatments of graduated intensities and determine what options work best for patient subgroups based on anxiety severity and other comorbidities. METHODS The PACER trial will enroll 375 emergency department patients with low-risk chest pain and anxiety (GAD-7 score ≥ 8) and randomize them to either: 1) referral to primary care with enhanced care coordination, 2) online self-administered cognitive behavioral therapy with guided peer support, or 3) therapist-administered cognitive behavior therapy. Outcomes include anxiety symptoms (primary) as well as physical symptom burden, depression symptoms, functional impairment, ED recidivism, and occurrence of major adverse cardiac events. Statistical analyses will be conducted primarily using linear mixed models to perform a repeated measures analysis of patient-reported outcomes, assessed at 3, 6, 9, and 12-month follow-ups. DISCUSSION PACER is an innovative and pragmatic clinical trial that will compare the effectiveness of several evidence-based telecare-delivered treatments for anxiety. Results have the potential to inform clinical guidelines for evaluation and management of low-risk chest pain patients and promote adoption of findings in ED departments across the country.
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Affiliation(s)
- Jill Nault Connors
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Patrick Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kate Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julie Hayden
- National Alliance on Mental Illness (NAMI) of Greater Indianapolis, Inc., Indianapolis, IN, United States
| | - Chet Montgomery
- Patient Advisory Committee, Community Member, Indianapolis, IN, United States
| | - George Brenner
- Continuing the Care, LLC, Indianapolis, IN, United States
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, Australia
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
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12
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Amin R, Mittendorfer-Rutz E, Mehlum L, Runeson B, Helgesson M, Tinghög P, Björkenstam E, Holmes E, Qin P. Does country of resettlement influence the risk of suicide in refugees? A case-control study in Sweden and Norway. Eur Psychiatry 2022. [PMCID: PMC9564977 DOI: 10.1192/j.eurpsy.2022.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent, inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. Objectives We aimed to investigate the risk of suicide among refugees in Sweden and Norway according to their sex, age, region/country of birth and duration of residence. Methods Each suicide case between the age of 18-64 years during 1998 and 2018 (17,572 and 9,443 cases in Sweden and Norway, respectively) was matched with up to 20 population-based controls, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Results
The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI: 0.5-0.6) and 0.3 (95% CI: 0.3-0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI: 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age. Conclusions
The findings of almost similar suicide mortality advantages among refugees in two host countries may suggest that resiliency and culture/religion-bound attitudes could be more influential for suicide risk among refugees than other post-migration environmental and structural factors in the host country. Disclosure No significant relationships.
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13
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Cawood A, Beggs E, Holmes E, Stratton R. Malnutrition Prevalence and Nutritional Care in Adults in the UK: An analysis of data from a BAPEN survey. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Farmer A, Jones L, Newhouse N, Kenning C, Williams N, Chi Y, Bartlett YK, Plumpton C, McSharry J, Cholerton R, Holmes E, Robinson S, Allen J, Gudgin B, Velardo C, Rutter H, Horne R, Tarassenko L, Williams V, Locock L, Rea R, Yu LM, Hughes D, Bower P, French D. Supporting People With Type 2 Diabetes in the Effective Use of Their Medicine Through Mobile Health Technology Integrated With Clinical Care to Reduce Cardiovascular Risk: Protocol for an Effectiveness and Cost-effectiveness Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e32918. [PMID: 35188478 PMCID: PMC8902673 DOI: 10.2196/32918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a common lifelong condition that affects over 400 million people worldwide. The use of effective medications and active self-management can reduce the risk of serious complications. However, people often have concerns when starting new medications and face difficulties in taking their medications regularly. Support provided by brief messages delivered through mobile phone-based SMS text messages can be effective in some long-term conditions. We have identified promising behavior change techniques (BCTs) to promote medication adherence in this population via a systematic review and developed SMS text messages that target these BCTs. Feasibility work has shown that these messages have fidelity to intended BCTs, are acceptable to patients, and are successful in changing the intended determinants of medication adherence. We now plan to test this intervention on a larger scale in a clinical trial. OBJECTIVE The aim of this trial is to determine the effectiveness and cost-effectiveness of this intervention for reducing cardiovascular risk in people with type 2 diabetes by comparing it with usual care. METHODS The trial will be a 12-month, multicenter, individually randomized controlled trial in primary care and will recruit adults (aged ≥35 years) with type 2 diabetes in England. Consenting participants will be randomized to receive short SMS text messages intended to affect a change in medication adherence 3 to 4 times per week in addition to usual care. The aim is to test the effectiveness and cost-effectiveness of the intervention when it is added to usual care. The primary clinical outcome will be a composite cardiovascular risk measure. Data including patient-reported measures will be collected at baseline, at 13 and 26 weeks, and at the end of the 12-month follow-up period. With 958 participants (479 in each group), the trial is powered at 92.5% to detect a 4-percentage point difference in cardiovascular risk. The analysis will follow a prespecified plan. A nested quantitative and qualitative process analysis will be used to examine the putative mechanisms of behavior change and wider contextual influences. A health economic analysis will be used to assess the cost-effectiveness of the intervention. RESULTS The trial has completed the recruitment phase and is in the follow-up phase. The publication of results is anticipated in 2024. CONCLUSIONS This trial will provide evidence regarding the effectiveness and cost-effectiveness of this intervention for people with type 2 diabetes. TRIAL REGISTRATION ISRCTN Registry ISRCTN15952379; https://www.isrctn.com/ISRCTN15952379. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32918.
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Affiliation(s)
- Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Louise Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Cassandra Kenning
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yuan Chi
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Y Kiera Bartlett
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Rachel Cholerton
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Stephanie Robinson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Bernard Gudgin
- Patient Advocate, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
- Sensyne Health plc, Oxford, United Kingdom
| | - Heather Rutter
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Rob Horne
- Centre for Behavioural Medicine, University College London, London, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | | | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Peter Bower
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - David French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
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15
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Johnson S, Marshall A, Hughes D, Holmes E, Henrich F, Nurmikko T, Sharma M, Frank B, Bassett P, Marshall A, Magerl W, Goebel A. Mechanistically informed non-invasive peripheral nerve stimulation for peripheral neuropathic pain: a randomised double-blind sham-controlled trial. J Transl Med 2021; 19:458. [PMID: 34742297 PMCID: PMC8572078 DOI: 10.1186/s12967-021-03128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Induction of long-term synaptic depression (LTD) is proposed as a treatment mechanism for chronic pain but remains untested in clinical populations. Two interlinked studies; (1) A patient-assessor blinded, randomised, sham-controlled clinical trial and (2) an open-label mechanistic study, sought to examine therapeutic LTD for persons with chronic peripheral nerve injury pain. METHODS (1) Patients were randomised using a concealed, computer-generated schedule to either active or sham non-invasive low-frequency nerve stimulation (LFS), for 3 months (minimum 10 min/day). The primary outcome was average pain intensity (0-10 Likert scale) recorded over 1 week, at 3 months, compared between study groups. (2) On trial completion, consenting subjects entered a mechanistic study assessing somatosensory changes in response to LFS. RESULTS (1) 76 patients were randomised (38 per group), with 65 (31 active, 34 sham) included in the intention to treat analysis. The primary outcome was not significant, pain scores were 0.3 units lower in active group (95% CI - 1.0, 0.3; p = 0.30) giving an effect size of 0.19 (Cohen's D). Two non-device related serious adverse events were reported. (2) In the mechanistic study (n = 19) primary outcomes of mechanical pain sensitivity (p = 0.006) and dynamic mechanical allodynia (p = 0.043) significantly improved indicating reduced mechanical hyperalgesia. CONCLUSIONS Results from the RCT failed to reach significance. Results from the mechanistic study provide new evidence for effective induction of LTD in a clinical population. Taken together results add to mechanistic understanding of LTD and help inform future study design and approaches to treatment. Trial registration ISRCTN53432663.
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Affiliation(s)
- Selina Johnson
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK. .,Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | - Anne Marshall
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation (CHEME) Department, Bangor University, Bangor, Wales, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation (CHEME) Department, Bangor University, Bangor, Wales, UK
| | - Florian Henrich
- Department of Neurophysiology, Mannheim Centre for Translational Neurosciences, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Heidelberg, Germany
| | - Turo Nurmikko
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
| | - Manohar Sharma
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
| | - Bernhard Frank
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK.,Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Andrew Marshall
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK.,Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Walter Magerl
- Department of Neurophysiology, Mannheim Centre for Translational Neurosciences, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Heidelberg, Germany
| | - Andreas Goebel
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK.,Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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16
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Rutter MD, Evans R, Hoare Z, Von Wagner C, Deane J, Esmaily S, Larkin T, Edwards R, Yeo ST, Spencer LH, Holmes E, Saunders BP, Rees CJ, Tsiamoulos ZP, Beintaris I. WASh multicentre randomised controlled trial: water-assisted sigmoidoscopy in English NHS bowel scope screening. Gut 2021; 70:845-852. [PMID: 32895334 PMCID: PMC8040154 DOI: 10.1136/gutjnl-2020-321918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The English Bowel Cancer Screening Programme invites 55 year olds for a sigmoidoscopy (Bowel Scope Screening (BSS)), aiming to resect premalignant polyps, thus reducing cancer incidence. A national patient survey indicated higher procedural pain than anticipated, potentially impacting on screening compliance and effectiveness. We aimed to assess whether water-assisted sigmoidoscopy (WAS), as opposed to standard CO2 technique, improved procedural pain and detection of adenomatous polyps. DESIGN The WASh (Water-Assisted Sigmoidoscopy) trial was a multicentre, single-blind, randomised control trial for people undergoing BSS. Participants were randomised to either receive WAS or CO2 from five sites across England. The primary outcome measure was patient-reported moderate/severe pain, as assessed by patients on a standard Likert scale post procedure prior to discharge. The key secondary outcome was adenoma detection rate (ADR). The costs of each technique were also measured. RESULTS 1123 participants (50% women, mean age 55) were randomised (561 WAS, 562 CO2). We found no difference in patient-reported moderate/severe pain between WAS and CO2 (14% in WAS, 15% in CO2; p=0.47). ADR was 15% in the CO2 arm and 11% in the WAS arm (p=0.03); however, it remained above the minimum national performance standard in both arms. There was no statistical difference in mean number of adenomas nor overall polyp detection rate. There was negligible cost difference between the two techniques. CONCLUSION In the context of enema-prepared unsedated screening sigmoidoscopies performed by screening-accredited endoscopists, no difference in patient-reported pain was seen when using either a CO2 or WAS intubation technique. TRIAL REGISTRATION NUMBER ISRCTN81466870.
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Affiliation(s)
- Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK .,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Evans
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | | | - Jill Deane
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Shiran Esmaily
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | | | - Rhiannon Edwards
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Seow Tien Yeo
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Llinos Haf Spencer
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Emily Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Colin J Rees
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK,Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | | | - Iosif Beintaris
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
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17
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Chebib N, Abou-Ayash S, Maniewicz S, Srinivasan M, Hill H, McKenna G, Holmes E, Schimmel M, Brocklehurst P, Müller F. Exploring Older Swiss People's Preferred Dental Services for When They Become Dependent. Swiss Dent J 2020; 130:876-884. [PMID: 33140630] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The objective of this study was to explore the preferred dental services of older people for when they become dependent. It aimed to assess their preferred type of health care professional and location of dental service, and relate their preferences to their willingness to pay (WTP) and willingness to travel (WTT). Older people aged 65 years or older were invited to participate in a questionnaire-based discrete choice experiment (DCE), to measure preferences for dental examinations and treatment, defined by two attributes: type of professional and location of the activity. Hypothetical scenarios based attributes were displayed in a projected visual presentation and participants noted their personal preference using a response sheet. Data was analyzed using a random-effects logit model. Eighty-nine participants (mean age 73.7 ± 6.6 years) attended focus group sessions. Respondents preferred that the family dentist (β: 0.2596) or an auxiliary (β: 0.2098) undertake the examination and wanted to avoid a medical doctor (β: –0.469). The preferred location for dental examination was at a dental practice (β: 0.2204). Respondents preferred to avoid treatments at home (β: –0.3875); they had a significant preference for treatment at the dental office (β: 0.2255) or in a specialist setting (β: 0.1620, ns). However, the type of professional did not have a significant influence on overall preference. Participants with a low WTP preferred examination at home (β: 0.2151) and wanted to avoid the dental practice (β: –0.0235), whereas those with a high WTP preferred the dental office (β: 0.4535) rather than home (β: –0.3029). WTT did not have a significant influence on preference. The study showed that older people generally preferred receiving dental services in a dental practice or specialist setting, and would prefer not to be treated at home. Continuity of dental services provided by the family dentist should therefore be prioritized where possible and further studies should examine the role of domiciliary care at home.
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Affiliation(s)
- Najla Chebib
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Samir Abou-Ayash
- Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sabrina Maniewicz
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Murali Srinivasan
- Clinic of General- Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Harry Hill
- Health and Decision Science, University of Sheffield, Sheffield, UK
| | - Gerald McKenna
- Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, Bangor Bangor, UK
| | - Martin Schimmel
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
- Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Paul Brocklehurst
- NWORTH Clinical Trials Unit, Bangor University, Bangor Gwynedd, Wales, UK
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Friedlander M, Moore K, Colombo N, Scambia G, Kim BG, Oaknin A, Lisyanskaya A, Floquet A, Leary A, Sonke G, Gourley C, Banerjee S, Oza A, González-Martín A, Aghajanian C, Bradley W, Holmes E, Lowe E, Disilvestro P. 234O Maintenance olaparib for patients (pts) with newly diagnosed, advanced ovarian cancer (OC) and a BRCA mutation (BRCAm): 5-year (y) follow-up (f/u) from SOLO1. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.228] [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: 10/22/2022] Open
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19
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Herz N, Bar-Haim Y, Tavor I, Tik N, Sharon H, Holmes E, Censor N. Neuromodulation of visual cortex reduces the intensity of intrusive visual emotional memories. J Vis 2020. [DOI: 10.1167/jov.20.11.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Noble A, Nevitt S, Holmes E, Ridsdale L, Morgan M, Tudur-Smith C, Hughes D, Goodacre S, Marson T, Snape D. Seizure first aid training for people with epilepsy attending emergency departments and their significant others: the SAFE intervention and feasibility RCT. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
No seizure first aid training intervention exists for people with epilepsy who regularly attend emergency departments and their significant others, despite such an intervention’s potential to reduce clinically unnecessary and costly visits.
Objectives
The objectives were to (1) develop Seizure first Aid training For Epilepsy (SAFE) by adapting a broader intervention and (2) determine the feasibility and optimal design of a definitive randomised controlled trial to test SAFE’s efficacy.
Design
The study involved (1) the development of an intervention informed by a co-design approach with qualitative feedback and (2) a pilot randomised controlled trial with follow-ups at 3, 6 and 12 months and assessments of treatment fidelity and the cost of SAFE’s delivery.
Setting
The setting was (1) third-sector patient support groups and professional health-care organisations and (2) three NHS emergency departments in England.
Participants
Participants were (1) people with epilepsy who had visited emergency departments in the prior 2 years, their significant others and emergency department, paramedic, general practice, commissioning, neurology and nursing representatives and (2) people with epilepsy aged ≥ 16 years who had been diagnosed for ≥ 1 year and who had made two or more emergency department visits in the prior 12 months, and one of their significant others. Emergency departments identified ostensibly eligible people with epilepsy from attendance records and patients confirmed their eligibility.
Interventions
Participants in the pilot randomised controlled trial were randomly allocated 1 : 1 to SAFE plus treatment as usual or to treatment as usual only.
Main outcome measures
Consent rate and availability of routine data on emergency department use at 12 months were the main outcome measures. Other measures of interest included eligibility rate, ease with which people with epilepsy could be identified and routine data secured, availability of self-reported emergency department data, self-reported emergency department data’s comparability with routine data, SAFE’s effect on emergency department use, and emergency department use in the treatment as usual arm, which could be used in sample size calculations.
Results
(1) Nine health-care professionals and 23 service users provided feedback that generated an intervention considered to be NHS feasible and well positioned to achieve its purpose. (2) The consent rate was 12.5%, with 53 people with epilepsy and 38 significant others recruited. The eligibility rate was 10.6%. Identifying people with epilepsy from attendance records was resource intensive for emergency department staff. Those recruited felt more stigmatised because of epilepsy than the wider epilepsy population. Routine data on emergency department use at 12 months were secured for 94.1% of people with epilepsy, but the application process took 8.5 months. Self-reported emergency department data were available for 66.7% of people with epilepsy, and people with epilepsy self-reported more emergency department visits than were captured in routine data. Most participants (76.9%) randomised to SAFE received the intervention. The intervention was delivered with high fidelity. No related serious adverse events occurred. Emergency department use at 12 months was lower in the SAFE plus treatment as usual arm than in the treatment as usual only arm, but not significantly so. Calculations indicated that a definitive trial would need ≈ 674 people with epilepsy and ≈ 39 emergency department sites.
Limitations
Contrary to patient statements on recruitment, routine data secured at the pilot trial’s end indicated that ≈ 40% may not have satisfied the inclusion criterion of two or more emergency department visits.
Conclusions
An intervention was successfully developed, a pilot randomised controlled trial conducted and outcome data secured for most participants. The consent rate did not satisfy a predetermined ‘stop/go’ level of ≥ 20%. The time that emergency department staff needed to identify eligible people with epilepsy is unlikely to be replicable. A definitive trial is currently not feasible.
Future work
Research to more easily identify and recruit people from the target population is required.
Trial registration
Current Controlled Trials ISRCTN13871327.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 39. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adam Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Emily Holmes
- Centre for Health Economics and Medicine Evaluation, Bangor University, Bangor, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King’s College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | | | - Dyfrig Hughes
- Centre for Health Economics and Medicine Evaluation, Bangor University, Bangor, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Darlene Snape
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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21
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Ding NS, McDonald JAK, Perdones-Montero A, Rees DN, Adegbola SO, Misra R, Hendy P, Penez L, Marchesi JR, Holmes E, Sarafian MH, Hart AL. Metabonomics and the Gut Microbiome Associated With Primary Response to Anti-TNF Therapy in Crohn's Disease. J Crohns Colitis 2020; 14:1090-1102. [PMID: 32119090 DOI: 10.1093/ecco-jcc/jjaa039] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Anti-tumour necrosis factor [anti-TNF] therapy is indicated for treatment of moderate to severe inflammatory bowel disease [IBD], but has a primary non-response rate of around 30%. We aim to use metabonomic and metataxonomic profiling to identify predictive biomarkers of anti-TNF response in Crohn's disease. METHODS Patients with luminal Crohn's disease, commencing anti-TNF therapy, were recruited with urine, faeces, and serum samples being collected at baseline and 3-monthly. Primary response was defined according to a combination of clinical and objective markers of inflammation. Samples were measured using three UPLC-MS assays: lipid, bile acid, and Hydrophillic Interaction Liquid Chromatography [HILIC] profiling with 16S rRNA gene sequencing of faeces. RESULTS Samples were collected from 76 Crohn's disease patients who were anti-TNF naïve and from 13 healthy controls. There were 11 responders, 37 non-responders, and 28 partial responders in anti-TNF-treated Crohn's patients. Histidine and cysteine were identified as biomarkers of response from polar metabolite profiling [HILIC] of serum and urine. Lipid profiling of serum and faeces found phosphocholines, ceramides, sphingomyelins, and triglycerides, and bile acid profiling identified primary bile acids to be associated with non-response to anti-TNF therapy, with higher levels of phase 2 conjugates in non-responders. Receiver operating curves for treatment response demonstrated 0.94 +/ -0.10 [faecal lipid], 0.81 +/- 0.17 [faecal bile acid], and 0.74 +/- 0.15 [serum bile acid] predictive ability for anti-TNF response in Crohn's disease. CONCLUSIONS This prospective, longitudinal cohort study of metabonomic and 16S rRNA gene sequencing analysis demonstrates that a range of metabolic biomarkers involving lipid, bile acid, and amino acid pathways may contribute to prediction of response to anti-TNF therapy in Crohn's disease. PODCAST This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
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Affiliation(s)
- N S Ding
- St Vincent's Hospital, Inflammatory Bowel Disease, Melbourne, VIC, Australia.,St Mark's Hospital, Inflammatory Bowel Disease Unit, London, UK.,Division of Computational Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - J A K McDonald
- Division of Digestive Diseases, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - A Perdones-Montero
- Division of Computational Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Douglas N Rees
- Division of Digestive Diseases, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - S O Adegbola
- St Mark's Hospital, Inflammatory Bowel Disease Unit, London, UK.,Division of Computational Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - R Misra
- St Mark's Hospital, Inflammatory Bowel Disease Unit, London, UK.,Division of Computational Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - P Hendy
- St Mark's Hospital, Inflammatory Bowel Disease Unit, London, UK
| | - L Penez
- St Mark's Hospital, Inflammatory Bowel Disease Unit, London, UK
| | - J R Marchesi
- School of Biosciences, Cardiff University, Cardiff, UK.,Division of Digestive Diseases, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - E Holmes
- Division of Computational Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK.,Institute of Health Futures, Murdoch University, Perth, WA, Australia
| | - M H Sarafian
- Division of Computational Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - A L Hart
- St Mark's Hospital, Inflammatory Bowel Disease Unit, London, UK.,Division of Computational Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
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22
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Alozkan Sever C, Cuijpers P, Bryant R, Dawson K, Mittendorfer-Rutz E, Holmes E, Sijbrandi M. Adaptation of the Problem Management Plus programme for Syrian, Eritrean and Afghan refugee youth. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Common mental health problems are prevalent among refugee minors and impair their daily functioning. Due to various barriers such as lack of culturally appropriate treatments, waiting lists, and stigma they have limited access to care. Problem Management Plus (PM+) was developed by the World Health Organization to address these barriers. PM+ is transdiagnostic, delivered by non-professional helpers, and consists of 5 sessions of problem-solving skills, behavioural activation and stress management. PM+ is effective in reducing adults' distress and improve functioning. We aimed to adapt PM+ for refugee minors and add an emotional processing module to target symptoms of posttraumatic stress disorder.
Methods
We culturally and contextually adapted PM+ for use in Syrian, Eritrean and Afghan refugee minors (age 16-18 years). Data were collected through: 1) free list interviews with Syrian, Eritrean and Afghan refugee minors (n = 30), 2) key informant interviews with knowledgeable refugees (n = 6), professionals (n = 6), policy makers (n = 6) and 3) focus group discussions (n = 24). Data were analysed in ATLAS.ti through inductive and deductive framework analysis.
Results
The interviews with youth revealed daily life problems around the following themes: language, family and peers, and substance use. The overall results suggested the need for culture- and age-specific adaptations of 1) the PM+ manual content (language, metaphors, illustrations) and 2) intervention delivery (modality, content and presentation of the trauma processing module, and duration).
Conclusions
This study led to specific adaptations of PM+ for refugee adolescents to be used in two randomized controlled trials in the Netherlands and Sweden.
Key message
Refugee minors face numerous barriers reaching mental health care. Scalable, culturally adapted psychological interventions should be developed and evaluated to address common mental disorders in refugee youth.
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Affiliation(s)
- C Alozkan Sever
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, VU Amsterdam, Amsterdam, Netherlands
| | - R Bryant
- UNSW Traumatic Stress Clinic, University of New South Wales, Sydney, Australia
| | - K Dawson
- School of psychology, University of New South Wales, Sydney, Australia
| | - E Mittendorfer-Rutz
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E Holmes
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Sijbrandi
- Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
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23
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Banerjee S, Moore K, Colombo N, Scambia G, Kim BG, Oaknin A, Friedlander M, Lisyanskaya A, Floquet A, Leary A, Sonke G, Gourley C, Oza A, Martín AG, Aghajanian C, Bradley W, Holmes E, Lowe E, DiSilvestro P. 811MO Maintenance olaparib for patients (pts) with newly diagnosed, advanced ovarian cancer (OC) and a BRCA mutation (BRCAm): 5-year (y) follow-up (f/u) from SOLO1. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.950] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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24
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Steel C, Wright K, Goodwin G, Simon J, Morant N, Taylor R, Brown M, Jennings S, Hales S, Holmes E. The IBER study: study protocol for a feasibility randomised controlled trial of Imagery Based Emotion Regulation for the treatment of anxiety in bipolar disorder. Pilot Feasibility Stud 2020; 6:83. [PMID: 32549994 PMCID: PMC7294606 DOI: 10.1186/s40814-020-00628-8] [Citation(s) in RCA: 4] [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: 10/22/2019] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background Anxiety is highly prevalent in people diagnosed with bipolar disorder (BD), and can persist between acute episodes of mania and depression. Recent studies indicate that people with BD are prone to experiencing frequent, intrusive and emotional mental images which further fuel their levels of anxiety and mood instability. These intrusive emotional mental images represent a specific target for treatment for this disorder with the potential to reduce anxiety and improve mood stability. A new brief structured psychological intervention for BD called Imagery Based Emotion Regulation (IBER) has been developed, which translates experimental work in the area of imagery and emotion into a skills training programme to improve the regulation of intrusive and distressing emotional mental images in BD. A feasibility trial is required in order to assess whether a full randomised controlled trial is indicated in order to evaluate this approach. Methods The design is a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site and minimised on medication status and anxiety severity. Participants are 60 individuals diagnosed with bipolar disorder and experiencing at least a mild level of anxiety. Sites are defined by the geographical boundaries of two National Health Service (NHS) Trusts, with recruitment from NHS teams, GP surgeries and self-referral. The intervention is up to 12 sessions of Imagery Based Emotion Regulation within 16 weeks. The comparator is NHS standard care. The primary aim is to assess the feasibility of conducting a powered multi-site RCT to evaluate effectiveness. Measures of anxiety, depression, mania, mood stability and health care use will be conducted at baseline, end of treatment and at 16-week follow-up. Discussion This is the first feasibility trial of an imagery-based intervention for the treatment of anxiety in bipolar disorder. If the trial proves feasible, a large multi-site trial will be required. Trial registration ISRCTN16321795. Registered on October 16, 2018. 10.1186/ISRCTN16321795
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Affiliation(s)
- Craig Steel
- Oxford Health NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK.,Warneford Hospital, Oxford, OX3 7JX UK
| | | | | | - Judit Simon
- Oxford Health NHS Foundation Trust, Oxford, UK.,Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - Susie Hales
- Oxford Health NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK
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25
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O'Philbin L, Woods B, Holmes E. People with dementia and caregiver preferences for digital life story work service interventions. A discrete choice experiment and digital survey. Aging Ment Health 2020; 24:353-361. [PMID: 30587008 DOI: 10.1080/13607863.2018.1525606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Little is understood about the optimal way to implement digital life story work (LSW). The aim of this research was to explore the preferences of people with dementia and caregivers in relation to digital LSW in an effort to improve future engagement.Methods: 67 caregivers responded to an online discrete choice experiment (DCE) survey containing 16 pairwise choices. The DCE was analysed using a random effects logit model. Willingness to pay and odds ratios were also calculated. 17 participants with dementia completed an online survey in which they made choices about different aspects of digital LSW services.Results: Caregivers valued four out of five attributes [setting (p = 0.000), price (p = 0.000), elementary usability and accessibility (p = 0.001), and follow-up assistance (p = 0.034)]. In data from participants with dementia, the most preferred setting was individual one-to-one (70.6%), and the most preferred use of digital life storybooks was to share memories with others (64.7%). Marginally more participants with dementia said they would pay for the service (53%) rather than only use it free of charge (47%). Those with advanced ICT skills preferred to learn how to use the digital life storybook (64.7%), while those with elementary/intermediate skills, preferred to have it created for them (35.3%).Conclusions: This exploratory study provides an insight into preferences of people with dementia and caregivers, of how digital LSW is implemented. Results can contribute to future planning and tailoring of these services.
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Affiliation(s)
- Laura O'Philbin
- Dementia Services Development Centre Wales, Bangor University, Bangor, Wales, UK
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, Wales, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Wales, UK
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26
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Cawood A, Burden S, Holmes E, Stratton R. A national survey to assess the use of the Malnutrition Universal Screening Tool (‘MUST’) in electronic patient records in primary care. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.021] [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: 10/25/2022]
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27
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Loibl S, Majewski I, Guarneri V, Nekljudova V, Holmes E, Bria E, Denkert C, Schem C, Sotiriou C, Loi S, Untch M, Conte P, Bernards R, Piccart M, von Minckwitz G, Baselga J. PIK3CA mutations are associated with reduced pathological complete response rates in primary HER2-positive breast cancer: pooled analysis of 967 patients from five prospective trials investigating lapatinib and trastuzumab. Ann Oncol 2019; 30:1180. [PMID: 30624609 DOI: 10.1093/annonc/mdy536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Affiliation(s)
- Emily Holmes
- Arlene R. Gordon Research Institute, The Lighthouse Inc., Ill East 59th Street, New York, NY 10022
| | - Aries Arditi
- Arlene R. Gordon Research Institute, The Lighthouse Inc., Ill East 59th Street, New York, NY 10022
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29
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Ring A, Jacoby A, Baker G, Holmes E, Hughes D, Kierans C, Marson A. What really matters? A mixed methods study of treatment preferences and priorities among people with epilepsy in the UK. Epilepsy Behav 2019; 95:181-191. [PMID: 31071641 DOI: 10.1016/j.yebeh.2019.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 12/26/2022]
Abstract
The widening range of treatment options for epilepsy, and their potential outcomes, mean decisions about treatment for people with epilepsy (PWE) are often complex. While antiepileptic drugs (AEDs) represent the mainstay of treatment, other potential nondrug interventions are gaining in importance. These treatments all have the potential for harming those using them, as well as bringing benefits. This study examined the views and experiences of PWE about a range of treatment options. We used both qualitative and quantitative approaches - a series of depth-narrative interviews, followed by a large-scale survey. Treatment options and healthcare priorities deemed important by at least 10% of interview participants were then addressed as a series of statements in the follow-on survey questionnaire. Quantitative responses supported healthcare priorities identified through the qualitative interviews. The key goal of treatment among study participants was to be able to live 'a normal life'. Important physical, psychological, and life benefits of treatment were identified - most being the direct consequence of improved seizure control. One psychological benefit, reduced worry, was also identified as an important treatment goal. All participants viewed AEDs as appropriate first-line treatment; and since adverse effects of AEDs had implications for individual levels of daily function and wellbeing, their appropriate management was considered important. In contrast, surgery was almost always regarded as the treatment of last resort. Despite lack of research evidence supporting their use, participants were interested in complementary therapies as adjunctive treatment and a means of coping with having epilepsy, with yoga and meditation of particular interest. An important finding was the desire for targeted services to help with memory problems, as was the call to increase availability of psychological/counseling services. Our findings emphasize the importance of providing treatment responsive to the life context of individual patients. They highlight not only the level of demand for specific treatment options, but also the need for high-quality evidence to support future investment in their provision.
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Affiliation(s)
- Adele Ring
- Department of Public Health & Policy, University of Liverpool, UK.
| | - Ann Jacoby
- Department of Public Health & Policy, University of Liverpool, UK
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Wales, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Wales, UK
| | - Ciara Kierans
- Department of Public Health & Policy, University of Liverpool, UK
| | - Anthony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
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30
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Shi W, Jiang T, Nuciforo P, Hatzis C, Holmes E, Harbeck N, Sotiriou C, Peña L, Loi S, Rosa DD, Chia S, Wardley A, Ueno T, Rossari J, Eidtmann H, Armour A, Piccart-Gebhart M, Rimm DL, Baselga J, Pusztai L. Pathway level alterations rather than mutations in single genes predict response to HER2-targeted therapies in the neo-ALTTO trial. Ann Oncol 2019; 30:1018. [PMID: 30624555 DOI: 10.1093/annonc/mdy530] [Citation(s) in RCA: 2] [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: 11/13/2022] Open
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31
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Poolman M, Roberts J, Byrne A, Perkins P, Hoare Z, Nelson A, Hiscock J, Hughes D, Foster B, O'Connor J, Reymond L, Healy S, Roberts R, Wee B, Lewis P, Johnstone R, Roberts S, Holmes E, Wright S, Hendry A, Wilkinson C. CARer-ADministration of as-needed subcutaneous medication for breakthrough symptoms in homebased dying patients (CARiAD): study protocol for a UK-based open randomised pilot trial. Trials 2019; 20:105. [PMID: 30732624 PMCID: PMC6367805 DOI: 10.1186/s13063-019-3179-9] [Citation(s) in RCA: 5] [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: 12/10/2018] [Accepted: 01/04/2019] [Indexed: 11/16/2022] Open
Abstract
Background While the majority of seriously ill people wish to die at home, only half achieve this. The likelihood of someone dying at home often depends on the availability of able and willing lay carers to support them. Dying people are usually unable to take oral medication. When top-up symptom relief medication is required, a clinician travels to the home to administer injectable medication, with attendant delays. The administration of subcutaneous injections by lay carers, though not widespread practice in the UK, has proven key in achieving home deaths in other countries. Our aim is to determine if carer-administration of as-needed subcutaneous medication for four frequent breakthrough symptoms (pain, nausea, restlessness and noisy breathing) in home-based dying patients is feasible and acceptable in the UK. Methods This paper describes a randomised pilot trial across three UK sites, with an embedded qualitative study. Dyads of adult patients/carers are eligible, where patients are in the last weeks of life and wish to die at home, and lay carers who are willing to be trained to give subcutaneous medication. Dyads who do not meet strict risk assessment criteria (including known history of substance abuse or carer ability to be trained to competency) will not be approached. Carers in the intervention arm will receive a manualised training package delivered by their local nursing team. Dyads in the control arm will receive usual care. The main outcomes of interest are feasibility, acceptability, recruitment rates, attrition and selection of the most appropriate outcome measures. Interviews with carers and healthcare professionals will explore attitudes to, experiences of and preferences for giving subcutaneous medication and experience of trial processes. The study has obtained full ethical approval. Discussion This study will rehearse the procedures and logistics which will be undertaken in a future definitive randomised controlled trial and will inform the design of such a study. Findings will illuminate methodological and ethical issues pertaining to researching last days of life care. The study is funded by the National Institute for Health Research (Health Technology Assessment [HTA] project 15/10/37). Trial registration ISRCTN, ISRCTN 11211024. Registered on 27 September 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3179-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marlise Poolman
- Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK. .,Betsi Cadwaladr University Health Board, Bangor, UK.
| | - Jessica Roberts
- Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
| | - Anthony Byrne
- Marie Curie Research Centre, Cardiff University, Bangor, UK.,Cardiff and Vale University Health Board, Cardiff, UK
| | - Paul Perkins
- Sue Ryder Leckhampton Court Hospice, Cheltenham, UK.,Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Zoe Hoare
- Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
| | | | - Julia Hiscock
- Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Betty Foster
- North Wales Cancer Network Patient Forum, Bangor, UK
| | | | - Liz Reymond
- Queensland Health Metro South Hospital Health Service, Brisbane, Australia
| | - Sue Healy
- Queensland Health Metro South Hospital Health Service, Brisbane, Australia
| | | | - Bee Wee
- University of Oxford, Oxford, UK
| | - Penney Lewis
- The Dickson Poon School of Law, King's College London, London, UK
| | | | - Sian Roberts
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Stella Wright
- Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
| | - Annie Hendry
- Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
| | - Clare Wilkinson
- Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
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32
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Holmes E, Bourke S, Plumpton C. Attitudes towards epilepsy in the UK population: Results from a 2018 national survey. Seizure 2019; 65:12-19. [DOI: 10.1016/j.seizure.2018.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022] Open
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33
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Devenay S, Holmes E. A retrospective 12 month audit of all lung cancer patients attending the Acute Oncology Assessment Unit at a Scottish Regional Cancer Centre. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30168-0] [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: 10/27/2022]
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34
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Ridwanul Amin M, Helgesson M, Runeson B, Tinghög P, Mehlum L, Holmes E, Mittendorfer-Rutz E. The risk of suicidal behaviour in refugees and other immigrants to Sweden. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - B Runeson
- Karolinska Institute, Stockholm, Sweden
| | - P Tinghög
- Swedish Red Cross University College, Huddinge, Sweden
| | - L Mehlum
- National Centre for Suicide Research and Prevention, Oslo, Norway
| | - E Holmes
- Karolinska Institute, Stockholm, Sweden
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35
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Loibl S, Majewski I, Guarneri V, Nekljudova V, Holmes E, Bria E, Denkert C, Schem C, Sotiriou C, Loi S, Untch M, Conte P, Bernards R, Piccart M, von Minckwitz G, Baselga J. PIK3CA mutations are associated with reduced pathological complete response rates in primary HER2-positive breast cancer: pooled analysis of 967 patients from five prospective trials investigating lapatinib and trastuzumab. Ann Oncol 2018; 29:2151. [PMID: 29701763 DOI: 10.1093/annonc/mdx803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shi W, Jiang T, Nuciforo P, Hatzis C, Holmes E, Harbeck N, Sotiriou C, Peña L, Loi S, Rosa DD, Chia S, Wardley A, Ueno T, Rossari J, Eidtmann H, Armour A, Piccart-Gebhart M, Rimm DL, Baselga J, Pusztai L. Pathway level alterations rather than mutations in single genes predict response to HER2-targeted therapies in the neo-ALTTO trial. Ann Oncol 2018; 29:2152. [PMID: 29701764 DOI: 10.1093/annonc/mdx805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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Arora A, Holmes E, Morris AM, Norton J, Bates T, Davey H. 90ADMISSION AVOIDANCE IN EMERGENCY DEPARTMENT - WHAT WORKS FOR FRAIL OLDER PEOPLE: THE EXEMPLAR FRONT DOOR (EFD) INITIATIVE. Age Ageing 2018. [DOI: 10.1093/ageing/afy126.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Arora
- University Hospitals of North Midlands, Stoke on Trent
| | - E Holmes
- University Hospitals of North Midlands, Stoke on Trent
| | - A M Morris
- University Hospitals of North Midlands, Stoke on Trent
| | - J Norton
- University Hospitals of North Midlands, Stoke on Trent
| | - T Bates
- University Hospitals of North Midlands, Stoke on Trent
| | - H Davey
- University Hospitals of North Midlands, Stoke on Trent
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Arora A, Futers A, Opiniano N, Turner G, Morris S, Holmes E. 91DO WE REALLY KNOW WHO IS IN OUR BEDS: FRAILTY SCORING IN A UNIVERSITY TEACHING HOSPITAL SETTING. Age Ageing 2018. [DOI: 10.1093/ageing/afy126.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Arora
- Department for Older Adults, Royal Stoke University Hospital, University Hospitals of North Midlands
| | - A Futers
- Department for Older Adults, Royal Stoke University Hospital, University Hospitals of North Midlands
| | - N Opiniano
- Department for Older Adults, Royal Stoke University Hospital, University Hospitals of North Midlands
| | - G Turner
- Department for Older Adults, Royal Stoke University Hospital, University Hospitals of North Midlands
| | - S Morris
- Department for Older Adults, Royal Stoke University Hospital, University Hospitals of North Midlands
| | - E Holmes
- Department for Older Adults, Royal Stoke University Hospital, University Hospitals of North Midlands
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Fowokan A, Black J, Holmes E, Seto D, Lear S. Examining risk factors for cardiovascular disease among food bank members in Vancouver. Prev Med Rep 2018; 10:359-362. [PMID: 29868392 PMCID: PMC5984241 DOI: 10.1016/j.pmedr.2018.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/07/2018] [Accepted: 04/21/2018] [Indexed: 11/30/2022] Open
Abstract
Food banks provide supplemental food to low-income households, yet little is known about the cardiovascular health of food banks members. This study therefore described cardiovascular disease (CVD) risk factors among food bank members and explored associations between food insecurity and CVD risk. Adults ≥18 years (n = 77) from three food bank sites in metro Vancouver, British Columbia completed surveys and physical assessments examining a range of socio-demographic variables and CVD risk factors. A composite measure of myocardial infarction (MI) risk called the INTERHEART score was assessed and household food insecurity was measured using the Household Food Security Survey Module. Regression models were used to explore associations between food insecurity and CVD risk measures, including the INTERHEART score. Ninety-seven percent of food bank members reported experiencing food insecurity, 65% were current smokers, 53% reported either chronic or several periods of stress in the past year, 55% reported low physical activity levels and 80% reported consuming fewer than five servings of fruit and vegetables daily. Prevalence of self-reported diabetes and hypertension were 13% and 29% respectively. Fifty-two percent of the sample were at high risk of non-fatal MI. No statistically significant associations were found between increased severity of food insecurity and CVD risk factors among this sample where both severe food insecurity and high CVD risks were prevalent. Food bank members were at elevated risk for CVD compared with the general population. Strategies are needed to reduce prevalence of food insecurity and CVD risk factors, both of which disproportionately affected food bank members.
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Affiliation(s)
- A.O. Fowokan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby V5A 1S6, BC, Canada
| | - J.L. Black
- Faculty of Land and Food Systems, Food Nutrition and Health, University of British Columbia, 2205 East Mall, Vancouver V6T 1Z4, BC, Canada
| | - E. Holmes
- Faculty of Land and Food Systems, Food Nutrition and Health, University of British Columbia, 2205 East Mall, Vancouver V6T 1Z4, BC, Canada
| | - D. Seto
- Greater Vancouver Food Bank, Vancouver, BC, Canada
| | - S.A. Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby V5A 1S6, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby V5A 1S6, BC, Canada
- Division of Cardiology, Providence Health Care, Vancouver V6Z 1Y6, BC, Canada
- Corresponding author at: Healthy Heart Program, St. Paul's Hospital, 180-1081 Burrard St, Vancouver V6Z 1Y6, BC, Canada.
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Mclean K, Holmes E, Penewit K, Waalkes A, Ren M, Harwood R, Lee S, Gasper J, Manoil C, Salipante S. P036 Whole genome variant analysis and transposon sequencing provides insight into aztreonam resistance in cystic fibrosis Pseudomonas aeruginosa airway infection. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Shi W, Jiang T, Nuciforo P, Hatzis C, Holmes E, Harbeck N, Sotiriou C, Peña L, Loi S, Rosa DD, Chia S, Wardley A, Ueno T, Rossari J, Eidtmann H, Armour A, Piccart-Gebhart M, Rimm DL, Baselga J, Pusztai L. Pathway level alterations rather than mutations in single genes predict response to HER2-targeted therapies in the neo-ALTTO trial. Ann Oncol 2018; 28:128-135. [PMID: 28177460 DOI: 10.1093/annonc/mdw434] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background We performed whole-exome sequencing of pretreatment biopsies and examined whether genome-wide metrics of overall mutational load, clonal heterogeneity or alterations at variant, gene, and pathway levels are associated with treatment response and survival. Patients and Methods Two hundred and three biopsies from the NeoALTTO trial were analyzed. Mutations were called with MuTect, and Strelka, using pooled normal DNA. Associations between DNA alterations and outcome were evaluated by logistic and Cox-proportional hazards regression. Results There were no recurrent single gene mutations significantly associated with pathologic complete response (pCR), except PIK3CA [odds ratio (OR) = 0.42, P = 0.0185]. Mutations in 33 of 714 pathways were significantly associated with response, but different genes were affected in different individuals. PIK3CA was present in 23 of these pathways defining a ‘trastuzumab resistance-network’ of 459 genes. Cases with mutations in this network had low pCR rates to trastuzumab (2/50, 4%) compared with cases with no mutations (9/16, 56%), OR = 0.035; P < 0.001. Mutations in the ‘Regulation of RhoA activity’ pathway were associated with higher pCR rate to lapatinib (OR = 14.8, adjusted P = 0.001), lapatinib + trastuzumab (OR = 3.0, adjusted P = 0.09), and all arms combined (OR = 3.77, adjusted P = 0.02). Patients (n = 124) with mutations in the trastuzumab resistance network but intact RhoA pathway had 2% (1/41) pCR rate with trastuzumab alone (OR = 0.026, P = 0.001) but adding lapatinib increased pCR rate to 45% (17/38, OR = 1.68, P = 0.3). Patients (n = 46) who had no mutations in either gene set had 6% pCR rate (1/15) with lapatinib, but had the highest pCR rate, 52% (8/15) with trastuzumab alone. Conclusions Mutations in the RhoA pathway are associated with pCR to lapatinib and mutations in a PIK3CA-related network are associated with resistance to trastuzumab. The combined mutation status of these two pathways could define patients with very low response rate to trastuzumab alone that can be augmented by adding lapatinib or substituting trastuzumab with lapatinib.
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Affiliation(s)
- W Shi
- Department of Breast Medical Oncology, Yale University, Yale Cancer Center, New Haven, USA
| | - T Jiang
- Department of Breast Medical Oncology, Yale University, Yale Cancer Center, New Haven, USA
| | - P Nuciforo
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - C Hatzis
- Department of Breast Medical Oncology, Yale University, Yale Cancer Center, New Haven, USA
| | - E Holmes
- Frontier Science, Inverness, Scotland
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University of Munich, Germany
| | - C Sotiriou
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - L Peña
- Spanish Breast Cancer Cooperative Group SOLTI, Barcelona, Spain
| | - S Loi
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - D D Rosa
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - S Chia
- Department of Medical Oncology, BC Cancer Agency, Vancouver, Canada
| | - A Wardley
- The Christie/NIHR Clinical Research Facility, Manchester, UK
| | - T Ueno
- Department of Breast Surgery, Kyoto University Hospital, Kyoto, Japan
| | - J Rossari
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - H Eidtmann
- Department of Obstetrics and Gynecology, Campus Kiel, University Hospital Kiel, Kiel, Germany
| | | | - M Piccart-Gebhart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - D L Rimm
- Department of Breast Medical Oncology, Yale University, Yale Cancer Center, New Haven, USA
| | - J Baselga
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, New York, USA
| | - L Pusztai
- Department of Breast Medical Oncology, Yale University, Yale Cancer Center, New Haven, USA
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Holmes E, Crome P, Arora A. Patients' preferences and existential perspective: what to consider and how should patient's expectations be guided? Aging Clin Exp Res 2018; 30:271-275. [PMID: 29305795 DOI: 10.1007/s40520-017-0868-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/24/2017] [Indexed: 11/27/2022]
Abstract
With an ageing population, surgical procedures in older patients are becoming increasingly more common. This can pose clinical and ethical dilemmas, during which clinicians need to make complex decisions. In this paper we discuss the importance of assessing mental capacity to assess if the older patient can make his or her own decisions relating to surgery. We also discuss the importance of understanding ethical principles, in order that clinicians can better guide patient's decision-making. In addition, we look at ageism, frailty, and co-morbidities, and their influence on clinician's decisions regarding surgery in older patients. Further to this, we look at the influence of evidence-based medicine on treatment options, and the under representation of older people in clinical trials and the importance of this. Finally, we consider the importance of considered decisions regarding resuscitation, when considering surgical intervention in older patients. We conclude that patient-centred individualised care, considering patients expectations, wishes, and priorities is vital, whilst aiming to improve or maintain quality of life, and minimise risks when able.
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Affiliation(s)
- E Holmes
- Department of Elderly Care Medicine, University Hospitals of North Midlands, Stoke on Trent, UK
| | - P Crome
- Keele University, Stoke on Trent, UK
- Department of Primary Care and Population Health, University College London, London, UK
| | - A Arora
- Department of Elderly Care Medicine, University Hospitals of North Midlands, Stoke on Trent, UK.
- Keele University, Stoke on Trent, UK.
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Holmes E, Baker G, Jacoby A, Ring A, Marson A, Hughes D. 1151 Patients’ preferences for anti-epileptic drugs (aeds). J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ozsivadjian A, Hollocks MJ, Southcott J, Absoud M, Holmes E. Erratum to: Anxious Imagery in Children With and Without Autism Spectrum Disorder: An Investigation into Occurrence, Content, Features and Implications for Therapy. J Autism Dev Disord 2017; 47:3833. [DOI: 10.1007/s10803-016-2858-6] [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: 10/21/2022]
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Ozsivadjian A, Hollocks MJ, Southcott J, Absoud M, Holmes E. Anxious Imagery in Children With and Without Autism Spectrum Disorder: An Investigation into Occurrence, Content, Features and Implications for Therapy. J Autism Dev Disord 2017; 47:3822-3832. [PMID: 27328680 PMCID: PMC5676832 DOI: 10.1007/s10803-016-2840-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mental imagery has been implicated in anxiety disorders in adults, but has not been investigated in child and adolescent populations. Anxiety is highly prevalent in autism spectrum disorder (ASD), and as people with ASD are often thought of as 'visual thinkers', the potential role of distressing imagery in children with ASD merits exploration. Participants aged 8-16 years were grouped as follows: ASD/high anxiety, ASD/low anxiety, non-ASD/high anxiety and non-ASD/low anxiety. Imagery and associated features were assessed using an interview. Group differences were found in number and frequency of images experienced. There were few differences between the groups in the characteristics of the spontaneous images, which included emotional valence, vividness, controllability and realism. Implications for treatment are discussed.
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Affiliation(s)
- Ann Ozsivadjian
- Children's Complex Neurodevelopmental Disability Service, Children's Neurosciences Centre Newcomen at St Thomas', South Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Matthew J Hollocks
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jess Southcott
- Children's Complex Neurodevelopmental Disability Service, Children's Neurosciences Centre Newcomen at St Thomas', South Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Michael Absoud
- Children's Complex Neurodevelopmental Disability Service, Children's Neurosciences Centre Newcomen at St Thomas', South Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Emily Holmes
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
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Abstract
Nutrition provides the building blocks for growth, repair, and maintenance of the body and is key to maintaining health. Exposure to fast foods, mass production of dietary components, and wider importation of goods have challenged the balance between diet and health in recent decades, and both scientists and clinicians struggle to characterize the relationship between this changing dietary landscape and human metabolism with its consequent impact on health. Metabolic phenotyping of foods, using high-density data-generating technologies to profile the biochemical composition of foods, meals, and human samples (pre- and postfood intake), can be used to map the complex interaction between the diet and human metabolism and also to assess food quality and safety. Here, we outline some of the techniques currently used for metabolic phenotyping and describe key applications in the food sciences, ending with a broad outlook at some of the newer technologies in the field with a view to exploring their potential to address some of the critical challenges in nutritional science.
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Affiliation(s)
- J Brignardello
- Computational and Systems Medicine, Imperial College London, London, United Kingdom
| | - E Holmes
- Computational and Systems Medicine, Imperial College London, London, United Kingdom
| | - I Garcia-Perez
- Nutrition and Dietetic Research Group, Imperial College London, London, United Kingdom.
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Johnson S, Goebel A, Richey R, Holmes E, Hughes D. A randomised, patient-assessor blinded, sham-controlled trial of external non-invasive peripheral nerve stimulation for chronic neuropathic pain following peripheral nerve injury (EN-PENS trial): study protocol for a randomised controlled trial. Trials 2016; 17:574. [PMID: 27919285 PMCID: PMC5139024 DOI: 10.1186/s13063-016-1709-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Eight percent of people in the UK are estimated to have persistent (chronic) neuropathic pain, and for many there is no effective treatment. Medications are the most common first-line treatment but often have limited benefit or adverse events. Surgical treatments, such as spinal cord stimulation, are then often considered. External non-invasive peripheral nerve stimulation (EN-PENS) is a form of electrical stimulation that involves placing a pen-shaped electrode onto the skin, which can be easily self-administered by patients. Observational studies suggest that EN-PENS may relieve pain for people with localised neuropathic pain; however, there is currently no evidence from controlled trials to confirm the efficacy and confidently determine the effect size for patients with longstanding neuropathic pain. Methods EN-PENS is a single-site, blinded, randomised controlled parallel-group superiority add-on trial with a 1:1 allocation ratio, designed to evaluate the efficacy of treatment versus control treatment in 76 patients with longstanding neuropathic pain following peripheral nerve injury. Patients with moderate to -severe neuropathic pain following peripheral nerve injury will be randomised to receive either the active or control treatment, followed by an optional treatment extension or treatment switch to the alternative treatment arm. The primary outcome is average 24-h pain intensity recorded on an 11-point (0–10) numerical rating scale, averaged over the last 7 days of treatment. Discussion Study results will be used to inform potential treatment efficacy and cost-effectiveness of EN-PENS for this population group. Trial registration ISRCTN53432663. Registered on 7 July 2016.
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Affiliation(s)
- Selina Johnson
- The Walton Centre NHS Trust, Liverpool, UK. .,The University of Liverpool, Liverpool, L69 3BX, UK.
| | - Andreas Goebel
- The Walton Centre NHS Trust, Liverpool, UK.,The University of Liverpool, Liverpool, L69 3BX, UK
| | | | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, LL57 2PZ, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, LL57 2PZ, UK
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Petropoulou K, Chambers ES, Morrison DJ, Preston T, Godsland IF, Wilde P, Narbad A, Parker R, Salt L, Morris VJ, Domoney C, Persaud SJ, Holmes E, Penson S, Watson J, Stocks M, Buurman M, Luterbacher M, Frost G. Identifying crop variants with high resistant starch content to maintain healthy glucose homeostasis. NUTR BULL 2016. [DOI: 10.1111/nbu.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- K. Petropoulou
- Nutrition and Dietetic Research Group; Section of Investigative Medicine; Faculty of Medicine; Imperial College London; London UK
| | - E. S. Chambers
- Nutrition and Dietetic Research Group; Section of Investigative Medicine; Faculty of Medicine; Imperial College London; London UK
| | - D. J. Morrison
- Stable Isotope Biochemistry Laboratory; Scottish Universities Environmental Research Centre; University of Glasgow; Glasgow UK
| | - T. Preston
- Stable Isotope Biochemistry Laboratory; Scottish Universities Environmental Research Centre; University of Glasgow; Glasgow UK
| | - I. F. Godsland
- Section of Metabolic Medicine; Division of Diabetes, Endocrinology and Metabolism; Faculty of Medicine; Imperial College London; London UK
| | - P. Wilde
- Institute of Food Research; Norwich Research Park; Norwich UK
| | - A. Narbad
- Institute of Food Research; Norwich Research Park; Norwich UK
| | - R. Parker
- Institute of Food Research; Norwich Research Park; Norwich UK
| | - L. Salt
- Institute of Food Research; Norwich Research Park; Norwich UK
| | - V. J. Morris
- Institute of Food Research; Norwich Research Park; Norwich UK
| | - C. Domoney
- Department of Metabolic Biology; John Innes Centre; Norwich Research Park; Norwich UK
| | - S. J. Persaud
- Division of Diabetes and Nutritional Sciences; King's College London; London UK
| | - E. Holmes
- Department of Surgery and Cancer, Computational and Systems Medicine; Imperial College London; London UK
| | | | | | - M. Stocks
- Plant Bioscience Limited; Norwich Research Park; Norwich UK
| | | | - M. Luterbacher
- The Norwich BioScience Institutes; Norwich Research Park Norwich UK
| | - G. Frost
- Nutrition and Dietetic Research Group; Section of Investigative Medicine; Faculty of Medicine; Imperial College London; London UK
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Bilderbeck AC, Atkinson LZ, McMahon HC, Voysey M, Simon J, Price J, Rendell J, Hinds C, Geddes JR, Holmes E, Miklowitz DJ, Goodwin GM. Psychoeducation and online mood tracking for patients with bipolar disorder: A randomised controlled trial. J Affect Disord 2016; 205:245-251. [PMID: 27454410 DOI: 10.1016/j.jad.2016.06.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychoeducation is an effective adjunct to medications in bipolar disorder (BD). Brief psychoeducational approaches have been shown to improve early identification of relapse. However, the optimal method of delivery of psychoeducation remains uncertain. Here, our objective was to compare a short therapist-facilitated vs. self-directed psychoeducational intervention for BD. METHODS BD outpatients who were receiving medication-based treatment were randomly assigned to 5 psychoeducation sessions administered by a therapist (Facilitated Integrated Mood Management; FIMM; n=60), or self-administered psychoeducation (Manualized Integrated Mood Management; MIMM; n=61). Follow-up was based on patients' weekly responses to an electronic mood monitoring programme over 12 months. RESULTS Over follow-up, there were no group differences in weekly self-rated depression symptoms or relapse/readmission rates. However, knowledge of BD (assessed with the Oxford Bipolar Knowledge questionnaire (OBQ)) was greater in the FIMM than the MIMM group at 3 months. Greater illness knowledge at 3 months was related to a higher proportion of weeks well over 12 months. LIMITATIONS Features of the trial may have reduced the sensitivity to our psychoeducation approach, including that BD participants had been previously engaged in self-monitoring. CONCLUSIONS Improved OBQ score, while accelerated by a short course of therapist-administered psychoeducation (FIMM), was seen after both treatments. It was associated with better outcome assessed as weeks well. When developing and testing a new psychosocial intervention, studies should consider proximal outcomes (e.g., acquired knowledge) and their short-term impact on illness course in bipolar disorder.
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Affiliation(s)
- Amy C Bilderbeck
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lauren Z Atkinson
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Hannah C McMahon
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Merryn Voysey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Judit Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Jonathan Price
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jennifer Rendell
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Chris Hinds
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - John R Geddes
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Emily Holmes
- University Department of Psychiatry, University of Oxford, Oxford, UK; MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - David J Miklowitz
- University Department of Psychiatry, University of Oxford, Oxford, UK; Semel Institute, UCLA, Los Angeles, CA, USA
| | - Guy M Goodwin
- University Department of Psychiatry, University of Oxford, Oxford, UK.
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Anwar M, Vorkas P, Li J, Adesina-Georgiadis K, Reslan O, Raffetto J, Want E, Khalil R, Holmes E, Davies A. Prolonged Mechanical Circumferential Stretch Induces Metabolic Changes in Rat Inferior Vena Cava. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.09.007] [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: 11/17/2022]
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