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Radhoe SP, Boersma E, Bertrand M, Remme W, Ferrari R, Fox K, MacMahon S, Chalmers J, Simoons ML, Brugts JJ. The Effects of a Perindopril-Based Regimen in Relation to Statin Use on the Outcomes of Patients with Vascular Disease: a Combined Analysis of the ADVANCE, EUROPA, and PROGRESS Trials. Cardiovasc Drugs Ther 2024; 38:131-139. [PMID: 36194352 PMCID: PMC10876738 DOI: 10.1007/s10557-022-07384-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effects of a perindopril-based regimen on cardiovascular (CV) outcomes in patients with vascular disease in relation to background statin therapy. METHODS A pooled analysis of the randomized ADVANCE, EUROPA, and PROGRESS trials was performed to evaluate CV outcomes in 29,463 patients with vascular disease treated with perindopril-based regimens versus placebo. The primary endpoint was a composite of CV mortality, nonfatal myocardial infarction, and stroke. Multivariable Cox regression analyses were performed to assess the effects of a perindopril-based regimen versus placebo in relation to statin use. RESULTS At randomization, 39.5% of the overall combined study population used statins. After a mean follow-up of 4.0 years (SD 1.0), the cumulative event-free survival was highest in the statin/perindopril group and lowest in the no statin/placebo group (91.2% vs. 85.6%, respectively, log-rank p < 0.001). In statin users (adjusted hazard ratio [aHR] 0.87, 95% confidence interval [CI] 0.77-0.98) and non-statin users (aHR 0.80, 95% CI 0.74-0.87), a perindopril-based regimen was associated with a significantly lower risk of the primary endpoint when compared to placebo. The additional treatment effect appeared numerically greater in non-statin users, but the observed difference was statistically nonsignificant. CONCLUSION Our data suggest that the treatment benefits of a perindopril-based regimen in patients with vascular disease are independent of statin use.
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Affiliation(s)
- S P Radhoe
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands.
| | - E Boersma
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | | | - W Remme
- STICARES Cardiovascular Research Institute, Rhoon, the Netherlands
| | - R Ferrari
- Department of Cardiology, University of Ferrara, Ferrara, Italy
| | - K Fox
- NHLI, Imperial College and Royal Brompton Hospital, London, UK
| | - S MacMahon
- The George Institute for Global Health, The University of NSW, Sydney, NSW, Australia
| | - J Chalmers
- The George Institute for Global Health, The University of NSW, Sydney, NSW, Australia
| | - M L Simoons
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - J J Brugts
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
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McCleave R, Li Z, Einarsson G, Loebinger M, Chalmers J, Elborn S, Haworth C, McKenna J, Fairley D, Allen D, Tunney M, Sherrard L. P126 Pseudomonas aeruginosa infection during long-term suppression treatment with tobramycin inhalation powder (TIP). J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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3
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Capozza K, Schwartz A, Lang JE, Chalmers J, Camilo J, Abuabara K, Kelley K, Harrison J, Vastrup A, Stancavich L, Tai A, Kimball AB, Finlay AY. The Impact of Childhood Atopic Dermatitis on Life Decisions for Caregivers and Families. J Eur Acad Dermatol Venereol 2022; 36:e451-e454. [DOI: 10.1111/jdv.17943] [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: 11/30/2022]
Affiliation(s)
- K. Capozza
- Global Parents for Eczema Research Santa Barbara USA
| | - A. Schwartz
- Departments of Medical Education and Pediatrics University of Illinois Chicago USA
| | - JE Lang
- Global Parents for Eczema Research Santa Barbara USA
| | - J Chalmers
- Centre of Evidence Based Dermatology University of Nottingham Nottingham UK
| | - J Camilo
- ADERMAP ‐ Associação Dermatite Atópica Portugal Lisboa Portugal
| | - K Abuabara
- Department of Dermatology University of California San Francisco USA
| | - K. Kelley
- Global Parents for Eczema Research Santa Barbara USA
| | - J. Harrison
- Global Parents for Eczema Research Santa Barbara USA
| | - A. Vastrup
- Atopisk Eksem Forening Copenhagen Denmark
| | - L. Stancavich
- Global Parents for Eczema Research Santa Barbara USA
| | - A. Tai
- Global Parents for Eczema Research Santa Barbara USA
| | | | - AY Finlay
- Division of Infection and Immunity School of Medicine Cardiff University Cardiff UK
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Wang N, Rueter P, Harris K, Woodward M, Chalmers J, Rodgers A. Cumulative Systolic Blood Pressure Load and Risk of Cardiovascular Outcomes in Patients With Diabetes. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.045] [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: 10/16/2022]
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5
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Shih V, Jison M, Bark E, Chalmers J. P063 BRIDGING THE GAP: A NOVEL SYMPTOM DIARY FOR NON-CYSTIC FIBROSIS BRONCHIECTASIS (NCFB) EXACERBATIONS. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.092] [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: 10/19/2022]
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de Courson H, Ferrer L, Barbieri A, Tully P, Woodward M, Chalmers J, Tzourio C, Leffondre K. Impact of model choice when studying the relationship between blood pressure variability and risk of stroke. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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7
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van de Ven K, Ritter A, Vuong T, Livingston M, Berends L, Chalmers J, Dobbins T. A comparison of structural features and vulnerability between government and nongovernment alcohol and other drug (AOD) treatment providers. J Subst Abuse Treat 2021; 132:108467. [PMID: 34098205 DOI: 10.1016/j.jsat.2021.108467] [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: 08/18/2020] [Revised: 04/13/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Both public (government-run), and not-for-profit (nongovernment) service providers provide alcohol and other drug (AOD) treatment services. Research has rarely studied the structural features of these providers, such as workforce characteristics, procurement arrangements, and funding security. The study reported here sought to document and analyze the differences between these two AOD treatment provider types in Australia. METHODS The study administered an online survey instrument targeted at managers of AOD treatment sites. The survey comprised three sections: (1) the service (e.g., treatment types); (2) workforce (e.g., total number of staff); and (3) funding and procurement arrangements (e.g., contract length). The study completed a total of 207 site surveys. The studied compared government and nongovernment services on structural features that may create a more or less sustainable or vulnerable service (funding arrangements, payment mechanisms, and contract length). RESULTS Government providers were more likely to provide medically oriented treatment types such as withdrawal management and pharmacotherapy, whereas nongovernment organization (NGO) providers were more likely to offer rehabilitation. Consistent with this, government services were more likely to employ medical professionals and nurses, indicative of a more medically oriented workforce, while NGO services were more likely to employ AOD workers, youth workers, peer workers, and counselors. Our data illustrate that NGO services were more likely to be subject to competitive tendering and to have shorter contract lengths, compared with government services, and overall to be more structurally vulnerable. CONCLUSION Despite the reliance on NGOs to provide the majority of specialist care (71% of all treatment episodes in Australia), these services are more vulnerable than their government counterparts. To ensure that a comprehensive suite of treatment services is available, procurement arrangements that support stability and security in nongovernment service providers and government service providers are essential.
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Affiliation(s)
- K van de Ven
- Centre for Rural Criminology, School of Humanities, Arts, and Social Sciences, University of New England, Armidale, New South Wales, Australia; Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia.
| | - A Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia
| | - T Vuong
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia
| | - M Livingston
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - L Berends
- TRACE Research; National Drug and Research Centre, UNSW, Australia
| | - J Chalmers
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - T Dobbins
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
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Chalmers J, Tung YCL, Liu CH, O'Kane CJ, O'Rahilly S, Yeo GSH. A multicomponent screen for feeding behaviour and nutritional status in Drosophila to interrogate mammalian appetite-related genes. Mol Metab 2021; 43:101127. [PMID: 33242659 PMCID: PMC7753202 DOI: 10.1016/j.molmet.2020.101127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE More than 300 genetic variants have been robustly associated with measures of human adiposity. Highly penetrant mutations causing human obesity do so largely by disrupting satiety pathways in the brain and increasing food intake. Most of the common obesity-predisposing variants are in, or near, genes expressed highly in the brain, but little is known of their function. Exploring the biology of these genes at scale in mammalian systems is challenging. We sought to establish and validate the use of a multicomponent screen for feeding behaviour phenotypes, taking advantage of the tractable model organism Drosophila melanogaster. METHODS We validated a screen for feeding behaviour in Drosophila by comparing results after disrupting the expression of centrally expressed genes that influence energy balance in flies to those of 10 control genes. We then used this screen to explore the effects of disrupted expression of genes either a) implicated in energy homeostasis through human genome-wide association studies (GWAS) or b) expressed and nutritionally responsive in specific populations of hypothalamic neurons with a known role in feeding/fasting. RESULTS Using data from the validation study to classify responses, we studied 53 Drosophila orthologues of genes implicated by human GWAS in body mass index and found that 15 significantly influenced feeding behaviour or energy homeostasis in the Drosophila screen. We then studied 50 Drosophila homologues of 47 murine genes reciprocally nutritionally regulated in POMC and agouti-related peptide neurons. Seven of these 50 genes were found by our screen to influence feeding behaviour in flies. CONCLUSION We demonstrated the utility of Drosophila as a tractable model organism in a high-throughput genetic screen for food intake phenotypes. This simple, cost-efficient strategy is ideal for high-throughput interrogation of genes implicated in feeding behaviour and obesity in mammals and will facilitate the process of reaching a functional understanding of obesity pathogenesis.
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Affiliation(s)
- J Chalmers
- Medical Research Council (MRC) Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
| | - Y C L Tung
- Medical Research Council (MRC) Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
| | - C H Liu
- Department of Physiology, Development and Neuroscience, Cambridge University, Downing St, Cambridge, CB2 3EG, UK.
| | - C J O'Kane
- Department of Genetics, University of Cambridge, Downing Street, Cambridge, CB2 3EH, UK.
| | - S O'Rahilly
- Medical Research Council (MRC) Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
| | - G S H Yeo
- Medical Research Council (MRC) Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
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Canoy D, Copland E, Ramakrishnan R, Pinho-Gomes A, Nazarzadeh M, Bidel Z, Salimi-Khorshidi G, Woodward M, Davis B, Pepine C, Chalmers J, Teo K, Rahimi K. Stratified effects of blood pressure-lowering treatment on long-term blood pressure: an individual patient-level meta-analysis involving 50 randomised trials and 334,219 participants. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Meta-analyses of randomised controlled trials (RCT) have shown the efficacy of pharmacologic lowering of blood pressure (BP) in reducing cardiovascular disease (CVD) risk. While efficacy has been shown across important patient characteristics, meta-analysis based on aggregate data could not fully account for potential sources of variation due to individual-level characteristics. Moreover, it is unclear if any variation in treatment effects due to patient characteristics are reflected in differential effects of BP-lowering treatment on long-term BP according to these characteristics.
Purpose
We determined the effects of BP-lowering treatment on repeated measures of blood pressure, identified trial- and participant-level sources of heterogeneity, and examined consistency of these BP-lowering effects across different patient characteristics.
Methods
We conducted an individual patient-level data meta-analysis (N=50 trials) using one-stage approach. We classified trials according to trial design: drug comparison (N=28), placebo-controlled (N=21) and BP-lowering intensity (N=8) trials. We fitted mixed models with fixed treatment effects and fixed time effect, random intercepts at trial and participant level, and a random slope for time at participant level. We adjusted for age, sex and baseline BP (except when used as stratification factor). We used likelihood ratio test and Akaike information criterion to compare models.
Results
This meta-analysis included 334,219 (42% women) participants. At baseline, mean age=65 (SD=9) years, among whom 18% were current smokers, 47% had cardiovascular disease, 29% had diabetes, and 73% were previously on BP-lowering medication. Participants had an average of 8 BP measurements over 4 years of mean follow-up. For drug comparison trials, mean differences (95% confidence interval) in systolic BP (SBP) and diastolic BP (DBP) between comparison arms were 1.3 (1.2 to 1.3) mmHg and 0.5 (0.5 to 0.5) mmHg, respectively; for placebo-controlled trials, the SBP and DBP differences were 4.2 (4.0 to 4.3) mmHg and 1.9 (1.9 to 2.0) mmHg, respectively; and for BP-lowering intensity trials, the SBP and DBP differences were 8.2 (8.0 to 8.4) mmHg and 3.7 (3.6 to 3.9) mmHg, respectively. However, BP reduction differed by duration of follow-up, type of trial. In particular, for placebo-controlled and BP-intensity trials, heterogeneity in BP reductions according to patient characteristics such as baseline BP, age, sex, prior CVD, diabetes and non-randomised anti-hypertensive use were observed.
Conclusion
This study shows the role of pharmacologic agents in effectively reducing long-term BP across individuals with a wide range of characteristics. The magnitude of BP reduction varied by several patient characteristics. This might have implications for investigation and explanation of any differential effects of BP treatment on major clinical outcomes.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): British Heart Foundation; NIHR Oxford Biomedial Research Centre
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Affiliation(s)
- D Canoy
- University of Oxford, Oxford, United Kingdom
| | - E Copland
- University of Oxford, Oxford, United Kingdom
| | | | | | | | - Z Bidel
- University of Oxford, Oxford, United Kingdom
| | | | - M Woodward
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - B.R Davis
- University of Texas, School of Public Health, Austin, United States of America
| | - C.J Pepine
- University of Florida, Department of Medicine, Florida, United States of America
| | - J Chalmers
- The George Institute for Global Health, Sydney, Australia
| | - K Teo
- McMaster University, Population Health Research Institute, Hamilton, Canada
| | - K Rahimi
- University of Oxford, Oxford, United Kingdom
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Hua X, Lung TWC, Woodward M, Salomon JA, Hamet P, Harrap SB, Mancia G, Poulter N, Chalmers J, Clarke PM. Self-rated health scores predict mortality among people with type 2 diabetes differently across three different country groupings: findings from the ADVANCE and ADVANCE-ON trials. Diabet Med 2020; 37:1379-1385. [PMID: 31967344 PMCID: PMC7496988 DOI: 10.1111/dme.14237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 01/19/2023]
Abstract
AIMS To explore whether there is a different strength of association between self-rated health and all-cause mortality in people with type 2 diabetes across three country groupings: nine countries grouped together as 'established market economies'; Asia; and Eastern Europe. METHODS The ADVANCE trial and its post-trial follow-up were used in this study, which included 11 140 people with type 2 diabetes from 20 countries, with a median follow-up of 9.9 years. Self-rated health was reported on a 0-100 visual analogue scale. Cox proportional hazard models were fitted to estimate the relationship between the visual analogue scale score and all-cause mortality, controlling for a range of demographic and clinical risk factors. Interaction terms were used to assess whether the association between the visual analogue scale score and mortality varied across country groupings. RESULTS The visual analogue scale score had different strengths of association with mortality in the three country groupings. A 10-point increase in visual analogue scale score was associated with a 15% (95% CI 12-18) lower mortality hazard in the established market economies, a 25% (95% CI 21-28) lower hazard in Asia, and an 8% (95% CI 3-13) lower hazard in Eastern Europe. CONCLUSIONS Self-rated health appears to predict 10-year all-cause mortality for people with type 2 diabetes worldwide, but this relationship varies across groups of countries.
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Affiliation(s)
- X. Hua
- School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - T. W. C. Lung
- George Institute for Global HealthUNSW SydneySydneyNSWAustralia
- School of Public HealthFaculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
| | - M. Woodward
- George Institute for Global HealthUNSW SydneySydneyNSWAustralia
- George Institute for Global HealthUniversity of OxfordOxfordUK
- Department of EpidemiologyJohns Hopkins UniversityBaltimoreMDUSA
| | - J. A. Salomon
- Department of MedicineStanford Medical SchoolStanfordCAUSA
| | - P. Hamet
- Centre de RechercheCentre Hospitalier de l'Université de MontréalMontréalQCCanada
- Department of MedicineUniversity of MontréalMontréalQCCanada
| | - S. B. Harrap
- Department of PhysiologyUniversity of MelbourneMelbourneVICAustralia
| | - G. Mancia
- University of Milano‐BicoccaMilanItaly
| | - N. Poulter
- Imperial Clinical Trials UnitSchool of Public HealthImperial College LondonLondonUK
| | - J. Chalmers
- George Institute for Global HealthUNSW SydneySydneyNSWAustralia
| | - P. M. Clarke
- School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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OSHIMA M, Wong M, Hara A, Toyama T, Jun M, Jardine M, Pollock C, Woodward M, Chalmers J, Perkovic V, Wada T. SUN-161 CIRCULATING AUTOANTIBODIES TO ERYTHROPOIETIN RECEPTOR AND KIDNEY DISEASE PROGRESSION IN TYPE 2 DIABETES MELLITUS: RESULTS FROM THE ADVANCE STUDIES. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Wang N, Harris K, Woodward M, Chalmers J, Rodgers A. 060 The Effects of Combination Blood Pressure Lowering in the Presence or Absence of Background Statin and Aspirin Therapy – a Combined Analysis of PROGRESS and ADVANCE. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Pintwala S, Fraigne J, Chalmers J, Belsham D, Peever J. Transplanting immortal orexin cells in narcolepsy. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.847] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Summers S, Chalmers J, Wallwork S, Leake H, Moseley L. Interrogating neural representations in elite athletes with persistent posterior thigh pain – new targets for intervention? J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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OSHIMA M, Jun M, Toyama T, Perkovic V, Chalmers J, Woodward M. SAT-287 eGFR SLOPE AND THE SUBSEQUENT RISK OF CLINICAL OUTCOMES IN TYPE 2 DIABETES. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Chalmers J, Wang X, Moullaali T, Minhas J, Anderson C, Robinson T. ASSOCIATIONS OF EARLY BLOOD PRESSURE CONTROL AND OUTCOME IN THROMBOLYSIS-ELIGIBLE ACUTE ISCHAEMIC STROKE IN THE ENHANCED CONTROL OF HYPERTENSION AND THROMBOLYSIS STROKE STUDY. J Hypertens 2019. [DOI: 10.1097/01.hjh.0000570324.46857.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Teasdale E, Lalonde A, Muller I, Chalmers J, Smart P, Hooper J, El‐Gohary M, Thomas K, Santer M. Patients' understanding of cellulitis and views about how best to prevent recurrent episodes: mixed-methods study in primary and secondary care. Br J Dermatol 2019; 180:810-820. [PMID: 30451281 PMCID: PMC6487809 DOI: 10.1111/bjd.17445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately one-third of cases. The only proven strategy to reduce the risk of recurrence is long-term, low-dose antibiotics. Given current concerns about antibiotic resistance and the pressure to reduce antibiotic prescribing, other prevention strategies are needed. OBJECTIVES To explore patients' views about cellulitis and different ways of preventing recurrent episodes. METHODS Adults aged ≥ 18 years with a history of first-episode or recurrent cellulitis were invited through primary care, hospitals and advertising to complete a survey, take part in an interview or both. RESULTS Thirty interviews were conducted between August 2016 and July 2017. Two hundred and forty surveys were completed (response rate 17%). Triangulation of quantitative and qualitative data showed that people who have had cellulitis have wide-ranging beliefs about what can cause cellulitis and are often unaware of risk of recurrence or potential strategies to prevent recurrence. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were more popular potential strategies than the use of compression stockings or long-term antibiotics. Participants expressed caution about long-term oral antibiotics, particularly those who had experienced only one episode of cellulitis. CONCLUSIONS People who have had cellulitis are keen to know about possible ways to prevent further episodes. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were generally viewed to be more acceptable, feasible strategies than compression or antibiotics, but further research is needed to explore uptake and effectiveness in practice.
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Affiliation(s)
- E.J. Teasdale
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
| | - A. Lalonde
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
| | - I. Muller
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
| | - J. Chalmers
- Centre for Evidence Based DermatologyUniversity of NottinghamNottinghamU.K
| | | | | | - M. El‐Gohary
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
| | - K.S. Thomas
- Centre for Evidence Based DermatologyUniversity of NottinghamNottinghamU.K
| | - M. Santer
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
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Teasdale E, Lalonde A, Muller I, Chalmers J, Smart P, Hooper J, El‐Gohary M, Thomas K, Santer M. Preventing recurrent cellulitis. Br J Dermatol 2019. [DOI: 10.1111/bjd.17658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Teasdale E, Lalonde A, Muller I, Chalmers J, Smart P, Hooper J, El‐Gohary M, Thomas K, Santer M. 防止复发性蜂窝织炎. Br J Dermatol 2019. [DOI: 10.1111/bjd.17674] [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: 12/01/2022]
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Chalmers J, di Mascio L, Thottakam B, Galley H. Melatonin increases endorphin production by pituitary cells. Br J Anaesth 2019. [DOI: 10.1016/j.bja.2018.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ewig S, Kolditz M, Pletz MW, Chalmers J. Healthcare-associated pneumonia: is there any reason to continue to utilize this label in 2019? Clin Microbiol Infect 2019; 25:1173-1179. [PMID: 30825674 DOI: 10.1016/j.cmi.2019.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/04/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is an ongoing controversy on the role of the healthcare-associated pneumonia (HCAP) label in the treatment of patients with pneumonia. OBJECTIVE To provide an update of the literature on patients meeting criteria for HCAP between 2014 and 2018. SOURCES The review is based on a systematic literature search using PubMed-Central full-text archive of biomedical and life sciences literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM). CONTENT Studies compared clinical characteristics of patients with HCAP and community-acquired pneumonia (CAP). HCAP patients were older and had a higher comorbidity. Mortality rates in HCAP varied from 5% to 33%, but seemed lower than those cited in the initial reports. Criteria behind the HCAP classification differed considerably within populations. Microbial patterns differed in that there was a higher incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, and, to a lesser extent, enterobacteriaceae. Definitions and rates of multidrug-resistant (MDR) pneumonia also varied considerably. Broad-spectrum guideline-concordant treatment did not reduce mortality in four observational studies. The HCAP criteria performed poorly as a predictive tool to identify MDR pneumonia or pathogens not covered by treatment for CAP. A new score (Drug Resistance in Pneumonia, DRIP) outperformed HCAP in the prediction of MDR pathogens. Comorbidity and functional status, but not different microbial patterns, seem to account for increased mortality. IMPLICATIONS HCAP should no longer be used to identify patients at risk of MDR pathogens. The use of validated predictive scores along with implementation of de-escalation strategies and careful individual assessment of comorbidity and functional status seem superior strategies for clinical management.
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Affiliation(s)
- S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Herne und Bochum, Germany.
| | - M Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - J Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
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Find’o S, Skuban M, Kajba M, Chalmers J, Kalaš M. Identifying attributes associated with brown bear (Ursus arctos) road-crossing and roadkill sites. CAN J ZOOL 2019. [DOI: 10.1139/cjz-2018-0088] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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]
Abstract
Habitat fragmentation caused by transportation infrastructure is an issue of growing concern worldwide. We show how secondary roads may affect landscape permeability for brown bears (Ursus arctos Linnaeus, 1758). We focused on identifying environmental variables that govern the selection of road-crossing zones by bears (crossing model). We also investigated whether variables that characterize road-crossing zones differ from those that are typical for bear–vehicle collision sites (collision model). The study area was located in north-central Slovakia. To identify road-crossing sites, we used the GPS fixes of 27 bears and identified 35 bear–vehicle collision sites from a different data set. We used mixed-effects logistic regression to model resource selection at road-crossing sites and to compare bear-crossing sites with bear-kill sites. The crossing model showed that the traffic volume with distance to forest and grassland were the most influential factors in bear selection of road-crossing sites. Results of the collision model indicated that successful road crossings by bears were located at different road sections from vehicle collisions, which differed by a traffic volume of 5000 vehicles/24 h. The outcomes of this study can facilitate improved mitigation measures on secondary roads.
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Affiliation(s)
- S. Find’o
- Carpathian Wildlife Society, Tulská 2461/29, 961 01 Zvolen, Slovakia
- Slovak State Nature Conservancy, Tajovského 28 B, 974 01 Banská Bystrica, Slovakia
| | - M. Skuban
- Carpathian Wildlife Society, Tulská 2461/29, 961 01 Zvolen, Slovakia
| | - M. Kajba
- YMS, a. s. (Inc.), Hornopotočná 1, 917 01 Trnava, Slovakia
| | - J. Chalmers
- Carpathian Wildlife Society, Tulská 2461/29, 961 01 Zvolen, Slovakia
| | - M. Kalaš
- Slovak State Nature Conservancy, Tajovského 28 B, 974 01 Banská Bystrica, Slovakia
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Santo K, Singleton A, Rogers K, Thiagalingam A, Chalmers J, Chow C, Redfern J. 1109Medication reminder apps to improve medication adherence in coronary heart disease patients (MedApp-CHD): a randomised clinical trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Santo
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - A Singleton
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - K Rogers
- The George Institute for Global Health, Sydney, Australia
| | - A Thiagalingam
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - J Chalmers
- The George Institute for Global Health, Sydney, Australia
| | - C Chow
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - J Redfern
- University of Sydney, Sydney Medical School, Sydney, Australia
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Brugts JJ, Bertrand M, Remme W, Ferrari R, Fox K, MacMahon S, Chalmers J, Simoons ML, Boersma E. The Treatment Effect of an ACE-Inhibitor Based Regimen with Perindopril in Relation to Beta-Blocker use in 29,463 Patients with Vascular Disease: a Combined Analysis of Individual Data of ADVANCE, EUROPA and PROGRESS Trials. Cardiovasc Drugs Ther 2018; 31:391-400. [PMID: 28856537 PMCID: PMC5607906 DOI: 10.1007/s10557-017-6747-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In everyday practice, angiotensin converting enzyme inhibitors and beta-blockers are cornerstone treatments in patients with (cardio-)vascular disease. Clear data that evaluate the effects of the combination of these agents on morbidity and mortality are lacking. METHODS In this retrospective pooled analysis of three large perindopril outcome trials (ADVANCE, EUROPA, PROGRESS), clinical outcomes were evaluated in 29,463 patients with vascular disease. Multivariate Cox regression analyses were performed in patients randomized to a perindopril-based regimen or placebo (treatment effect), and data were stratified according to background beta-blocker treatment. The primary endpoint was a composite of cardiovascular mortality, non-fatal myocardial infarction, and stroke. RESULTS The cumulative incidence of the primary endpoint over mean follow-up of 4.0 years (Sd 1.0) was significantly lower in the beta-blocker/perindopril group (9.6%; 545/5700 patients) as compared to beta-blocker/placebo (11.8%; 676/5718 patients) (p < 0.01). Adding perindopril to existing beta-blocker treatment reduced the relative risk of the primary endpoint by 20% (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.71-0.90), non-fatal myocardial infarction by 23% (HR 0.77; 95% CI 0.65-0.91), and all-cause mortality by 22% (HR 0.78; 95% CI 0.68-0.88) as compared to placebo. Significant treatment benefit was not observed for stroke (HR 0.93; 95% CI 0.75-1.15). Significance was maintained for the primary endpoint and cardiovascular endpoints when data were further stratified by baseline hypertension. However, the mortality benefit was only observed in patients with hypertension with background beta-blocker use. CONCLUSIONS These data suggest that the beneficial cardioprotective effects of perindopril treatment are additive to the background beta-blockers use.
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Affiliation(s)
- J J Brugts
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | | | - W Remme
- STICARES Cardiovascular Research Institute, Rhoon, The Netherlands
| | - R Ferrari
- Centro Cardiologico Universitario University of Ferrara, Italy and Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Ravenna, Italy
| | - K Fox
- NHLI, Imperial College and ICMS, Royal Brompton Hospital, London, UK
| | - S MacMahon
- The George Institute for Global Health, The Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - J Chalmers
- The George Institute for Global Health, The Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - M L Simoons
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - E Boersma
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Kottner J, Jacobi L, Hahnel E, Alam M, Balzer K, Beeckman D, Busard C, Chalmers J, Deckert S, Eleftheriadou V, Furlan K, Horbach S, Kirkham J, Nast A, Spuls P, Thiboutot D, Thorlacius L, Weller K, Williams H, Schmitt J. Core outcome sets in dermatology: report from the second meeting of the International Cochrane Skin Group Core Outcome Set Initiative. Br J Dermatol 2018. [DOI: 10.1111/bjd.16506] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kottner J, Jacobi L, Hahnel E, Alam M, Balzer K, Beeckman D, Busard C, Chalmers J, Deckert S, Eleftheriadou V, Furlan K, Horbach S, Kirkham J, Nast A, Spuls P, Thiboutot D, Thorlacius L, Weller K, Williams H, Schmitt J. 皮肤医学的核心结果集合:来自国际Cochrane皮肤小组核心结果集合倡议的报告. Br J Dermatol 2018. [DOI: 10.1111/bjd.16575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Kottner J, Jacobi L, Hahnel E, Alam M, Balzer K, Beeckman D, Busard C, Chalmers J, Deckert S, Eleftheriadou V, Furlan K, Horbach S, Kirkham J, Nast A, Spuls P, Thiboutot D, Thorlacius L, Weller K, Williams H, Schmitt J. Core outcome sets in dermatology: report from the second meeting of the International Cochrane Skin Group Core Outcome Set Initiative. Br J Dermatol 2018; 178:e279-e285. [DOI: 10.1111/bjd.16324] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 01/25/2023]
Affiliation(s)
- J. Kottner
- Department of Dermatology and Allergy Charité‐Universitätsmedizin Berlin Berlin Germany
| | - L. Jacobi
- Center for Evidence‐based Healthcare Medizinische Fakultät Carl Gustav Carus Dresden Germany
| | - E. Hahnel
- Department of Dermatology and Allergy Charité‐Universitätsmedizin Berlin Berlin Germany
| | - M. Alam
- Department of Dermatology Northwestern University Chicago IL U.S.A
| | - K. Balzer
- Institute for Social Medicine and Epidemiology University of Lübeck Germany
| | - D. Beeckman
- University Centre for Nursing and Midwifery Department of Public Health Ghent University Ghent Belgium
| | - C. Busard
- Department of Dermatology Academic Medical Center Amsterdam the Netherlands
| | - J. Chalmers
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - S. Deckert
- Center for Evidence‐based Healthcare Medizinische Fakultät Carl Gustav Carus Dresden Germany
| | - V. Eleftheriadou
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - K. Furlan
- Department of Dermatology Northwestern University Chicago IL U.S.A
| | - S.E.R. Horbach
- Department of Dermatology Academic Medical Center Amsterdam the Netherlands
| | - J. Kirkham
- Department of Biostatistics University of Liverpool Liverpool U.K
| | - A. Nast
- Department of Dermatology and Allergy Charité‐Universitätsmedizin Berlin Berlin Germany
| | - P. Spuls
- Department of Dermatology Academic Medical Center Amsterdam the Netherlands
| | - D. Thiboutot
- Department of Dermatology The Pennsylvania State University College of Medicine Hershey PA U.S.A
| | - L. Thorlacius
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - K. Weller
- Department of Dermatology and Allergy Charité‐Universitätsmedizin Berlin Berlin Germany
| | - H.C. Williams
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - J. Schmitt
- Center for Evidence‐based Healthcare Medizinische Fakultät Carl Gustav Carus Dresden Germany
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Blomster JI, Zoungas S, Woodward M, Neal B, Harrap S, Poulter N, Marre M, Williams B, Chalmers J, Hillis GS. The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study. Diabetes Res Clin Pract 2017; 127:212-217. [PMID: 28395214 DOI: 10.1016/j.diabres.2017.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/12/2016] [Accepted: 03/16/2017] [Indexed: 11/29/2022]
Abstract
AIMS The relationship between educational level and the risk of all-cause mortality is well established, whereas the association with vascular events in individuals with type 2 diabetes is not well described. Any association may reflect a link with common cardiovascular or lifestyle-based risk factors. METHODS The relationships between the highest level of educational attainment and major cardiovascular events, microvascular complications and all-cause mortality were explored in a cohort of 11,140 individuals with type 2 diabetes. Completion of formal education before the age of 16 was categorized as a low level of education. Regional differences between Asia, East Europe and Established Market Economies were also assessed. RESULTS During a median of 5years of follow up, 1031 (9%) patients died, 1147 (10%) experienced a major cardiovascular event and 1136 (10%) a microvascular event. After adjustment for baseline characteristics and risk factors, individuals with lower education had an increased risk of cardiovascular events (hazard ratio (HR) 1.31, 95% CI 1.16-1.48, p<0.0001), microvascular events (HR 1.23, 95% CI 1.08-1.39, p=0.0013) and all-cause mortality (HR 1.34, 95% CI 1.18-1.52, p<0.0001). In regional analyses the increased risk of studied outcomes associated with lower education was weakest in Established Market Economies and strongest in East Europe. CONCLUSIONS A low level of education is associated with an increased risk of vascular events and death in patients with type 2 diabetes, independently of common lifestyle associated cardiovascular risk factors. The effect size varies between geographical regions.
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Affiliation(s)
- J I Blomster
- The George Institute for Global Health, University of Sydney, Sydney, Australia; University of Turku, Turku, Finland.
| | - S Zoungas
- The George Institute for Global Health, University of Sydney, Sydney, Australia; School of Public Health, Monash University, Melbourne, Australia
| | - M Woodward
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, USA; The George Institute for Global Health, University of Oxford, UK
| | - B Neal
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - S Harrap
- Department of Physiology, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - N Poulter
- Imperial College London and Hammersmith Hospital, London, UK
| | - M Marre
- Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
| | - B Williams
- University College London and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, UK
| | - J Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - G S Hillis
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Perth Hospital, Perth, Australia
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Santo K, Kirkendall S, Chalmers J, Chow C, Redfern J. Mobile Phone Usage Patterns in an Acute Coronary Syndrome Cohort. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.101] [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: 10/19/2022]
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Thakkar J, Heeley EL, Chalmers J, Chow CK. Inaccurate risk perceptions contribute to treatment gaps in secondary prevention of cardiovascular disease. Intern Med J 2016; 46:339-46. [PMID: 26662342 DOI: 10.1111/imj.12982] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/21/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND All patients with cardiovascular disease (CVD) are at high risk of recurrent events. Despite strong evidence, large treatment gaps exist in CVD secondary prevention. We hypothesise that patients' self-perception and general practitioner's (GP) assessment of future cardiovascular (CV) risk may influence secondary prevention behaviours. AIM To examine in patients with known CVD the perceived risk of future CV events and its relationship with use of secondary prevention medications and risk factor control. METHODS We examined patient and practitioner's perceived risk and its relationship with the uptake of secondary prevention recommendations in adults with CVD participating in the Australian Hypertension and Absolute Risk Study. RESULTS Among the 1453 participants, only 11% reported having a high absolute risk and 29% reported high relative risk of recurrent events. The GP categorised only 30% as having a 5-year risk ≥15%. After adjusting for covariates, hospitalisation within the preceding 12 months was the only significant predictor of patients' accurate risk perception. Conventional CV risk factors were predictive of the GP's risk estimates. Patients who accurately understood their risk reported higher smoking cessation rates (7 vs 3%, P = 0.003) and greater use of antiplatelet, blood pressure lowering therapy and statins (P ≤ 0.01). However, there was no relationship between GP's risk perception and secondary prevention treatments. CONCLUSION Both patients and GP have optimistic bias and underestimate the risk of future CV events. Patients' accurate self-perception, but not GP risk perception, was associated with improved secondary preventative behaviours. This suggests that helping patients to understand their risk may influence their motivation towards secondary prevention. Providing support to GP or programmes to help patients better understand their risks could have potential benefit on secondary prevention behaviours.
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Affiliation(s)
- J Thakkar
- The George Institute for Global Health, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - E L Heeley
- The George Institute for Global Health, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - J Chalmers
- The George Institute for Global Health, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - C K Chow
- The George Institute for Global Health, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
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Ritchie A, Singanayagam A, Manalan K, Connell D, Chalmers J, Sridhar S, Lalvani A, Wickremasinghe M, Kon OM. P112 Serum inflammatory biomarkers as predictors of treatment outcome in pulmonary tuberculosis. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.255] [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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Welte T, Ringshausen FC, Chalmers J, Polverino E, Aliberti S, Zurawski A. Editorial. Pneumologie 2016. [DOI: 10.1055/s-0036-1592224] [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: 10/20/2022]
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Danby SG, Chalmers J, Brown K, Williams HC, Cork MJ. A functional mechanistic study of the effect of emollients on the structure and function of the skin barrier. Br J Dermatol 2016; 175:1011-1019. [PMID: 27097823 DOI: 10.1111/bjd.14684] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Preventing relapses of atopic dermatitis (AD) through the regular use of topical products to repair the skin barrier defect is an emerging concept. It is still unclear if some commonly used emollients exert a positive effect on the skin barrier. OBJECTIVES To determine the skin barrier effects of emollients commonly prescribed in the U.K. MATERIALS AND METHODS Two cohorts of volunteers with quiescent AD undertook observer-blind forearm-controlled studies. The first cohort (18 volunteers) treated the volar side of one forearm with two fingertip units of Doublebase™ gel twice daily for 4 weeks. The second cohort (19 volunteers) undertook the same regimen using Diprobase® cream. Transepidermal water loss (TEWL), stratum corneum integrity and hydration, skin surface pH and redness were determined at the test sites before and after treatment. RESULTS Neither Diprobase® cream nor Doublebase™ gel significantly affected the underlying skin barrier function. Both emollients were associated with significantly increased skin surface pH immediately after application (by 0·8 ± 0·19 and 1·0 ± 0·18 units, respectively), and no erythema. Diprobase® cream artificially and transiently (6 h) improved permeability barrier function by 2·9-3·1 g m-2 h-1 TEWL and increased skin hydration by 6·0-6·2 units. Doublebase™ gel, containing humectants, was associated with a greater (between 10·1 and 13·0 units during the first 6 h) and more sustained increase in hydration, lasting more than 12 h following repeated use. CONCLUSIONS Diprobase® cream and Doublebase™ gel are not associated with skin barrier harm and appear to be appropriate for AD treatment. While displaying emollient properties, neither formulation displayed an ability to actively improve sustained skin barrier function.
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Affiliation(s)
- S G Danby
- The Academic Unit of Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K.
| | - J Chalmers
- The Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - K Brown
- The Academic Unit of Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K
| | - H C Williams
- The Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - M J Cork
- The Academic Unit of Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K.,The Paediatric Dermatology Clinic, Sheffield Children's Hospital, Sheffield, U.K.,Department of Dermatology, Royal Hallamshire Hospital, Sheffield, U.K
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Fischbacher CM, Steiner M, Bhopal R, Chalmers J, Jamieson J, Knowles D, Povey C. Variations in all Cause and Cardiovascular Mortality by Country of Birth in Scotland, 1997-2003. Scott Med J 2016; 52:5-10. [PMID: 18092629 DOI: 10.1258/rsmsmj.52.4.5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background and Aims Country of birth provides a proxy for ethnic group for recent migrants. Major differences in mortality by country of birth have been demonstrated in England and Wales, but similar published data for Scotland are lacking. We aimed to examine variations in mortality by country of birth for Scottish residents. Methods We calculated standardised mortality ratios by country of birth for Scottish residents aged 25 years and over between January 1997 and March 2003. Results and Conclusion Comparisons with England and Wales showed high allcause, coronary heart disease (CHD) and stroke mortality among Scottish residents born in Scotland, Northern Ireland, the Republic of Ireland, India and Hong Kong. However, most country of birth groups had similar or lower mortality than the Scottish born. These are the first data on mortality by country of birth in Scotland and they demonstrate major variations. Comparisons within the Scottish population might be interpreted as reassuring, since they do not show the excesses in CHD mortality by country of birth reported in England and Wales. However, the use of England and Wales as a comparison group shows a substantial excess of CHD risk among South Asians in Scotland, comparable to that reported in England and Wales.
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Affiliation(s)
- CM Fischbacher
- Consultant in Public Health Medicine, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
- Honorary Senior Lecturer, Department of Public Health Sciences, University of Edinburgh, EH8 9AG
| | - M Steiner
- Senior Registrar, Department of Environmental and Occupational Medicine, Liberty Safe Work Research Centre, Forresterhill Road, Aberdeen, AB25 2ZP. (Formerly, Department of Public Health Sciences, University of Edinburgh, EH8 9AG)
| | - R Bhopal
- Professor of Public Health, Department of Public Health Sciences, University of Edinburgh, EH8 9AG
| | - J Chalmers
- Consultant in Public Health Medicine, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
- Honorary Senior Lecturer, Department of Public Health Sciences, University of Edinburgh, EH8 9AG
| | - J Jamieson
- Programme Manager, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
| | - D Knowles
- Head of Group, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
| | - C Povey
- Information Analyst, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
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Nowson C, Lim K, Grimes C, O'Halloran S, Land M, Webster J, Shaw J, Chalmers J, Smith W, Flood V, Woodward M, Neal B. Dietary salt intake and discretionary salt use in an Australian population sample: 2011 and 2014. Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Santo K, Kirkendall S, Laba T, Thakkar J, Webster R, Chalmers J, Chow C, Redfern J. PM082 Interventions to Improve Medication Adherence in Coronary Disease Patients: A Systematic Review of Randomised Controlled Trials. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.289] [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] Open
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Woodward M, Hirakawa Y, Kengne AP, Matthews DR, Zoungas S, Patel A, Poulter N, Grobbee R, Cooper M, Jardine M, Chalmers J. Prediction of 10-year vascular risk in patients with diabetes: the AD-ON risk score. Diabetes Obes Metab 2016; 18:289-94. [PMID: 26661693 DOI: 10.1111/dom.12614] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 10/03/2015] [Revised: 11/11/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Abstract
AIMS To formulate a combined cardiovascular risk score in diabetes that could be useful both to physicians and healthcare funders. METHODS Data were derived from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation Observational (ADVANCE-ON) study, a randomized controlled trial (mean duration 5 years) with a post-randomization follow-up (mean 4.9 years), that included 11 140 high-risk patients with diabetes. The outcome analysed was the occurrence of either fatal or non-fatal macrovascular or renal disease. A Cox regression model was used to determine weightings in the risk score. The resultant score was recalibrated to each of three major global regions, as covered by the ADVANCE-ON study. RESULTS Over a median of 9.9 years, 1145 patients experienced at least one component of the combined outcome event. The resultant score, the AD-ON risk score, incorporated 13 demographic or clinical variables. Its discrimination was modest [c-statistic = 0.668 (95% confidence interval 0.651, 0.685)] but its calibration was excellent (predicted and observed risks coincided well, within disparate global regions). In terms of the integrated discrimination improvement index, its performance was marginally superior, over a 10-year risk horizon, to existing risk scores in clinical use, from a restricted version of the same data, for macrovascular and renal disease separately. CONCLUSIONS The AD-ON risk score has advantages over the existing vascular risk scores in diabetes that used data from the original ADVANCE trial, which treat macrovascular and renal diseases separately. These advantages include its simplicity of use and global application.
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Affiliation(s)
- M Woodward
- George Institute for Global Health, University of Sydney, Sydney, Australia
- George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Y Hirakawa
- George Institute for Global Health, University of Sydney, Sydney, Australia
| | - A-P Kengne
- George Institute for Global Health, University of Sydney, Sydney, Australia
- Non-Communicable Diseases Research Unit, South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | - D R Matthews
- Oxford Centre for Diabetes, Endocrinology Metabolism, University of Oxford, Oxford, UK
| | - S Zoungas
- George Institute for Global Health, University of Sydney, Sydney, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - A Patel
- George Institute for Global Health, University of Sydney, Sydney, Australia
| | - N Poulter
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - R Grobbee
- Julius Global Health, the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Cooper
- The Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - M Jardine
- George Institute for Global Health, University of Sydney, Sydney, Australia
| | - J Chalmers
- George Institute for Global Health, University of Sydney, Sydney, Australia
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Rådholm K, Wiréhn AB, Chalmers J, Östgren CJ. Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study. Diabet Med 2016; 33:218-23. [PMID: 26036276 PMCID: PMC5034798 DOI: 10.1111/dme.12822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 11/26/2022]
Abstract
AIMS To explore the gender- and age-specific risk of developing a first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared with people with no pharmaceutical treatment for diabetes or depression. METHODS A cohort of all Swedish residents aged 45-84 years (n = 4 083 719) was followed for a period of 3 years. Data were derived from three nationwide registers. The prescription and dispensing of antidiabetic and antidepressant drugs were used as markers of disease. All study subjects were reallocated according to treatment and the treatment categories were updated every year. Data were analysed using a Cox regression model with a time-dependent variable. The outcome of interest was first fatal or non-fatal myocardial infarction. RESULTS During follow-up, 42 840 people had a first myocardial infarction, 3511 of which were fatal. Women aged 45-64 years, receiving both antidiabetic and antidepressant drugs had a hazard ratio for myocardial infarction of 7.4 (95% CI 6.3-8.6) compared with women receiving neither. The corresponding hazard ratio for men was 3.1 (95% CI 2.8-3.6). CONCLUSIONS The combined use of antidiabetic and antidepressant drugs was associated with a higher risk of myocardial infarction compared with use of either group of drugs alone. The increase in relative risk was greater in middle-aged women than in middle-aged men.
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Affiliation(s)
- K Rådholm
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, Linköping, Sweden
| | - A-B Wiréhn
- Research and Development Unit in Local Health Care, and Department of Medicine and Health Sciences, Linköping University, Motala, Sweden
| | - J Chalmers
- The George Institute for Global Health, University of Sydney, NSW, Australia
| | - C J Östgren
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, Linköping, Sweden
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Schmitt J, Deckert S, Alam M, Apfelbacher C, Barbaric J, Bauer A, Chalmers J, Chosidow O, Delamere F, Doney E, Eleftheriadou V, Grainge M, Johannsen L, Kottner J, Le Cleach L, Mayer A, Pinart M, Prescott L, Prinsen CAC, Ratib S, Schlager JG, Sharma M, Thomas KS, Weberschock T, Weller K, Werner RN, Wild T, Wilkes SR, Williams HC. Report from the kick-off meeting of the Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN). Br J Dermatol 2016; 174:287-95. [PMID: 26779929 DOI: 10.1111/bjd.14337] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
Abstract
A major obstacle of evidence-based clinical decision making is the use of nonstandardized, partly untested outcome measurement instruments. Core Outcome Sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcomes and outcome measurement instruments in clinical trials, in order to pool results of trials or to allow indirect comparison between interventions. A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population. The international, multidisciplinary Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN) aims to develop and implement COSs in dermatology, thus making trial evidence comparable and, herewith, more useful for clinical decision making. The inaugural meeting of CSG-COUSIN was held on 17-18 March 2015 in Dresden, Germany, as the exclusive theme of the Annual Cochrane Skin Group Meeting. In total, 29 individuals representing a broad mix of different stakeholder groups, professions, skills and perspectives attended. This report provides a description of existing COS initiatives in dermatology, highlights current methodological challenges in COS development, and presents the concept, aims and structure of CSG-COUSIN.
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Affiliation(s)
- J Schmitt
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.,Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - S Deckert
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - M Alam
- Department of Dermatology, Northwestern University, Chicago, IL, U.S.A
| | - C Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - J Barbaric
- Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
| | - A Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - J Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - O Chosidow
- Department of Dermatology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,Université Paris-Est Créteil, Créteil, France.,Satellite Français du Cochrane Skin Group, France.,EA EpiDermE, INSERM Créteil, Créteil, France
| | - F Delamere
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - E Doney
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - V Eleftheriadou
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - M Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, U.K
| | - L Johannsen
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - J Kottner
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Le Cleach
- Department of Dermatology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,Université Paris-Est Créteil, Créteil, France.,Satellite Français du Cochrane Skin Group, France.,EA EpiDermE, INSERM Créteil, Créteil, France
| | - A Mayer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Pinart
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L Prescott
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - C A C Prinsen
- VU University Medical Center, Department of Epidemiology and Biostatistics, the EMGO Institute for Health and Care Research, Amsterdam, the Netherlands
| | - S Ratib
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - J G Schlager
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Sharma
- Derby Teaching Hospitals NHS Foundation Trust, Derby, U.K
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - T Weberschock
- Department of Dermatology, Venereology, and Allergology, J.W. Goethe-University, Hospital, Frankfurt, Germany.,Evidence-Based Medicine Frankfurt, Institute for General Practice, Goethe-University, Frankfurt, Germany
| | - K Weller
- Department of Dermatology, Venerology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R N Werner
- Department of Dermatology, Venerology and Allergy, Division of Evidence Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Wild
- Centre of Wound Healing, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - S R Wilkes
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
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Sato S, Heeley E, Arima H, Delcourt C, Hirakawa Y, Pamidimukkala V, Li Z, Tao Q, Xu Y, Hennerici MG, Robinson T, Tzourio C, Lindley RI, Chalmers J, Anderson CS, Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, Heeley E, Skulina C, Parsons MW, Kim JS, Tao QL, Li YC, Jiang JD, Tai LW, Zhang LJ, Xu E, Cheng Y, Heritier S, Morgenstern LB, Chalmers J. Higher mortality in patients with right hemispheric intracerebral haemorrhage: INTERACT1 and 2. J Neurol Neurosurg Psychiatry 2015; 86:1319-23. [PMID: 25589782 DOI: 10.1136/jnnp-2014-309870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 12/22/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Controversy exists over the prognostic significance of the affected hemisphere in stroke. We aimed to determine the relationship between laterality of acute intracerebral haemorrhage (ICH) and poor clinical outcomes. METHODS A subsidiary analysis of the INTERACT Pilot and INTERACT2 studies--randomised controlled trials of patients with spontaneous acute ICH with elevated systolic blood pressure (BP), randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Outcomes were the combined and separate end points of death and major disability (modified Rankin scale (mRS) scores of 3-6, 6 and 3-5, respectively) at 90 days. RESULTS A total of 2708 patients had supratentorial/hemispheric ICH and information on mRS at 90 days. Patients with right hemispheric ICH (1327, 49%) had a higher risk of death at 90 days compared to those with left hemispheric ICH after adjustment for potential confounding variables (OR, 1.77 (95% CI 1.33 to 2.37)). There were no differences between patients with right and left hemispheric ICH regarding the combined end point of death or major disability or major disability in the multivariable-adjusted models (1.07 (0.89 to 1.29) and 0.85 (0.72 to 1.01), respectively). CONCLUSIONS Right hemispheric lesion was associated with increased risk of death in patients with acute ICH. The laterality of the ICH does not appear to affect the level of disability in survivors. TRIAL REGISTRATION NUMBER URL: http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079.
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Affiliation(s)
- Shoichiro Sato
- The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Emma Heeley
- The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hisatomi Arima
- The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Candice Delcourt
- The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Yoichiro Hirakawa
- The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | - Zhendong Li
- Department of Neurology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Qingling Tao
- Department of Neurology, Chang Ning District Central Hospital, Shanghai, China
| | - Yuehong Xu
- Department of Neurology, Shijiazhuang 260 Hospital, Hebei, China
| | - Michael G Hennerici
- Department of Neurology, University of Heidelberg UMM Mannheim, Mannheim, Germany
| | - Thompson Robinson
- Department of Cardiovascular Sciences, and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, UK
| | | | - Richard I Lindley
- The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Craig S Anderson
- The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Moffitt KL, Martin SL, Chalmers J, Walker B. P102 Development of a Novel Assay for the Detection of Active Neutrophil Elastase in Patients with Chronic Obstructive Pulmonary Disease. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barbarot S, Abuabara K, Aubert H, Chalmers J, Flohr C, Hanifin J, Naldi L, Margolis D, Paul C, Rogers N, Ridd M, Schuttelaar ML, Simpson E, Tauber M, Volke A, Weidinger S, Wilkes S, Wollenberg A, Thomas K. Comment évaluer le contrôle à long terme de la dermatite atopique dans les essais randomisés ? Une revue systématique. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mandal P, Chalmers J, Sidhu M, Davidson D, Rossi A, Hill A. S16 A Randomised Controlled Trial Of Atorvastatin As A Stable Treatment In Bronchiectasis. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.22] [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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45
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Delnord M, Szamotulska K, Monhangoo A, Gissler M, Barona C, Barros H, Berrut S, Chalmers J, Dattani N, Sakkeus L, Zile I, Zeitlin J. Linking databases on perinatal health: a review of the literature and current practices in Europe. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku164.087] [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: 11/14/2022] Open
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46
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van Dieren S, Kengne AP, Chalmers J, Beulens JWJ, Davis TME, Fulcher G, Heller SR, Patel A, Colagiuri S, Hamet P, Mancia G, Marre M, Neal B, Williams B, Peelen LM, van der Schouw YT, Woodward M, Zoungas S. Intensification of medication and glycaemic control among patients with type 2 diabetes - the ADVANCE trial. Diabetes Obes Metab 2014; 16:426-32. [PMID: 24251579 DOI: 10.1111/dom.12238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/02/2013] [Accepted: 11/02/2013] [Indexed: 02/04/2023]
Abstract
AIMS The aim of this study was to assess associations between patient characteristics, intensification of blood glucose-lowering treatment through oral glucose-lowering therapy and/or insulin and effective glycaemic control in type 2 diabetes. METHODS 11 140 patients from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial who were randomized to intensive glucose control or standard glucose control and followed up for a median of 5 years were categorized into two groups: effective glycaemic control [haemoglobin A1c (HbA1c) ≤ 7.0% or a proportionate reduction in HbA1c over 10%] or ineffective glycaemic control (HbA1c > 7.0% and a proportionate reduction in HbA1c less than or equal to 10%). Therapeutic intensification was defined as addition of an oral glucose-lowering agent or commencement of insulin. Pooled logistic regression models examined the associations between patient factors, intensification and effective glycaemic control. RESULTS A total of 7768 patients (69.7%), including 3198 in the standard treatment group achieved effective glycaemic control. Compared to patients with ineffective control, patients with effective glycaemic control had shorter duration of diabetes and lower HbA1c at baseline and at the time of treatment intensification. Treatment intensification with addition of an oral agent or commencement of insulin was associated with a 107% [odds ratio, OR: 2.07 (95% confidence interval, CI: 1.95-2.20)] and 152% [OR: 2.52 (95% CI: 2.30-2.77)] greater chance of achieving effective glycaemic control, respectively. These associations were robust after adjustment for several baseline characteristics and not modified by the number of oral medications taken at the time of treatment intensification. CONCLUSIONS Effective glycaemic control was associated with treatment intensification at lower HbA1c levels at all stages of the disease course and in both arms of the ADVANCE trial.
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Affiliation(s)
- S van Dieren
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Kassim J, Shipman A, Szczecinska W, Siah T, Lam M, Chalmers J, Macbeth A. How effective is intralesional injection of triamcinolone acetonide compared with topical treatments in inducing and maintaining hair growth in patients with alopecia areata? A Critically Appraised Topic. Br J Dermatol 2014; 170:766-71. [DOI: 10.1111/bjd.12863] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2013] [Indexed: 12/14/2022]
Affiliation(s)
- J.M. Kassim
- Department of Dermatology; Norfolk and Norwich University Hospital NHS Foundation Trust; Norwich NR4 7UY U.K
| | - A.R. Shipman
- Department of Dermatology; Warwick Hospital; South Warwickshire NHS Foundation Trust; Warwick CV34 5BW U.K
| | - W. Szczecinska
- Department of Dermatology; University Hospital Coventry; University Hospitals Coventry and Warwickshire; Coventry CV2 2DX U.K
| | - T.W. Siah
- Department of Dermatology; Royal Victoria Infirmary; The Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne NE1 4LP U.K
| | - M. Lam
- Department of Dermatology; Queen's Medical Centre; Nottingham University Hospitals NHS Trust; Nottingham NG7 2UH U.K
| | - J. Chalmers
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham NG7 2RD U.K
| | - A.E. Macbeth
- Department of Dermatology; Norfolk and Norwich University Hospital NHS Foundation Trust; Norwich NR4 7UY U.K
- Department of Vasculitis; Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's); Cambridge CB2 0QQ U.K
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Chalmers J, Matthew-Simmons F, Hughes C. The Recent Expansion in the Australian Cocaine Market: Who are the New Users and What are the Harms? ACTA ACUST UNITED AC 2014; 6:98-111. [DOI: 10.2174/1874473706666131205150424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 07/26/2013] [Accepted: 07/31/2013] [Indexed: 11/22/2022]
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Gottesman RF, Chalmers J. Blood pressure and cerebral ischemia: A continuing dilemma. Neurology 2014; 82:1018-9. [DOI: 10.1212/wnl.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Stapf C, Heeley E, Delcourt C, Arima H, Chalmers J, Anderson CS. Abstract 180: The Relation of Timing and Degree of Blood Pressure Control with Hematoma Growth - Secondary Analysis of The Interact2 Trial. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.180] [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: 11/16/2022]
Abstract
Background:
Acute blood pressure (BP) lowering therapy has shown clinical benefit in patients with acute intracerebral hemorrhage (ICH), but the effect of timing and degree of BP control on ICH growth has received less study.
Methods:
Among the INTERACT2 participants (N=2839) with acute ICH allocated either to intensive BP lowering therapy (IT, systolic target <140mmHg) or standard BP treatment (ST), CT brain imaging at baseline and 24 hours were centrally analysed in a subset of 491 (34%) in the IT and 473 (34%) in the ST groups.
Results:
Absolute mean ICH growth was lower in patients reaching BP target in <1h from randomization (1.7ml), as compared to those reaching target in 1-6h (4.2ml), and >6h (4.6ml, p=0.04). Hematoma growth was particularly high (14.4ml, 95%CI:10.0-18.8) in patients admitted with systolic BP>160mmHg who achieved <10mmHg systolic BP lowering over 24h, as compared to those achieving 10-20mmHg (3.7ml, 95%CI:0.3-7.1) or 20-30mmHg BP reduction (2.7ml, 95%CI:1.1-4.3); p<0.01). Patients maintaining target BP at 0-2 measurements over 24h had higher absolute volume increase (3.6ml; 95%CI:1.8-5.4) as compared to those who maintained target BP over 3-4 (1.6ml, 95%CI:-0.3-3.5), or 5-8 measurements (0.4ml, 95%CI:-1.7-2.4; p=0.01).
Conclusion:
These findings suggest that early and sustained BP control have favorable effects on hematoma growth. This reinforces the principle for patients with acute ICH to receive BP lowering therapy as early as possible and to achieve a lower level of systolic BP for the most favorable outcome.
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Affiliation(s)
- C. Stapf
- APHP - Hôpital Lariboisière, Paris, France
| | - E. Heeley
- The George Institute of Global Health, Sydney, Australia
| | - C. Delcourt
- The George Institute of Global Health, Sydney, Australia
| | - H. Arima
- The George Institute of Global Health, Sydney, Australia
| | - J. Chalmers
- The George Institute of Global Health, Sydney, Australia
| | - C. S Anderson
- The George Institute of Global Health, Sydney, Australia
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