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Laskar S, Manjali JJ, Chargari C, Chard J. Brachytherapy for Organ and Function Preservation in Soft-Tissue Sarcomas in Adult and Paediatric Patients. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00218-2. [PMID: 37344243 DOI: 10.1016/j.clon.2023.06.005] [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: 01/06/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
Adjuvant radiotherapy is an integral component in the management of soft-tissue sarcomas. Brachytherapy is a very convenient and conformal way of delivering adjuvant radiotherapy in such tumours, which spares the surrounding normal tissue. Randomised studies have established the efficacy of brachytherapy in the adjuvant setting, with a 5-year local control of 80-85%. High dose rate, low dose rate and pulsed dose rate have shown equivalent local control, but high dose rate has gained popularity owing to patient convenience, radiation safety and flexibility in dose optimisation. Freehand insertion perioperative brachytherapy (intraoperative placement and postoperative treatment) is the most commonly used technique in soft-tissue sarcomas, with intraoperative radiotherapy and radioactive seed placement being the less commonly used techniques. Brachytherapy can be used as monotherapy or in combination with external beam radiotherapy, such as in cases of close/positive margins for safe dose escalation. Although the quantum of side-effects with external beam radiotherapy has considerably reduced with the evolution of technology and the introduction of intensity modulation (intensity-modulated radiotherapy), brachytherapy still scores better in terms of dose conformality, especially in recurrent tumours (previously irradiated) and when used to treat paediatric and geriatric patients.
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Affiliation(s)
- S Laskar
- Department of Radiation Oncology, Tata Memorial Centre (TMC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India.
| | - J J Manjali
- Department of Radiation Oncology, Tata Memorial Centre (TMC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - C Chargari
- Department of Radiation Oncology, Institute Gustave Roussy, France
| | - J Chard
- Department of Radiation Oncology, Westmead Hospital, Sydney, Australia
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Flower E, Busuttil G, Zanjani S, Thwaites D, Thiru N, Chard J. PO-1792 Implementation of IGABT evidence-based planning aims, whilst changing brachytherapy systems. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03755-0] [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: 10/18/2022]
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Flower E, Busuttil G, Sullivan E, Zanjani S, Tran K, Nguyen H, Thwaites D, Sykes J, Chard J, Salkeld A. PP-0148 A brachytherapy process review and failure mode effect analysis during a system replacement. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06440-9] [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: 11/27/2022]
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Chard J, Karpelowsky J, Flower E, Busuttil G, Bucci J, Ahern V. PO-0262 Brachytherapy for paediatric pelvic tumours – sole local therapy modality and combined with surgery. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wilkins JJ, Chan PLS, Chard J, Smith G, Smith MK, Beer M, Dunn A, Flandorfer C, Franklin C, Gomeni R, Harnisch L, Kaye R, Moodie S, Sardu ML, Wang E, Watson E, Wolstencroft K, Cheung SYA. Thoughtflow: Standards and Tools for Provenance Capture and Workflow Definition to Support Model-Informed Drug Discovery and Development. CPT Pharmacometrics Syst Pharmacol 2017; 6:285-292. [PMID: 28504472 PMCID: PMC5445227 DOI: 10.1002/psp4.12171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/21/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022] Open
Abstract
Pharmacometric analyses are complex and multifactorial. It is essential to check, track, and document the vast amounts of data and metadata that are generated during these analyses (and the relationships between them) in order to comply with regulations, support quality control, auditing, and reporting. It is, however, challenging, tedious, error-prone, and time-consuming, and diverts pharmacometricians from the more useful business of doing science. Automating this process would save time, reduce transcriptional errors, support the retention and transfer of knowledge, encourage good practice, and help ensure that pharmacometric analyses appropriately impact decisions. The ability to document, communicate, and reconstruct a complete pharmacometric analysis using an open standard would have considerable benefits. In this article, the Innovative Medicines Initiative (IMI) Drug Disease Model Resources (DDMoRe) consortium proposes a set of standards to facilitate the capture, storage, and reporting of knowledge (including assumptions and decisions) in the context of model-informed drug discovery and development (MID3), as well as to support reproducibility: "Thoughtflow." A prototype software implementation is provided.
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Affiliation(s)
| | - PLS Chan
- Pharmacometrics, Global Clinical PharmacologyPfizer, SandwichUK
| | - J Chard
- Mango SolutionsChippenhamWiltshireUK
| | - G Smith
- Scientific Computing Group, Cyprotex Discovery LimitedMacclesfieldCreweUK
| | - MK Smith
- Pharmacometrics, Global Clinical PharmacologyPfizer, SandwichUK
| | | | - A Dunn
- Mango SolutionsChippenhamWiltshireUK
| | | | - C Franklin
- GSK, Clinical Pharmacology Modelling & SimulationStockley ParkUK
| | - R Gomeni
- PharmacoMetricaLa FouilladeFrance
| | - L Harnisch
- Pharmacometrics, Global Clinical PharmacologyPfizer, SandwichUK
| | - R Kaye
- Mango SolutionsChippenhamWiltshireUK
| | | | - ML Sardu
- Merck Institute for Pharmacometrics, Merck Serono S.A.Switzerland
| | - E Wang
- Global PK/PD and Pharmacometrics, Eli Lilly and CompanyIndianapolisIndianaUSA
| | - E Watson
- Predictive Compound Safety & ADME, Drug Safety & MetabolismInnovative Medicines, AstraZenecaGothenburgSweden
| | - K Wolstencroft
- Leiden Institute of Advanced Computer Science (LIACS), Leiden UniversityLeidenThe Netherlands
| | - SYA Cheung
- Quantitative Clinical Pharmacology, Early Clinical Development, Innovative Medicine, AstraZenecaCambridgeUK
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Swat MJ, Moodie S, Wimalaratne SM, Kristensen NR, Lavielle M, Mari A, Magni P, Smith MK, Bizzotto R, Pasotti L, Mezzalana E, Comets E, Sarr C, Terranova N, Blaudez E, Chan P, Chard J, Chatel K, Chenel M, Edwards D, Franklin C, Giorgino T, Glont M, Girard P, Grenon P, Harling K, Hooker AC, Kaye R, Keizer R, Kloft C, Kok JN, Kokash N, Laibe C, Laveille C, Lestini G, Mentré F, Munafo A, Nordgren R, Nyberg HB, Parra-Guillen ZP, Plan E, Ribba B, Smith G, Trocóniz IF, Yvon F, Milligan PA, Harnisch L, Karlsson M, Hermjakob H, Le Novère N. Pharmacometrics Markup Language (PharmML): Opening New Perspectives for Model Exchange in Drug Development. CPT Pharmacometrics Syst Pharmacol 2015; 4:316-9. [PMID: 26225259 PMCID: PMC4505825 DOI: 10.1002/psp4.57] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 05/06/2015] [Indexed: 12/02/2022] Open
Abstract
The lack of a common exchange format for mathematical models in pharmacometrics has been a long-standing problem. Such a format has the potential to increase productivity and analysis quality, simplify the handling of complex workflows, ensure reproducibility of research, and facilitate the reuse of existing model resources. Pharmacometrics Markup Language (PharmML), currently under development by the Drug Disease Model Resources (DDMoRe) consortium, is intended to become an exchange standard in pharmacometrics by providing means to encode models, trial designs, and modeling steps.
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Affiliation(s)
- MJ Swat
- EMBL-European Bioinformatics Institute, Wellcome Trust Genome CampusHinxton, Cambridgeshire, UK
| | | | - SM Wimalaratne
- EMBL-European Bioinformatics Institute, Wellcome Trust Genome CampusHinxton, Cambridgeshire, UK
| | | | | | - A Mari
- National Research Council, Institute of Biomedical EngineeringPadova, Italy
| | - P Magni
- Dipartimento di Ingegneria Industriale e dell'Informazione, Università degli Studi di PaviaPavia, Italy
| | - MK Smith
- Global Clinical Pharmacology, PfizerSandwich, UK
| | - R Bizzotto
- INSERM, IAME, UMR 1137, Paris, France, University Paris Diderot, IAME, UMR 1137Sorbonne Paris Cité, Paris, France
| | - L Pasotti
- Dipartimento di Ingegneria Industriale e dell'Informazione, Università degli Studi di PaviaPavia, Italy
| | - E Mezzalana
- Dipartimento di Ingegneria Industriale e dell'Informazione, Università degli Studi di PaviaPavia, Italy
| | - E Comets
- INSERM, IAME, UMR 1137, Paris, France, University Paris Diderot, IAME, UMR 1137Sorbonne Paris Cité, Paris, France
| | - C Sarr
- Advanced Quantitative Sciences (AQS), NovartisBasel, Switzerland
| | - N Terranova
- Merck Institute for Pharmacometrics, Merck SeronoLausanne, Switzerland
| | | | - P Chan
- Global Clinical Pharmacology, PfizerSandwich, UK
| | - J Chard
- Mango SolutionsChippenham, Wiltshire, UK
| | | | - M Chenel
- SGS Exprimo NV, Mechelen, Belgium, Clinical Pharmacokinetics and Pharmacometrics, Institut de Recherches Internationales ServierSuresnes, France
| | - D Edwards
- Simcyp (a Certara company)Sheffield, UK
| | - C Franklin
- CPMS Technology and DevelopmentSouthall, UK
| | - T Giorgino
- National Research Council, Institute of Biomedical EngineeringPadova, Italy
| | - M Glont
- EMBL-European Bioinformatics Institute, Wellcome Trust Genome CampusHinxton, Cambridgeshire, UK
| | - P Girard
- Merck Institute for Pharmacometrics, Merck SeronoLausanne, Switzerland
| | - P Grenon
- CHIME, University College LondonLondon, UK
| | - K Harling
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsala, Sweden
| | - AC Hooker
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsala, Sweden
| | - R Kaye
- Mango SolutionsChippenham, Wiltshire, UK
| | - R Keizer
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsala, Sweden
| | - C Kloft
- Freie Universtitaet Berlin, Germany, Institute of Pharmacy, Department of Clinical Pharmacy and BiochemistryBerlin, Germany
| | - JN Kok
- Leiden Institute of Advanced Computer Science (LIACS), Leiden UniversityLeiden, The Netherlands
| | - N Kokash
- Leiden Institute of Advanced Computer Science (LIACS), Leiden UniversityLeiden, The Netherlands
| | - C Laibe
- EMBL-European Bioinformatics Institute, Wellcome Trust Genome CampusHinxton, Cambridgeshire, UK
| | - C Laveille
- SGS Exprimo NV, Mechelen, Belgium, Clinical Pharmacokinetics and Pharmacometrics, Institut de Recherches Internationales ServierSuresnes, France
| | - G Lestini
- INSERM, IAME, UMR 1137, Paris, France, University Paris Diderot, IAME, UMR 1137Sorbonne Paris Cité, Paris, France
| | - F Mentré
- INSERM, IAME, UMR 1137, Paris, France, University Paris Diderot, IAME, UMR 1137Sorbonne Paris Cité, Paris, France
| | - A Munafo
- Merck Institute for Pharmacometrics, Merck SeronoLausanne, Switzerland
| | - R Nordgren
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsala, Sweden
| | - HB Nyberg
- Mango SolutionsChippenham, Wiltshire, UK
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsala, Sweden
| | - ZP Parra-Guillen
- Freie Universtitaet Berlin, Germany, Institute of Pharmacy, Department of Clinical Pharmacy and BiochemistryBerlin, Germany
| | - E Plan
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsala, Sweden
| | - B Ribba
- Inria Grenoble - Rhône-AlpesGrenoble, France
| | - G Smith
- Scientific Computing Group, Cyprotex Discovery LimitedMacclesfield, Crewe, UK
| | - IF Trocóniz
- Department of Pharmacy and Pharmaceutical Technology, University of NavarraPamplona, Spain
| | - F Yvon
- EMBL-European Bioinformatics Institute, Wellcome Trust Genome CampusHinxton, Cambridgeshire, UK
| | - PA Milligan
- Global Clinical Pharmacology, PfizerSandwich, UK
| | - L Harnisch
- Global Clinical Pharmacology, PfizerSandwich, UK
| | - M Karlsson
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsala, Sweden
| | - H Hermjakob
- EMBL-European Bioinformatics Institute, Wellcome Trust Genome CampusHinxton, Cambridgeshire, UK
| | - N Le Novère
- EMBL-European Bioinformatics Institute, Wellcome Trust Genome CampusHinxton, Cambridgeshire, UK
- Babraham Institute, Babraham Research CampusCambridge, UK
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Harnisch L, Matthews I, Chard J, Karlsson MO. Drug and disease model resources: a consortium to create standards and tools to enhance model-based drug development. CPT Pharmacometrics Syst Pharmacol 2013; 2:e34. [PMID: 23887647 PMCID: PMC3615532 DOI: 10.1038/psp.2013.10] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/31/2013] [Indexed: 11/11/2022]
Abstract
Model-based drug development (MBDD) is accepted as a vital approach in understanding patients' drug-related benefit and risk by integrating quantitative information integration from diverse sources collected throughout drug development.1 This perspective introduces the activities of the Drug and Disease Model Resources (DDMoRe) consortium, founded in 2011 through the Innovative Medicines Initiative Joint Undertaking (IMI-JU)2 as a European public–private partnership to address a lack of common tools, languages, and standards for modeling and simulation (M&S) to improve model-based knowledge integration.
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Affiliation(s)
- L Harnisch
- Clinical Pharmacology/Pharmacometrics, Pfizer, Sandwich, UK
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Chard J, Kuczawski M, Black N, van der Meulen J. Outcomes of elective surgery undertaken in independent sector treatment centres and NHS providers in England: audit of patient outcomes in surgery. BMJ 2011; 343:d6404. [PMID: 22012180 PMCID: PMC3198262 DOI: 10.1136/bmj.d6404] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare characteristics of patients and outcomes after elective surgery in independent sector treatment centres (ISTCs) and NHS providers. DESIGN Follow-up study with outcomes reported by patients three to six months after surgery. SETTING 25 ISTCs and 72 NHS providers in England. Population Consecutive patients undergoing hip or knee replacement (5671 in ISTCs and 14,292 in NHS), inguinal hernia repair (640 and 2023, respectively), or surgery for varicose veins (248 and 1336, respectively). MAIN OUTCOMES Symptoms and disability reported by patients (Oxford hip and knee scores on a 48 point scale; Aberdeen varicose vein questionnaire) and quality of life (EuroQol EQ-5D score). RESULTS Patients in ISTCs were healthier than those in NHS providers, had less severe preoperative symptoms, and were more affluent, though the differences were small. With adjustment, patients undergoing joint replacements in NHS providers had poorer outcomes: difference of -1.7 (95% confidence interval -2.5 to -0.9) on the Oxford hip score and -0.9 (-1.6 to -0.2) on the Oxford knee score. They more often reported complications: odds ratio 1.3 (95% confidence interval 1.1 to 1.5) for hip and 1.4 (1.2 to 1.6) for knee. There were no significant differences in outcomes after surgery for hernia or varicose veins, except that NHS patients more often reported poor results after hernia repair (1.4, 1.0 to 1.9) and additional surgery after varicose vein surgery (2.8, 1.2 to 6.8). CONCLUSION Patients undergoing surgery in ISTCs were slightly healthier and had less severe conditions than those undergoing surgery in NHS providers. Some outcomes were better in ISTCs, but differences were small compared with the impact ISTCs could have on the provision of elective services.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/standards
- Elective Surgical Procedures/standards
- England
- Follow-Up Studies
- Health Facilities, Proprietary/standards
- Health Status
- Herniorrhaphy/adverse effects
- Herniorrhaphy/standards
- Humans
- Medical Audit
- Outcome Assessment, Health Care
- Postoperative Complications/etiology
- Quality of Life
- State Medicine/standards
- Treatment Outcome
- Varicose Veins/surgery
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Affiliation(s)
- J Chard
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
| | - M Kuczawski
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
| | - N Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
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Chard J, Dickson J, Tallon D, Dieppe P. A comparison of the views of rheumatologists, general practitioners and patients on the treatment of osteoarthritis. Rheumatology (Oxford) 2002; 41:1208-10. [PMID: 12364653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Chard J, Dickson J, Tallon D, Dieppe P. A comparison of the views of rheumatologists, general practitioners and patients on the treatment of osteoarthritis. Rheumatology (Oxford) 2002. [DOI: 10.1093/rheumatology/41.10.1208-b] [Citation(s) in RCA: 12] [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: 11/14/2022] Open
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Affiliation(s)
- D. Russell
- SAC, West Mains Road, Edinburgh, EH9 3JG, UK
| | - J. Chard
- SAC, West Mains Road, Edinburgh, EH9 3JG, UK
| | - R. McKinlay
- SAC, West Mains Road, Edinburgh, EH9 3JG, UK
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Chard J, Dieppe P. Glucosamine for osteoarthritis: magic, hype, or confusion? It's probably safe-but there's no good evidence that it works. BMJ 2001; 322:1439-40. [PMID: 11408287 PMCID: PMC1120508 DOI: 10.1136/bmj.322.7300.1439] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chard J, Dieppe P. The case for nonpharmacologic therapy of osteoarthritis. Curr Rheumatol Rep 2001; 3:251-7. [PMID: 11794136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
This paper reviews the most commonly used nonpharmaceutical treatments for osteoarthritis, summarizing the available evidence. Four general areas are reviewed: aids and appliances, exercise and physiotherapy, education and behavioral change, and alternative and complementary therapies. The results of this review indicate that the use of nonpharmaceutical interventions in osteoarthritis is essential for good management of the disease. However, further research is required to improve the evidence base of the use of nonpharmacologic interventions in and the overall management of osteoarthritis.
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Affiliation(s)
- J Chard
- Department of Social Medicine, University of Bristol, UK
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Abstract
OBJECTIVE To explore the perceived importance of symptoms, treatment preferences, and research priorities of people with osteoarthritis (OA) of the knee. METHODS Results of a focus group were used to facilitate the design of a questionnaire, distributed to 112 people with knee OA. RESULTS Pain, disability, and instability in the joint were the most important symptoms, and anxiety about knee OA caused distress to many people. Oral drugs (90%), physical therapy (62%), and aids and adaptations (56%) were the most commonly used treatments. Surgery, oral drugs, and intra-articular injections were perceived as the most efficacious interventions. Patients' highest priorities for research were surgery and educational interventions, despite the fact that few had had surgery and education was not perceived as very effective. CONCLUSIONS The lack of a patient-centered approach to care leads professionals to ignore key symptoms and issues for individuals, and to a preoccupation with pharmaceutical interventions, rather than the treatment options that their patients prefer.
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Affiliation(s)
- D Tallon
- Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK
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Abstract
BACKGROUND Previous studies have suggested that research agendas can be biased. To determine whether there is a mismatch between available research evidence and the research preferences of consumers we examined research on interventions for the treatment of osteoarthritis of the knee joint. METHODS We searched published and unpublished studies on interventions in this condition to assess the structure of the evidence base. Focus groups and a postal survey of research consumers were then undertaken to examine their views and research priorities. FINDINGS Review of published and unpublished reports showed that the evidence base was dominated by studies of pharmaceutical (550, 59%) and surgical (238, 26%) interventions. 24 (36%) of 67 survey respondents ranked knee replacement as the highest priority for research, whereas 14 (21%) chose education and advice as their first choice. INTERPRETATION There is a mismatch between the amount of published work on different interventions, and the degree of interest of consumers. We suggest that broadening of the research agenda would be more in line with current treatment patterns and consumer views. If this mismatch is not addressed, then evidence-based medicine will not be representative of consumer needs.
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Affiliation(s)
- D Tallon
- MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK
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Tallon D, Chard J, Dieppe P. Consumer involvement in research is essential. BMJ 2000; 320:380-1. [PMID: 10657346 PMCID: PMC1127156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Abstract
The standard linear method of commissioning research involves many stages, some lengthy. While assessment criteria are usually explicit, their weighting and interaction are not. Output is assessed on completion. This method is suitable where the research question is clear-cut. However, it has drawbacks when the research question and the form and scope of the research are not clear at the outset, as is often the case with research on the delivery and organisation of services. Also, it does not encourage potential users of the research to develop a sense of ownership. An alternative method is proposed by which the scope, form and content of research are not specified in advance but are developed iteratively. A programme director, advised by a group of potential users and research commissioners, has devolved authority to commit funding for the stages of the work as it unfolds, predicated on evolving need. There are foreseeable but avoidable risks of the group over-identifying with the researchers, of research management becoming cumbersome, and of unproductive friction between research groups when they are required to work together. The iterative method, being new and untried, is itself an organisational change requiring evaluation. However, from our local experience, it provides for productive dialogue between research commissioners, researchers and potential users.
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Affiliation(s)
- R Lilford
- Department of Public Health and Epidemiology, University of Birmingham, UK
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Dieppe P, Basler HD, Chard J, Croft P, Dixon J, Hurley M, Lohmander S, Raspe H. Knee replacement surgery for osteoarthritis: effectiveness, practice variations, indications and possible determinants of utilization. Rheumatology (Oxford) 1999; 38:73-83. [PMID: 10334686 DOI: 10.1093/rheumatology/38.1.73] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Dieppe
- MRC Health Services Research Collaboration, University of Bristol, UK
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Affiliation(s)
- R J Lilford
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT.
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