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Ganeshan G, Sekar H, Reilly S, Kuo C, Singh S, Michaels J, Yoong W. The effect of the COVID-19 pandemic on the mental health of obstetrics and gynaecology trainees: a world-wide literature review. J OBSTET GYNAECOL 2024; 44:2319791. [PMID: 38419407 DOI: 10.1080/01443615.2024.2319791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/10/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Coronavirus (COVID-19) pandemic has affected the training and wellbeing of obstetrics and gynaecology (O&G) trainees. The aim of this review is to offer a worldwide overview on its' impact on the mental health of O&G trainees, so that measures can be put into place to better support trainees during the transition back to the 'new normal'. METHODS Key search terms used on PubMed and Google Scholar databases include: mental health, COVID-19, O&G, trainees, residents. RESULTS Fifteen articles (cumulative number of respondents = 3230) were identified, of which eight employed validated questionnaires (n = 1807 respondents), while non-validated questionnaires were used in seven (n = 1423 respondents). Studies showed that COVID-19 appeared to exert more of a negative impact on females and on senior trainees' mental health, while protective factors included marriage/partner and having had children. Validated and non-validated questionnaires suggested that trainees were exposed to high levels of anxiety and depression. Their mental health was also affected by insomnia, stress, burnout and fear of passing on the virus. DISCUSSION This review analyses the global impact of COVID-19 on O&G trainees' mental health, showing a pervasive negative effect linked to fear of the virus. Limited psychological support has led to prolonged issues, hindering patient safety and increasing sick leave. The study underscores the urgency of comprehensive support, particularly in female-dominated fields. Addressing these challenges is crucial for future pandemics, highlighting the need to learn from past mistakes and prioritise mental health resources for trainee well-being during and beyond pandemics.
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Affiliation(s)
- G Ganeshan
- St George's International School of Medicine, Grenada, Caribbean
| | - H Sekar
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
| | - S Reilly
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
| | - C Kuo
- St George's International School of Medicine, Grenada, Caribbean
| | - S Singh
- St George's International School of Medicine, Grenada, Caribbean
| | - J Michaels
- St George's International School of Medicine, Grenada, Caribbean
| | - W Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
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2
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Dimitriadis PA, Moinie A, Michaels J, Bance R, Vijendren A, Mochloulis G. Indeterminate thyroid nodules (Thy3): malignancy rate and characteristics in a study of 118 patients. Ann R Coll Surg Engl 2023. [PMID: 36927065 DOI: 10.1308/rcsann.2022.0163] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Thyroid nodules are common, and the combined use of ultrasound and fine needle aspiration cytology provides useful information on their malignancy risk. The Thy reporting system is widely used in the United Kingdom, with malignancy rates for Thy3 cytology being quoted between 5% and 30%. This study aims to establish the risk of thyroid cancer in operated patients with Thy3 cytology and correlate it with patient demographics and nodule size. METHODS This is a retrospective observational study of all thyroidectomies that took place in a single institution over a 3-year period (2019-2022). Those with a preoperative cytology of Thy3 were analysed further and in particular, nodule size, final histology and patients' demographics were documented. RESULTS Some 260 thyroidectomies were performed during the study period. Of these, 118 patients had Thy3 cytology. In the Thy3a group (n = 70), the malignancy rate was 27.1%. The average age of those with thyroid cancer was 51.4 vs 51.2 years for those with benign disease. The nodule size was under 40mm for both groups (36mm vs 39.7mm). In the Thy3f group (n = 48), the malignancy rate was 43.8%. The average age of those with thyroid cancer was 53.5 vs 56.2 years for those with benign disease. The nodule size was similar (24.5mm vs 27.6mm). CONCLUSIONS In this study, one in three patients with Thy3 cytology was diagnosed with thyroid cancer. We urge local units to analyse their data, to aid patients' informed decision-making. Within the subgroups, there was no significant difference in average nodule size or patients' age.
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Affiliation(s)
- P A Dimitriadis
- Department of Otolaryngology-Head and Neck Surgery, Lister Hospital, East and North Hertfordshire NHS Trust, UK
| | - A Moinie
- Department of Otolaryngology-Head and Neck Surgery, Lister Hospital, East and North Hertfordshire NHS Trust, UK
| | - J Michaels
- Department of Otolaryngology-Head and Neck Surgery, Lister Hospital, East and North Hertfordshire NHS Trust, UK
| | - R Bance
- Department of Otolaryngology-Head and Neck Surgery, Lister Hospital, East and North Hertfordshire NHS Trust, UK
| | - A Vijendren
- Department of Otolaryngology-Head and Neck Surgery, Lister Hospital, East and North Hertfordshire NHS Trust, UK
| | - G Mochloulis
- Department of Otolaryngology-Head and Neck Surgery, Lister Hospital, East and North Hertfordshire NHS Trust, UK
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Perrouin Verbe M, Goudelocke C, Xavier K, Pecha B, Burgess K, Krlin R, Michaels J, Shah S, Peyronnet B, Zaslau S, Papi B, Keller D, Elterman D, Nitti V. Device programming of the rechargeable InterStim Micro sacral neuromodulation device through 12 months in a global post-market study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00747-9] [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: 02/12/2023]
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4
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Elterman D, Goudelocke C, Xavier K, Pecha B, Burgess K, Perrouin-Verbe MA, Krlin R, Michaels J, Shah S, Peyronnet B, Zaslau S, Grunow N, Bittner K, Nitti V. Evaluation of rechargeable InterStim™ micro system performance and safety: 3-month results from the OAB cohort of the ELITE study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00529-2] [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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Tong T, Thokala P, Chilcott J, Aber A, Maheswaran R, Michaels J. PSU6 A Patient-LEVEL Simulation for Economic Evaluation of Vascular Service Reconfiguration in England. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.548] [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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6
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Aber A, Phillips P, Hughes J, Keetharuth AD, Rooney G, Radley S, Walters S, Nawaz S, Jones G, Michaels J. Electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS): development and validity. Br J Surg 2020; 107:1004-1012. [DOI: 10.1002/bjs.11531] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/25/2019] [Accepted: 01/15/2020] [Indexed: 11/06/2022]
Abstract
Abstract
Background
This paper describes the development and validation of an electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS) that captures the symptomatology, quality of life and clinically relevant data of patients presenting to vascular services.
Methods
A two-stage survey was conducted in patients attending a tertiary vascular department. Patients completed the ePAQ-VAS remotely online, or on site using an electronic tablet. In the first stage of the survey, the responses were used to perform confirmatory factor analysis to assess the construct validity and remove redundant items. The internal reliability of disease-specific scales was investigated. In the second stage of the survey, the acceptability, known-group validity, test–retest reliability, and responsiveness of ePAQ-VAS was assessed.
Results
In total, 721 patients completed ePAQ-VAS. Their mean(s.d.) age was 63·5(15·7) years and 468 (64·9 per cent) were men. Some 553 patients (76·7 per cent) completed the questionnaire in clinic and the remainder completed the questionnaire online. The results of the confirmatory factor analysis confirmed the conceptual model for ePAQ-VAS structure and eliminated six items. Internal reliability was acceptable for all the scales (Cronbach's α greater than 0·7). The test–retest reliability measured by the intraclass correlation coefficient ranged from 0·65 to 0·99. The results showed that the instrument was responsive over time with the standardized response mean ranging from 0·69 to 1·60.
Conclusion
ePAQ-VAS is a holistic data-collection process that is relevant to vascular service users and has potential to contribute to patient-focused care and the collection of aggregate data for service evaluation. A demonstration version of the final version of ePAQ can be viewed at http://demo-questionnaire.epaq.co.uk/home/project?id=VASC_1.7&page=1.
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Affiliation(s)
- A Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Phillips
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A D Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Rooney
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - S Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G Jones
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Wickramasekera N, Howard A, Philips P, Rooney G, Hughes J, Wilson E, Aber A, Michaels J, Shackley P. Author response to: Comment on: Strength of public preferences for endovascular or open aortic aneurysm repair. Br J Surg 2020; 107:613-614. [PMID: 32187668 DOI: 10.1002/bjs.11514] [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] [Received: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/10/2022]
Affiliation(s)
- N Wickramasekera
- School of Health and Related Research, University of Sheffield, and
| | - A Howard
- Department of Economics, National University of Ireland Galway, Galway, Ireland
| | - P Philips
- Academic Unit of Clinical Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, and
| | - G Rooney
- School of Health and Related Research, University of Sheffield, and
| | - J Hughes
- School of Health and Related Research, University of Sheffield, and
| | - E Wilson
- School of Health and Related Research, University of Sheffield, and
| | - A Aber
- School of Health and Related Research, University of Sheffield, and
| | - J Michaels
- School of Health and Related Research, University of Sheffield, and
| | - P Shackley
- School of Health and Related Research, University of Sheffield, and
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8
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Wickramasekera N, Howard A, Philips P, Rooney G, Hughes J, Wilson E, Aber A, Michaels J, Shackley P. Strength of public preferences for endovascular or open aortic aneurysm repair. Br J Surg 2019; 106:1775-1783. [DOI: 10.1002/bjs.11265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/12/2019] [Accepted: 05/17/2019] [Indexed: 11/11/2022]
Abstract
Abstract
Background
This study evaluated public preferences for the treatment processes for abdominal aortic aneurysm repair in order to allow them to be incorporated into a cost-effectiveness analysis.
Methods
This was a telephone survey using a trade-off method in UK resident adults (aged at least 18 years) with no previous diagnosis of a vascular condition.
Results
Some 167 of 209 participants (79·9 per cent) stated that they would prefer endovascular aneurysm repair (EVAR), 40 (19·1 per cent) preferred open surgery and two (1·0 per cent) stated no preference. Participants preferred EVAR because of the less invasive nature of the intervention and quicker recovery. Participants preferring open surgery cited reasons such as having a single follow-up appointment, and a procedure that felt more permanent. When participants were asked to make a sacrifice in order to have their preferred treatment, 122 (58·4 per cent) favoured EVAR, 18 (8·6 per cent) favoured open surgery and 69 (33·0 per cent) had no preference. Those preferring EVAR were willing to give up a mean of 0·135 expected quality-adjusted life-years (QALYs) to have EVAR, compared with a willingness to give up 0·033 expected QALYs among those preferring open repair.
Conclusion
These results indicate a clear preference for EVAR over open surgery for aortic aneurysm.
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Affiliation(s)
- N Wickramasekera
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Howard
- Department of Economics National University of Ireland Galway, Galway, Ireland
| | - P Philips
- Academic Unit of Clinical Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G Rooney
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Wilson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Shackley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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9
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Wahab A, Michaels J, Ellenger K, Ninan S. 70DID YOU MEAN TO MAKE ME BLEED? TREATING FRAIL OLDER PEOPLE WITH NSTEMI CARRIES A HIGH RISK OF BLEEDING. Age Ageing 2019. [DOI: 10.1093/ageing/afy197.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Wahab
- Department of Elderly Medicine, Leeds Teaching Hospitals NHS Trust
| | - J Michaels
- Department of Elderly Medicine, Leeds Teaching Hospitals NHS Trust
| | - K Ellenger
- Department of Elderly Medicine, Leeds Teaching Hospitals NHS Trust
| | - S Ninan
- Department of Elderly Medicine, Leeds Teaching Hospitals NHS Trust
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10
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Aber A, Tong TS, Chilcott J, Thokala P, Maheswaran R, Thomas SM, Nawaz S, Walters S, Michaels J. Sex differences in national rates of repair of emergency abdominal aortic aneurysm. Br J Surg 2018; 106:82-89. [PMID: 30395361 DOI: 10.1002/bjs.11006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/17/2018] [Accepted: 08/28/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to assess the sex differences in both the rate and type of repair for emergency abdominal aortic aneurysm (AAA) in England. METHODS Hospital Episode Statistics (HES) data sets from April 2002 to February 2015 were obtained. Clinical and administrative codes were used to identify patients who underwent primary emergency definitive repair of ruptured or intact AAA, and patients with a diagnosis of AAA who died in hospital without repair. These three groups included all patients with a primary AAA who presented as an emergency. Sex differences between repair rates and type of surgery (endovascular aneurysm repair (EVAR) versus open repair) over time were examined. RESULTS In total, 15 717 patients (83·3 per cent men) received emergency surgical intervention for ruptured AAA and 10 276 (81·2 per cent men) for intact AAA; 12 767 (62·0 per cent men) died in hospital without attempted repair. The unadjusted odds ratio for no repair in women versus men was 2·88 (95 per cent c.i. 2·75 to 3·02). Women undergoing repair of ruptured AAA were older and had a higher in-hospital mortality rate (50·0 versus 41·0 per cent for open repair; 30·9 versus 23·5 per cent for EVAR). After adjustment for age, deprivation and co-morbidities, the odds ratio for no repair in women versus men was 1·34 (1·28 to 1·40). The in-hospital mortality rate after emergency repair of an intact AAA was also higher among women. CONCLUSION Women who present as an emergency with an AAA are less likely to undergo repair than men. Although some of this can be explained by differences in age and co-morbidities, the differences persist after case-mix adjustment.
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Affiliation(s)
- A Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - T S Tong
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Chilcott
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Maheswaran
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S M Thomas
- Sheffield Vascular Institute, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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11
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Michaels J, Wang L, Nawabit R, Stone K, Marcus G, Varosy P, Redline S, Ensurd K, Mehra R. 0604 Sleep Disordered Breathing as a Predictor of Incident Polysomnographically-Identified Cardiac Arrhythmia: The Outcomes of Sleep Disorders in Older Men study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Michaels
- Cleveland Clinic foundation, Cleveland, OH
| | - L Wang
- Cleveland Clinic foundation, Cleveland, OH
| | - R Nawabit
- Cleveland Clinic foundation, Cleveland, OH
| | - K Stone
- California Pacific Medical Center, San Francisco, CA
| | - G Marcus
- University of California, San Francisco, CA
| | - P Varosy
- University of Colorado, Aurora, CA
| | | | - K Ensurd
- University of Minnesota Medical School, Minneapolis, MN
| | - R Mehra
- Cleveland Clinic foundation, Cleveland, OH
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12
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Poku E, Aber A, Phillips P, Essat M, Buckley Woods H, Palfreyman S, Kaltenthaler E, Jones G, Michaels J. Systematic review assessing the measurement properties of patient-reported outcomes for venous leg ulcers. BJS Open 2017; 1:138-147. [PMID: 29951616 PMCID: PMC5989950 DOI: 10.1002/bjs5.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 06/19/2017] [Accepted: 09/14/2017] [Indexed: 12/21/2022] Open
Abstract
Background A variety of instruments have been used to assess outcomes for patients with venous leg ulcers. This study sought to identify, evaluate and recommend the most appropriate patient‐reported outcome measures (PROMs) for English‐speaking patients with venous leg ulcers. Methods This systematic review used a two‐stage search approach. Electronic searches of major databases including MEDLINE were completed in October 2015, and then updated in July 2016. Additional studies were identified from citation checking. Study selection, data extraction and quality assessment were undertaken independently by at least two reviewers. Evaluation and summary of measurement properties of identified PROMs were done using standard and adapted study‐relevant criteria. Results Ten studies with data for four generic PROMS and six condition‐specific measures were identified. No generic PROM showed adequate content and criterion validity; however, the EuroQoL Five Dimensions (EQ‐5D™), Nottingham Health Profile (NHP) and 12‐item Short‐Form Health Survey (SF‐12®) had good acceptability. In general, the EQ‐5D™ showed poor responsiveness in patients with venous leg ulcers. Most condition‐specific PROMs demonstrated poor criterion and construct validity. Overall, there was some evidence of internal consistency for the Venous Leg Ulcer Quality of Life (VLU‐QoL) and the Sheffield Preference‐based Venous Ulcer questionnaire (SPVU‐5D). Test–retest reliability was satisfactory for the Venous Leg Ulcer Self‐Efficacy Tool (VeLUSET). Conclusion The NHP and VLU‐QoL questionnaire seemed the most suitable PROMs for use by clinicians. However, a valid condition‐specific PROM is still required.
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Affiliation(s)
- E Poku
- School of Health and Related Research University of Sheffield Sheffield UK
| | - A Aber
- School of Health and Related Research University of Sheffield Sheffield UK
| | - P Phillips
- School of Health and Related Research University of Sheffield Sheffield UK
| | - M Essat
- School of Health and Related Research University of Sheffield Sheffield UK
| | - H Buckley Woods
- School of Health and Related Research University of Sheffield Sheffield UK
| | - S Palfreyman
- Edmonton Clinic Health Academy, University of Alberta Edmonton, Alberta Canada
| | - E Kaltenthaler
- School of Health and Related Research University of Sheffield Sheffield UK
| | - G Jones
- School of Social Sciences Leeds Beckett University Leeds UK
| | - J Michaels
- School of Health and Related Research University of Sheffield Sheffield UK
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13
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Crawford AH, Stoll AL, Sanchez-Masian D, Shea A, Michaels J, Fraser AR, Beltran E. Clinicopathologic Features and Magnetic Resonance Imaging Findings in 24 Cats With Histopathologically Confirmed Neurologic Feline Infectious Peritonitis. J Vet Intern Med 2017; 31:1477-1486. [PMID: 28833469 PMCID: PMC5598904 DOI: 10.1111/jvim.14791] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/15/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Feline infectious peritonitis (FIP) is the most common infectious central nervous system (CNS) disease in the cat and is invariably fatal. Improved means of antemortem diagnosis is required to facilitate clinical decision making. Information regarding the magnetic resonance imaging (MRI) findings of neurologic FIP currently is limited, resulting in the need for better descriptions to optimize its use as a diagnostic tool. OBJECTIVE To describe the clinicopathologic features and MRI findings in cases of confirmed neurologic FIP. ANIMALS Twenty-four client-owned cats with histopathologic confirmation of neurologic FIP. METHODS Archived records from 5 institutions were retrospectively reviewed to identify cases with confirmed neurologic FIP that had undergone antemortem MRI of the CNS. Signalment, clinicopathologic, MRI, and histopathologic findings were evaluated. RESULTS Three distinct clinical syndromes were identified: T3-L3 myelopathy (3), central vestibular syndrome (7), and multifocal CNS disease (14). Magnetic resonance imaging abnormalities were detected in all cases, including meningeal contrast enhancement (22), ependymal contrast enhancement (20), ventriculomegaly (20), syringomyelia (17), and foramen magnum herniation (14). Cerebrospinal fluid was analysed in 11 cases; all demonstrated a marked increase in total protein concentration and total nucleated cell count. All 24 cats were euthanized with a median survival time of 14 days (range, 2-115) from onset of clinical signs. Histopathologic analysis identified perivascular pyogranulomatous infiltrates, lymphoplasmacytic infiltrates, or both affecting the leptomeninges (16), choroid plexuses (16), and periventricular parenchyma (13). CONCLUSIONS AND CLINICAL IMPORTANCE Magnetic resonance imaging is a sensitive means of detecting neurologic FIP, particularly in combination with a compatible signalment, clinical presentation, and CSF analysis.
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Affiliation(s)
- A H Crawford
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Herts, UK
| | - A L Stoll
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Herts, UK.,School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - D Sanchez-Masian
- Institute of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Neston, Cheshire, UK
| | - A Shea
- Animal Health Trust, Kentford, Newmarket, Suffolk, UK
| | - J Michaels
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN.,Department of Neurology, Angell Animal Medical Center, Boston, MA
| | - A R Fraser
- UVet, University of Melbourne, Werribee, Vic., Australia.,Anderson Moores Veterinary Specialists, Hursley, Winchester, UK
| | - E Beltran
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Herts, UK
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14
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Aber A, Poku E, Phillips P, Essat M, Buckley Woods H, Palfreyman S, Kaltenthaler E, Jones G, Michaels J. Systematic review of patient-reported outcome measures in patients with varicose veins. Br J Surg 2017; 104:1424-1432. [DOI: 10.1002/bjs.10639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/20/2017] [Accepted: 06/04/2017] [Indexed: 02/04/2023]
Abstract
Abstract
Background
Varicose veins can affect quality of life. Patient-reported outcome measures (PROMs) provide a direct report from the patient about the impact of the disease without interpretation from clinicians or anyone else. The aim of this study was to examine the quality of the psychometric evidence for PROMs used in patients with varicose veins.
Methods
A systematic review was undertaken to identify studies that reported the psychometric properties of generic and disease-specific PROMs in patients with varicose veins. Literature searches were conducted in databases including MEDLINE, up to July 2016. The psychometric criteria used to assess these studies were adapted from published recommendations in accordance with US Food and Drug Administration guidance.
Results
Nine studies were included which reported on aspects of the development and/or validation of one generic (36-Item Short Form Health Survey, SF-36®) and three disease-specific (Aberdeen Varicose Vein Questionnaire, AVVQ; Varicose Veins Symptoms Questionnaire, VVSymQ®; Specific Quality-of-life and Outcome Response – Venous, SQOR-V) PROMs. The evidence from included studies provided data to support the construct validity, test–retest reliability and responsiveness of the AVVQ. However, its content validity, including weighting of the AVVQ questions, was biased and based on the opinion of clinicians, and the instrument had poor acceptability. VVSymQ® displayed good responsiveness and acceptability rates. SF-36® was considered to have satisfactory responsiveness and internal consistency.
Conclusion
There is a scarcity of psychometric evidence for PROMs used in patients with varicose veins. These data suggest that AVVQ and SF-36® are the most rigorously evaluated PROMs in patients with varicose veins.
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Affiliation(s)
- A Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Poku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Phillips
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Essat
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - H Buckley Woods
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Palfreyman
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - E Kaltenthaler
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Sidloff DA, Saratzis A, Sweeting MJ, Michaels J, Powell JT, Thompson SG, Bown MJ. Sex differences in mortality after abdominal aortic aneurysm repair in the UK. Br J Surg 2017; 104:1656-1664. [PMID: 28745403 PMCID: PMC5655705 DOI: 10.1002/bjs.10600] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 01/20/2017] [Revised: 04/15/2017] [Accepted: 04/20/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The UK abdominal aortic aneurysm (AAA) screening programmes currently invite only men for screening because the benefit in women is uncertain. Perioperative risk is critical in determining the effectiveness of screening, and contemporary estimates of these risks in women are lacking. The aim of this study was to compare mortality following AAA repair between women and men in the UK. METHODS Anonymized data from the UK National Vascular Registry (NVR) for patients undergoing AAA repair (January 2010 to December 2014) were analysed. Co-variables were extracted for analysis by sex. The primary outcome measure was in-hospital mortality. Secondary outcome measures included mortality by 5-year age groups and duration of hospital stay. Logistic regression was performed to adjust for age, calendar time, AAA diameter and smoking status. NVR-based outcomes were checked against Hospital Episode Statistics (HES) data. RESULTS A total of 23 245 patients were included (13·0 per cent women). Proportionally, more women than men underwent open repair. For elective open AAA repair, the in-hospital mortality rate was 6·9 per cent in women and 4·0 per cent in men (odds ratio (OR) 1·48, 95 per cent c.i. 1·08 to 2·02; P = 0·014), whereas for elective endovascular AAA repair it was 1·8 per cent in women and 0·7 per cent in men (OR 2·86, 1·72 to 4·74; P < 0·001); the results in HES were similar. For ruptured AAA, there was no sex difference in mortality within the NVR; however, in HES, for ruptured open AAA repair, the in-hospital mortality rate was higher in women (33·6 versus 27·1 per cent; OR 1·36, 1·16 to 1·59; P < 0·001). CONCLUSION Women have a higher in-hospital mortality rate than men after elective AAA repair even after adjustment. This higher mortality may have an impact on the benefit offered by any screening programme offered to women.
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Affiliation(s)
- D A Sidloff
- Vascular Surgery Group, Department of Cardiovascular Sciences and National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
| | - A Saratzis
- Vascular Surgery Group, Department of Cardiovascular Sciences and National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
| | - M J Sweeting
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - J Michaels
- Health Economics and Decision Science, University of Sheffield, Sheffield, UK
| | - J T Powell
- Vascular Surgery Research Group, Imperial College, London, UK
| | - S G Thompson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - M J Bown
- Vascular Surgery Group, Department of Cardiovascular Sciences and National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
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16
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Phillips P, Poku E, Essat M, Woods H, Goka E, Kaltenthaler E, Walters S, Shackley P, Michaels J. Procedure Volume and the Association with Short-term Mortality Following Abdominal Aortic Aneurysm Repair in European Populations: A Systematic Review. Eur J Vasc Endovasc Surg 2017; 53:77-88. [DOI: 10.1016/j.ejvs.2016.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/10/2016] [Indexed: 01/03/2023]
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17
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Duncan R, Essat M, Jones G, Booth A, Buckley Woods H, Poku E, Kaltenthaler E, Keetharuth AD, Palfreyman S, Michaels J. Systematic review and qualitative evidence synthesis of patient-reported outcome measures for abdominal aortic aneurysm. Br J Surg 2016; 104:317-327. [PMID: 27935014 DOI: 10.1002/bjs.10407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/29/2016] [Accepted: 09/20/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim was to identify and evaluate existing patient-reported outcome measures (PROMs) for use in patients with an abdominal aortic aneurysm (AAA) to inform the selection for use in surgical practice. METHODS Two reviews were conducted: a systematic review to identify valid, reliable and acceptable PROMs for patients with an AAA, and a qualitative evidence synthesis to assess the relevance to patients of the identified PROM items. PROM studies were evaluated for their psychometric properties using established assessment criteria, and for their methodological quality using the COSMIN checklist. Qualitative studies were synthesized using framework analysis, and concepts identified were then triangulated using a protocol with the item concepts of the identified PROMs. RESULTS Four PROMs from three studies were identified in the first review: Short Form 36, Australian Vascular Quality of Life Index, Aneurysm Dependent Quality of Life (AneurysmDQoL) and Aneurysm Symptoms Rating Questionnaire (AneurysmSRQ). None of the identified PROMs had undergone a rigorous psychometric evaluation within the AAA population. Four studies were included in the qualitative synthesis, from which 28 concepts important to patients with an AAA were identified. The AneurysmDQoL and AneurysmSRQ together provided the most comprehensive assessment of these concepts. Fear of rupture, control, ability to forget about the condition and size of aneurysm were all concepts identified in the qualitative studies but not covered by items in the identified PROMs. CONCLUSION Further research is needed to develop PROMs for AAA that are reliable, valid and acceptable to patients.
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Affiliation(s)
- R Duncan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Essat
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Jones
- School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - A Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - H Buckley Woods
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Poku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Kaltenthaler
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A D Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Palfreyman
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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18
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Isenman H, Michaels J, Fisher D. Global variances in infection control practices for vancomycin resistant Enterococcus - results of an electronic survey. Antimicrob Resist Infect Control 2016; 5:41. [PMID: 27822366 PMCID: PMC5094057 DOI: 10.1186/s13756-016-0140-5] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/10/2016] [Indexed: 11/13/2022] Open
Abstract
An electronic survey was disseminated amongst infection control practitioners to investigate the variation in practices toward vancomycin resistant enterococci. There were 235 analysable responses, mostly from doctors, in 48 countries. The survey considered active surveillance, in-hospital precautions and tagging and untagging processes. There was a great variation in responses between and within countries highlighting a gap in guidance for practitioners on which to base institutional policy.
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Affiliation(s)
- H Isenman
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore
| | - J Michaels
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore
| | - D Fisher
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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19
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Carroll C, Hummel S, Leaviss J, Ren S, Stevens JW, Cantrell A, Michaels J. Systematic review, network meta-analysis and exploratory cost-effectiveness model of randomized trials of minimally invasive techniques versus surgery for varicose veins. Br J Surg 2014; 101:1040-52. [PMID: 24964976 DOI: 10.1002/bjs.9566] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/27/2014] [Accepted: 04/17/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND A Health Technology Assessment was conducted to evaluate the relative clinical effectiveness and cost-effectiveness of minimally invasive techniques (foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA)) for managing varicose veins, in comparison with traditional surgery. METHODS A systematic review of randomized clinical trials (RCTs) was undertaken to assess the effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. RESULTS The literature search conducted in July 2011 identified 1453 unique citations: 31 RCTs (51 papers) satisfied the criteria for effectiveness review. Differences between treatments were negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Total FS costs were estimated to be lowest, and FS was marginally more effective than surgery. However, relative effectiveness was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs were similar to those for surgery. These findings are subject to various uncertainties, including the risk of bias present in the evidence base and variation in reported costs. CONCLUSION This assessment of currently available evidence suggests there is little to choose between surgery and the minimally invasive techniques in terms of efficacy or safety, so the relative cost of the treatments becomes one of the deciding factors. High-quality RCT evidence is needed to verify and further inform these findings.
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Affiliation(s)
- C Carroll
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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20
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Carroll C, Hummel S, Leaviss J, Ren S, Stevens JW, Everson-Hock E, Cantrell A, Stevenson M, Michaels J. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation. Health Technol Assess 2014; 17:i-xvi, 1-141. [PMID: 24176098 DOI: 10.3310/hta17480] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Varicose veins are enlarged, visibly lumpy knotted veins, usually in the legs. Uncomplicated varicose veins can cause major discomfort and some complications. They are part of chronic venous disease (CVD), which is reported to have a substantial negative impact on health-related quality of life (HRQoL). Traditional treatments for varicose veins involve surgical stripping and ligation and liquid sclerotherapy (LS), but can be invasive and painful. New minimally invasive treatments offer an alternative. These treatments typically involve use of laser, radiofrequency or foam sclerosant. They are increasingly widely used and offer potential benefits such as reduced complications, faster recovery, fewer physical limitations and improved quality of life. OBJECTIVE The aim of this report is to evaluate the clinical effectiveness, safety and cost-effectiveness of the minimally invasive techniques of foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in comparison with other techniques, including traditional surgical techniques, LS and conservative management, in the management of varicose veins. DATA SOURCES A systematic search was made of 11 bibliographic databases of published and unpublished literature from their inception to July 2011: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library; Biological Abstracts; Science Citation Index (SCI); Social Sciences Citation Index; Conference Proceedings Citation Index-Science; UK Clinical Research Network; Current Controlled Trials; and ClinicalTrials.gov. REVIEW METHODS A systematic review of randomised controlled trials (RCTs) to assess the clinical effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, retreatment and clinical symptoms, as measured by the Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. RESULTS The literature search identified 1453 unique citations, of which 34 RCTs (54 papers) satisfied the criteria for the clinical effectiveness review. The minimally invasive techniques reported clinical outcomes similar to surgery. Rates of recurrence were slightly lower for EVLA, RFA and FS, especially for longer follow-up periods; VCSS score was lower for EVLA and FS than for stripping, but slightly higher for RFA; short-term pain was less for FS and RFA but higher for EVLA; higher quality-of-life scores were reported for all evaluated interventions than for stripping. Differences between treatments were therefore negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Our central estimate is that total FS costs were lowest and FS is marginally more effective than stripping. However, this result was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs are equivalent to stripping. These findings are subject to uncertainty on account of the risk of bias present in the evidence base and the variation in costs. LIMITATIONS The relative clinical effectiveness and cost-effectiveness of the techniques are principally based on rates of post-operative technical recurrence rather than symptomatic recurrence, as this was the reported outcome in all trials. The true proportion of treated individuals who are likely to present with symptoms of recurrence requiring retreatment is therefore not certain. A figure reflecting the likely proportion of treated individuals who would experience symptomatic recurrence requiring retreatment (with its associated costs), therefore, had to be calculated by the authors based on a small number of studies. The findings of this report also need to be verified by data from future trials with longer follow-up and using more standardised outcome measures. CONCLUSIONS This assessment of the currently available evidence suggests there is little to choose between the minimally invasive techniques in terms of efficacy or cost, and each offers a viable, clinically effective alternative to stripping. FS might offer the most cost-effective alternative to stripping, within certain time parameters. High-quality RCT evidence is needed. Future trials should aim to measure and report outcomes in a standardised manner, which would permit more efficient pooling of their results. STUDY REGISTRATION PROSPERO number CRD42011001355. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Carroll
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
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21
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Bermingham S, Sparrow K, Mullis R, Fox M, Shearman C, Bradbury A, Michaels J. The Cost-effectiveness of Supervised Exercise for the Treatment of Intermittent Claudication. Eur J Vasc Endovasc Surg 2013; 46:707-14. [DOI: 10.1016/j.ejvs.2013.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/04/2013] [Indexed: 11/27/2022]
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22
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Bermingham S, Sparrow K, Mullis R, Fox M, Shearman C, Bradbury A, Michaels J. The Cost-effectiveness of Supervised Exercise for the Treatment of Intermittent Claudication. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.10.066] [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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23
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Stevens JW, Simpson E, Harnan S, Squires H, Meng Y, Thomas S, Michaels J, Stansby G. Authors' reply: Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication ( Br J Surg 2012; 99: 1630–1638). Br J Surg 2013; 100:1838-9. [DOI: 10.1002/bjs.9358] [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: 11/08/2022]
Affiliation(s)
- J W Stevens
- Centre for Bayesian Statistics in Health Economics, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - E Simpson
- Centre for Bayesian Statistics in Health Economics, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - S Harnan
- Centre for Bayesian Statistics in Health Economics, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - H Squires
- Centre for Bayesian Statistics in Health Economics, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - Y Meng
- Centre for Bayesian Statistics in Health Economics, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - S Thomas
- Centre for Bayesian Statistics in Health Economics, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - J Michaels
- Centre for Bayesian Statistics in Health Economics, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - G Stansby
- Centre for Bayesian Statistics in Health Economics, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
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Stevens JW, Simpson E, Harnan S, Squires H, Meng Y, Thomas S, Michaels J, Stansby G. Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication. Br J Surg 2012; 99:1630-8. [PMID: 23034699 DOI: 10.1002/bjs.8895] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND A systematic review and network meta-analysis was undertaken to consider the evidence for the efficacy and tolerability of placebo, cilostazol, naftidrofuryl oxalate and pentoxifylline in patients with intermittent claudication due to peripheral arterial disease (PAD). METHODS MEDLINE, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Conference Proceedings, BIOSIS, National Research Register and MetaRegister databases were searched. Eligible studies were randomized controlled trials (RCTs) and published systematic reviews of patients with intermittent claudication due to PAD and whose symptoms persisted despite a period of conservative management. Study selection was conducted by one reviewer with involvement from a clinician. Data were extracted by one reviewer with no blinding to authors or journal, and checked by a second reviewer. Outcome measures were maximum walking distance (MWD) and pain-free walking distance (PFWD). RESULTS The review identified 1876 citations; 26 RCTs met the inclusion criteria for the systematic review. Eleven trials provided data relevant for the meta-analysis. Naftidrofuryl oxalate was ranked first for both MWD and PFWD (probability of 0·947 and 0·987, respectively, of being the best treatment) followed by cilostazol and pentoxifylline. For naftidrofuryl oxalate, cilostazol and pentoxifylline, MWD increased by 60 (95 per cent credible interval 20 to 114) per cent, 25 (11 to 40) per cent and 11 (-1 to 24) per cent respectively relative to placebo, and PFWD increased by 49, 13 and 9 per cent. CONCLUSION Naftidrofuryl oxalate and cilostazol are both effective treatments for claudication; naftidrofuryl oxalate is likely to be the most effective, with minimal serious adverse events.
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Affiliation(s)
- J W Stevens
- Centre for Bayesian Statistics in Health Economics, University of Sheffield, UK.
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25
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Squires H, Simpson E, Meng Y, Harnan S, Stevens J, Wong R, Thomas S, Michaels J, Stansby G. A systematic review and economic evaluation of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease. Health Technol Assess 2012; 15:1-210. [PMID: 22142554 DOI: 10.3310/hta15400] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is a condition in which there is blockage or narrowing of the arteries that carry blood to the legs and arms. It is estimated to affect around 4.5% of people aged between 55 and 74 years within the UK. The most common symptom of PAD is intermittent claudication (IC), characterised by pain in the legs on walking that is relieved with rest. OBJECTIVE To assess the effectiveness and cost-effectiveness of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate, compared with no vasoactive drugs, for IC due to PAD in adults whose symptoms continue despite a period of conventional management. DATA SOURCE Electronic bibliographic databases were searched during April to June 2010 (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Conference Proceedings Citation Index, BIOSIS Previews). REVIEW METHODS Effectiveness outcomes sought were maximal walking distance (MWD), pain-free walking distance (PFWD), ankle-brachial pressure index, cardiovascular events, mortality, adverse events (AEs) and health-related quality of life (HRQoL). A narrative synthesis was provided for all outcomes and a network meta-analysis was undertaken for the walking distance outcomes. A Markov model was developed to assess the relative cost-effectiveness of the interventions from a NHS perspective over a lifetime. The model has three states: vasoactive drug treatment, no vasoactive drug treatment and death. Each 1-week cycle, patients may continue with the drug, discontinue the drug or die. Regression analysis was undertaken to model the relationship between MWD and utility so that a cost per quality-adjusted life-year (QALY) outcome measure could be presented. Univariate and probabilistic sensitivity analyses were undertaken. All costs and outcomes were discounted at 3.5%. RESULTS Twenty-six randomised controlled trials were identified that met the inclusion criteria for the clinical effectiveness review. There was evidence that walking distance outcomes were significantly improved by both cilostazol and naftidrofuryl oxalate; the 95% credible intervals for the difference from placebo in the logarithm mean change MWD from baseline were 0.108 to 0.337 and 0.181 to 0.762, respectively. It was not possible to include inositol nicotinate within the meta-analysis of MWD and PFWD owing to the lack of 24-month data; however, the shorter-term data did not suggest a significant effect. AEs were minor for all drugs and included headaches and gastrointestinal difficulties. The incidence of serious adverse events (SAEs), including cardiovascular events and mortality, was not increased by the vasoactive drugs compared with placebo; however, most studies had a relatively short follow-up time to address this outcome. HRQoL data were limited. Two studies of limited quality were identified within the review of cost-effectiveness. The de novo model developed suggests that naftidrofuryl oxalate dominates cilostazol and pentoxifylline and has a cost per QALY gained of around £6070 compared with no vasoactive drug. This result is reasonably robust to changes within the key model assumptions. Inositol nicotinate was not included within the main analysis owing to lack of data. However, it is unlikely to be considered to be cost-effective due to its high acquisition cost (£900 vs £100-500 per year for the other drugs). CONCLUSIONS Naftidrofuryl oxalate and cilostazol both appear to be effective treatments for this patient population, with minimal SAEs. However, naftidrofuryl oxalate is the only treatment that is likely to be considered cost-effective. The long-term effectiveness is uncertain and hence a trial comparing cilostazol, naftidrofuryl oxalate and placebo beyond 24 weeks would be beneficial. Outcomes associated with naftidrofuryl oxalate could also be compared with those associated with supervised exercise programmes and angioplasty.
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Affiliation(s)
- H Squires
- School of Health and Related Research, Technology Assessment Group, University of Sheffield, Sheffield, UK
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26
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Heidemann R, Zhang C, Qi H, Larrick Rule J, Rozales C, Park S, Chuppa S, Ray M, Michaels J, Konstantinov K, Naveh D. The use of peptones as medium additives for the production of a recombinant therapeutic protein in high density perfusion cultures of mammalian cells. Cytotechnology 2011; 32:157-67. [PMID: 19002977 DOI: 10.1023/a:1008196521213] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Protein hydrolysates as substitutes for serum havebeen employed by many in cell culture mediumformulation, especially with the shift to low proteinor protein-free media. More recently, vegetablehydrolysates have also been added as nutritionalsupplements to fortify the amino acid content in smallpeptide form for batch and fed-batch fermentations. Several of these new hydrolysates (peptones of soy,rice, wheat gluten etc.) were tested as protein-freemedium supplements for the production of a recombinanttherapeutic protein. Multiple peptone-supplemented,continuous perfusion bioreactor experiments wereconducted, varying dilution rates and basal mediumcomposition over the various runs. Cell specificrates and product quality studies were obtained forthe various peptones and compared with peptone-freemedium. The potential for peptones to decreaseintrinsic and proteolytic degradation of the productwas also investigated.It was found that peptones confer a nutritionalbenefit, especially at low dilution rates, for therecombinant BHK cell line used in this investigation.The specific productivity increased 20-30% comparedto the peptone-free controls. However, this benefitwas also fully delivered by using fortified medium inplace of the peptone-enriched media. Therefore, whilepeptones may be considered as useful medium additiveswhen development time is limited, their addition maybe avoided by systematic medium development ifpermitted by the time line of the project.
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Affiliation(s)
- R Heidemann
- Bayer Corporation, 800 Dwight Way, P.O. Box 1686, Berkeley, CA, 94701, USA,
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Chambers D, Epstein D, Walker S, Fayter D, Paton F, Wright K, Michaels J, Thomas S, Sculpher M, Woolacott N. Endovascular stents for abdominal aortic aneurysms: a systematic review and economic model. Health Technol Assess 2009; 13:1-189, 215-318, iii. [DOI: 10.3310/hta13480] [Citation(s) in RCA: 57] [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] [Indexed: 11/22/2022] Open
Affiliation(s)
- D Chambers
- Centre for Reviews and Dissemination, University of York, UK
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Michaels J, Ranjan T, Harrison J. G.P.11.08 Long term remissions in MuSK-positive myasthenia gravis after a single course of Rituximab. Neuromuscul Disord 2009. [DOI: 10.1016/j.nmd.2009.06.255] [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: 10/20/2022]
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29
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Klonizakis M, Tew G, Michaels J, Saxton J. Exercise training improves cutaneous microvascular endothelial function in post-surgical varicose vein patients. Microvasc Res 2009; 78:67-70. [PMID: 19289135 DOI: 10.1016/j.mvr.2009.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 03/06/2009] [Accepted: 03/06/2009] [Indexed: 11/16/2022]
Abstract
This study investigated the effects of exercise training on cutaneous microvascular function in post-surgical varicose vein patients. Sixteen post-surgical (4-5 weeks) varicose vein patients were randomised to a treadmill-walking exercise group or a non-exercise control group. The exercise group trained twice weekly for 8 weeks. Changes in cutaneous microvascular function of the gaiter area were assessed using laser Doppler flowmetry combined with incremental-dose iontophoretic administration of acetylcholine chloride (ACh) and sodium nitroprusside (SNP) in both supine and standing positions. At 8 weeks, peak flux responses to ACh in the supine position were increased in the exercise group (44+/-30 to 62+/-33 PU; P=0.03) with a similar trend in the standing position (37+/-27 to 74+/-31 PU; P=0.08). There were no such changes in the control group (P>0.05). Additionally, peak flux responses to SNP were unchanged in both groups and body positions (P>0.05). The results suggest that moderate-intensity lower-limb exercise training improves microvascular endothelial vasodilator function in post-surgical varicose vein patients.
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Affiliation(s)
- M Klonizakis
- Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
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30
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Gold L, Rahman M, Michaels J, Callaghan M, Deveau-Rosen J, Michalak M, Gurtner G, Nanney L. 085
Calreticulin Enhances Wound Healing Via Multiple Biological Effects. Wound Repair Regen 2008. [DOI: 10.1111/j.1067-1927.2005.130215cg.x] [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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31
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Haldipur N, Brennan V, Michaels J. Graft materials for open abdominal aortic aneurysm repair. Hippokratia 2008. [DOI: 10.1002/14651858.cd004280.pub2] [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: 11/08/2022]
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32
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Epstein DM, Sculpher MJ, Manca A, Michaels J, Thompson SG, Brown LC, Powell JT, Buxton MJ, Greenhalgh RM. Modelling the long-term cost-effectiveness of endovascular or open repair for abdominal aortic aneurysm. Br J Surg 2007; 95:183-90. [PMID: 17876749 DOI: 10.1002/bjs.5911] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Recent randomized trials have shown that endovascular abdominal aortic aneurysm repair (EVAR) has a 3 per cent aneurysm-related survival benefit in patients fit for open surgery, but it also has uncertain long-term outcomes and higher costs. This study assessed the cost-effectiveness of EVAR.
Methods
A decision model was constructed to estimate the lifetime costs and quality-adjusted life years (QALYs) with EVAR and open repair in men aged 74 years. The model includes the risks of death from aneurysm, other cardiovascular and non-cardiovascular causes, secondary reinterventions and non-fatal cardiovascular events. Data were taken largely from the EVAR trial 1 and supplemented from other sources.
Results
Under the base-case (primary) assumptions, EVAR cost £3800 (95 per cent confidence interval (c.i.) £2400 to £5200) more per patient than open repair but produced fewer lifetime QALYs (mean − 0·020 (95 per cent c.i. − 0·189 to 0·165)). These results were sensitive to alternative model assumptions.
Conclusion
EVAR is unlikely to be cost-effective on the basis of existing devices, costs and evidence, but there remains considerable uncertainty.
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Affiliation(s)
- D M Epstein
- Centre for Health Economics, University of York, York, UK.
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33
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Hamou C, Dempsey M, Michaels J, Ghali S, Gurtner G. P240. J Surg Res 2007. [DOI: 10.1016/j.jss.2006.12.424] [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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34
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Scheinfeld N, Michaels J, Serradell N, Rosa E, Bolós J. Alitretinoin. DRUG FUTURE 2007. [DOI: 10.1358/dof.2007.032.11.1149766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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35
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Affiliation(s)
- J Michaels
- The Rayne Institute, University College London, London WC1E 6JJ, UK
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36
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37
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Bika D, Tardos G, Panmai S, Farber L, Michaels J. Strength and morphology of solid bridges in dry granules of pharmaceutical powders. POWDER TECHNOL 2005. [DOI: 10.1016/j.powtec.2004.11.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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38
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Michaels J, Dobryansky M, Galiano RD, Bhatt KA, Ashinoff R, Ceradini DJ, Levine JP, Gurnter GC. 050 The Angiogenesis Inhibitor Endostatin Impairs Wound Healing at Tumor?inhibiting Doses. Wound Repair Regen 2004. [DOI: 10.1111/j.1067-1927.2004.0abstractaw.x] [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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39
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Gold L, Michaels J, Callaghan M, Galiano R, Rahman M, Gurtner G, Nanney L. 145 Biological Effects of Calreticulin on Wound Repair. Wound Repair Regen 2004. [DOI: 10.1111/j.1067-1927.2004.0abstracten.x] [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]
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40
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Callaghan M, Kinnuncan E, Michaels J, Simon B, Gurtner G. 074 Wound Healing Enhancement by Pulsed Electromagnetic Fields. Wound Repair Regen 2004. [DOI: 10.1111/j.1067-1927.2004.0abstractbu.x] [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]
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41
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Haldipur N, Brennan V, Michaels J. Graft materials for open abdominal aortic aneurysm repair. Hippokratia 2003. [DOI: 10.1002/14651858.cd004280] [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: 11/11/2022]
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42
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Rigby K, Palfreyman S, Michaels J. Mortality following aortic surgery as a possible indicator of clinical performance. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2001.01757-35.x] [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: 11/20/2022]
Abstract
Abstract
Background
The mortality rate following aortic surgery has been suggested as a possible indicator of clinical performance.
Methods
Routine hospital data on mortality following aortic surgery were collected for a 2-year interval in the Trent region. Procedural and diagnostic codes, mode of admission, district of residence, treatment and specialty data were analysed and compared with audit data and the Operating Theatre Information System.
Results
Inaccuracies in coding using the HRG (Health Resource Group) codes meant that 21·4 per cent of elective aortic cases (HRG Q01) were probably emergencies and 26 per cent of probable emergency ruptures were not coded as vascular emergencies. The HRG system does not identify complex procedures carried out in specialist centres, thereby distorting the overall mortality figures. Case mix and patient selection introduced a bias, apparent between tertiary and district general hospitals, with higher-risk elective and lower-risk emergency cases at tertiary referral centres. For patients aged over 80 years, two districts undertook no elective aortic surgery, and the rates for emergency surgery varied between 16 and 25 per cent in the districts and 77 per cent in the tertiary centre. After correction for these factors, there remains significant variation in mortality rates between tertiary referral centres and the district hospitals (Table).
Conclusion
Some of the difficulties in using crude mortality rates as an indicator of performance have been highlighted. They are subject to bias and distortions owing to the collection of incorrect information, patient selection differences between hospitals, case-mix differences and tertiary transfer of complicated cases. Other case-mix factors can be accounted for only with more detailed collection of clinical data such as POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scores. However, there remains considerable and worrying variation in selection and outcomes of patients undergoing aortic surgery.
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Affiliation(s)
- K Rigby
- Northern General Hospital, Sheffield, UK
| | | | - J Michaels
- Northern General Hospital, Sheffield, UK
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43
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Michaels J, Palfreyman S, Shackley P, Slack R, Brazier J. Modelling the effects of the reorganization of vascular services. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01420-64.x] [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: 11/20/2022]
Abstract
Abstract
Background
Vascular services are currently in a state of evolution in many areas. A study has been carried out to model the economic and outcome implications of possible reconfiguration of vascular services.
Methods
Computer modelling was carried out based on an urban area with a teaching hospital (TH) and four surrounding district hospitals (DGHs) serving a population of 1·8 million. Data for the model were derived from a number of sources including local activity analysis, record linkage for cross-boundary flows, local audit, prospective surveys and systematic literature reviews.
Results
Analysis demonstrated a number of key differences in service provision between the TH and DGHs which were consistent with findings from literature reviews. These included differences in the use of endovascular treatments and femorodistal bypass, differences in case-mix and rates of particular procedures, and differences in outcome as measured by mortality and amputation rates. Computer modelling examined a number of options for the reconfiguration of services, including variations on fully centralized and hub and spoke arrangements. Cost estimates suggested that centralization and hub and spoke would result in an increased cost of £1 240 000–1 430 000 per year for the entire service, with over 80 per cent of these costs being related to expected increases in activity. Consideration of a number of key areas suggested that the resultant changes would save approximately 20 lives, 65 amputations and seven strokes per year for the population under consideration.
Conclusion
Reconfiguration of vascular services is likely to be highly cost effective. There is little difference in expected cost and outcomes between fully centralized and hub and spoke arrangements but the latter is preferred on the basis of decreased shift of resources and strong patient preference for local services.
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Affiliation(s)
- J Michaels
- Sheffield Vascular Institute and ScHARR, University of Sheffield, Sheffield, UK
| | - S Palfreyman
- Sheffield Vascular Institute and ScHARR, University of Sheffield, Sheffield, UK
| | - P Shackley
- Sheffield Vascular Institute and ScHARR, University of Sheffield, Sheffield, UK
| | - R Slack
- Sheffield Vascular Institute and ScHARR, University of Sheffield, Sheffield, UK
| | - J Brazier
- Sheffield Vascular Institute and ScHARR, University of Sheffield, Sheffield, UK
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44
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Abstract
OBJECTIVES To investigate whether and to what extent vascular patients are willing to trade expected health outcomes for improvements in non-health benefits, such as the availability of local services, in the provision of peripheral vascular surgery. METHODS Conjoint analysis was used to elicit patient preferences via a mailed questionnaire. Respondents were asked to consider pairwise descriptions of vascular services described in terms of a number of key attributes and asked to indicate which scenario description they preferred. Multivariate regression analysis was used to estimate the relative importance of the attributes to respondents. RESULTS Of the 339 patients invited to participate, 161 (47%) returned a completed questionnaire, although 36 (11%) were found to be internally inconsistent and could not be used, leaving 125 (36%) for analysis. An unexpected problem arose with respect to the design of the conjoint analysis questionnaire. Specifically, three of the attributes in the regression model were found to be collinear. The source of this problem, how it was overcome and how it can be avoided in future studies is discussed. The results of the regression analysis indicated that the patients who responded had a preference for local treatment to the extent that they were willing to incur increased risks of perioperative mortality and amputation to receive treatment at their local hospital. These results are discussed in connection with those from a different study which elicited patient preferences for local treatment using a standard gamble technique. CONCLUSIONS Policy-makers, when considering the potential benefits of regionalising health care, should seek to elicit the preferences of those patients who will be affected by the reorganisation.
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Affiliation(s)
- P Shackley
- Sheffield Health Economics Group, School of Health and Related Research, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
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45
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Prasad GA, Jones PG, Michaels J, Garland JS, Shivpuri CR. Outbreak of Serratia marcescens infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2001; 22:303-5. [PMID: 11428443 DOI: 10.1086/501906] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report an outbreak of Serratia marcescens infection in the neonatal intensive care unit of a community hospital. The outbreak involved eight neonates, (five infected and three colonized), one of whom died. Pulsed-field gel electrophoresis confirmed that all isolates were identical strains. Cohorting and isolation of the infected neonates helped to control the outbreak. No environmental source of infection was found.
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Affiliation(s)
- G A Prasad
- Department of Internal Medicine, University of Wisconsin Medical School, Sinai Samaritan Medical Center, Milwaukee, USA
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46
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Michaels J, Brazier J, Palfreyman S, Shackley P, Slack R. Cost and outcome implications of the organisation of vascular services. Health Technol Assess 2000; 4:i-iv, 1-191. [PMID: 10944744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Affiliation(s)
- J Michaels
- Sheffield Vascular Institute, Northern General Hospital, UK
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47
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Shackley P, Slack R, Booth A, Michaels J. Is there a positive volume-outcome relationship in peripheral vascular surgery? Results of a systematic review. Eur J Vasc Endovasc Surg 2000; 20:326-35. [PMID: 11035964 DOI: 10.1053/ejvs.2000.1188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to examine the evidence for the existence, or otherwise, of a positive volume-outcome relationship in the area of peripheral vascular surgery. DESIGN systematic overview of prospective or retrospective volume-outcome studies. DATA SOURCES seven bibliographic databases were searched for English-language articles published between 1986 and 1998. STUDY SELECTION thirty-six articles published in peer-reviewed journals; excluding editorials, letters or abstracts; and addressing volume and outcome in peripheral vascular surgery. Criteria were applied and agreed by consensus between two of the authors. DATA EXTRACTION the articles identified were independently assessed by two of the authors. Studies were categorised into three distinct areas - carotid endarterectomy- (17 studies), abdominal aortic aneurysm repair (16 studies) and other vascular interventions (four studies). Within each category studies were further classified according to full adjustment, partial adjustment or no adjustment for case mix. Where discrepancies arose, decisions were referred to a third author for arbitration. DATA SYNTHESIS findings for carotid endarterectomy identified a positive volume-outcome relationship for both mortality and stroke at the physician level. There was less support for a positive relationship for mortality at the hospital level, and no evidence of benefits for stroke in higher volume hospitals. If only studies making a full adjustment for case mix are included, there is no clear support from statistically significant evidence for or against a positive volume-outcome relationship. For repair of unruptured abdominal aortic aneurysms there is evidence of a positive volume-outcome relationship at both the physician and hospital level, with evidence being particularly strong at the level of the hospital. For ruptured aneurysms the evidence is suggestive of there not being a positive volume-outcome relationship at the hospital level, while for physicians the evidence is more balanced with no clear support either way. For other vascular interventions there were insufficient studies (n=4) from which to draw meaningful conclusions. CONCLUSIONS our results show that evidence of a relationship between volume and outcome in peripheral vascular surgery may be attributable to factors such as lack of adjustment for case-mix, different definitions of volume and poor quality of studies, especially those of retrospective design. Future studies should address these deficiencies by making full adjustment for case mix and by being prospective in design.
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Affiliation(s)
- P Shackley
- Sheffield Health Economics Group, ScHARR, UK
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48
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Abstract
OBJECTIVE The objective of this study was to assess the level of reporting in economic studies in the area of peripheral vascular disease. Adequate reporting of data is necessary to judge the quality of economic studies by means of critical appraisal criteria. METHODS A systematic review of the journal literature between 1986 and the first half of 1997 was undertaken. Studies that have attempted to estimate the resource consequences of one or more vascular procedure were the focus of the review. The extent of reporting in each study was assessed by using published guidelines. RESULTS The review identified 30 articles from nine different countries for inclusion in the study. Of these, more than half were published in the last 2(1/2) years of the search period, indicating a recent and rapid growth in economic studies in this area. When subjected to the reporting guidelines, the studies performed rather poorly overall. CONCLUSIONS Although the vascular studies can be criticized for inadequate reporting of economic data, it appears from the limited evidence from elsewhere that inadequate reporting is a problem in other clinical areas. In view of the importance of reporting to the ability to critically assess studies-and thus separate the "good" from the "bad"-there is a need for reporting to improve future published studies.
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Affiliation(s)
- P Shackley
- Sheffield Health Economics Group, School of Health and Related Research, University of Sheffield, United Kingdom
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49
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Casper RC, Michaels J, Simon K. Body perception and emotional health in athletes: a study of female adolescents involved in aesthetic sports. World Rev Nutr Diet 1997; 82:134-47. [PMID: 9270317 DOI: 10.1159/000059623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R C Casper
- Stanford University School of Medicine, Calif., USA
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50
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Sculpher M, Michaels J, McKenna M, Minor J. A cost-utility analysis of laser-assisted angioplasty for peripheral arterial occlusions. Int J Technol Assess Health Care 1996; 12:104-25. [PMID: 8690551 DOI: 10.1017/s0266462300009430] [Citation(s) in RCA: 27] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite the perception of many people that lasers represent the cutting edge of high-technology medicine, this form of medical technology has been subject to relatively little rigorous evaluation. This dearth of research relates particularly to economic evaluation, where there have been few attempts to justify the high cost of laser equipment. This paper details an economic evaluation of the use of laser technology as a secondary adjunct to angioplasty to treat peripheral arterial occlusions. Using data from a range of sources, including a published randomized trial, a cost-utility model is developed to estimate the costs and benefits of the laser, relative to standard angioplasty. The best available data indicate a cost-effective role for the laser, but important areas of uncertainty exist, including the laser's secondary recanalization rate, which has been estimated on the basis of limited numbers of patients. This uncertainty suggests that further research is required before widespread diffusion of the laser for use in this clinical context.
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