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Nowrouzi-Kia B, Nixon J, Ritchie S, Wenghofer E, VanderBurgh D, Sherman J. Examining the quality of work-life of paramedics in northern Ontario, Canada: A cross-sectional study. Work 2022; 72:135-147. [DOI: 10.3233/wor-205025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Paramedics are exposed to multiple stressors in the workplace. They are more likely to develop occupational-related stress conditions compared to other occupations. This study focused on understanding the factors affecting QoWL of paramedics in northern Ontario, Canada; a particular focus was on understanding the personal and organizational factors, such as practicing community paramedicine (CP), which may be associated with Quality of Work Life (QoWL). METHODS: Paramedic QoWL was assessed using an online survey that was distributed to approximately 879 paramedics across northern Ontario. The survey included the 23-Item Work- Related Quality of Work Life Scale. Data analysis involved linear regressions with nine predictor variables deemed to be related to QoWL for paramedics with QoWL and its six subscales as dependent variables. Multiple linear regressions were used to assess the personal and organizational factors, such as practicing of CP, which predicted QoWL. RESULTS: One hundred and ninety-seven paramedics completed the questionnaire. Overall, the mean QoWL score of all paramedic participants was 73.99, and this average compared to relevant published norms for other occupations. Factors that were most associated with higher QoWL were, experience practicing CP (p < 0.05), number of sick days/year (p < 0.01), and higher self- rated mental health (p < 0.001). CONCLUSIONS: Higher paramedic QoWL appears to be associated with many factors such as number of sick days per year, self-rated mental health, and participation in CP. EMS organizations should consider establishing necessary workplace health promotion strategies that are targeted at improving QoWL for paramedics.
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Affiliation(s)
- B. Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, ON, Canada
- School of Kinesiology and Health Sciences, Faculty of Education and Health, Laurentian University, Sudbury, ON, Canada
- Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, ON, Canada
| | | | - S.D. Ritchie
- School of Kinesiology and Health Sciences, Faculty of Education and Health, Laurentian University, Sudbury, ON, Canada
- Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, ON, Canada
| | - E.F. Wenghofer
- School of Kinesiology and Health Sciences, Faculty of Education and Health, Laurentian University, Sudbury, ON, Canada
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, ON, Canada
| | - D. VanderBurgh
- Department of Family Medicine, McMaster University, Hamilton, Ontario, ON, Canada
| | - J.E. Sherman
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, ON, Canada
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Siddle H, Bonner R, Leighton P, McGinnis E, Rahma S, Stubbs N, Hinchcliff R, Wright-Hughes A, Nixon J, Richards S, Russell D. 652 Fate of The Contralateral Limb Following Major Lower Limb Amputation in Patients with Peripheral Arterial Disease And/Or Diabetes: Case Series from Two Regional Vascular Centres. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1119] [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: 11/14/2022]
Abstract
Abstract
Introduction
This is the first clinical case series to report time to ulceration, minor and major amputation of the contralateral limb (CLL) in the first 12 months following major lower limb amputation (LLA) in patients with peripheral arterial disease (PAD) and/or diabetes.
Method
Consecutive patient samples at two regional UK vascular centres were included; from 2010 to 2017 (site 1) and 2014 to 2016 (site 2). Data were extracted from electronic records for 12 months following index major LLA. Survival analyses are presented for the event of mortality in the total study population, plus major amputation-free survival, and complication-free survival in site 1 only; results are stratified by diabetes status.
Results
Of 381 patients reviewed (n = 197 site 1; n = 184 site 2), 208 (54.6%) were diagnosed with diabetes at the time of their index major LLA. The mean survival time of patients was lower in those without diabetes (HR: 0.64 [95% CI, 0.43 to 0.95], p=.03). The mean time to major amputation of the CLL or death in patients was lower in those without diabetes (HR: 0.65 [95% CI, 224 0.40 to 1.06]; p=.08). The median time to any complication of the CLL or death was greater in those without diabetes (HR: 1.25 [95% CI, 227 0.88 to 1.78]; p=.21).
Conclusions
Death rates were higher in patients without diabetes, whilst those with diabetes had high levels of CLL complications. Optimisation of care to protect the CLL following major LLA and guidance for carers, patients, and clinicians is required.
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Affiliation(s)
- H Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
- Podiatry Department, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, United Kingdom
| | - R Bonner
- Leeds Institute for Health Sciences, University of Leeds, Leeds, United Kingdom
| | - P Leighton
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - E McGinnis
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - S Rahma
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds General 25 Infirmary, Leeds, United Kingdom
| | - N Stubbs
- Leeds Community Healthcare NHS Trust, Leeds, United Kingdom
| | - R Hinchcliff
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, United Kingdom
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - A Wright-Hughes
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - J Nixon
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - S Richards
- Leeds Institute for Health Sciences, University of Leeds, Leeds, United Kingdom
| | - D Russell
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds General 25 Infirmary, Leeds, United Kingdom
- Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, University of Leeds, Leeds, United Kingdom
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Bradley P, Wilson J, Taylor R, Nixon J, Redfern J, Whittemore P, Gaddah M, Kavuri K, Haley A, Denny P, Withers C, Robey RC, Logue C, Dahanayake N, Min DSH, Coles J, Deshmukh MS, Ritchie S, Malik M, Abdelaal H, Sivabalah K, Hartshorne MD, Gopikrishna D, Ashish A, Nuttall E, Bentley A, Bongers T, Gatheral T, Felton TW, Chaudhuri N, Pearmain L. Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation. EClinicalMedicine 2021; 40:101122. [PMID: 34514360 PMCID: PMC8424135 DOI: 10.1016/j.eclinm.2021.101122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.
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Affiliation(s)
- P Bradley
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- NWCORR North West Collaborative Organisation for Respiratory Research
| | - J Wilson
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Taylor
- Research and Development, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Nixon
- Respiratory department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- NWCORR North West Collaborative Organisation for Respiratory Research
| | - J Redfern
- Respiratory department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - P Whittemore
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Gaddah
- Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - K Kavuri
- Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - A Haley
- Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - P Denny
- Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - C Withers
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - RC Robey
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Logue
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - N Dahanayake
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Siaw Hui Min
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Coles
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M S Deshmukh
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Ritchie
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Malik
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - H Abdelaal
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - K Sivabalah
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - MD Hartshorne
- Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - D Gopikrishna
- Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - A Ashish
- Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - E Nuttall
- Respiratory department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - A Bentley
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - T Bongers
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - T Gatheral
- Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - TW Felton
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - N Chaudhuri
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - L Pearmain
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- NWCORR North West Collaborative Organisation for Respiratory Research
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Corresponding author. L Pearmain. Piper Hanley Laboratory, Floor 3 AV Hill Building, The University of Manchester, Manchester, UK, M13 9PT
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Affiliation(s)
- J Nixon
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
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5
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Lechner A, Kottner J, Coleman S, Muir D, Beeckman D, Chaboyer W, Cuddigan J, Moore Z, Rutherford C, Schmitt J, Nixon J, Balzer K. Outcomes for Pressure Ulcer Trials (OUTPUTs) project: review and classification of outcomes reported in pressure ulcer prevention research. Br J Dermatol 2020; 184:617-626. [DOI: 10.1111/bjd.19304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Affiliation(s)
- A. Lechner
- Charité – Universitätsmedizin Berlin Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Berlin Germany
| | - J. Kottner
- Charité – Universitätsmedizin Berlin Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Berlin Germany
- University Centre for Nursing and Midwifery Ghent University Ghent Belgium
| | - S. Coleman
- Institute of Clinical Trials Research Clinical Trials Research Unit University of Leeds Leeds UK
| | - D. Muir
- Institute of Clinical Trials Research Clinical Trials Research Unit University of Leeds Leeds UK
| | - D. Beeckman
- University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- School of Health Sciences, Nursing and Midwifery University of Surrey Guildford UK
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Faculty of Medicine and Health Sciences Dublin Ireland
- School of Health Sciences Örebro University Örebro Sweden
| | - W. Chaboyer
- School of Nursing and Midwifery Menzies Health Institute Queensland Griffith University and Gold Coast Hospital and Health Service Southport QLD Australia
| | - J. Cuddigan
- University of Nebraska Medical Center College of Nursing Omaha NE USA
| | - Z. Moore
- Royal College of Surgeons in Ireland Dublin Ireland
- Monash University Melbourne VIC Australia
- Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
- Lida Institute Shanghai China
- Cardiff University Cardiff UK
| | - C. Rutherford
- Faculty of Science Quality of Life Office School of Psychology University of Sydney Sydney NSW Australia
- Faculty of Medicine and Health Susan Wakil School of Nursing and Midwifery Cancer Nursing Research Unit (CNRU) University of Sydney Sydney NSW Australia
| | - J. Schmitt
- Centre for Evidence‐based Healthcare Medical Faculty Carl Gustav Carus Technical University Dresden Dresden Germany
| | - J. Nixon
- Institute of Clinical Trials Research Clinical Trials Research Unit University of Leeds Leeds UK
| | - K. Balzer
- Institute of Clinical Trials Research Clinical Trials Research Unit University of Leeds Leeds UK
- Institute for Social Medicine and Epidemiology Nursing Research Unit University of Lübeck Lübeck Germany
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6
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Affiliation(s)
- J Nixon
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
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7
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Nixon J, Cowie F, White J, Chong P, Lo S, Bodie D, Hayward L, Ferguson M, Campbell L. EP-1602 Role of clinical networks in sarcomas: The Scottish Sarcoma Network(SSN)Experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32022-5] [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: 10/26/2022]
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Macdonald SJ, Nixon J, Deacon L. 'Loneliness in the city': examining socio-economics, loneliness and poor health in the North East of England. Public Health 2018; 165:88-94. [PMID: 30384033 DOI: 10.1016/j.puhe.2018.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 03/23/2018] [Revised: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to discover whether lower socio-economic status is associated with increased experiences of loneliness and isolation. The research subsequently determined whether this relationship impacted health inequalities. STUDY DESIGN The study used a cross-sectional, self-reported survey collecting information on loneliness, isolation and poor health (n = 680). The survey was administered through Sunderland District Council in 2016-2017, and data were analysed at The University of Sunderland. METHODS The study used a quantitative approach, and data were analysed using descriptive statistics, engaging in univariate, bivariate and multivariate levels of analysis. RESULTS A number of significant findings emerged from the data analysis, linking lower socio-economic status to experiences of loneliness (P = 0.000) and social isolation (P = 0.000). When determining if social isolation and socio-economics had a detrimental impact on a person's health, no statistical association was discovered (P = 0.098). Yet, there was a significant relationship concerning socio-economic status, loneliness and poor health (P = 0.026). CONCLUSIONS The authors have identified a number of associations within the data with reference to isolation, loneliness and poor health. Therefore, participants from a lower socio-economic group experienced disproportionately high levels of social isolation and emotional loneliness when compared with other socio-economic groups. The data also demonstrate that participants who experienced loneliness, and who were from a lower socio-economic background, were consistently more likely to report poor health than those from other socio-economic backgrounds.
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Affiliation(s)
- S J Macdonald
- School of Social Sciences, Faculty of Education and Society, University of Sunderland, The Reg Vardy Centre, St Peter's Way, Sunderland, SR6 0DD, UK.
| | - J Nixon
- People Services Directorate - Public Health, Sunderland Civic Centre, Burdon Road, Sunderland City Council, UK.
| | - L Deacon
- Applied Social Studies/Social Work, Faculty of Education and Society, The Reg Vardy Centre, St Peter's Way, Sunderland, SR6 0DD, UK.
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Ellis L, Samarut E, Nixon J, Drapeau P. Assessing the efficacy of Zebrafish seizure models for testing cannabinoids. Am J Transl Res 2018. [DOI: 10.1055/s-0038-1644918] [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: 10/28/2022]
Affiliation(s)
- L Ellis
- National Research Council of Canada, Halifax, Nova Scotia, Canada
| | - E Samarut
- University of Montreal, Montreal, Quebec, Canada
| | - J Nixon
- National Research Council of Canada, Halifax, Nova Scotia, Canada
| | - P Drapeau
- University of Montreal, Montreal, Quebec, Canada
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Ndosi M, Wright‐Hughes A, Brown S, Backhouse M, Lipsky BA, Bhogal M, Reynolds C, Vowden P, Jude EB, Nixon J, Nelson EA. Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. Diabet Med 2018; 35:78-88. [PMID: 29083500 PMCID: PMC5765512 DOI: 10.1111/dme.13537] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 01/07/2023]
Abstract
AIMS To determine clinical outcomes and explore prognostic factors related to ulcer healing in people with a clinically infected diabetic foot ulcer. METHODS This multicentre, prospective, observational study reviewed participants' data at 12 months after culture of a diabetic foot ulcer requiring antibiotic therapy. From participants' notes, we obtained information on the incidence of wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization and death. We estimated the cumulative incidence of healing at 6 and 12 months, adjusted for lower extremity amputation and death using a competing risk analysis, and explored the relationship between baseline factors and healing incidence. RESULTS In the first year after culture of the index ulcer, 45/299 participants (15.1%) had died. The ulcer had healed in 136 participants (45.5%), but recurred in 13 (9.6%). An ipsilateral lower extremity amputation was recorded in 52 (17.4%) and revascularization surgery in 18 participants (6.0%). Participants with an ulcer present for ~2 months or more had a lower incidence of healing (hazard ratio 0.55, 95% CI 0.39 to 0.77), as did those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of ≥2 (hazard ratio 0.37, 95% CI 0.25 to 0.55). Participants with a single ulcer on their index foot had a higher incidence of healing than those with multiple ulcers (hazard ratio 1.90, 95% CI 1.18 to 3.06). CONCLUSIONS Clinical outcomes at 12 months for people with an infected diabetic foot ulcer are generally poor. Our data confirm the adverse prognostic effect of limb ischaemia, longer ulcer duration and the presence of multiple ulcers.
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Affiliation(s)
- M. Ndosi
- Department of Nursing and MidwiferyUniversity of the West of EnglandBristolUK
- Academic Rheumatology UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | | | - S. Brown
- Clinical Trials Research UnitUniversity of LeedsLeedsUK
| | - M. Backhouse
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
| | - B. A. Lipsky
- Division of Medical SciencesUniversity of OxfordOxfordUK
| | - M. Bhogal
- School of Biomedical SciencesUniversity of LeedsLeedsUK
| | - C. Reynolds
- Clinical Trials Research UnitUniversity of LeedsLeedsUK
| | | | - E. B. Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust Ashton‐Under‐LyneUK
- University of ManchesterManchesterUK
| | - J. Nixon
- Clinical Trials Research UnitUniversity of LeedsLeedsUK
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11
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Smith IL, Brown S, Nixon J, Cowdell FC, Ersser S, Fernandez C, Goodfield M, Green CM, Hampton P, Lear JT, Smith CH, Sunderland L, Tubeuf S, Wittmann M. Treatment of severe, chronic hand eczema: results from a UK-wide survey. Clin Exp Dermatol 2016; 42:185-188. [PMID: 27910127 DOI: 10.1111/ced.13015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2016] [Indexed: 11/30/2022]
Abstract
Treatment of severe hand eczema (HE) that is resistant to topical potent corticosteroid treatment is challenging. In 2013, we surveyed 194 UK dermatologists to obtain information about their usual treatment pathways to inform the choice of the comparator in a trial of alitretinoin in severe HE (ALPHA trial); the results indicated that the treatment approaches favoured by UK dermatologists differ. Psoralen combined with ultraviolet A (PUVA) and alitretinoin were identified as the most frequent first-line treatment options for hyperkeratotic HE, whereas oral corticosteroids were identified as the most frequent first-line treatment for vesicular HE, followed by PUVA and alitretinoin. In terms of potential adverse effects of long-term or repeated use, oral steroids and ciclosporin A were reported to cause most concern. There is uncertainty about which treatment gives the best short and long-term outcomes, because of a lack of definitive randomised controlled trials evaluating the effectiveness of different treatment pathways in severe HE.
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Affiliation(s)
- I L Smith
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK
| | - S Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK
| | - J Nixon
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK
| | - F C Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - S Ersser
- School of Healthcare, University of Leeds, Leeds, Yorkshire, UK
| | - C Fernandez
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK
| | - M Goodfield
- Department of Dermatology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, UK
| | - C M Green
- Department of Dermatology, Ninewells Hospital, Dundee, Tayside, UK
| | - P Hampton
- Department of Dermatology, Newcastle Hospitals, Newcastle, Tyne and Wear, UK
| | - J T Lear
- Department of Dermatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - S Tubeuf
- Academic Unit of Health Economics, University of Leeds, Leeds, Yorkshire, UK
| | - M Wittmann
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, Yorkshire, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, Yorkshire, UK.,Department of Dermatology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Yorkshire, UK
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12
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Coleman S, Nixon J, Keen J, Muir D, Wilson L, McGinnis E, Stubbs N, Dealey C, Nelson EA. Using cognitive pre-testing methods in the development of a new evidenced-based pressure ulcer risk assessment instrument. BMC Med Res Methodol 2016; 16:158. [PMID: 27852237 PMCID: PMC5112672 DOI: 10.1186/s12874-016-0257-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/12/2016] [Accepted: 11/03/2016] [Indexed: 11/22/2022] Open
Abstract
Background Variation in development methods of Pressure Ulcer Risk Assessment Instruments has led to inconsistent inclusion of risk factors and concerns about content validity. A new evidenced-based Risk Assessment Instrument, the Pressure Ulcer Risk Primary Or Secondary Evaluation Tool - PURPOSE-T was developed as part of a National Institute for Health Research (NIHR) funded Pressure Ulcer Research Programme (PURPOSE: RP-PG-0407-10056). This paper reports the pre-test phase to assess and improve PURPOSE-T acceptability, usability and confirm content validity. Methods A descriptive study incorporating cognitive pre-testing methods and integration of service user views was undertaken over 3 cycles comprising PURPOSE-T training, a focus group and one-to-one think-aloud interviews. Clinical nurses from 2 acute and 2 community NHS Trusts, were grouped according to job role. Focus group participants used 3 vignettes to complete PURPOSE-T assessments and then participated in the focus group. Think-aloud participants were interviewed during their completion of PURPOSE-T. After each pre-test cycle analysis was undertaken and adjustment/improvements made to PURPOSE-T in an iterative process. This incorporated the use of descriptive statistics for data completeness and decision rule compliance and directed content analysis for interview and focus group data. Data were collected April 2012-June 2012. Results Thirty-four nurses participated in 3 pre-test cycles. Data from 3 focus groups, 12 think-aloud interviews incorporating 101 PURPOSE-T assessments led to changes to improve instrument content and design, flow and format, decision support and item-specific wording. Acceptability and usability were demonstrated by improved data completion and appropriate risk pathway allocation. The pre-test also confirmed content validity with clinical nurses. Conclusions The pre-test was an important step in the development of the preliminary PURPOSE-T and the methods used may have wider instrument development application. PURPOSE-T proposes a new approach to pressure ulcer risk assessment, incorporating a screening stage, the inclusion of skin status to distinguish between those who require primary prevention and those who require secondary prevention/treatment and the use of colour to support pathway allocation and decision making. Further clinical evaluation is planned to assess the reliability and validity of PURPOSE-T and it’s impact on care processes and patient outcomes.
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Affiliation(s)
- S Coleman
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - J Nixon
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - J Keen
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - D Muir
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - L Wilson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.,Mid Yorkshire Hospital NHS Trust, Wakefield, UK
| | - E McGinnis
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Stubbs
- Wound Prevention and Management Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - C Dealey
- School of Health & Population Sciences, University of Birmingham, Birmingham, UK
| | - E A Nelson
- School of Healthcare, University of Leeds, Leeds, UK
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Bennett AN, Nixon J, Roberts A, Barker-Davies R, Villar R, Houghton JM. Prospective 12-month functional and vocational outcomes of hip arthroscopy for femoroacetabular impingement as part of an evidence-based hip pain rehabilitation pathway in an active military population. BMJ Open Sport Exerc Med 2016; 2:e000144. [PMID: 27900190 PMCID: PMC5117082 DOI: 10.1136/bmjsem-2016-000144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 01/22/2023] Open
Abstract
Background Femoroacetabular impingement (FAI) is common with an estimated prevalence of 10–15% among young active individuals. The natural history of the disorder is progression to early osteoarthritis. Hip arthroscopy is recommended if conservative treatments fail; however, outcomes are unclear, particularly in highly active populations. Aim To evaluate the functional and vocational outcome of hip arthroscopy, as part of an evidence-based rehabilitation hip pain pathway, for the treatment of FAI in an active military population. Methods All patients in the defence rehabilitation hip pain pathway, with a confirmed diagnosis of FAI who failed conservative treatment, were assessed prior to surgery and at 2, 6 and 12 months postsurgery. Outcome measures included the Visual Analogue Scale (VAS) for hip pain, Non-Arthritic Hip Score (NAHS) for function, and vocational assessments including functional activity assessment (FAA) and Joint Medical Employment Standard for military employability and deployability. Results 101 patients completed the study (mean age=33 years) (male:female:75:26) (Royal Navy/British Army/Royal Air Force: 13%/48%/39%). Outcomes demonstrated significant improvements with large effect size. Preoperative NAHS mean=62.9 (SD 16.4), 12-month postoperative NAHS mean=78.8 (18.3), mean improvement in NAHS=15.9 (95% CI 12.3 to 19.5, p<0.001). Preoperative VAS pain mean=51.3 (20.9), 12-month postoperative VAS pain=25.6 (24.5). Mean improvement 25.7 (95% CI 19.4 to 31.99, p<0.001). 73% of patients had a deployable medical category at 12 months postoperative. Conclusions These data confirm that hip arthroscopy as part of a structured evidence-based multidisciplinary care pathway produces significant and continued symptomatic, functional and vocational improvements over a 12-month period in a military population exposed to high intensity, weight-bearing exercise in uncontrolled and unforgiving environments.
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Affiliation(s)
- A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - J Nixon
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
| | - A Roberts
- Academic Department of Military Rehabilitation , Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
| | - R Barker-Davies
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
| | - R Villar
- Department of Trauma and Orthopaedics , Wellington Hospital , London , UK
| | - J M Houghton
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
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Affiliation(s)
- S K Chhetri
- From the The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - S Khan
- Department of Cardiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - J Nixon
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
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Nixon J, Bing A, Hayward L, Salter D, Dixon M. EP-1338: Breast sarcoma: 14 year experience of a single institution. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thom J, Cooney J, Nelis S, Hindle J, Nixon J, Jones I, Whitaker C, Clare L. Behaviour change to promote healthy ageing in over 1950s: Physical activity, function and health results from the Agewell trial. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.301] [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: 10/24/2022]
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Bryant M, Ashton L, Nixon J, Jebb S, Wright J, Roberts K, Brown J. Framework of outcome measures recommended for use in the evaluation of childhood obesity treatment interventions: the CoOR framework. Pediatr Obes 2014; 9:e116-31. [PMID: 24729517 DOI: 10.1111/j.2047-6310.2014.220.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/03/2013] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Consensus is lacking in determining appropriate outcome measures for assessment of childhood obesity treatments. Inconsistency in the use and reporting of such measures impedes comparisons between treatments and limits consideration of effectiveness. This study aimed to produce a framework of recommended outcome measures: the Childhood obesity treatment evaluation Outcomes Review (CoOR) framework. METHODS A systematic review including two searches was conducted to identify (1) existing trial outcome measures and (2) manuscripts describing development/evaluation of outcome measures. Outcomes included anthropometry, diet, eating behaviours, physical activity, sedentary time/behaviour, fitness, physiology, environment, psychological well-being and health-related quality of life. Eligible measures were appraised by the internal team using a system developed from international guidelines, followed by appraisal from national external expert collaborators. RESULTS A total of 25,486 papers were identified through both searches. Eligible search 1 trial papers cited 417 additional papers linked to outcome measures, of which 56 were eligible. A further 297 outcome development/evaluation papers met eligibility criteria from search 2. Combined, these described 191 outcome measures. After internal and external appraisal, 52 measures across 10 outcomes were recommended for inclusion in the CoOR framework. CONCLUSION Application of the CoOR framework will ensure greater consistency in choosing robust outcome measures that are appropriate to population characteristics.
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Affiliation(s)
- M Bryant
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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Czoski MCJ, Meads DM, McCabe C, Edlin R, Rutherford C, Hulme CT, Nixon J. A Utility Algorithm forthe Pressure Ulcer Quality of Life - Utility Instrument (Puqol-Ui). Value Health 2014; 17:A513. [PMID: 27201583 DOI: 10.1016/j.jval.2014.08.1582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - C McCabe
- University of Alberta, Edmonton, AB, Canada
| | - R Edlin
- University of Auckland, Auckland, New Zealand
| | | | | | - J Nixon
- University of Leeds, Leeds, UK
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Meads DM, Czoski-Murray C, Rutherford C, Dealey C, McGinnis E, Stubbs N, Wilson L, Nixon J, Hulme CT, McCabe C. Health State Utilities for Pressure Ulcers - A Comparison of Condition-Specific and Generic Measures and Time-Trade-Off (Tto). Value Health 2014; 17:A610. [PMID: 27202124 DOI: 10.1016/j.jval.2014.08.2137] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | - C Dealey
- Birmingham Hospitals NHS Trust and University of Birmingham, Birmingham, UK
| | - E McGinnis
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Stubbs
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | | | - J Nixon
- University of Leeds, Leeds, UK
| | | | - C McCabe
- University of Alberta, Edmonton, AB, Canada
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Forster A, Dickerson J, Young J, Patel A, Kalra L, Nixon J, Smithard D, Knapp M, Holloway I, Anwar S, Farrin A. A cluster randomised controlled trial and economic evaluation of a structured training programme for caregivers of inpatients after stroke: the TRACS trial. Health Technol Assess 2014; 17:1-216. [PMID: 24153026 DOI: 10.3310/hta17460] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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 The majority of stroke patients are discharged home dependent on informal caregivers, usually family members, to provide assistance with activities of daily living (ADL), including bathing, dressing and toileting. Many caregivers feel unprepared for this role and this may have a detrimental effect on both the patient and caregiver. OBJECTIVE To evaluate whether or not a structured, competency-based training programme for caregivers [the London Stroke Carer Training Course (LSCTC)] improved physical and psychological outcomes for patients and their caregivers after disabling stroke, and to determine if such a training programme is cost-effective. DESIGN A pragmatic, multicentre, cluster randomised controlled trial. SETTING Stratified randomisation of 36 stroke rehabilitation units (SRUs) to the intervention or control group by geographical region and quality of care. PARTICIPANTS A total of 930 stroke patient and caregiver dyads were recruited. Patients were eligible if they had a confirmed diagnosis of stroke, were medically stable, were likely to return home with residual disability at the time of discharge and had a caregiver available, willing and able to provide support after discharge. The caregiver was defined as the main person--other than health, social or voluntary care provider--helping with ADL and/or advocating on behalf of the patient. INTERVENTION The intervention (the LSCTC) comprised a number of caregiver training sessions and competency assessment delivered by SRU staff while the patient was in the SRU and one recommended follow-up session after discharge. The control group continued to provide usual care according to national guidelines. Recruitment was completed by independent researchers and participants were unaware of the SRUs' allocation. MAIN OUTCOME MEASURES The primary outcomes were self-reported extended ADL for the patient and caregiver burden measured at 6 months after recruitment. Secondary outcomes included quality of life, mood and cost-effectiveness, with final follow-up at 12 months. RESULTS No differences in primary outcomes were found between the groups at 6 months. Adjusted mean differences were -0.2 points [95% confidence interval (CI) -3.0 to 2.5 points; p = 0.866; intracluster correlation coefficient (ICC) = 0.027] for the patient Nottingham Extended Activities of Daily Living score and 0.5 points (95% CI -1.7 to 2.7 points; p = 0.660; ICC = 0.013) for the Caregiver Burden Scale. Furthermore, no differences were detected in any of the secondary outcomes. Intervention compliance varied across the units. Half of the participating centres had a compliance rating of > 60%. Analysis showed no evidence of higher levels of patient independence or lower levels of caregiver burden in the SRUs with better levels of intervention compliance. The economic evaluation suggests that from a patient and caregiver perspective, health and social care costs, societal costs and outcomes are similar for the intervention and control groups at 6 months, 12 months and over 1 year. CONCLUSIONS We have conducted a robust multicentre, cluster randomised trial, demonstrating for the first time that this methodology is feasible in stroke rehabilitation research. There was no difference between the LSCTC and usual care with respect to improving stroke patients' recovery, reducing caregivers' burden, or improving other physical and psychological outcomes, nor was it cost-effective compared with usual care. Compliance with the intervention varied, but analysis indicated that a dose effect was unlikely. It is possible that the immediate post-stroke period may not be the ideal time for the delivery of structured training. The intervention approach might be more relevant if delivered after discharge by community-based teams. TRIAL REGISTRATION Current Controlled Trials ISRCTN49208824. FUNDING This project was funded by the MRC and is managed by the NIHR (project number 09/800/10) on behalf of the MRC-NIHR partnership, and will be published in full in Health Technology Assessment; Vol. 17, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- A Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford and University of Leeds, Leeds, UK
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Da Costa M, Grimes J, Oviedo-Rondón E, Barasch I, Evans C, Dalmagro M, Nixon J. Footpad dermatitis severity on turkey flocks and correlations with locomotion, litter conditions, and body weight at market age. J APPL POULTRY RES 2014. [DOI: 10.3382/japr.2013-00848] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Miller D, Revelo M, Wever-Pinzon J, Nixon J, Hammond M, Stehlik J, Gilbert E, Fang J, Everitt M, Drakos S, Alharethi R, Budge D, Kfoury A. Recovery of Myocardial Capillary Bed (Microvascular) Density Persists in Long Term Follow Up of CAV Patients Treated With Sirolimus. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Plein S, Kidambi A, Sourbron S, Maredia N, Uddin A, Motwani M, Ripley DP, Herzog B, Brown JMB, Nixon J, Everett CC, Greenwood JP. 097 FACTORS ASSOCIATED WITH FALSE NEGATIVE CARDIOVASCULAR MAGNETIC RESONANCE PERFUSION STUDIES: A CE-MARC SUBSTUDY. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wachter S, Nixon J, Oberton S, Kfoury A, Budge D, Nativi J, Stehlik J, Alharethi R, Selzman C, Reid B, Gilbert E. Are the Clinical Implications of Lactic Acidosis Similar Post-Cardiac Transplantation Verus Post-LVAD Implantation? J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Alharethi R, Knight S, Galenko O, Carlquist J, Horne B, Budge D, Frampton S, Rassmusson K, Nixon J, Rollo J, Brunisholz K, Kfoury A. Insulin Growth Factor 1 and Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bicknell S, Chaudhuri R, Shepherd M, Lee N, Pitman N, Spears M, Cameron E, Cowan D, Nixon J, Thompson J, Thomson NC. P5 Introducing Bronchial Thermoplasty Treatment into a Severe Asthma Clinical Service: Abstract P5 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Greenwood JP, Kidambi A, Zaman A, Maredia N, Motwani M, Dickinson CJ, Brown JM, Nixon J, Everett CC, Ball SG, Plein S. 088 Comparison of cardiovascular magnetic resonance stress perfusion with single photon emission CT (SPECT) in patients with left main stem disease: a CE-MARC substudy. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rasmusson K, Brunisholz K, Labedi M, Knight S, Budge D, Stehlik J, Alharethi R, Nixon J, Frampton S, Kfoury A. 385 Predictors of Graft Survival in Heart Transplant Recipients with Peripartum Cardiomyopathy: Insights from the United Network for Organ Sharing (UNOS) Database. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Gorecki C, Nixon J, Madill A, Firth J, Brown J. What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors. J Tissue Viability 2012; 21:3-12. [DOI: 10.1016/j.jtv.2011.11.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 11/15/2011] [Indexed: 11/25/2022]
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Rasmusson K, Alharethi R, Horne B, Bair T, Brunisholz K, Budge D, Nixon J, Connolly J, Kfoury A. Is B-Type Natriuretic Peptide Predictive of Outcomes in Non-Heart Failure Patients with Differing Body Mass? J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.06.269] [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: 10/17/2022]
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Abstract
This case report is of a patient who presented with clinical features suggestive of Guillain-Barré syndrome, who on investigation was found to have neurosarcoidosis. The patient was treated with high-dose corticosteroids and physiotherapy and he improved in condition substantially over 1 month. Neurosarcoidosis and its various presentations are discussed in the literature review.
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Affiliation(s)
- A Oldroyd
- Department of Medicine, Lancaster University, Lancaster, UK.
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Kimble R, Wallis B, Nixon J, Watt K, Cass D, Gillen T, Griffin B. 10 year review of low speed vehicle run-overs in 0-15 year olds across Queensland. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Graham J, Mullins SH, Miller B, Nixon J, Eoff S, Brann M, Aitken ME. A pilot trial of all-terrain vehicle safety messaging in a movie theatre. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Price H, Waters AM, Mighty D, Nixon J, Burton N, Picket J, Sullivan AK. Texting appointment reminders reduces ‘Did not Attend’ rates, is popular with patients and is cost-effective. Int J STD AIDS 2009; 20:142-3. [DOI: 10.1258/ijsa.2008.008448] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- H Price
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - A M Waters
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - D Mighty
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - J Nixon
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - N Burton
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - J Picket
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - A K Sullivan
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital Foundation Trust, London, UK
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Fayter D, Nixon J, Hartley S, Rithalia A, Butler G, Rudolf M, Glasziou P, Bland M, Stirk L, Westwood M. Effectiveness and cost-effectiveness of height-screening programmes during the primary school years: a systematic review. Arch Dis Child 2008; 93:278-84. [PMID: 17475693 DOI: 10.1136/adc.2006.109843] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the effectiveness and cost-effectiveness of height screening (of children aged 4 to 11) to identify height-related conditions. DESIGN Systematic review and economic modelling. SETTING AND INTERVENTION We included published and unpublished screening studies of any design, except case reports, conducted in any setting that measured children's height as part of a population-level assessment. Studies were identified by electronic database searches, contact with experts and from bibliographies of retrieved studies. PARTICIPANTS Children aged between 4 and 11 years. OUTCOME MEASURES Diagnostic yield of height-related conditions and change in quality of life, as measured by quality-adjusted life years (QALYs), for early versus late treatment of underlying conditions. RESULTS Twelve studies described a height-screening programme and provided data on the diagnostic yield of newly diagnosed height-related conditions. Where reported, yield for growth-hormone deficiency (per 1000 children screened) ranged from 0.05 (1 in 20,000) to 0.62 (approximately 1 in 1500) and for Turner syndrome (per 1000 children screened) was between 0.02 (1 in 50,000) and 0.07 (approximately 1 in 14,000). As a secondary gain, children with other potentially treatable conditions were identified; diagnostic yields ranged from 0.22 to 1.84 per 1000 children screened. Three studies did not detect any new cases, but all of these studies had methodological limitations. Economic modelling suggested that height screening is associated with health improvements and is cost effective for a willingness to pay threshold of pound 30,000 per QALY. CONCLUSIONS This review indicates the utility and acceptable cost-effectiveness of height screening arising from increased detection of height-related disorders and secondary pick-up of other undiagnosed conditions. Further research is needed to obtain more reliable data on quality of life gains and costs associated with early interventions for height-related conditions. The exact role of height-screening programmes in improving child health remains to be determined.
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Affiliation(s)
- D Fayter
- Centre for Reviews and Dissemination, University of York, York, UK
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Fayter D, Nixon J, Hartley S, Rithalia A, Butler G, Rudolf M, Glasziou P, Bland M, Stirk L, Westwood M. A systematic review of the routine monitoring of growth in children of primary school age to identify growth-related conditions. Health Technol Assess 2007; 11:iii, xi-xii, 1-163. [PMID: 17580001 DOI: 10.3310/hta11220] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 11/22/2022] Open
Abstract
OBJECTIVES To clarify the role of growth monitoring in primary school children, including obesity, and to examine issues that might impact on the effectiveness and cost-effectiveness of such programmes. DATA SOURCES Electronic databases were searched up to July 2005. Experts in the field were also consulted. REVIEW METHODS Data extraction and quality assessment were performed on studies meeting the review's inclusion criteria. The performance of growth monitoring to detect disorders of stature and obesity was evaluated against National Screening Committee (NSC) criteria. RESULTS In the 31 studies that were included in the review, there were no controlled trials of the impact of growth monitoring and no studies of the diagnostic accuracy of different methods for growth monitoring. Analysis of the studies that presented a 'diagnostic yield' of growth monitoring suggested that one-off screening might identify between 1:545 and 1:1793 new cases of potentially treatable conditions. Economic modelling suggested that growth monitoring is associated with health improvements [incremental cost per quality-adjusted life-year (QALY) of 9500 pounds] and indicated that monitoring was cost-effective 100% of the time over the given probability distributions for a willingness to pay threshold of 30,000 pounds per QALY. Studies of obesity focused on the performance of body mass index against measures of body fat. A number of issues relating to human resources required for growth monitoring were identified, but data on attitudes to growth monitoring were extremely sparse. Preliminary findings from economic modelling suggested that primary prevention may be the most cost-effective approach to obesity management, but the model incorporated a great deal of uncertainty. CONCLUSIONS This review has indicated the potential utility and cost-effectiveness of growth monitoring in terms of increased detection of stature-related disorders. It has also pointed strongly to the need for further research. Growth monitoring does not currently meet all NSC criteria. However, it is questionable whether some of these criteria can be meaningfully applied to growth monitoring given that short stature is not a disease in itself, but is used as a marker for a range of pathologies and as an indicator of general health status. Identification of effective interventions for the treatment of obesity is likely to be considered a prerequisite to any move from monitoring to a screening programme designed to identify individual overweight and obese children. Similarly, further long-term studies of the predictors of obesity-related co-morbidities in adulthood are warranted. A cluster randomised trial comparing growth monitoring strategies with no growth monitoring in the general population would most reliably determine the clinical effectiveness of growth monitoring. Studies of diagnostic accuracy, alongside evidence of effective treatment strategies, could provide an alternative approach. In this context, careful consideration would need to be given to target conditions and intervention thresholds. Diagnostic accuracy studies would require long-term follow-up of both short and normal children to determine sensitivity and specificity of growth monitoring.
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Affiliation(s)
- D Fayter
- Centre for Reviews and Dissemination, University of York, UK
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Mortimer K, Nixon J, Holden S, Jones A, Weston V. Aetiology of septic arthritis in patients admitted to hospital in Nottingham 1997–2001 and an audit of management guidelines. J Infect 2007. [DOI: 10.1016/j.jinf.2007.04.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Harvey A, Zhang H, Nixon J, Brown CJ. Comparison of data extraction from standardized versus traditional narrative operative reports for database-related research and quality control. Surgery 2007; 141:708-14. [PMID: 17560246 DOI: 10.1016/j.surg.2007.01.022] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Revised: 12/13/2006] [Accepted: 01/06/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to compare the completeness and reproducibility of data extracted from a standardized operative report (SOR) with the non-standardized operative report (NSOR). METHODS Between July and December 2003, operative data were collected from all laparoscopic cholecystectomy procedures performed at the Peter Lougheed Centre Hospital. A standardized format for dictating laparoscopic cholecystectomy operative reports was introduced on October 1, 2003. Non-standardized operative reports dictated in the first 3 months of the study period were compared with SORs dictated in the final 3 months. Two physicians independently extracted data from each operative report into a surgical database. RESULTS During the study period, 221 cholecystectomy reports were analyzed (119 SOR and 102 NSOR). Completeness of data extraction for identifying variables (eg, patient name, age, and date of procedure) was similar in the 2 types of reports. However, most other operative and perioperative details were more completely reported in the SOR (95% to 100%) when compared to the NSOR (14% to 100% complete). Furthermore, interobserver agreement between 2 independent data extractors was better for the SOR than the NSOR (0.9972 vs 0.9809, P < .0001). CONCLUSIONS Standardized operative reports result in more complete and reliably interpretable operative data compared with NSORs.
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Affiliation(s)
- A Harvey
- Division of General Surgery, Peter Lougheed Center, Calgary, Canada
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Hewison J, Nixon J, Fountain J, Hawkins K, Jones CR, Mason G, Morley S, Thornton JG. A randomised trial of two methods of issuing prenatal test results: the ARIA (Amniocentesis Results: Investigation of Anxiety) trial. BJOG 2007; 114:462-8. [PMID: 17378819 DOI: 10.1111/j.1471-0528.2007.01276.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 11/29/2022]
Abstract
BACKGROUND Many pregnant women experience anxiety while waiting for the results of diagnostic tests. Policies and practices intended to reduce this anxiety require evaluation. OBJECTIVES To test the following two hypotheses: * That giving amniocentesis results out on a fixed date alters maternal anxiety during the waiting period, compared with a policy of telling parents that the result will be issued "when available" (i.e. variable date). * That issuing early results from a rapid molecular test alters maternal anxiety during the waiting period, compared with not receiving any results prior to the karyotype. The effects of the two interventions on anxiety 1 month after receiving karyotype results were also examined. DESIGN A multicentre, randomised, controlled, open fixed sample, 2 x 2 factorial design trial, with equal randomisation. SETTING The prenatal diagnosis clinics in 12 hospitals in England offering amniocentesis as a diagnostic test for Down's syndrome. SAMPLE Two hundred and twenty-six women who had had an amniocentesis were randomised between June 2002 and July 2004. Eight women with abnormal results or test failure were excluded post-randomisation. INTERVENTIONS Issuing karyotype results on a prespecified fixed date, rather than issuing them as soon as they became available. Issuing karyotype results alone, or subsequent to issuing results from a rapid molecular test for the most common chromosomal abnormalities. MAIN OUTCOME MEASURES Average anxiety during the waiting period, calculated using daily scores from the short version of the Spielberger State-Trait Anxiety Inventory (STAI). Anxiety 1 month after receiving karyotype results, measured using the short form STAI. RESULTS Issuing early results from a partial but rapid test reduced maternal anxiety by a clinically significant amount during the waiting period (mean daily score 12.5 versus 14.8; scale score difference -2.36, 95% CI -1.2, -3.6), compared with receiving only the full karyotype results. There was no evidence that giving out karyotype results on a fixed or on a variable date altered maternal anxiety during the waiting period (mean daily score 13.2 versus 14.2; scale score difference -1.02, 95% CI -2.2, 0.2). One month after receiving normal karyotype results, anxiety was low in all groups, but women who had been given rapid test results tended to be more anxious than those who had not (mean single day score 9.2 versus 8.3; mean scale score difference 0.95, 95% CI -0.03, 1.9). This small to moderate effect did not reach conventional levels of statistical significance. CONCLUSIONS Rapid testing was a beneficial addition to karyotyping, at least in the short term. This does not necessarily imply that early results would be preferred to comprehensive ones if women had to choose between them. Because there are no clear advantages in anxiety terms of issuing karyotype results as soon as they become available, or on a fixed date, women could be given a choice between them.
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Affiliation(s)
- J Hewison
- Department of Obstetrics and Gynaecology, University of Leeds, Leeds, UK
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Scott D, Harrison J, Purdie D, Bain C, Najman J, Nixon J, Spinks AB, McClure RJ. The properties of the International Classification of the External Cause of Injury when used as an instrument for injury prevention research. Inj Prev 2007; 12:253-7. [PMID: 16887948 PMCID: PMC2586785 DOI: 10.1136/ip.2006.011510] [Citation(s) in RCA: 15] [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: 11/04/2022]
Abstract
OBJECTIVE To demonstrate properties of the International Classification of the External Cause of Injury (ICECI) as a tool for use in injury prevention research. METHODS The Childhood Injury Prevention Study (CHIPS) is a prospective longitudinal follow up study of a cohort of 871 children 5-12 years of age, with a nested case crossover component. The ICECI is the latest tool in the International Classification of Diseases (ICD) family and has been designed to improve the precision of coding injury events. The details of all injury events recorded in the study, as well as all measured injury related exposures, were coded using the ICECI. This paper reports a substudy on the utility and practicability of using the ICECI in the CHIPS to record exposures. Interrater reliability was quantified for a sample of injured participants using the Kappa statistic to measure concordance between codes independently coded by two research staff. RESULTS There were 767 diaries collected at baseline and event details from 563 injuries and exposure details from injury crossover periods. There were no event, location, or activity details which could not be coded using the ICECI. Kappa statistics for concordance between raters within each of the dimensions ranged from 0.31 to 0.93 for the injury events and 0.94 and 0.97 for activity and location in the control periods. DISCUSSION This study represents the first detailed account of the properties of the ICECI revealed by its use in a primary analytic epidemiological study of injury prevention. The results of this study provide considerable support for the ICECI and its further use.
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Affiliation(s)
- D Scott
- Queensland Injury Surveillance Unit, Mater Children's Hospital, Brisbane, Queensland, Australia
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Hewison J, Nixon J, Fountain J, Cocks K, Jones C, Mason G, Morley S, Thornton J. Amniocentesis results: investigation of anxiety. The ARIA trial. Health Technol Assess 2007; 10:iii, ix-x, 1-78. [PMID: 17134598 DOI: 10.3310/hta10500] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/22/2022] Open
Abstract
OBJECTIVES The Amniocentesis Results: Investigation of Anxiety (ARIA) trial tested two hypotheses: first, that giving amniocentesis results out on a fixed date alters maternal anxiety during the waiting period, compared with a policy of telling parents that the result will be issued 'when available' (i.e. a variable date), and secondly, that issuing early results from a rapid molecular test alters maternal anxiety during the waiting period, compared with not receiving any results prior to the karyotype. The effects of the two interventions on anxiety 1 month after receiving karyotype results were also examined. DESIGN A multi-centre, randomised, controlled, open fixed sample, 2 x 2 factorial design trial, with equal randomisation. SETTING Twelve hospitals in England offering amniocentesis as a diagnostic test for Down's syndrome. PARTICIPANTS A total of 226 women who had had an amniocentesis were randomised between June 2002 and July 2004. Eight women with abnormal results or test failure were excluded post-randomisation. INTERVENTIONS Issuing karyotype results on a prespecified fixed date, rather than issuing them as soon as they became available and issuing karyotype results alone, or subsequent to issuing results from a rapid molecular test for the most common chromosomal abnormalities. MAIN OUTCOME MEASURES Average anxiety during the waiting period, calculated using daily scores from the short version of the Spielberger State-Trait Anxiety Inventory (STAI). Recalled anxiety, measured 1 month after receiving karyotype results, using a rating scale. Anxiety at the 1-month follow-up, measured using the short-form STAI. RESULTS There was no evidence that giving out karyotype results on a fixed or on a variable date altered maternal anxiety during the waiting period. However, the analysis only had sufficient power to detect a moderate to large effect. Issuing early results from a partial, but rapid, test reduced maternal anxiety during the waiting period, compared with receiving only the full karyotype results. This was a moderate to large effect. In addition, group differences in recalled anxiety reflected fairly closely the differences in anxiety women had experienced while waiting for results. One month after receiving normal karyotype results, anxiety was low in all groups, but women who had been given rapid test results were more anxious than those who had not. This was a small to moderate effect. CONCLUSIONS Since there are no clear advantages in anxiety terms of issuing karyotype results as soon as they become available, or on a fixed date, women could be given a choice between them. Rapid testing was a beneficial addition to karyotyping, at least in the short term. This does not necessarily imply that early results would be preferred to comprehensive ones if women had to choose between them. There should be further research, including more qualitative studies, into the causes, characteristics and consequences of anxiety associated with prenatal testing. The effects of different testing regimes on short- and long-term anxiety, on the preferences of women and on the relationship between anxiety and preference should be investigated. More research is needed on the ways in which information might be used to minimise anxiety in different testing regimes. Further research is also required into the policy implications of incorporating individual preferences for different testing regimes into prenatal testing programmes.
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Affiliation(s)
- J Hewison
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, UK
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Aitken ME, Mullins HM, Nixon J, Parnell DM, Dick R, Graham J. IMPACT OF A RURAL COMMUNITY-BASED ALL-TERRAIN VEHICLE SAFETY CAMPAIGN. J Investig Med 2007. [DOI: 10.1097/00042871-200701010-00805] [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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Rodgers M, Nixon J, Hempel S, Aho T, Kelly J, Neal D, Duffy S, Ritchie G, Kleijnen J, Westwood M. Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation. Health Technol Assess 2006; 10:iii-iv, xi-259. [PMID: 16729917 DOI: 10.3310/hta10180] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [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: 11/22/2022] Open
Abstract
OBJECTIVES To determine the most effective diagnostic strategy for the investigation of microscopic and macroscopic haematuria in adults. DATA SOURCES Electronic databases from inception to October 2003, updated in August 2004. REVIEW METHODS A systematic review was undertaken according to published guidelines. Decision analytic modelling was undertaken, based on the findings of the review, expert opinion and additional information from the literature, to assess the relative cost-effectiveness of plausible alternative tests that are part of diagnostic algorithms for haematuria. RESULTS A total of 118 studies met the inclusion criteria. No studies that evaluated the effectiveness of diagnostic algorithms for haematuria or the effectiveness of screening for haematuria or investigating its underlying cause were identified. Eighteen out of 19 identified studies evaluated dipstick tests and data from these suggested that these are moderately useful in establishing the presence of, but cannot be used to rule out, haematuria. Six studies using haematuria as a test for the presence of a disease indicated that the detection of microhaematuria cannot alone be considered a useful test either to rule in or rule out the presence of a significant underlying pathology (urinary calculi or bladder cancer). Forty-eight of 80 studies addressed methods to localise the source of bleeding (renal or lower urinary tract). The methods and thresholds described in these studies varied greatly, precluding any estimate of a 'best performance' threshold that could be applied across patient groups. However, studies of red blood cell morphology that used a cut-off value of 80% dysmorphic cells for glomerular disease reported consistently high specificities (potentially useful in ruling in a renal cause for haematuria). The reported sensitivities were generally low. Twenty-eight studies included data on the accuracy of laboratory tests (tumour markers, cytology) for the diagnosis of bladder cancer. The majority of tumour marker studies evaluated nuclear matrix protein 22 or bladder tumour antigen. The sensitivity and specificity ranges suggested that neither of these would be useful either for diagnosing bladder cancer or for ruling out patients for further investigation (cystoscopy). However, the evidence remains sparse and the diagnostic accuracy estimates varied widely between studies. Fifteen studies evaluating urine cytology as a test for urinary tract malignancies were heterogeneous and poorly reported. The calculated specificity values were generally high, suggesting some possible utility in confirming malignancy. However, the evidence suggests that urine cytology has no application in ruling out malignancy or excluding patients from further investigation. Fifteen studies evaluated imaging techniques [computed tomography (CT), intravenous urography (IVU) or ultrasound scanning (US)] to detect the underlying cause of haematuria. The target condition and the reference standard varied greatly between these studies. The diagnostic accuracy data for several individual studies appeared promising but meaningful comparison of the available imaging technologies was impossible. Eight studies met the inclusion criteria but addressed different parts of the diagnostic chain (e.g. screening programmes, laboratory investigations, full urological work-up). No single study addressed the complete diagnostic process. The review also highlighted a number of methodological limitations of these studies, including their lack of generalisability to the UK context. Separate decision analytic models were therefore developed to progress estimation of the optimal strategy for the diagnostic management of haematuria. The economic model for the detection of microhaematuria found that immediate microscopy following a positive dipstick test would improve diagnostic efficiency as it eliminates the high number of false positives produced by dipstick testing. Strategies that use routine microscopy may be associated with high numbers of false results, but evidence was lacking regarding the accuracy of routine microscopy and estimates were adopted for the model. The model for imaging the upper urinary tract showed that US detects more tumours than IVU at one-third of the cost, and is also associated with fewer false results. For any cause of haematuria, CT was shown to have a mean incremental cost-effectiveness ratio of pounds sterling 9939 in comparison with the next best option, US. When US is followed up with CT for negative results with persistent haematuria, it dominates the initial use of CT alone, with a saving of pounds sterling 235,000 for the evaluation of 1000 patients. The model for investigation of the lower urinary tract showed that for low-risk patients the use of immediate cystoscopy could be avoided if cystoscopy were used for follow-up patients with a negative initial test using tumour markers and/or cytology, resulting in a saving of pounds sterling 483,000 for the evaluation of 1000 patients. The clinical and economic impact on delayed detection of both upper and lower urinary tract tumours through the use of follow-up testing should be evaluated in future studies. CONCLUSIONS There are insufficient data currently available to derive an evidence-based algorithm of the diagnostic pathway for haematuria. A hypothetical algorithm based on the opinion and practice of clinical experts in the review team, other published algorithms and the results of economic modelling is presented in this report. This algorithm is presented, for comparative purposes, alongside current US and UK guidelines. The ideas contained in these algorithms and the specific questions outlined should form the basis of future research. Quality assessment of the diagnostic accuracy studies included in this review highlighted several areas of deficiency.
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Affiliation(s)
- M Rodgers
- Centre for Reviews and Dissemination, University of York, UK
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Nixon J, Nelson EA, Cranny G, Iglesias CP, Hawkins K, Cullum NA, Phillips A, Spilsbury K, Torgerson DJ, Mason S. Pressure relieving support surfaces: a randomised evaluation. Health Technol Assess 2006; 10:iii-iv, ix-x, 1-163. [PMID: 16750060 DOI: 10.3310/hta10220] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [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: 11/22/2022] Open
Abstract
OBJECTIVES To determine differences between alternating pressure overlays and alternating pressure replacement mattresses with respect to the development of new pressure ulcers, healing of existing pressure ulcers, patient acceptability and cost-effectiveness of the different pressure-relieving surfaces. Also to investigate the specific additional impact of pressure ulcers on patients' well-being. DESIGN A multicentre, randomised, controlled, open, fixed sample, parallel-group trial with equal randomisation was undertaken. The trial used remote, concealed allocation and intention-to-treat (ITT) analysis. The main trial design was supplemented with a qualitative study involving a purposive sample of 20-30 patients who developed pressure ulcers, to assess the impact of the pressure ulcers on their well-being. In addition, a focus group interview was carried out with clinical research nurses, who participated in the PRESSURE (Pressure RElieving Support SUrfaces: a Randomised Evaluation) Trial, to explore the experiences of their role and observations of pressure area care. SETTING The study took place in 11 hospital-based research centres within six NHS trusts in England. PARTICIPANTS Acute and elective patients aged 55 years or older and admitted to vascular, orthopaedic, medical or care of the elderly wards in the previous 24 hours were investigated. INTERVENTIONS Patients were randomised to either an alternating pressure overlay or an alternating pressure mattress replacement, with mattress specifications clearly defined to enable the inclusion of centres using products from different manufacturers, and to exclude hybrid mattress systems (which either combine foam or constant low pressure with alternating pressure in one mattress, or can be used as either an overlay or a replacement mattress). MAIN OUTCOME MEASURES Development of a new pressure ulcer (grade < or =2, i.e. partial-thickness wound involving epidermis/dermis only) on any skin site. Also healing of existing pressures ulcers, patient acceptability and cost-effectiveness. RESULTS In total, 6155 patients were assessed for eligibility to the trial and 1972 were randomised: 990 to the alternating pressure overlay (989 after one postrandomisation exclusion) and 982 to the alternating pressure mattress replacement. ITT analysis found no statistically significant difference in the proportions of patients developing a new pressure ulcer of grade 2 or above [10.7% overlay patients, 10.3% mattress replacement patients, a difference of 0.4%, 95% confidence interval (CI) -2.3 to 3.1%, p = 0.75]. When logistic regression analysis was used to adjust for minimisation factors and prespecified baseline covariates, there was no difference between the mattresses with respect to the odds of ulceration (odds ratio 0.94, 95% CI 0.68 to 1.29). There was no evidence of a difference between the mattress groups with respect to time to healing (p = 0.86). The Kaplan-Meier estimate of the median time to healing was 20 days for each intervention. More patients allocated overlays requested mattress changes due to dissatisfaction (23.3%) than mattress replacement patients (18.9%, p = 0.02) and more than one-third of patients reporting difficulties associated with movement in bed and getting into or out of bed. There is a higher probability (64%) that alternating mattress replacements are cost-saving; they were associated with lower overall costs (74.50 pounds sterling per patient on average, mainly due to reduced length of stay) and greater benefits (a delay in time to ulceration of 10.64 days on average). Patients' accounts highlighted that the development of a pressure ulcer could be pivotal in the trajectory from illness to recovery, by preventing full recovery or causing varied impacts on their quality of life. CONCLUSIONS There is no difference between alternating pressure mattress replacements and overlays in terms of the proportion of patients developing new pressure ulcers; however, alternating pressure mattress replacements are more likely to be cost-saving. The results suggest that when renewing alternating pressure surfaces or ordering equipment within a rental contract, mattress replacements should be specified; however, overlays are acceptable if no replacement mattress is available. Similarly, patient preferences can be supported, without any great increase in risk, if individual patients request an overlay rather than a replacement mattress. Further research could include a randomised controlled trial comparing alternating pressure mattress replacements and high-specification foam mattresses in patients at moderate to high risk; an accurate costing study to understand better how much pressure ulcers cost health and social services in the UK; and trials in higher risk groups of patients. Also future trials should measure time to ulceration as the primary end-point, since this is more informative economically and possibly also from a patient and clinical perspective.
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Affiliation(s)
- J Nixon
- Clinical Trial Research Unit, University of Leeds, UK
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Drummond MF, Aguiar-Ibanez R, Nixon J. Economic evaluation. Singapore Med J 2006; 47:456-61; quiz 462. [PMID: 16752012] [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: 05/10/2023]
Abstract
Given the need to assess the value for money of healthcare treatments, economic evaluation has been gaining popularity over the past ten years. Studies comparing the costs and consequences of alternative healthcare interventions have been published in all fields of healthcare. This article describes the basic forms of economic evaluation and outlines the key methodological features to be considered in the critical appraisal of studies. Issues such as the appropriateness of the study question, the selection of alternatives to be compared, the measurement of costs and consequences, and the assessment of uncertainty are discussed. Additionally, an analytical critique of economic evaluations undertaken in Singapore is provided, and the prospects for economic evaluation in the future are discussed.
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Affiliation(s)
- M F Drummond
- Centre for Health Economics, University of York, Heslington, York YO10 5DD, The United Kingdom.
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Abstract
It is important that breeders have the means to assess genetic scoring data for segregation distortion because of its probable effect on the design of efficient breeding strategies. Scoring data is usually assessed for segregation distortion by separate nonindependent chi2 tests at each locus in a set of marker loci. This analysis gives the loci most affected by selection if it exists, but it cannot give a statistically correct test for the presence or absence of selection in a linkage group as a whole. I have used a combined test based on the statistic, which is the most significant P-value from the above tests, called the single locus test. I have also derived mathematically a new combined statistical test, the overall test, for segregation distortion that requires genetic scoring data for a single linkage group. This test also takes genetic linkage into account. Using a range of marker densities and population sizes, simulations were carried out, to compare the power of these two statistical tests to detect the effect of selection at one or two loci. The single locus test was always found to be more powerful than the overall test, but the single locus test required a more complicated P-value correction. For the single locus test, approximate correction factors for the P-values are given for a range of marker densities and genetic lengths.
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Affiliation(s)
- J Nixon
- Molecular Genetics, Agriculture and Agri-Food Canada, Saskatoon Research Centre, 107 Science Place, Saskatoon, SK, Canada S7N 0X2.
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Mason S, Barrow H, Phillips A, Eddison G, Nelson A, Cullum N, Nixon J. Brief report on the experience of using proxy consent for incapacitated adults. J Med Ethics 2006; 32:61-2. [PMID: 16373526 PMCID: PMC2563273 DOI: 10.1136/jme.2005.012302] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The Medicines for Human Use (Clinical Trials) Regulations 2004, which came into force in the UK in May 2004, cover the conduct of clinical trials on medicinal products. They allow a legal representative (a person not connected with the conduct of the trial) to consent to the participation of incompetent adults in medical research. Currently, very little is known about how such representatives will make their decisions. We have experience with proxy consent for older adults in a large, national trial. From 2445 potentially eligible but incapacitated patients, proxy, relative assent resulted in trial participation of only 87 (3.6%) patients. The reasons for this were that a large number of incapacitated patients had no relative available for assent (2286), but also a high proportion of relatives approached refused to provide assent (72/159, 45.3%). In comparison, 17.7% of patients declined participation in the trial.Proxy consent allowed only a small increase in trial recruitment of incapacitated patients. The fact that a greater proportion of relatives than patients refused to provide assent implies that they were more cautious than the patients themselves, or perhaps used different criteria, when making their decision. In future research involving incapacitated older patients there is likely to be heavy reliance on proxy consent provision by legal representatives. Our findings imply that consent decisions of legal representatives will not necessarily reflect those of patients themselves.
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Affiliation(s)
- S Mason
- Clinical Trials Research Unit, University of Leeds, 17 Springfield Mount, Leeds, LS2 9NG, UK.
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Sayed AR, Nixon J, Bourne DE. Folic acid awareness among women of reproductive age in Cape Town. S Afr Med J 2006; 96:12. [PMID: 16440103] [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: 05/06/2023] Open
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