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Mullins E, Perry A, Banerjee J, Townson J, Grozeva D, Milton R, Kirby N, Playle R, Bourne T, Lees C. Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study. Eur J Obstet Gynecol Reprod Biol 2022; 276:161-167. [PMID: 35914420 PMCID: PMC9295331 DOI: 10.1016/j.ejogrb.2022.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/15/2022] [Accepted: 07/14/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. METHODS Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. RESULTS Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3-1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. CONCLUSIONS Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians' threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection. The proportion affected by pre-eclampsia amongst participants was not higher than would be expected, although we report a higher than expected proportion affected by eclampsia. There appears to be no effect on birthweight or congenital malformations in women affected by SARS-CoV-2 infection in pregnancy and neonatal infection is uncommon. This study reflects a population with a range of infection severity for SARS-COV-2 in pregnancy, generalisable to whole obstetric populations.
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Affiliation(s)
- E Mullins
- Imperial College London and The George Institute for Global Health, Imperial College Healthcare NHS Trust, London W12 0HS, UK.
| | - A Perry
- Lead Research Midwife and Manager, Women's Health Research Centre, Imperial College London, W12 0HS, UK
| | - J Banerjee
- Imperial College Healthcare NHS Trust, Institute of Reproductive and Developmental Biology, Imperial College London, W12 0HS, UK
| | - J Townson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - D Grozeva
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - R Milton
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - N Kirby
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - R Playle
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - T Bourne
- Imperial College London, Consultant Gyanecologist, Queen Charlotte's and Chelsea Hospital, London W12 0HS, UK
| | - C Lees
- Centre for Fetal Care, Imperial College Healthcare NHS Trust, Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK
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Gualtieri T, Ferrari M, Taboni S, Chan H, Townson J, Mattavelli D, Sahovaler A, Eu D, Dey K, Mathews S, Re F, Bernardi S, Borsani E, Viswanathan S, Nicolai P, Sartore L, Russo D, Gilbert R, Irish J. 3D-mapping of mesenchymal stem cells growth on bioengineered scaffolds for maxillofacial skeleton regeneration: a preclinical, in vitro study. Cytotherapy 2021. [DOI: 10.1016/s146532492100517x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, Playle R, Perry A, Bourne T, Lees CC. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol 2021; 57:573-581. [PMID: 33620113 PMCID: PMC8014713 DOI: 10.1002/uog.23619] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [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] [Received: 02/02/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal-Perinatal Medicine (SONPM) National Perinatal COVID-19 Registry. METHODS This was an analysis of data from the PAN-COVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP-SONPM National Perinatal COVID-19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. RESULTS We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP-SONPM). For obstetric outcomes, in PAN-COVID overall and in those with confirmed infection in PAN-COVID and AAP-SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (< 37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.1% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP-SONPM. Extreme preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP-SONPM. Neonatal SARS-CoV-2 infection was reported in 0.9% of all deliveries in PAN-COVID overall, in 2.0% in those with confirmed infection in PAN-COVID and in 1.8% in AAP-SONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a small-for-gestational-age (SGA) neonate were 8.2% in PAN-COVID overall, 9.7% in those with confirmed infection and 9.6% in AAP-SONPM. Mean gestational-age-adjusted birth-weight Z-scores were -0.03 in PAN-COVID and -0.18 in AAP-SONPM. CONCLUSIONS The findings from the UK and USA registries of pregnancies with SARS-CoV-2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a SGA infant or early neonatal death were comparable to those in historical and contemporaneous UK and USA data. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of pregnant women and women planning pregnancy. Copyright © 2021 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E. Mullins
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - M. L. Hudak
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - J. Banerjee
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - T. Getzlaff
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - J. Townson
- Centre for Trials ResearchCollege of Biomedical and Life Sciences, Cardiff UniversityCardiffUK
| | - K. Barnette
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - R. Playle
- Centre for Trials ResearchCollege of Biomedical and Life Sciences, Cardiff UniversityCardiffUK
| | - A. Perry
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - T. Bourne
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - C. C. Lees
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
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Deylami R, Townson J, Mann M, Gregory JW. Systematic review of publicity interventions to increase awareness amongst healthcare professionals and the public to promote earlier diagnosis of type 1 diabetes in children and young people. Pediatr Diabetes 2018; 19:566-573. [PMID: 28782293 DOI: 10.1111/pedi.12565] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Children with new onset type 1 diabetes (T1D) are at risk of developing the life-threatening condition ketoacidosis if they have a delayed diagnosis. The rate of children presenting in ketoacidosis remains high in a number of countries worldwide. To ensure interventions to raise awareness of symptoms are effective a systematic review was conducted to evaluate previous publicity campaigns. METHODS A range of databases was searched using search terms relating to T1D, publicity campaigns, and symptom awareness. Identified articles were checked against the inclusion criteria, ensuring interventions were designed to target individuals prior to diagnosis of T1D. Papers were independently assessed under the criteria specified within the Critical Appraisal Skills Programme checklist. RESULTS The initial search retrieved 1537 papers and following screening 20 were identified for full consideration. Thirteen did not meet the inclusion criteria, leaving 7 to be assessed. Of these 7, 2 observational case-control studies reported a reduction in the rate of ketoacidosis following a publicity campaign using posters and providing glucose testing equipment to primary healthcare professionals. Four observational cohort studies, utilized posters, and media campaigns; 2 reported a reduction in the rate of ketoacidosis and 2 reported no difference following their interventions. A feasibility study, not designed to evaluate effectiveness, reported some anecdotal evidence of a more timely diagnosis. CONCLUSION Due to the methodological limitations of the studies identified, it is not possible to make a definitive conclusion on the effectiveness of the interventions reported.
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Affiliation(s)
- R Deylami
- School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - J Townson
- Centre for Trial Research (CTR), Cardiff University, Cardiff, Wales, UK
| | - M Mann
- Specialist Unit for Review Evidence (SURE), Cardiff University, Cardiff, Wales, UK
| | - J W Gregory
- Division of Population Medicine, Cardiff University, Cardiff, Wales, UK
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Townson J, Gregory JW, Cowley L, Gallagher D, Channon S, Robling M, Williams D, Hughes C, Murphy S, Lowes L. Establishing the feasibility of a community and primary health care intervention to raise awareness of symptoms of Type 1 Diabetes-The Early Detection of Type 1 Diabetes in Youth (EDDY) study. Pediatr Diabetes 2017; 18:955-963. [PMID: 28261940 DOI: 10.1111/pedi.12516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/17/2017] [Accepted: 02/06/2017] [Indexed: 11/29/2022] Open
Abstract
AIMS To design, develop, and evaluate the feasibility of delivering a multi-component community based intervention to parents and primary health care professionals to raise awareness of the symptoms of Type 1 diabetes (T1D) in childhood in 3 adjoining borough counties of South Wales. MATERIALS AND METHODS Parent and primary health care advisory groups were established to design the intervention. Qualitative interviews with stakeholders and parents assessed the acceptability, feasibility and any potential impact of the intervention. RESULTS The parent component of the intervention developed was a re-useable shopping bag with the 4 main symptoms of T1D illustrated on the side, based on the road traffic system of red warning triangles and an octagon "stop" sign stating "Seek Medical Help". Accompanying the bag was an A5 leaflet giving further information. Both were overwrapped with clear plastic and delivered to 98% (323/329) schools, equating to 101 371 children. The primary health care professional component was a dual glucose/ketone meter, single use lancets, stickers, the A5 parent leaflet displayed as a poster and an educational visit from a Community Diabetes Liaison Nurse. 87% (73/84) of GP practices received the intervention, 100% received the materials. The intervention was delivered within Cardiff, the Vale of Glamorgan and Bridgend. Qualitative analyses suggest that the intervention raised awareness and had some impact. CONCLUSION This study showed that it is feasible and acceptable to design, develop and deliver a community based intervention to raise awareness of T1D. There is some suggestion of impact but a definitive evaluation of effectiveness is still required.
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Affiliation(s)
- J Townson
- Centre for Trial Research (CTR), Cardiff University, Cardiff, UK
| | - J W Gregory
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - L Cowley
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - D Gallagher
- Centre for Trial Research (CTR), Cardiff University, Cardiff, UK
| | - S Channon
- Centre for Trial Research (CTR), Cardiff University, Cardiff, UK
| | - M Robling
- Centre for Trial Research (CTR), Cardiff University, Cardiff, UK
| | | | - C Hughes
- Patient representative, Cardiff, UK
| | - S Murphy
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - L Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Collins P, Cannings-John R, Bruynseels D, Mallaiah S, Dick J, Elton C, Weeks A, Sanders J, Aawar N, Townson J, Hood K, Hall J, Harding K, Gauntlett R, Collis R. Viscoelastometry guided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study. Br J Anaesth 2017; 119:422-434. [DOI: 10.1093/bja/aex245] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 12/22/2022] Open
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Morgan-Trimmer S, Gregory J, Townson J, Channon S, Chestnutt I, Chadwick B, Murphy S, Hutchings S. OP86 Understanding intervention acceptability: changing participant views over time and the importance of context. Methods 2017. [DOI: 10.1136/jech-2017-ssmabstracts.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chestnutt IG, Playle R, Hutchings S, Morgan-Trimmer S, Fitzsimmons D, Aawar N, Angel L, Derrick S, Drew C, Hoddell C, Hood K, Humphreys I, Kirby N, Lau TMM, Lisles C, Morgan MZ, Murphy S, Nuttall J, Onishchenko K, Phillips C, Pickles T, Scoble C, Townson J, Withers B, Chadwick BL. Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness. J Dent Res 2017; 96:754-761. [PMID: 28394709 DOI: 10.1177/0022034517702094] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).
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Affiliation(s)
- I G Chestnutt
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - R Playle
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK.,2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Hutchings
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Morgan-Trimmer
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - D Fitzsimmons
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Aawar
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - L Angel
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Derrick
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - C Drew
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Hoddell
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - K Hood
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - I Humphreys
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Kirby
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - T M M Lau
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Lisles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - M Z Morgan
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - S Murphy
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - J Nuttall
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - K Onishchenko
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - C Phillips
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - T Pickles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Scoble
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - J Townson
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - B Withers
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - B L Chadwick
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
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Morgan-Trimmer S, Channon S, Gregory JW, Townson J, Lowes L. Family preferences for home or hospital care at diagnosis for children with diabetes in the DECIDE study. Diabet Med 2016; 33:119-24. [PMID: 26287652 PMCID: PMC5019260 DOI: 10.1111/dme.12891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 11/30/2022]
Abstract
AIMS A diagnosis of Type 1 diabetes in childhood can be a difficult life event for children and families. For children who are not severely ill, initial home rather than hospital-based care at diagnosis is an option although there is little research on which is preferable. Practice varies widely, with long hospital stays in some countries and predominantly home-based care in others. This article reports on the comparative acceptability and experience of children with Type 1 diabetes and their parents taking part in the DECIDE study evaluating outcomes of home or hospital-based treatment from diagnosis in the UK. METHODS Semi-structured interviews with 11 (pairs of) parents and seven children were conducted between 15 and 20 months post diagnosis. Interviewees were asked about adaptation to, management and impact of the diabetes diagnosis, and their experience of initial post-diagnosis treatment. RESULTS There were no differences between trial arms in adaptation to, management of or impact of diabetes. Most interviewees wanted to be randomized to the 'home' arm initially but expressed a retrospective preference for whichever trial arm they had been in, and cited benefits relating to learning about diabetes management. CONCLUSIONS The setting for early treatment did not appear to have a differential impact on families in the long term. However, the data presented here describe different experiences of early treatment settings from the perspective of children and their families, and factors that influenced how families felt initially about treatment setting. Further research could investigate the short-term benefits of both settings.
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MESH Headings
- Adaptation, Psychological
- Adolescent
- Child
- Child, Preschool
- Combined Modality Therapy/adverse effects
- Cost of Illness
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Female
- Glycated Hemoglobin/analysis
- Health Knowledge, Attitudes, Practice
- Home Care Services
- Hospitalization
- Humans
- Hyperglycemia/prevention & control
- Infant
- Male
- Parents/education
- Patient Compliance
- Patient Education as Topic
- Patient Preference
- Stress, Psychological/complications
- Stress, Psychological/prevention & control
- United Kingdom
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Affiliation(s)
- S Morgan-Trimmer
- Psychology Applied to Health (PAtH) Group, University of Exeter Medical School, Exeter, UK
| | - S Channon
- Institute of Primary Care & Public Health, Cardiff University, Cardiff, UK
| | - J W Gregory
- Institute of Molecular & Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - J Townson
- South East Wales Trials Unit (SEWTU), Cardiff University, Cardiff, UK
| | - L Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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MacMahon P, Stenfert Kroese B, Jahoda A, Stimpson A, Rose N, Rose J, Townson J, Hood K, Willner P. 'It's made all of us bond since that course…' - a qualitative study of service users' experiences of a CBT anger management group intervention. J Intellect Disabil Res 2015; 59:342-352. [PMID: 25092530 DOI: 10.1111/jir.12144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Accepted: 06/04/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) are rarely asked about their experiences as users of psychological services and little is known about the views of clients with ID who have undergone cognitive behavioural therapy (CBT). This study aimed to gather the views of adults with ID who had recently taken part in a cluster randomised control trial (RCT) of a staff-delivered manualised CBT anger management group intervention. METHOD A qualitative method, Interpretative Phenomenological Analysis (IPA), was employed and eleven participants were interviewed. The interviews took place after the intervention, within two weeks of the end of the group, to gain an understanding of service users' experiences of participating in a CBT group. RESULTS IPA of the interview transcripts indicated that the intervention was experienced as effective and enjoyable and a number of themes were identified including: 'the importance of relationships', 'a new me', 'new and improved relationships', 'presenting myself in a positive light' and 'what the group didn't change'. CONCLUSIONS The results will be discussed in the context of applying group CBT for adults with ID and implications for service development.
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Affiliation(s)
- P MacMahon
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Felce D, Cohen D, Willner P, Rose J, Kroese B, Rose N, Shead J, Jahoda A, MacMahon P, Lammie C, Stimpson A, Woodgate C, Gillespie D, Townson J, Nuttall J, Hood K. Cognitive behavioural anger management intervention for people with intellectual disabilities: costs of intervention and impact on health and social care resource use. J Intellect Disabil Res 2015; 59:68-81. [PMID: 24404992 DOI: 10.1111/jir.12112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Accepted: 11/25/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Anger and aggression among adults with intellectual disability (ID) are associated with a range of adverse consequences for their well-being and that of their family or staff carers. The aims were to evaluate the effectiveness of an anger management intervention for adults with mild to moderate ID and to evaluate the costs of the intervention and its impact on health and social care resource use. This paper is concerned with the latter aim. METHODS A cluster-randomised controlled trial was conducted involving day services for adults with ID in Scotland, England and Wales. Incremental costs of delivering the intervention and its impact on subsequent total health and social care package costs were calculated. Full data comparing costs between baseline and follow-up 10 months later were collected for 67 participants in the intervention arm and 62 participants in the control arm. Cost differences between the groups at follow-up, adjusted for baseline levels, were calculated using non-parametric bootstrapping controlling for clustering. RESULTS The mean hourly excess cost of intervention over treatment as usual was £12.34. A mean adjusted cost difference of £22.46 per person per week in favour of the intervention group was found but this was not statistically significant. CONCLUSIONS The baseline-adjusted cost difference at follow-up would result in a fairly immediate compensation for the excess costs of intervention, provided the difference is not a statistical artefact. Further research is needed to clarify the extent to which it might represent a real saving in service support costs.
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Affiliation(s)
- D Felce
- Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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Quinn L, Debono K, Dawes H, Rosser A, Nemeth A, Quarrell O, Rickards H, Tabrizi S, Trender-Gerhard I, Kelson M, Townson J, Busse M. J05 Task-specific Training In Huntington's Disease: A Randomised, Controlled Feasibility Trial. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.188] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mansel RE, MacNeill F, Horgan K, Goyal A, Britten A, Townson J, Clarke D, Newcombe RG, Keshtgar M, Kissin M, Layer G, Hilson A, Ell P, Wishart G, Brown D, West N. Results of a national training programme in sentinel lymph node biopsy for breast cancer. Br J Surg 2013; 100:654-61. [PMID: 23389843 DOI: 10.1002/bjs.9058] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND New Start, a structured, validated, multidisciplinary training programme in sentinel lymph node biopsy (SLNB), was established to allow the introduction and rapid transfer of appropriate knowledge and technical skills to ensure safe and competent practice across the UK. METHODS Multidisciplinary teams attended a theory/skills laboratory course, following which they performed 30 consecutive SLNBs, either concurrently with their standard axillary staging procedure (training model A) or as stand-alone SLNB (training model B). SLNB was performed according to a standard protocol using the combined technique of isotope ((99m) Tc-labelled albumin colloid) and blue dye. An accredited New Start trainer mentored the first five procedures in the participant's hospital, or all 30 if stand-alone. Validation standards for model A and B were a localization rate of at least 90 per cent. In addition, for model A only, in which a minimum of ten patients were required to be node-positive, a false-negative rate (FNR) of 10 per cent or less was required. RESULTS From October 2004 to December 2008, 210 SLNB-naive surgeons, in 103 centres, performed 6685 SLNB procedures. The overall sentinel lymph node (SLN) localization rate was 98·9 (95 per cent confidence interval 98·6 to 99·1) per cent (6610 of 6685) and the FNR 9·1 (7·9 to 10·5) per cent (160 of 1757). The FNR was related to nodal yield, ranging from 14·8 per cent for one node and declining to 9·7, 6·6, 4·7 and 4·1 per cent for two, three, four and more than four SLNs respectively. No learning curve was identified for localization or FNR. CONCLUSION The programme successfully trained a wide range of UK breast teams to perform safe SLNB and suggested that a standard injection protocol and structured multidisciplinary training can abolish learning curves.
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Affiliation(s)
- R E Mansel
- Department of Surgery, Cardiff University, Cardiff, UK.
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Mansel R, Goyal A, MacNeill F, Newcombe R, Layer G, Kissin M, Horgan K, Britten A, Hilson A, Clarke D, Townson J, Ell P, Wishart G, Brown D, West N, Keshtgar M. Abstract P1-01-01: Learning Sentinel Node Biopsy in the UK: Results of the NEW START Training Program. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: NEW START-a structured, validated multi-professional surgical training programme, was established to allow rapid transfer of appropriate knowledge and technical skills to ensure safe and competent practice of sentinel lymph node biopsy (SLNB) across the UK.
Methods: Multi-professional teams attended a theory/skills-lab course delivering a standardized educational package, following which they performed SLNB in 30 consecutive patients, either concurrently with their standard axillary staging procedure — mentorship training model-or as stand-alone SLNB — apprenticeship training model. An accredited NEW START trainer mentored the first 5 procedures in the participants’ hospital, or all 30 if stand-alone. Validation standards were a localization rate of ≥90% and in the mentorship program where a minimum of 10 cases were node positive, a false-negative rate of ≥10%. SLNB was performed according to a standardised protocol using the combined technique of isotope (0.05-0.1ml of 99mTc-albumin colloid — Nanocoll®) and blue dye (Patent blue V) injected into the tumour quadrant peri-areolar tissue. Isotope was injected intra-dermally and static scintigraphic images were obtained, blue dye was injected sub-dermally after anaesthetic induction.
Results: From October 2004 to December 2008, 210 SLNB naive surgeons, in 103 centres, performed 6,685 SLNB procedures of which 31% (2,098/6,685) were node positive. The mentorship training model was followed in 87% (5,849/6,685). Scintigraphy identified axillary lymph node drainage in 85% (5,564/6,511) with an overall SLN localization rate of 98.9% (6,610/6,685, 95% CI 98.6% to 99.1%). Node positivity was higher (P<0.001) for failed (58.7%, 44/75) than successful (31.1%, 2054/6610) localizations. The mentorship false negative rate (FNR) was 8.9% (163/1821, 95% CI 7.7% to 10.4%). The median SLN yield was 2.0 (range 1-11).
SLN localization and FNR improved with surgeon caseload so that after 20 procedures the FNR fell below 10% but no statistically significant learning curve was identified. The FNR patients who had one SLN harvested was 14.8%. The FNR rate declined to 9.4%, 6.3%, 4.5% and 4.0% for those patients with 2, 3, 4 and more than 4 SLNs removed.
Conclusion: NEW START demonstrates that a standardized injection protocol and structured multi-professional training can abolish learning curves so ensuring patient safety during national adoption of a new technique. Tumor quadrant injection using both isotope and dye has a high localization rate and low false-negative rate. Failed localization indicates higher probability of axillary nodal involvement. It is not necessary to remove more than 4 SLNs to achieve a FNR of less than 5%.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-01.
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Affiliation(s)
- R Mansel
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - A Goyal
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - F MacNeill
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - R Newcombe
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - G Layer
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - M Kissin
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - K Horgan
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - A Britten
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - A Hilson
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - D Clarke
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - J Townson
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - P Ell
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - G Wishart
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - D Brown
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - N West
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - M. Keshtgar
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
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Morais SA, Morris J, Heslop T, Newcombe RG, Townson J, Mansel R, Bundred NJ, Trialists OBOTALMANAC. Early arm swelling predicts development of lymphoedema after axillary clearance. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-4137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #4137
Lymphoedema (≥10% increase in arm swelling) occurs in 30% of patients after axillary clearance but the factors predicting the development of early lymphoedema (within 18 months of surgery) are unknown. To determine factors predicting lymphoedema at 18 months we analysed the ALMANAC trial database.
 Methods: All patients had baseline and prospective tape arm measurements, prior to undergoing axillary dissection and statistical analysis of 13 management variables affecting lymphoedema was performed.
 Results: Out of 407, 91 (25%) underwent axillary sampling and the remainder had clearance surgery. Mean increase in arm volume was 4.02% and 5.14% at 3 and 6 months respectively. By 18 months, 148 (36%) women out of 407 had developed lymphoedema.
 Arm volume increases of 5% or greater at 3 or 6 months predicted development of lymphoedema by 18 months (p≤0.01) and identified 56% of patients with lymphoedema at 18 months. Increase in age (p=0.039), extent of axillary surgery (p=0.045) and breast radiotherapy (p=0.022) were also significant predictors of lymphoedema at 18 months. In multivariate analysis only early arm swelling remained predictive of lymphoedema.
 
 Conclusions: Early arm swelling after axillary clearance predicts early lymphoedema. Baseline arm measurement of patients undergoing axillary clearance should be routine preoperative care to identify women who need early intervention with arm compression sleeves.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4137.
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Affiliation(s)
- SA Morais
- 1 University of Manchester, Manchester, United Kingdom
| | - J Morris
- 1 University of Manchester, Manchester, United Kingdom
| | - T Heslop
- 1 University of Manchester, Manchester, United Kingdom
| | - RG Newcombe
- 2 Cardiff University, Cardiff, United Kingdom
| | - J Townson
- 2 Cardiff University, Cardiff, United Kingdom
| | - R Mansel
- 2 Cardiff University, Cardiff, United Kingdom
| | - NJ Bundred
- 1 University of Manchester, Manchester, United Kingdom
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Cotton PB, Denyer M, Stern R, Townson J, Corns C, Tough S, Miller A. Proceedings: Pure pancreatic juice response to low dose secretin in man. Br J Surg 1976; 63:155. [PMID: 1252739] [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: 12/26/2022]
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