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Cheema S, Stubberud A, Rantell K, Nachev P, Tronvik E, Matharu M. Phenotype of new daily persistent headache: subtypes and comparison to transformed chronic daily headache. J Headache Pain 2023; 24:109. [PMID: 37587430 PMCID: PMC10428606 DOI: 10.1186/s10194-023-01639-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND It is unknown whether new daily persistent headache (NDPH) is a single disorder or heterogenous group of disorders, and whether it is a unique disorder from chronic migraine and chronic tension-type headache. We describe a large group of patients with primary NDPH, compare its phenotype to transformed chronic daily headache (T-CDH), and use cluster analysis to reveal potential sub-phenotypes in the NDPH group. METHODS We performed a case-control study using prospectively collected clinical data in patients with primary NDPH and T-CDH (encompassing chronic migraine and chronic tension-type headache). We used logistic regression with propensity score matching to compare demographics, phenotype, comorbidities, and treatment responses between NDPH and T-CDH. We used K-means cluster analysis with Gower distance to identify sub-clusters in the NDPH group based on a combination of demographics, phenotype, and comorbidities. RESULTS We identified 366 patients with NDPH and 696 with T-CDH who met inclusion criteria. Patients with NDPH were less likely to be female (62.6% vs. 73.3%, p < 0.001). Nausea, vomiting, photophobia, phonophobia, motion sensitivity, vertigo, and cranial autonomic symptoms were all significantly less frequent in NDPH than T-CDH (p value for all < 0.001). Acute treatments appeared less effective in NDPH than T-CDH, and medication overuse was less common (16% vs. 42%, p < 0.001). Response to most classes of oral preventive treatments was poor in both groups. The most effective treatment in NDPH was doselupin in 45.7% patients (95% CI 34.8-56.5%). Cluster analysis identified three subgroups of NDPH. Cluster 1 was older, had a high proportion of male patients, and less severe headaches. Cluster 2 was predominantly female, had severe headaches, and few associated symptoms. Cluster 3 was predominantly female with a high prevalence of migrainous symptoms and headache triggers. CONCLUSIONS Whilst there is overlap in the phenotype of NDPH and T-CDH, the differences in migrainous, cranial autonomic symptoms, and vulnerability to medication overuse suggest that they are not the same disorder. NDPH may be fractionated into three sub-phenotypes, which require further investigation.
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Affiliation(s)
- Sanjay Cheema
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Anker Stubberud
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- High Dimensional Neurology Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- NorHEAD Norwegian Centre for Headache Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Khadija Rantell
- Education Unit, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Parashkev Nachev
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- High Dimensional Neurology Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- NorHEAD Norwegian Centre for Headache Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- NorHEAD Norwegian Centre for Headache Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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Espinasse A, Solovyeva O, Dimairo M, Weir C, Jaki T, Mander A, Kightley A, Evans J, Lee S, Bedding A, Hopewell S, Rantell K, Liu R, Chan AW, De Bono J, Yap C. SPIRIT and CONSORT extensions for early phase dose-finding clinical trials: the DEFINE (DosE-FIndiNg Extensions) study protocol. BMJ Open 2023; 13:e068173. [PMID: 36990492 PMCID: PMC10069529 DOI: 10.1136/bmjopen-2022-068173] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Early phase dose-finding (EPDF) studies are critical for the development of new treatments, directly influencing whether compounds or interventions can be investigated in further trials to confirm their safety and efficacy. There exists guidance for clinical trial protocols and reporting of completed trials in the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 and CONsolidated Standards Of Reporting Randomised Trials (CONSORT) 2010 statements. However, neither the original statements nor their extensions adequately cover the specific features of EPDF trials. The DEFINE (DosE-FIndiNg Extensions) study aims to enhance transparency, completeness, reproducibility and interpretation of EPDF trial protocols (SPIRIT-DEFINE) and their reports once completed (CONSORT-DEFINE), across all disease areas, building on the original SPIRIT 2013 and CONSORT 2010 statements. METHODS AND ANALYSIS A methodological review of published EPDF trials will be conducted to identify features and deficiencies in reporting and inform the initial generation of the candidate items. The early draft checklists will be enriched through a review of published and grey literature, real-world examples analysis, citation and reference searches and consultation with international experts, including regulators and journal editors. Development of CONSORT-DEFINE commenced in March 2021, followed by SPIRIT-DEFINE from January 2022. A modified Delphi process, involving worldwide, multidisciplinary and cross-sector key stakeholders, will be run to refine the checklists. An international consensus meeting in autumn 2022 will finalise the list of items to be included in both guidance extensions. ETHICS AND DISSEMINATION This project was approved by ICR's Committee for Clinical Research. The Health Research Authority confirmed Research Ethics Approval is not required. The dissemination strategy aims to maximise guideline awareness and uptake, including but not limited to dissemination in stakeholder meetings, conferences, peer-reviewed publications and on the EQUATOR Network and DEFINE study websites. REGISTRATION DETAILS SPIRIT-DEFINE and CONSORT-DEFINE are registered with the EQUATOR Network.
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Affiliation(s)
- Aude Espinasse
- Clinical Trial and Statistical Unit, Institute of Cancer Research Sutton, London, UK
| | - Olga Solovyeva
- Clinical Trial and Statistical Unit, Institute of Cancer Research Sutton, London, UK
| | - Munyaradzi Dimairo
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, University of Edinburgh, Usher Institute, Edinburgh, UK
| | - Thomas Jaki
- Computational Statistics Group, Department of Informatics and Data Science, University of Regensburg, Regensburg, Germany
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Adrian Mander
- Cardiff University Centre for Trials Research, Cardiff, UK
| | | | - Jeffry Evans
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Shing Lee
- Columbia University, New York, New York, USA
| | - Alun Bedding
- Data and Statistical Sciences Department, Roche Products Ltd, Welwyn Garden City, UK
| | - Sally Hopewell
- Centre for Statistics in Medicine, Oxford Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Khadija Rantell
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Rong Liu
- Biostatistics Department, Bristol-Myers Squibb Co, New York, New York, USA
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Johann De Bono
- Institute of Cancer Research, London, UK
- Royal Marsden Hospital, London, UK
| | - Christina Yap
- Clinical Trial and Statistical Unit, Institute of Cancer Research Sutton, London, UK
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Solovyeva O, Dimairo M, Weir C, de Bono J, Bedding A, Chan AW, Espinasse A, Evans T, Hee S, Hopewell S, Hughes S, Jaki T, Kightley A, Lee S, Mander A, Patel D, Rantell K, Rekowski J, Ursino M, Yap C. 79MO Developing international consensus-driven SPIRIT and CONSORT extensions for early phase dose-finding clinical trials: The DEFINE (DosE FIndiNg Extensions) study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100937] [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: 04/05/2023] Open
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Sridhara R, Marchenko O, Jiang Q, Barksdale E, Chen J, Dreyer N, Fashoyin-Aje L, Garrett-Mayer E, Gormley N, Gwise T, Hess L, Mandrekar S, Pignatti F, Rantell K, Raven A, Shen YL, Singh H, Tendler CL, Theoret M, Pazdur R. Evaluation of Treatment Effect in Underrepresented Population in Cancer Trials: Discussion with International Regulators. Stat Biopharm Res 2022. [DOI: 10.1080/19466315.2022.2128404] [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: 10/14/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Nicole Gormley
- Oncology Center of Excellence, US FDA, Silver Spring, MD
| | - Thomas Gwise
- Office of Biostatistics, CDER US FDA, Silver Spring, MD
| | | | | | | | | | | | - Yuan-Li Shen
- Office of Biostatistics, CDER US FDA, Silver Spring, MD
| | - Harpreet Singh
- Oncology Center of Excellence, US FDA, Silver Spring, MD
| | | | - Marc Theoret
- Oncology Center of Excellence, US FDA, Silver Spring, MD
| | - Richard Pazdur
- Oncology Center of Excellence, US FDA, Silver Spring, MD
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Cheema S, Stubberud A, Rantell K, Nachev P, Tronvik E, Matharu M. 008 Is primary new daily persistent headache de novo chronic migraine and chronic tension-type headache? J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveTo compare the clinical characteristics and treatment responses of primary new daily persis- tent headache (NDPH) to transformed chronic daily headache (T-CDH, encompassing chronic migraine and chronic tension-type headache).MethodsAnalysis of prospectively collected clinical data in consecutive patients seen in a headache clinic between 2007 and 2019.ResultsInclusion criteria were met by 366 patients with NDPH and 696 with T-CDH. There was a lower female preponderance in NDPH than T-CDH (62.6% vs. 73.3%, p <0.001).Nausea, vomiting, photophobia, phonophobia, motion sensitivity, vertigo, and cranial autonomic symptoms were all less common in NDPH than T-CDH (all p<0.001). Most T-CDH patients (85%) met ICHD-3 criteria for chronic migraine, whereas fewer NDPH patients did (64%).Acute treatments were less effective in NDPH, and medication overuse was less common (16% vs. 42%, p<0.001). Response to most classes of oral preventive treatments was poor. The most effective treatment in NDPH was doselupin in 45.7% patients (95% CI 34.8-56.5%). OnabotulinumtoxinA was less likely to be effective in NDPH than T-CDH (34% vs. 49%, p=0.003).ConclusionsWhilst there is overlap in the phenotype and response to treatment of NDPH and T-CDH; NDPH appears to be less symptomatically diverse, and less responsive to treatment.
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Lynggaard H, Bell J, Lösch C, Besseghir A, Rantell K, Schoder V, Lanius V. Principles and recommendations for incorporating estimands into clinical study protocol templates. Trials 2022; 23:685. [PMID: 35986349 PMCID: PMC9389514 DOI: 10.1186/s13063-022-06515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
Clinical study protocols are the foundation of good clinical studies. Prospective and multidisciplinary collaboration that pays attention to the design of all components of the study protocol can ensure that a clinical study will answer the research questions posed in a reliable manner that is meaningful for decision-makers and patients. The ICH E9(R1) addendum on estimands and sensitivity analysis in clinical trials provides a framework for clinical study planning to ensure alignment between study objectives, design, conduct, and analysis. The estimand or clinical question posed can be regarded as the backbone of the study and the clinical study protocol should reflect estimands accordingly. In practice, stakeholders are still learning how to embrace the estimand framework and how it impacts studies and study documents. In this paper, we anticipate that a protocol structure centred around estimands, or objectives rather than endpoints alone will prevail for all types of studies. To assist sponsors during this paradigm shift, this paper provides discussion and guidance for implementing the estimand framework in protocol templates.
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Sridhara R, Barksdale E, Marchenko O, Jiang Q, Ando Y, Bloomquist E, Coory M, Crouse M, Degtyarev E, Framke T, Freidlin B, Gerber DE, Gwise T, Josephson F, Hess L, Kluetz P, Li D, Mandrekar S, Posch M, Rantell K, Ratitch B, Raven A, Roes K, Rufibach K, Sarac SB, Simon R, Singh H, Theoret M, Thomson A, Zuber E, Shen YL, Pazdur R. Cancer Clinical Trials Beyond Pandemic: Report of an American Statistical Association Biopharmaceutical Section Open Forum Discussion. Stat Biopharm Res 2022. [DOI: 10.1080/19466315.2022.2103181] [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: 10/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center at UT Southwestern
| | | | | | | | | | | | | | - Martin Posch
- Institute for Medical Statistics at the Medical University of Vienna
| | | | | | | | - Kit Roes
- Radboud University Medical Center
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Lambru G, Lagrata S, Levy A, Cheema S, Davagnanam I, Rantell K, Kitchen N, Zrinzo L, Matharu M. Trigeminal microvascular decompression for short-lasting unilateral neuralgiform headache attacks. Brain 2022; 145:2882-2893. [PMID: 35325067 PMCID: PMC9420014 DOI: 10.1093/brain/awac109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
A significant proportion of patients with short-lasting unilateral neuralgiform headache attacks (SUNHA) are refractory to medical treatments. Neuroimaging studies have suggested a role for ipsilateral trigeminal neurovascular conflict with morphological changes in the pathophysiology of this disorder. We present the outcome of an uncontrolled open-label prospective single centre study conducted between 2012 and 2020, to evaluate the efficacy and safety of trigeminal microvascular decompression in refractory chronic SUNHA with magnetic resonance imaging evidence of trigeminal neurovascular conflict ipsilateral to the pain side. Primary endpoint was the proportion of patients who achieved an "excellent response", defined as 90-100% weekly reduction in attack frequency, or "good response", defined as a reduction in weekly headache attack frequency between 75% and 89% at final follow-up, compared to baseline. These patients were defined as responders. The study group consisted of 47 patients of whom 31 had SUNCT and 16 had SUNA (25 females, mean age ± SD 55.2 years ± 14.8). Participants failed to respond or tolerate a mean of 8.1 (±2.7) preventive treatments pre-surgery. Magnetic resonance imaging of the trigeminal nerves (n = 47 patients, n = 50 symptomatic trigeminal nerves) demonstrated ipsilateral neurovascular conflict with morphological changes in 39/50 (78.0%) symptomatic nerves and without morphological changes in 11/50 (22.0%) symptomatic nerves. Post-operatively, 37/47 (78.7%) patients obtained either an excellent or a good response. Ten patients (21.3%, SUNCT = 7 and SUNA = 3) reported no post-operative improvement. The mean post-surgery follow-up was 57.4 ± 24.3 months (range 11-96 months). At final follow-up, 31 patients (66.0%) were excellent/good responders. Six patients experienced a recurrence of headache symptoms. There was no statistically significant difference between SUNCT and SUNA in the response to surgery (p = 0.463). Responders at the last follow-up were however more likely not to have interictal pain (77.42% vs 22.58%, p = 0.021) and to show morphological changes on the magnetic resonance imaging (78.38% vs 21.62%, p = 0.001). The latter outcome was confirmed in the Kaplan Meyer analysis, where patients with no morphological changes were more likely to relapse overtime compared to those with morphological changes (p = 0.0001). All but one patient who obtained an excellent response without relapse, discontinued their preventive medications. Twenty-two post-surgery adverse events occurred in 18 patients (46.8%) but no mortality or severe neurological deficit was seen. Trigeminal microvascular decompression may be a safe and effective long-term treatment for short-lasting unilateral neuralgiform headache attacks patients with magnetic resonance evidence of neurovascular conflict with morphological changes.
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Affiliation(s)
- Giorgio Lambru
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Levy
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Khadija Rantell
- Biostatistician, Education Unit, UCL Queen Square Institute of Neurology, London UK
| | - Neil Kitchen
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Functional Neurosurgery Unit, Department of Clinical & Motor Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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Homer V, Yap C, Bond S, Holmes J, Stocken D, Walker K, Robinson EJ, Wheeler G, Brown S, Hinsley S, Schipper M, Weir CJ, Rantell K, Prior T, Yu LM, Kirkpatrick J, Bedding A, Gamble C, Gaunt P. Early phase clinical trials extension to guidelines for the content of statistical analysis plans. BMJ 2022; 376:e068177. [PMID: 35131744 PMCID: PMC8819597 DOI: 10.1136/bmj-2021-068177] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Victoria Homer
- Cancer Research Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Christina Yap
- Clinical Trials and Statistics Unit, Institute for Cancer Research, London, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge, UK
| | - Jane Holmes
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Deborah Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Katrina Walker
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Emily J Robinson
- Royal Marsden Clinical Trials Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Graham Wheeler
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samantha Hinsley
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Matthew Schipper
- Departments of Radiation Oncology and Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Khadija Rantell
- Medicines and Healthcare products Regulatory Agency, London, UK
| | - Thomas Prior
- Early Development Oncology Statistics Department, Janssen Research and Development, Spring House, PA, USA
| | - Ly-Mee Yu
- Primary Care Clinical Trials Unit, University of Oxford, Oxford, UK
| | | | | | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Piers Gaunt
- Cancer Research Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Sridhara R, Marchenko O, Jiang Q, Pazdur R, Posch M, Berry S, Theoret M, Shen YL, Gwise T, Hess L, Raven A, Rantell K, Roes K, Simon R, Redman M, Ji Y, Lu C. Use of Nonconcurrent Common Control in Master Protocols in Oncology Trials: Report of an American Statistical Association Biopharmaceutical Section Open Forum Discussion. Stat Biopharm Res 2021. [DOI: 10.1080/19466315.2021.1938204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | - Martin Posch
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Marc Theoret
- Oncology Center of Excellence US FDA, Silver Spring, MD
| | - Yuan Li Shen
- Oncology Center of Excellence US FDA, Silver Spring, MD
| | - Thomas Gwise
- Oncology Center of Excellence US FDA, Silver Spring, MD
| | | | | | | | - Kit Roes
- Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Yuan Ji
- University of Chicago, Chicago, IL
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Lambru G, Stubberud A, Rantell K, Lagrata S, Tronvik E, Matharu MS. Medical treatment of SUNCT and SUNA: a prospective open-label study including single-arm meta-analysis. J Neurol Neurosurg Psychiatry 2021; 92:233-241. [PMID: 33361408 PMCID: PMC7892380 DOI: 10.1136/jnnp-2020-323999] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The management of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) remains challenging in view of the paucity of data and evidence-based treatment recommendations are missing. METHODS In this single-centre, non-randomised, prospective open-label study, we evaluated and compared the efficacy of oral and parenteral treatments for SUNCT and SUNA in a real-world setting. Additionally, single-arm meta-analyses of the available reports of SUNCT and SUNA treatments were conducted. RESULTS The study cohort comprised 161 patients. Most patients responded to lamotrigine (56%), followed by oxcarbazepine (46%), duloxetine (30%), carbamazepine (26%), topiramate (25%), pregabalin and gabapentin (10%). Mexiletine and lacosamide were effective in a meaningful proportion of patients but poorly tolerated. Intravenous lidocaine given for 7-10 days led to improvement in 90% of patients, whereas only 27% of patients responded to a greater occipital nerve block. No statistically significant differences in responders were observed between SUNCT and SUNA. In the meta-analysis of the pooled data, topiramate was found to be significantly more effective in SUNCT than SUNA patients. However, a higher proportion of SUNA than SUNCT was considered refractory to medications at the time of the topiramate trial, possibly explaining this isolated difference. CONCLUSIONS We propose a treatment algorithm for SUNCT and SUNA for clinical practice. The response to sodium channel blockers indicates a therapeutic overlap with trigeminal neuralgia, suggesting that sodium channels dysfunction may be a key pathophysiological hallmark in these disorders. Furthermore, the therapeutic similarities between SUNCT and SUNA further support the hypothesis that these conditions are variants of the same disorder.
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Affiliation(s)
- Giorgio Lambru
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
| | - Anker Stubberud
- Department of Neuromedicine and Movement Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Khadija Rantell
- Education Unit, UCL Queen Square Institute of Neurology, London, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK.,Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Manjit Singh Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK .,Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, London, UK
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Lambru G, Rantell K, O'Connor E, Levy A, Davagnanam I, Zrinzo L, Matharu M. Trigeminal neurovascular contact in SUNCT and SUNA: a cross-sectional magnetic resonance study. Brain 2021; 143:3619-3628. [PMID: 33301567 PMCID: PMC7807031 DOI: 10.1093/brain/awaa331] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/16/2020] [Revised: 06/21/2020] [Accepted: 08/06/2020] [Indexed: 01/03/2023] Open
Abstract
Emerging data-points towards a possible aetiological and therapeutic relevance of trigeminal neurovascular contact in short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and perhaps in short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We aimed to assess the prevalence and significance of trigeminal neurovascular contact in a large cohort of consecutive SUNCT and SUNA patients and evaluate the radiological differences between them. The standard imaging protocol included high spatial and nerve-cistern contrast resolution imaging acquisitions of the cisternal segments of the trigeminal nerves and vessels. MRI studies were evaluated blindly by two expert evaluators and graded according to the presence, location and degree of neurovascular contact. The degree of contact was graded as with or without morphological changes. Neurovascular contact with morphological changes was defined as contact with distortion and/or atrophy. A total of 159 patients (SUNCT = 80; SUNA = 79) were included. A total of 165 symptomatic and 153 asymptomatic trigeminal nerves were analysed. The proportion of neurovascular contact on the symptomatic trigeminal nerves was higher (80.0%) compared to the asymptomatic trigeminal nerves (56.9%). The odds on having neurovascular contact over the symptomatic nerves was significantly higher than on the asymptomatic nerves [odds ratio (OR): 3.03, 95% confidence interval (CI) 1.84–4.99; P < 0.0001]. Neurovascular contact with morphological changes were considerably more prevalent on the symptomatic side (61.4%), compared to the asymptomatic side (31.0%) (OR 4.16, 95% CI 2.46–7.05; P < 0.0001). On symptomatic nerves, neurovascular contact with morphological changes was caused by an artery in 95.0% (n = 77/81). Moreover, the site of contact and the point of contact around the trigeminal root were respectively proximal in 82.7% (67/81) and superior in 59.3% (48/81). No significant radiological differences emerged between SUNCT and SUNA. The multivariate analysis of radiological predictors associated with the symptomatic side, indicated that the presence of neurovascular contact with morphological changes was strongly associated with the side of the pain (OR: 2.80, 95% CI 1.44–5.44; P = 0.002) even when adjusted for diagnoses. Our findings suggest that neurovascular contact with morphological changes is involved in the aetiology of SUNCT and SUNA. Along with a similar clinical phenotype, SUNCT and SUNA also display a similar structural neuroimaging profile, providing further support for the concept that the separation between them should be abandoned. Furthermore, these findings suggest that vascular compression of the trigeminal sensory root, may be a common aetiological factor between SUNCT, SUNA and trigeminal neuralgia thereby further expanding the overlap between these disorders.
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Affiliation(s)
- Giorgio Lambru
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Khadija Rantell
- Biostatistician, Education Unit, UCL Queen Square Institute of Neurology, London UK
| | - Emer O'Connor
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Levy
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Functional Neurosurgery Unit, Department of Clinical and Motor Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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Collignon O, Gartner C, Haidich A, James Hemmings R, Hofner B, Pétavy F, Posch M, Rantell K, Roes K, Schiel A. Current Statistical Considerations and Regulatory Perspectives on the Planning of Confirmatory Basket, Umbrella, and Platform Trials. Clin Pharmacol Ther 2020; 107:1059-1067. [DOI: 10.1002/cpt.1804] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/31/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Olivier Collignon
- Competence Centre in Methodology and Statistics Luxembourg Institute of Health Strassen Luxembourg
| | - Christian Gartner
- AGES – Österreichische Agentur für Gesundheit und Ernährungssicherheit/Austrian Agency for Health and Food Safety Vienna Austria
| | - Anna‐Bettina Haidich
- Department of Hygiene Social‐Preventive Medicine & Medical Statistics Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | - Robert James Hemmings
- Consilium Hemmings Unit 96, The Maltings Business Center The Maltings Stanstead Abbotts UK
| | - Benjamin Hofner
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Frank Pétavy
- European Medicines Agency Amsterdam The Netherlands
| | - Martin Posch
- Section for Medical Statistics Center for Medical Statistics, Informatics, and Intelligent Systems Medical University of Vienna Vienna Austria
| | - Khadija Rantell
- Medicines and Healthcare Products Regulatory Agency London UK
| | - Kit Roes
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht The Netherlands
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Ali S, Kjeken R, Niederlaender C, Markey G, Saunders TS, Opsata M, Moltu K, Bremnes B, Grønevik E, Muusse M, Håkonsen GD, Skibeli V, Kalland ME, Wang I, Buajordet I, Urbaniak A, Johnston J, Rantell K, Kerwash E, Schuessler-Lenz M, Salmonson T, Bergh J, Gisselbrecht C, Tzogani K, Papadouli I, Pignatti F. The European Medicines Agency Review of Kymriah (Tisagenlecleucel) for the Treatment of Acute Lymphoblastic Leukemia and Diffuse Large B-Cell Lymphoma. Oncologist 2019; 25:e321-e327. [PMID: 32043764 DOI: 10.1634/theoncologist.2019-0233] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/31/2019] [Indexed: 12/17/2022] Open
Abstract
Chimeric antigen receptor (CAR)-engineered T-cell therapy is becoming one of the most promising approaches in the treatment of cancer. On June 28, 2018, the Committee for Advanced Therapies (CAT) and the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Kymriah for pediatric and young adult patients up to 25 years of age with B-cell acute lymphoblastic leukemia (ALL) that is refractory, in relapse after transplant, or in second or later relapse and for adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) after two or more lines of systemic therapy. Kymriah became one of the first European Union-approved CAR T therapies. The active substance of Kymriah is tisagenlecleucel, an autologous, immunocellular cancer therapy that involves reprogramming the patient's own T cells to identify and eliminate CD19-expressing cells. This is achieved by addition of a transgene encoding a CAR. The benefit of Kymriah was its ability to achieve remission with a significant duration in patients with ALL and an objective response with a significant duration in patients with DLBCL. The most common hematological toxicity was cytopenia in both patients with ALL and those with DLBCL. Nonhematological side effects in patients with ALL were cytokine release syndrome (CRS), infections, secondary hypogammaglobulinemia due to B-cell aplasia, pyrexia, and decreased appetite. The most common nonhematological side effects in patients with DLBCL were CRS, infections, pyrexia, diarrhea, nausea, hypotension, and fatigue. Kymriah also received an orphan designation on April 29, 2014, following a positive recommendation by the Committee for Orphan Medicinal Products (COMP). Maintenance of the orphan designation was recommended at the time of marketing authorization as the COMP considered the product was of significant benefit for patients with both conditions. IMPLICATIONS FOR PRACTICE: Chimeric antigen receptor (CAR)-engineered T-cell therapy is becoming the most promising approach in cancer treatment, involving reprogramming the patient's own T cells with a CAR-encoding transgene to identify and eliminate cancer-specific surface antigen-expressing cells. On June 28, 2018, Kymriah became one of the first EMA approved CAR T therapies. CAR T technology seems highly promising for diseases with single genetic/protein alterations; however, for more complex diseases there will be challenges to target clonal variability within the tumor type or clonal evolution during disease progression. Products with a lesser toxicity profile or more risk-minimization tools are also anticipated.
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Affiliation(s)
- Sahra Ali
- European Medicines Agency, Amsterdam, The Netherlands
| | | | | | - Greg Markey
- Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | - Therese S Saunders
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Mona Opsata
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Kristine Moltu
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Bjørn Bremnes
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Eirik Grønevik
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Martine Muusse
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Gro D Håkonsen
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Venke Skibeli
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Maria Elisabeth Kalland
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Ingrid Wang
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Ingebjørg Buajordet
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - Ania Urbaniak
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Norwegian Medicines Agency, Oslo, Norway
| | - John Johnston
- Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | - Khadija Rantell
- Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | - Essam Kerwash
- Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | - Martina Schuessler-Lenz
- Committee for Advanced Therapies, European Medicines Agency, Amsterdam, The Netherlands
- Paul-Ehrlich-Institut, Langen, Germany
| | - Tomas Salmonson
- Committee for Medicinal Products for Human Use, European Medicines Agency, Amsterdam, The Netherlands
- Medical Products Agency, Uppsala, Sweden
| | - Jonas Bergh
- Scientific Advisory Group, European Medicines Agency, Amsterdam, The Netherlands
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital BioClinicum, New Karolinska Hospital, Solna, Sweden
| | - Christian Gisselbrecht
- Scientific Advisory Group, European Medicines Agency, Amsterdam, The Netherlands
- Institut d'Hématologie, Hôpital Saint Louis, Paris, France
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Lambru G, Rantell K, Levy A, Matharu MS. A prospective comparative study and analysis of predictors of SUNA and SUNCT. Neurology 2019; 93:e1127-e1137. [PMID: 31427501 DOI: 10.1212/wnl.0000000000008134] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/29/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Despite the similar phenotypes, comparison between short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic features (SUNA) has hitherto not been possible due to the dearth of studies validating the phenotype of SUNA. Therefore, these 2 syndromes have been kept separate in the International Classification of Headache Disorders. The aim of this study is to characterize and compare the clinical phenotypes of large clinic-based cohorts of patients with SUNA and SUNCT. METHODS The clinical phenotype of consecutive patients with SUNA identified from a single specialist headache center in the United Kingdom between 2007 and 2012 was studied and compared to that of patients with SUNCT. RESULTS Sixty-three patients with SUNA (18 male, 28.6%) and 70 patients with SUNCT (32 male, 35.7%) were included. The demographic and clinical characteristics of patients with SUNA were similar to those of patients with SUNCT. Ptosis and rhinorrhea were predictors of SUNCT. The corresponding odds ratios (ORs) (95% confidence interval) were 3.79 (1.64-8.77, p = 0.002) and 2.46 (1.09-5.59, p = 0.031), respectively. The presence of spontaneous only attacks was a predictor for SUNA (OR 2.58 [1.10-6.05], p = 0.029). CONCLUSION No major clinical differences have emerged between SUNCT and SUNA, bar the fact that SUNCT is characterized by more prominent cranial autonomic features and triggerability. We propose that the 2 disorders be placed together in a single diagnostic category for which new diagnostic criteria are proposed.
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Affiliation(s)
- Giorgio Lambru
- From the Headache Group (G.L., A.L., M.S.N.) and Education Unit (K.R.), UCL Queen Square Institute of Neurology; and National Hospital for Neurology and Neurosurgery (G.L., A.L., M.S.N.), London, UK
| | - Khadija Rantell
- From the Headache Group (G.L., A.L., M.S.N.) and Education Unit (K.R.), UCL Queen Square Institute of Neurology; and National Hospital for Neurology and Neurosurgery (G.L., A.L., M.S.N.), London, UK
| | - Andrew Levy
- From the Headache Group (G.L., A.L., M.S.N.) and Education Unit (K.R.), UCL Queen Square Institute of Neurology; and National Hospital for Neurology and Neurosurgery (G.L., A.L., M.S.N.), London, UK
| | - Manjit S Matharu
- From the Headache Group (G.L., A.L., M.S.N.) and Education Unit (K.R.), UCL Queen Square Institute of Neurology; and National Hospital for Neurology and Neurosurgery (G.L., A.L., M.S.N.), London, UK.
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16
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Pope RA, Thompson PJ, Rantell K, Stretton J, Wright MA, Foong J. Frontal lobe dysfunction as a predictor of depression and anxiety following temporal lobe epilepsy surgery. Epilepsy Res 2019; 152:59-66. [DOI: 10.1016/j.eplepsyres.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 11/26/2022]
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Coats CJ, Pavlou M, Watkinson OT, Protonotarios A, Moss L, Hyland R, Rantell K, Pantazis AA, Tome M, McKenna WJ, Frenneaux MP, Omar R, Elliott PM. Effect of Trimetazidine Dihydrochloride Therapy on Exercise Capacity in Patients With Nonobstructive Hypertrophic Cardiomyopathy: A Randomized Clinical Trial. JAMA Cardiol 2019; 4:230-235. [PMID: 30725091 PMCID: PMC6439550 DOI: 10.1001/jamacardio.2018.4847] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/04/2018] [Indexed: 12/18/2022]
Abstract
Importance Hypertrophic cardiomyopathy causes limiting symptoms in patients, mediated partly through inefficient myocardial energy use. There is conflicting evidence for therapy with inhibitors of myocardial fatty acid metabolism in patients with nonobstructive hypertrophic cardiomyopathy. Objective To determine the effect of oral therapy with trimetazidine, a direct inhibitor of fatty acid β-oxidation, on exercise capacity in patients with symptomatic nonobstructive hypertrophic cardiomyopathy. Design, Setting, and Participants This randomized, placebo-controlled, double-blind clinical trial at The Heart Hospital, University College London Hospitals, London, United Kingdom was performed between May 31, 2012, and September 8, 2014. The trial included 51 drug-refractory symptomatic (New York Heart Association class ≥2) patients aged 24 to 74 years with a maximum left ventricular outflow tract gradient 50 mm Hg or lower and a peak oxygen consumption during exercise of 80% or less predicted value for age and sex. Statistical analysis was performed from March 1, 2016 through July 4, 2018. Interventions Participants were randomly assigned to trimetazidine, 20 mg, 3 times daily (n = 27) or placebo (n = 24) for 3 months. Main Outcomes and Measures The primary end point was peak oxygen consumption during upright bicycle ergometry. Secondary end points were 6-minute walk distance, quality of life (Minnesota Living with Heart Failure questionnaire), frequency of ventricular ectopic beats, diastolic function, serum N-terminal pro-brain natriuretic peptide level, and troponin T level. Results Of 49 participants who received trimetazidine (n = 26) or placebo (n = 23) and completed the study, 34 (70%) were male; the mean (SD) age was 50 (13) years. Trimetazidine therapy did not improve exercise capacity, with patients in the trimetazidine group walking 38.4 m (95% CI, 5.13 to 71.70 m) less than patients in the placebo group at 3 months after adjustment for their baseline walking distance measurements. After adjustment for baseline values, peak oxygen consumption was 1.35 mL/kg per minute lower (95% CI, -2.58 to -0.11 mL/kg per minute; P = .03) in the intervention group after 3 months. Conclusions and Relevance In symptomatic patients with nonobstructive hypertrophic cardiomyopathy, trimetazidine therapy does not improve exercise capacity. Pharmacologic therapy for this disease remains limited. Trial Registration ClinicalTrials.gov identifier: NCT01696370.
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Affiliation(s)
- Caroline J. Coats
- University College London Institute of Cardiovascular Science, London, United Kingdom
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, United Kingdom
| | - Oliver T. Watkinson
- University College London Institute of Cardiovascular Science, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Alexandros Protonotarios
- University College London Institute of Cardiovascular Science, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Linda Moss
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | | | - Khadija Rantell
- University College London Institute of Neurology, London, United Kingdom
| | | | - Maite Tome
- St George’s Hospital, London, United Kingdom
| | - William J. McKenna
- University College London Institute of Cardiovascular Science, London, United Kingdom
| | | | - Rumana Omar
- Department of Statistical Science, University College London, London, United Kingdom
| | - Perry M. Elliott
- University College London Institute of Cardiovascular Science, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
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Sinai A, Mokrysz C, Bernal J, Bohnen I, Bonell S, Courtenay K, Dodd K, Gazizova D, Hassiotis A, Hillier R, McBrien J, McCarthy J, Mukherji K, Naeem A, Perez-Achiaga N, Rantell K, Sharma V, Thomas D, Walker Z, Whitham S, Strydom A. Predictors of Age of Diagnosis and Survival of Alzheimer's Disease in Down Syndrome. J Alzheimers Dis 2019; 61:717-728. [PMID: 29226868 PMCID: PMC6004911 DOI: 10.3233/jad-170624] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [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] [Indexed: 02/01/2023]
Abstract
Background: People with Down syndrome (DS) are an ultra-high risk population for Alzheimer’s disease (AD). Understanding the factors associated with age of onset and survival in this population could highlight factors associated with modulation of the amyloid cascade. Objective: This study aimed to establish the typical age at diagnosis and survival associated with AD in DS and the risk factors associated with these. Methods: Data was obtained from the Aging with Down Syndrome and Intellectual Disabilities (ADSID) research database, consisting of data extracted from clinical records of patients seen by Community Intellectual Disability Services (CIDS) in England. Survival times when considering different risk factors were calculated. Results: The mean age of diagnosis was 55.80 years, SD 6.29. Median survival time after diagnosis was 3.78 years, and median age at death was approximately 60 years. Survival time was associated with age of diagnosis, severity of intellectual disability, living status, anti-dementia medication status, and history of epilepsy. Age at diagnosis and treatment status remained predictive of survival time following adjustment. Conclusion: This study provides the best estimate of survival in dementia within the DS population to date, and is in keeping with previous estimates from smaller studies in the DS population. This study provides important estimates and insights into possible predictors of survival and age of diagnosis of AD in adults with DS, which will inform selection of participants for treatment trials in the future.
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Affiliation(s)
- Amanda Sinai
- Division of Psychiatry, University College London, London, UK.,Sheba Medical Center, Tel Hashomer, Israel
| | - Claire Mokrysz
- Division of Psychiatry, University College London, London, UK
| | - Jane Bernal
- Cornwall Partnership Foundation NHS Trust, UK
| | - Ingrid Bohnen
- Westminster Learning Disability Partnership, Central and North West London NHS Foundation Trust, London, UK
| | - Simon Bonell
- Livewell SouthWest (CIC), Plymouth, UK (data from South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK).,Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| | - Ken Courtenay
- Division of Psychiatry, University College London, London, UK.,Barnet Enfield and Haringey Mental Health NHS Trust, UK
| | - Karen Dodd
- Surrey and Borders Partnership NHS Foundation Trust, Epsom, UK
| | - Dina Gazizova
- Enfield Integrated Learning Disabilities Service, Enfield, UK
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | - Judith McBrien
- Plymouth Teaching Primary Care Trust (now known as Livewell Southwest CIC), UK
| | - Jane McCarthy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Asim Naeem
- Sutton MHLD Team, SW London and St George's Mental Health NHS Trust, Surrey, UK.,St George's University of London, UK
| | | | - Khadija Rantell
- Institute of Neurology, Queen Square, Education Unit, London, UK
| | - Vijaya Sharma
- Hertfordshire Partnership University NHS Foundation Trust, UK
| | - David Thomas
- Department of Community Mental Health, RAF Marham, Norfolk, UK (data from East London NHS Foundation Trust, UK)
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK.,Essex Partnership University NHS Foundation Trust, UK
| | | | - Andre Strydom
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The LonDownS Consortium
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19
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Sheehan R, Eady N, Rantell K, Sinai A, Bernal J, Bohnen I, Bonell S, Courtenay K, Dodd K, Gazizova D, Hassiotis A, Hillier R, McBrien J, Mukherji K, Naeem A, Perez-Achiaga N, Sharma V, Thomas D, Walker Z, McCarthy J, Strydom A. Author's reply. Br J Psychiatry 2018; 213:667-668. [PMID: 30741134 DOI: 10.1192/bjp.2018.194] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rory Sheehan
- Division of Psychiatry,University College London,UK
| | - Nicole Eady
- Division of Psychiatry,University College London,UK
| | | | - Amanda Sinai
- Division of Psychiatry,University College London,UK
| | | | | | - Simon Bonell
- Plymouth Community Learning Disabilities Team,Livewell Southwest,UK
| | - Ken Courtenay
- Haringey Learning Disability Partnership,Barnet Enfield Haringey Mental Health NHS Trust,UK
| | - Karen Dodd
- Surrey and Borders Partnership NHS Foundation Trust,UK
| | | | | | | | | | | | - Asim Naeem
- South West London and St George's Mental Health NHS Trust,UK
| | | | | | - David Thomas
- Hackney Learning Disability Team, East London NHS Foundation Trust,UK
| | | | - Jane McCarthy
- Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK
| | - André Strydom
- Division of Psychiatry,University College London, Institute of Psychiatry,Psychology and Neuroscience,King's College London and The LonDownS Consortium,UK
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20
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Eady N, Sheehan R, Rantell K, Sinai A, Bernal J, Bohnen I, Bonell S, Courtenay K, Dodd K, Gazizova D, Hassiotis A, Hillier R, McBrien J, Mukherji K, Naeem A, Perez-Achiaga N, Sharma V, Thomas D, Walker Z, McCarthy J, Strydom A. Author's reply to: Difficulties of diagnosing and managing dementia in people with Down syndrome. Br J Psychiatry 2018; 213:669. [PMID: 30741135 DOI: 10.1192/bjp.2018.208] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nicole Eady
- Division of Psychiatry,University College London,UK
| | - Rory Sheehan
- Division of Psychiatry,University College London,UK
| | | | - Amanda Sinai
- Division of Psychiatry,University College London,UK
| | | | | | - Simon Bonell
- Plymouth Community Learning Disabilities Team,Livewell Southwest,UK
| | - Ken Courtenay
- Haringey Learning Disability Partnership,Barnet Enfield Haringey Mental Health NHS Trust,UK
| | - Karen Dodd
- Surrey and Borders Partnership NHS Foundation Trust,UK
| | | | | | | | | | | | - Asim Naeem
- South West London and St George's Mental Health NHS Trust,UK
| | | | | | - David Thomas
- Hackney Learning Disability Team, East London NHS Foundation Trust,UK
| | | | - Jane McCarthy
- Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK
| | - André Strydom
- Division of Psychiatry,University College London, Institute of Psychiatry,Psychology and Neuroscience,King's College London and The LonDownS Consortium,UK
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21
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Eady N, Sheehan R, Rantell K, Sinai A, Bernal J, Bohnen I, Bonell S, Courtenay K, Dodd K, Gazizova D, Hassiotis A, Hillier R, McBrien J, Mukherji K, Naeem A, Perez-Achiaga N, Sharma V, Thomas D, Walker Z, McCarthy J, Strydom A. Impact of cholinesterase inhibitors or memantine on survival in adults with Down syndrome and dementia: clinical cohort study. Br J Psychiatry 2018; 212:155-160. [PMID: 29486820 DOI: 10.1192/bjp.2017.21] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is little evidence to guide pharmacological treatment in adults with Down syndrome and Alzheimer's disease. Aims To investigate the effect of cholinesterase inhibitors or memantine on survival and function in adults with Down syndrome and Alzheimer's disease. METHOD This was a naturalistic longitudinal follow-up of a clinical cohort of 310 people with Down syndrome diagnosed with Alzheimer's disease collected from specialist community services in England. RESULTS Median survival time (5.59 years, 95% CI 4.67-6.67) for those on medication (n = 145, mainly cholinesterase inhibitors) was significantly greater than for those not prescribed medication (n = 165) (3.45 years, 95% CI 2.91-4.13, log-rank test P<0.001). Sequential assessments demonstrated an early effect in maintaining cognitive function. CONCLUSIONS Cholinesterase inhibitors appear to offer benefit for people with Down syndrome and Alzheimer's disease that is comparable with sporadic Alzheimer's disease; a trial to test the effect of earlier treatment (prodromal Alzheimer's disease) in Down syndrome may be indicated. Declaration of interest A.S. has undertaken consulting for Ono Pharmaceuticals, outside the submitted work. Z.W. has received a consultancy fee and grant from GE Healthcare, outside the submitted work.
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Affiliation(s)
- Nicole Eady
- Division of Psychiatry,University College London,London
| | - Rory Sheehan
- Division of Psychiatry,University College London,London
| | | | - Amanda Sinai
- Division of Psychiatry,University College London,London
| | - Jane Bernal
- Cornwall Partnership Foundation Trust,Cornwall
| | | | - Simon Bonell
- Plymouth Community Learning Disabilities Team,Livewell Southwest,Plymouth
| | - Ken Courtenay
- Haringey Learning Disability Partnership,Barnet Enfield Haringey Mental Health NHS Trust,London
| | - Karen Dodd
- Surrey and Borders Partnership NHS Foundation Trust,Leatherhead
| | - Dina Gazizova
- Hillingdon Learning Disabilities Service,Uxbridge,London
| | | | | | | | | | - Asim Naeem
- South West London and St George's Mental Health NHS Trust,London
| | | | - Vijaya Sharma
- Hertfordshire Partnership NHS Foundation Trust,Stevenage
| | - David Thomas
- Hackney Learning Disability Team,East London NHS Foundation Trust,London
| | - Zuzana Walker
- Division of Psychiatry,University College London,London
| | - Jane McCarthy
- Institute of Psychiatry,Psychology and Neuroscience,King's College London,London
| | - André Strydom
- Division of Psychiatry,University College London,London;Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK;The LonDownS Consortium
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Abstract
OBJECTIVES To explore current delays in diagnosis of retinoblastoma (Rb) and effect on outcome with comparison to a study from the 1990s. SETTING Primary, secondary, tertiary care: majority from South of England. PARTICIPANTS A retrospective analysis of 93 new referrals of sporadic (non-familial) Rb to a specialist Rb unit in London, UK from January 2006 to February 2014. PRIMARY AND SECONDARY OUTCOMES International Intraocular Retinoblastoma Classification, lag times including parental delay and healthcare professional delay, patients requiring enucleation and requirement of adjuvant chemotherapy postenucleation (high-risk Rb). RESULTS During the study period, 29% presented via accident and emergency (A&E). The median referral time from symptom onset to visiting primary care (PC) was 28 days and PC to ophthalmologist 3 days (range 0-181 days). The median time from local ophthalmologist to the Rb Unit was 6 days (0-33). No significant correlation was found between delay and International Classification of Retinoblastoma grade (p>0.05) or between postenucleation adjuvant chemotherapy and enucleation groups (p>0.05). Less enucleations (60%) are being performed compared with the previous study (81%) (p=0.0015). CONCLUSIONS Parents are attending A&E more compared with the 1990s and this may reflect the effect of public awareness campaigns. More eyes are being salvaged despite a similar number of children requiring adjuvant chemotherapy. High-risk Rb and Group E eyes do not correlate with increased lag time in the UK. Other determinants such as tumour biology may be more relevant.
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Affiliation(s)
- Marcus Posner
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Adil Jaulim
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, London, UK
| | - Marina Vasalaki
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- The Western Eye Hospital, Marylebone, UK
| | - Khadija Rantell
- Education Unit, UCL Institute of Neurology, Queen Square, UK
| | - Mandeep S Sagoo
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - M Ashwin Reddy
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Moorfields Eye Hospital, London, UK
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Pitman AL, Rantell K, Moran P, Sireling L, Marston L, King M, Osborn D. Support received after bereavement by suicide and other sudden deaths: a cross-sectional UK study of 3432 young bereaved adults. BMJ Open 2017; 7:e014487. [PMID: 28554915 PMCID: PMC5729987 DOI: 10.1136/bmjopen-2016-014487] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To test the hypothesis that people bereaved by suicide are less likely to receive formal or informal support than people bereaved by other causes of sudden death. DESIGN National cross-sectional study. SETTING Adults working or studying at any UK higher education institution (HEI) in 2010. PARTICIPANTS A total of 3432 eligible respondents aged 18-40 years bereaved by the sudden death of a close friend or relative, sampled from approximately 659 572 bereaved and non-bereaved staff and students at 37 of 164 UK HEIs invited to participate. EXPOSURES Bereavement by suicide (n=614; 18%), by sudden unnatural causes (n=712; 21%) and by sudden natural causes (n=2106; 61%). MAIN OUTCOME MEASURES Receipt of formal and informal support postbereavement; timing of valued support. RESULTS 21% (725/3432) of our sample of bereaved adults reported receiving no formal or informal bereavement support, with no evidence for group differences. People bereaved by suicide were less likely to have received informal support than those bereaved by sudden natural causes (adjusted OR (AOR)=0.79; 95% CI 0.64 to 0.98) or unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96) but did not differ from either comparison group on receipt of formal support. People bereaved by suicide were less likely to have received immediate support (AOR=0.73; 95% CI 0.59 to 0.90) and more likely to report delayed receipt of support (AOR=1.33; 95% CI 1.08 to 1.64) than people bereaved by sudden natural causes. Associations were not modified by gender, or age bereaved, but became non-significant when adjusting for stigma. CONCLUSIONS People bereaved by suicide are less likely to receive informal support than people bereaved by other causes of sudden death and are more likely to perceive delays in accessing any support. This is concerning given their higher risk of suicide attempt and the recommendations within suicide prevention strategies regarding their need for support. STUDY REGISTRATION http://www.ucl.ac.uk/psychiatry/bereavementstudy/.
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Affiliation(s)
- Alexandra L Pitman
- UCL Division of Psychiatry, University College Medical School, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Khadija Rantell
- Institute of Neurology, University College London, London, UK
| | | | | | - Louise Marston
- Primary Care and Population Health, University College Medical School, London, UK
| | - Michael King
- UCL Division of Psychiatry, University College Medical School, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - David Osborn
- UCL Division of Psychiatry, University College Medical School, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
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24
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Pitman A, Rantell K, Marston L, King M, Osborn D. Perceived Stigma of Sudden Bereavement as a Risk Factor for Suicidal Thoughts and Suicide Attempt: Analysis of British Cross-Sectional Survey Data on 3387 Young Bereaved Adults. Int J Environ Res Public Health 2017; 14:ijerph14030286. [PMID: 28282958 PMCID: PMC5369122 DOI: 10.3390/ijerph14030286] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
The sudden death of a friend or relative, particularly by suicide, is a risk factor for suicide. People who experience sudden bereavement report feeling highly stigmatised by the loss, potentially influencing access to support. We assessed whether perceived stigma following sudden bereavement is associated with suicidal thoughts and suicide attempt. We analysed cross-sectional survey data on 3387 young adults bereaved by the sudden death of a close contact. We tested the association of high versus low perceived stigma (on the stigma sub-scale of the Grief Experience Questionnaire) with post-bereavement suicidal ideation and suicide attempt, using random effects logistic regression, adjusting for socio-demographic factors, pre-bereavement psychopathology, and mode of sudden bereavement (natural causes/unnatural causes/suicide). Subjects with high perceived stigma scores were significantly more likely to report post-bereavement suicidal thoughts (adjusted odds ratio (AOR) = 2.74; 95% confidence interval (CI) = 1.93-3.89) and suicide attempt (AOR = 2.73; 95% CI = 2.33-3.18) than those with low stigma scores. People who feel highly stigmatised by a sudden bereavement are at increased risk of suicidal thoughts and suicide attempt, even taking into account prior suicidal behaviour. General practitioners, bereavement counsellors, and others who support people bereaved suddenly, should consider inquiring about perceived stigma, mental wellbeing, and suicidal thoughts, and directing them to appropriate sources of support.
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Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, University College London, London W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK.
| | - Khadija Rantell
- Education Unit, UCL Institute of Neurology, University College London, London WC1N 3BG, UK.
| | - Louise Marston
- UCL Department of Primary Care and Population Health, University College London, London NW3 2PF, UK.
| | - Michael King
- UCL Division of Psychiatry, University College London, London W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK.
| | - David Osborn
- UCL Division of Psychiatry, University College London, London W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK.
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25
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Pitman AL, Osborn DP, Rantell K, King MB. The stigma perceived by people bereaved by suicide and other sudden deaths: A cross-sectional UK study of 3432 bereaved adults. J Psychosom Res 2016; 87:22-9. [PMID: 27411748 PMCID: PMC4988532 DOI: 10.1016/j.jpsychores.2016.05.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/08/2016] [Accepted: 05/26/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To test the hypothesis that perceived stigma scores in young adults bereaved by suicide are significantly higher than in young adults bereaved by other sudden deaths, whether blood-related to the deceased or not. METHODS We conducted a cross-sectional study of all staff and students aged 18-40 at 37 UK higher educational institutions in 2010, and identified 3432 respondents who had experienced a sudden bereavement of a close contact since reaching the age of 10, either due to sudden natural causes, sudden unnatural causes, or suicide. We used multivariable regression to compare scores on the stigma, shame, responsibility and guilt subscales of the Grief Experience Questionnaire, adjusting for socio-demographic factors and pre-bereavement psychopathology. RESULTS People bereaved by suicide (n=614) had higher stigma scores than people bereaved by sudden natural death (n=2106; adjusted coefficient=2.52; 95% CI=2.13-2.90; p=<0.001) and people bereaved by sudden unnatural death (n=712; adjusted coefficient=1.69; 95% CI=1.25-2.13; p=<0.001). Shame, responsibility and guilt scores were also significantly higher in people bereaved by suicide, whether compared with bereavement by sudden natural death or sudden unnatural death. Associations were not modified by whether the bereaved was blood-related to the deceased or not. CONCLUSIONS Stigma was perceived more acutely by the relatives and friends of those who died by suicide than those bereaved by other causes of sudden natural or sudden unnatural death. Their high levels of perceived stigma, shame, responsibility and guilt require qualitative investigation to identify whether these grief dimensions limit social functioning, help-seeking behaviour and/or support offered.
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Affiliation(s)
- Alexandra L. Pitman
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom,Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom,Corresponding author at: UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7NF, United Kingdom.UCL Division of PsychiatryMaple House149 Tottenham Court RoadLondonW1T 7NFUnited Kingdom
| | - David P.J. Osborn
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom,Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom
| | | | - Michael B. King
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom,Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom
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26
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Saverino A, Waller D, Rantell K, Parry R, Moriarty A, Playford ED. The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting. PLoS One 2016; 11:e0153469. [PMID: 27115880 PMCID: PMC4846032 DOI: 10.1371/journal.pone.0153469] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 03/30/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction There is a consistent body of evidence supporting the role of cognitive functions, particularly executive function, in the elderly and in neurological conditions which become more frequent with ageing. The aim of our study was to assess the role of different domains of cognitive functions to predict balance and fall risk in a sample of adults with various neurological conditions in a rehabilitation setting. Methods This was a prospective, cohort study conducted in a single centre in the UK. 114 participants consecutively admitted to a Neuro-Rehabilitation Unit were prospectively assessed for fall accidents. Baseline assessment included a measure of balance (Berg Balance Scale) and a battery of standard cognitive tests measuring executive function, speed of information processing, verbal and visual memory, visual perception and intellectual function. The outcomes of interest were the risk of becoming a faller, balance and fall rate. Results Two tests of executive function were significantly associated with fall risk, the Stroop Colour Word Test (IRR 1.01, 95% CI 1.00–1.03) and the number of errors on part B of the Trail Making Test (IRR 1.23, 95% CI 1.03–1.49). Composite scores of executive function, speed of information processing and visual memory domains resulted in 2 to 3 times increased likelihood of having better balance (OR 2.74 95% CI 1.08 to 6.94, OR 2.72 95% CI 1.16 to 6.36 and OR 2.44 95% CI 1.11 to 5.35 respectively). Conclusions Our results show that specific subcomponents of executive functions are able to predict fall risk, while a more global cognitive dysfunction is associated with poorer balance.
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Affiliation(s)
- A. Saverino
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
- Institute of Rehabilitation, Fondazione Salvatore Maugeri, Genova, Italy
- Wolfson Neurorehabilitation Centre, St Georges Hospital, London, United Kingdom
| | - D. Waller
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - K. Rantell
- Research Support Centre, Joint UCL/UCLH/Royal Free Hospital, London, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
| | - R. Parry
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - A. Moriarty
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - E. D. Playford
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
- * E-mail:
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27
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Abstract
OBJECTIVES US and UK suicide prevention strategies suggest that bereavement by the suicide of a relative or friend is a risk factor for suicide. However, evidence is lacking that the risk exceeds that of any sudden bereavement, is specific to suicide, or applies to peer suicide. We conducted the first controlled UK-wide study to test the hypothesis that young adults bereaved by suicide have an increased risk of suicidal ideation and suicide attempt compared with young adults bereaved by other sudden deaths. DESIGN National cross-sectional study. SETTING Staff and students at 37 UK higher educational institutions in 2010. PARTICIPANTS 3432 eligible respondents aged 18-40 exposed to sudden bereavement of a friend or relative after the age of 10. EXPOSURES Bereavement by suicide (n=614), by sudden unnatural causes (n=712) and by sudden natural causes (n=2106). PRIMARY OUTCOME MEASURES Incident suicidal ideation and suicide attempt. FINDINGS Adults bereaved by suicide had a higher probability of attempting suicide (adjusted OR (AOR)=1.65; 95% CI 1.12 to 2.42; p=0.012) than those bereaved by sudden natural causes. There was no such increased risk in adults bereaved by sudden unnatural causes. There were no group differences in probability of suicidal ideation. The effect of suicide bereavement was similar whether bereaved participants were blood-related to the deceased or not. The significant association between bereavement by suicide and suicide attempt became non-significant when adding perceived stigma (AOR=1.11; 95% CI 0.74 to 1.67; p=0.610). When compared with adults bereaved by sudden unnatural causes, those bereaved by suicide did not show significant differences in suicide attempt (AOR=1.48; 95% CI 0.94 to 2.33; p=0.089). CONCLUSIONS Bereavement by suicide is a specific risk factor for suicide attempt among young bereaved adults, whether related to the deceased or not. Suicide risk assessment of young adults should involve screening for a history of suicide in blood relatives, non-blood relatives and friends.
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Affiliation(s)
- Alexandra L Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - David P J Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Khadija Rantell
- Institute of Neurology, University College London, London, UK
| | - Michael B King
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
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Coats CJ, Rantell K, Bartnik A, Patel A, Mist B, McKenna WJ, Elliott PM. Cardiopulmonary Exercise Testing and Prognosis in Hypertrophic Cardiomyopathy. Circ Heart Fail 2015; 8:1022-31. [DOI: 10.1161/circheartfailure.114.002248] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 09/10/2015] [Indexed: 11/16/2022]
Abstract
Background—
Exercise testing is performed in patients with hypertrophic cardiomyopathy to evaluate blood pressure response, a risk factor for sudden cardiac death. The prognostic role of exercise gas exchange variables is unknown.
Methods and Results—
Between 1998 and 2010, 1898 patients (age 47±15 years, range 16–86 years; 67% male) with hypertrophic cardiomyopathy underwent cardiopulmonary exercise testing. A total of 178 (9.4%) patients reached the primary end point of all-cause mortality or heart transplant (death/transplant) during a median follow-up of 5.6 years (interquartile range 2.6–8.9), giving an annual event rate of 1.6% per person year. Peak oxygen consumption (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.77–0.88,
P
<0.001), ventilatory efficiency (adjusted HR 1.10, 95% CI 1.00–1.22,
P
=0.049), and ventilatory anaerobic threshold (adjusted HR 0.82, 95% CI 0.70–0.96,
P
=0.016) were predictors of the primary outcome after correction for age, sex, left atrial size, nonsustained ventricular tachycardia, and ejection fraction. The overall adjusted death/transplant estimates for patients in the lowest quartile with peak oxygen consumption ≤15.3 mL/kg/min were 14% at 5 years and 31% at 10 years. Peak oxygen consumption (HR 0.81, 95% CI 0.77–0.86,
P
<0.01) and ventilation to carbon dioxide production (HR 1.10, 95% CI 1.08–1.13,
P
<0.001) were predictors of death because of heart failure or transplantation but not sudden cardiac death or implantable cardioverter defibrillator shocks.
Conclusions—
Cardiopulmonary exercise testing provides prognostic information in patients with hypertrophic cardiomyopathy. Submaximal exercise parameters, such as ventilatory efficiency and anaerobic threshold, measured alone or in combination with peak oxygen consumption, predict death from heart failure.
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Affiliation(s)
- Caroline J. Coats
- From the Institute of Cardiovascular Science (C.J.C., B.M., W.J.M., P.M.E.), and Institute of Neurology (K.R.), University College London, London, United Kingdom; Royal Free Hospital NHS Trust, London, United Kingdom (A.B.); and University College London Hospitals NHS Trust, London, United Kingdom (A.P.)
| | - Khadija Rantell
- From the Institute of Cardiovascular Science (C.J.C., B.M., W.J.M., P.M.E.), and Institute of Neurology (K.R.), University College London, London, United Kingdom; Royal Free Hospital NHS Trust, London, United Kingdom (A.B.); and University College London Hospitals NHS Trust, London, United Kingdom (A.P.)
| | - Aleksandra Bartnik
- From the Institute of Cardiovascular Science (C.J.C., B.M., W.J.M., P.M.E.), and Institute of Neurology (K.R.), University College London, London, United Kingdom; Royal Free Hospital NHS Trust, London, United Kingdom (A.B.); and University College London Hospitals NHS Trust, London, United Kingdom (A.P.)
| | - Amour Patel
- From the Institute of Cardiovascular Science (C.J.C., B.M., W.J.M., P.M.E.), and Institute of Neurology (K.R.), University College London, London, United Kingdom; Royal Free Hospital NHS Trust, London, United Kingdom (A.B.); and University College London Hospitals NHS Trust, London, United Kingdom (A.P.)
| | - Bryan Mist
- From the Institute of Cardiovascular Science (C.J.C., B.M., W.J.M., P.M.E.), and Institute of Neurology (K.R.), University College London, London, United Kingdom; Royal Free Hospital NHS Trust, London, United Kingdom (A.B.); and University College London Hospitals NHS Trust, London, United Kingdom (A.P.)
| | - William J. McKenna
- From the Institute of Cardiovascular Science (C.J.C., B.M., W.J.M., P.M.E.), and Institute of Neurology (K.R.), University College London, London, United Kingdom; Royal Free Hospital NHS Trust, London, United Kingdom (A.B.); and University College London Hospitals NHS Trust, London, United Kingdom (A.P.)
| | - Perry M. Elliott
- From the Institute of Cardiovascular Science (C.J.C., B.M., W.J.M., P.M.E.), and Institute of Neurology (K.R.), University College London, London, United Kingdom; Royal Free Hospital NHS Trust, London, United Kingdom (A.B.); and University College London Hospitals NHS Trust, London, United Kingdom (A.P.)
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Pope RA, Thompson PJ, Rantell K, Stretton J, Wright MA, Foong J. PREDICTING PSYCHIATRIC OUTCOME FOLLOWING TEMPORAL LOBE EPILEPSY SURGERY: A LONGITUDINAL STUDY. J Neurol Neurosurg Psychiatry 2015. [DOI: 10.1136/jnnp-2015-311750.25] [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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Potier T, Tims E, Kilbride C, Rantell K. Evaluation of an evidence based quality improvement innovation for patients with musculoskeletal low back pain in an accident and emergency setting. BMJ Qual Improv Rep 2015; 4:u205903.w2411. [PMID: 26734383 PMCID: PMC4693031 DOI: 10.1136/bmjquality.u205903.w2411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/24/2015] [Indexed: 11/04/2022]
Abstract
We conducted a five stage pilot study which initially consisted of a review of 75 case notes of people attending an emergency department (ED) in an inner London Teaching Hospital with musculoskeletal (MSK) low back pain (LBP). This review highlighted inconsistencies in how they were assessed and managed across and within different staff groups. We found patient documentation was often incomplete and that a biomedical model approach to the management of these patients was common. As a result, four further stages in the project were conducted. Our primary aim was to evaluate the impact of implementing a locally developed quality improvement intervention for the assessment and treatment of MSK LBP in this ED. Secondary aims were to explore the user experience of the new pathway, measured by the patient experience questionnaire (PEQ), and any associated health economic costs of changes in practice. The quality improvement intervention consisted of an evidence based low back pain pathway (EBLBPP), a staff educational program, and a patient education booklet. We undertook a retrospective baseline audit of 100 clinical records of patients was undertaken prior to the instigation of the quality improvement intervention, and four months post implementation. The pre-defined variables of interest were: documentation of the case history, examination, classification of back pain (and if correct), prescribed management and if the documentation was compliant with medico-legal standards. All patients in the study were sent a PEQ to complete and return in a self-addressed envelope. Estimated health costs associated with each patient episode of care were calculated including re-attendance episodes for any people presenting with MSK LBP within a four week period. There was a significant improvement in all areas evaluated post implementation in all groups (simple, referred and simple, referred and serious spinal pathology combined). In particular; screening for red flags (22%) and biopsychosocial factors (29%), as well as noting the prevalence of previous symptoms (44%), observation of the painful area (57%), and analysis classification (59%) at a at 95% confidence interval (CI). In terms of management, an increase in adherence to the analgesic ladder, patients receiving reassurance and appropriate referral back to their GP's increased 45%, 23% and 44% at 95% CI respectively. Unfortunately, there was insufficient data to draw any meaningful conclusions from the patient experience data due to a low response rate. In conclusion, the introduction of the EBLBPP, patient education leaflet and teaching training for staff involved in the treatment of MSK LBP patients has improved the quality and consistency of the documented assessment and subsequent management of MSK LBP patients.
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Affiliation(s)
- Tara Potier
- Physiotherapy Division, Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, UK and UCL Institute of Neurology, Education Unit, Queen Square, London
| | - Emily Tims
- Physiotherapy Division, Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, UK and UCL Institute of Neurology, Education Unit, Queen Square, London
| | - Cherry Kilbride
- Physiotherapy Division, Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, UK and UCL Institute of Neurology, Education Unit, Queen Square, London
| | - Khadija Rantell
- Physiotherapy Division, Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, UK and UCL Institute of Neurology, Education Unit, Queen Square, London
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Kebets V, Gregoire SM, Charidimou A, Barnes J, Rantell K, Brown MM, Jäger HR, Cipolotti L, Werring DJ. Prevalence and cognitive impact of medial temporal atrophy in a hospital stroke service: retrospective cohort study. Int J Stroke 2015; 10:861-7. [PMID: 26043795 DOI: 10.1111/ijs.12544] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 10/10/2014] [Accepted: 03/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebrovascular disease and neurodegeneration cause cognitive impairment and frequently coexist. AIMS Our objectives were to investigate the prevalence and cognitive impact of medial temporal lobe atrophy - a radiological marker often associated with Alzheimer's disease - in a hospital stroke service. METHODS Retrospective cohort study of patients from a hospital stroke service. Patients assessed for suspected ischemic stroke or transient ischemic attack, irrespective of final diagnosis, underwent neuropsychological testing and magnetic resonance imaging. medial temporal lobe atrophy, white matter hyperintensities, lacunes, and cerebral microbleeds were rated using established criteria and validated scales. The associations between medial temporal lobe atrophy and cognition were tested using multivariable logistic regression analyses, adjusted for age and imaging markers of cerebrovascular disease. RESULTS Three hundred and ninety-three patients were included, of whom 169 (43%; 95% confidence interval: 38·1-48·1%) had medial temporal lobe atrophy; in 38 patients (9·7%), medial temporal lobe atrophy was severe (mean score ≥2). In unadjusted logistic regression analyses in the whole cohort, mean medial temporal lobe atrophy score was associated with verbal memory, nominal and perceptual skills, executive function, and speed and attention. After adjustment for age, white matter hyperintensities, number of lacunes, presence of cerebral microbleeds, previous ischemic stroke or transient ischemic attack, and premorbid intelligence quotient, mean medial temporal lobe atrophy score remained associated with impairment in verbal memory (odds ratio: 1·64; 95% confidence interval 1·04-2·58) and nominal skills (odds ratio: 1·61; 95% confidence interval 1·04-2·48). CONCLUSIONS Medial temporal lobe atrophy is common and has an independent impact on cognitive function in a stroke service population, independent of confounding factors including age and magnetic resonance imaging markers of cerebrovascular disease. Medial temporal lobe atrophy is independently related to verbal memory and nominal skills, while small vessel pathology also contributes to speed and attention, and executive and perceptual functions.
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Affiliation(s)
- Valeria Kebets
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Simone M Gregoire
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Andreas Charidimou
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Josephine Barnes
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Khadija Rantell
- Department of Biostatistics, Joint UCL/UCH/RFH Research Support Centre, National Hospital for Neurology and Neurosurgery, London, UK
| | - Martin M Brown
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Hans R Jäger
- Neuroradiological Academic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, Università di Palermo, Palermo, Italy.,Dipartimento di Psicologia, Università di Palermo, Palermo, Italy
| | - David J Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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Bloch E, Uddin N, Gannon L, Rantell K, Jain S. The effects of absence of stereopsis on performance of a simulated surgical task in two-dimensional and three-dimensional viewing conditions. Br J Ophthalmol 2015; 99:240-5. [PMID: 25185439 PMCID: PMC4316921 DOI: 10.1136/bjophthalmol-2013-304517] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 07/20/2014] [Accepted: 08/08/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Stereopsis is believed to be advantageous for surgical tasks that require precise hand-eye coordination. We investigated the effects of short-term and long-term absence of stereopsis on motor task performance in three-dimensional (3D) and two-dimensional (2D) viewing conditions. METHODS 30 participants with normal stereopsis and 15 participants with absent stereopsis performed a simulated surgical task both in free space under direct vision (3D) and via a monitor (2D), with both eyes open and one eye covered in each condition. RESULTS The stereo-normal group scored higher, on average, than the stereo-absent group with both eyes open under direct vision (p<0.001). Both groups performed comparably in monocular and binocular monitor viewing conditions (p=0.579). CONCLUSIONS High-grade stereopsis confers an advantage when performing a fine motor task under direct vision. However, stereopsis does not appear advantageous to task performance under 2D viewing conditions, such as in video-assisted surgery.
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Affiliation(s)
- Edward Bloch
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
- University College London Medical School, London, UK
| | - Nabil Uddin
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
| | - Laura Gannon
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
| | - Khadija Rantell
- Institute of Neurology, University College London, London, UK
| | - Saurabh Jain
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
- University College London Medical School, London, UK
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Thomas B, Courtenay K, Hassiotis A, Strydom A, Rantell K. Standardised patients with intellectual disabilities in training tomorrow's doctors. Psychiatr Bull (2014) 2014; 38:132-6. [PMID: 25237524 PMCID: PMC4115377 DOI: 10.1192/pb.bp.113.043547] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/26/2013] [Indexed: 12/01/2022]
Abstract
Aims and method To develop a programme to help undergraduate medical students and postgraduate trainees to improve their skills in communicating with people with intellectual disabilities through teaching sessions that had input from simulated patients with intellectual disabilities. We conducted four sessions of training for 47 undergraduate 4th-year medical students. The training involved a multiprofessional taught session followed by a clinical scenario role-play with simulated patients who were people with intellectual disabilities. The training was assessed by completing the healthcare provider questionnaire before and after the training. Results There were improvements in the students’ perceived skill, comfort and the type of clinical approach across all three scenarios. Clinical implications By involving people with intellectual disabilities in training medical students there has been a significant improvement in students’ communication skills in areas of perceived skills, comfort and type of clinical approach which will raise the quality of care provided by them in the future.
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Affiliation(s)
| | - Ken Courtenay
- Barnet, Enfield and Haringey Mental Health NHS Trust ; Mental Health Research Unit, University College London
| | - Angela Hassiotis
- Mental Health Research Unit, University College London ; Camden and Islington NHS Foundation Trust
| | - Andre Strydom
- Mental Health Research Unit, University College London ; Camden and Islington NHS Foundation Trust
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Kara E, Kiely AP, Proukakis C, Giffin N, Love S, Hehir J, Rantell K, Pandraud A, Hernandez DG, Nacheva E, Pittman AM, Nalls MA, Singleton AB, Revesz T, Bhatia KP, Quinn N, Hardy J, Holton JL, Houlden H. A 6.4 Mb duplication of the α-synuclein locus causing frontotemporal dementia and Parkinsonism: phenotype-genotype correlations. JAMA Neurol 2014; 71:1162-71. [PMID: 25003242 PMCID: PMC4362700 DOI: 10.1001/jamaneurol.2014.994] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE α-Synuclein (SNCA) locus duplications are associated with variable clinical features and reduced penetrance but the reasons underlying this variability are unknown. OBJECTIVES To report a novel family carrying a heterozygous 6.4 Mb duplication of the SNCA locus with an atypical clinical presentation strongly reminiscent of frontotemporal dementia and late-onset pallidopyramidal syndromes and study phenotype-genotype correlations in SNCA locus duplications. DESIGN, SETTING, AND PARTICIPANTS We report the clinical and neuropathologic features of a family carrying a 6.4 Mb duplication of the SNCA locus. To identify candidate disease modifiers, we completed a genetic analysis of the family and conducted statistical analysis on previously published cases carrying SNCA locus duplications using regression modeling with robust standard errors to account for clustering at the family level. MAIN OUTCOMES AND MEASURES We assessed whether length of the SNCA locus duplication influences disease penetrance and severity and whether extraduplication factors have a disease-modifying role. RESULTS We identified a large 6.4 Mb duplication of the SNCA locus in this family. Neuropathological analysis showed extensive α-synuclein pathology with minimal phospho-tau pathology. Genetic analysis showed an increased burden of Parkinson disease-related risk factors and the disease-predisposing H1/H1 microtubule-associated protein tau haplotype. Statistical analysis of previously published cases suggested there is a trend toward increasing disease severity and disease penetrance with increasing duplication size. The corresponding odds ratios from the univariable analyses were 1.17 (95% CI, 0.81-1.68) and 1.34 (95% CI, 0.78-2.31), respectively. Sex was significantly associated with both disease risk and severity; men compared with women had increased disease risk and severity and the corresponding odds ratios from the univariable analyses were 8.36 (95% CI, 1.97-35.42) and 5.55 (95% CI, 1.39-22.22), respectively. CONCLUSIONS AND RELEVANCE These findings further expand the phenotypic spectrum of SNCA locus duplications. Increased dosage of genes located within the duplicated region probably cannot increase disease risk and disease severity without the contribution of additional risk factors. Identification of disease modifiers accounting for the substantial phenotypic heterogeneity of patients with SNCA locus duplications could provide insight into molecular events involved in α-synuclein aggregation.
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Affiliation(s)
- Eleanna Kara
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Aoife P Kiely
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- The Queen Square Brain Bank, UCL Institute of Neurology, London, UK
| | - Christos Proukakis
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Nicola Giffin
- Department of Neurology, Frenchay Hospital, Bristol, UK
| | - Seth Love
- Department of Neuropathology, Frenchay Hospital, Bristol, UK
| | - Jason Hehir
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Khadija Rantell
- Biomedical Research Centre, UCL, London, UK
- Education Unit, UCL Institute of Neurology, Queen Square, London, UK
| | - Amelie Pandraud
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Dena G Hernandez
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- Laboratory of Neurogenetics, NIA, NIH, Bethesda, USA
| | | | - Alan M Pittman
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Mike A Nalls
- Laboratory of Neurogenetics, NIA, NIH, Bethesda, USA
| | | | - Tamas Revesz
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- The Queen Square Brain Bank, UCL Institute of Neurology, London, UK
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Niall Quinn
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - John Hardy
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Janice L Holton
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- The Queen Square Brain Bank, UCL Institute of Neurology, London, UK
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
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Coats C, Rantell K, Bartnik O, Patel A, Mist B, McKenna W, Elliott P. 88 Cardiopulmonary Exercise Testing and Prognosis in Hypertrophic Cardiomyopathy. Heart 2014. [DOI: 10.1136/heartjnl-2014-306118.88] [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: 11/03/2022]
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Saverino A, Moriarty A, Rantell K, Waller D, Ayres R, Playford D. A qualitative description of falls in a neuro-rehabilitation unit: the use of a standardised fall report including the International Classification of Functioning (ICF) to describe activities and environmental factors. Disabil Rehabil 2014; 37:355-62. [DOI: 10.3109/09638288.2014.923520] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alessia Saverino
- Institute of Neurology, University College London, London, UK,
- Institute of Rehabilitation, Fondazione Salvatore Maugeri, Genova, Italy, and
| | - Amy Moriarty
- Institute of Neurology, University College London, London, UK,
| | | | - Denise Waller
- Institute of Neurology, University College London, London, UK,
| | - Rachael Ayres
- Institute of Neurology, University College London, London, UK,
| | - Diane Playford
- Institute of Neurology, University College London, London, UK,
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Eissa AA, Tuck SM, Rantell K, Stott D. Trends in family planning and counselling for women with sickle cell disease in the UK over two decades. J Fam Plann Reprod Health Care 2014; 41:96-101. [DOI: 10.1136/jfprhc-2013-100763] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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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Mukadam N, Livingston G, Rantell K, Rickman S. Diagnostic rates and treatment of dementia before and after launch of a national dementia policy: an observational study using English national databases. BMJ Open 2014; 4:e004119. [PMID: 24413352 PMCID: PMC3902654 DOI: 10.1136/bmjopen-2013-004119] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the 2009 National Dementia Strategy's (NDS) impact on dementia diagnosis and treatment. SETTING AND PARTICIPANTS Primary care data for England before and after launch of the NDS. PRIMARY OUTCOME MEASURES We used nationally available data to estimate the trends over time in rates of dementia diagnoses recorded on the Quality Outcomes Framework (QOF) in Primary Care Trusts (PCT) and antidementia medication prescriptions from 2006/2007 (the first available figures) and the associated increase in cost relative to all other prescriptions. To establish PCT general practitioner (GP) QOF dementia recording validity, we correlated it with medication prescription using the NIC (net ingredient cost). RESULTS Regression analysis showed that dementia diagnosis rate was lower prior to launch of the NDS and increased significantly after it was launched. The number of antidementia prescriptions and the cost of antidementia drugs relative to total PCT prescribing costs increased significantly after 2009. GP recording of dementia diagnosis correlated highly with prescription of cholinesterase inhibitors and memantine in the same area (p<0.001 each year). CONCLUSIONS The launch of the NDS was associated with a significant increase in dementia diagnosis rates and prescriptions of antidementia drugs. We cannot establish the causality but this was a change from the prelaunch pattern. Further assessment of any intervention to increase the diagnoses should include an assessment of harm as well as potential benefit.
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Affiliation(s)
- Naaheed Mukadam
- Mental Health Sciences Unit, UCL, Charles Bell House, London, UK
| | - Gill Livingston
- Mental Health Sciences Unit, UCL, Charles Bell House, London, UK
| | | | - Sam Rickman
- Mental Health Sciences Unit, UCL, Charles Bell House, London, UK
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Gnanapavan S, Ho P, Heywood W, Jackson S, Grant D, Rantell K, Keir G, Mills K, Steinman L, Giovannoni G. Progression in multiple sclerosis is associated with low endogenous NCAM. J Neurochem 2013; 125:766-73. [PMID: 23495921 PMCID: PMC4298029 DOI: 10.1111/jnc.12236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 03/10/2013] [Accepted: 03/11/2013] [Indexed: 12/14/2022]
Abstract
Multiple sclerosis (MS) is a CNS disorder characterized by demyelination and neurodegeneration. Although hallmarks of recovery (remyelination and repair) have been documented in early MS, the regenerative capacity of the adult CNS per se remains uncertain with the wide held belief that it is either limited or non-existent. The neural cell adhesion molecule (NCAM) is a cell adhesion molecule that has been widely implicated in axonal outgrowth, guidance and fasciculation. Here, we used in vitro and in vivo of MS to investigate the role of NCAM in disease progression. We show that in health NCAM levels decrease over time, but this occurs acutely after demyelination and remains reduced in chronic disease. Our findings suggest that depletion of NCAM is one of the factors associated with or possibly responsible for disease progression in MS.
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Parker C, Kaplan RS, Gabe R, Ahmed HU, Rantell K, Emberton M. Multiparametric magnetic resonance imaging in the diagnosis and characterisation of prostate cancer: The PROMIS study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
62 Background: Over 1 million US men undergo prostate biopsy each year. About two thirds will test negative. This negative status is uncertain as up to a quarter will have prostate cancer on repeat biopsy. Further, a positive result often fails to discriminate clinically significant from insignificant disease. PROMIS will investigate whether multi-parametric MRI (mpMRI) can discriminate between men with no cancer or clinically insignificant cancer versus those with clinically significant cancer, using template prostate mapping (TPM) biopsies as the most accurate and appropriate reference test in men referred for biopsy. Methods: PROMIS is a multicenter, validating paired cohort study designed to include up to 714 men who will have an mpMRI (index test) and, under general anaesthetic, undergo 10-12 core TRUS biopsy (standard test) and TPM with sampling every 5mm throughout the prostate (reference test). All tests will be assessed independently. Clinically significant cancer on TPM is defined as dominant Gleason pattern ≥4 and/or cancer core length of ≥6mm. PROMIS is powered to measure an absolute increase in sensitivity from 48%, on TRUS biopsy, to at least 70%, by mpMRI. Results: The study will report the proportion of men (i) who could safely avoid biopsy and (ii) correctly identified by mpMRI to have clinically significant prostate cancer. mpMRI will be assessed using an ordinal score of 1 to 5 (highly likely benign - highly likely malignant), with a score ≥3 indicating a positive mpMRI for presence of clinically significant cancer. Secondary objectives will include outcomes based on another definition of clinically significant cancer (non-dominant Gleason pattern ≥4 and/or cancer core length ≥4mm), and cost-effectiveness of using mpMRI prior to biopsy. Conclusions: PROMIS will provide level 1 evidence by comparing mpMRI with the current standard, TRUS biopsy, using an accurate reference test that can be applied to all men advised to have a biopsy. If successful, mpMRI could in the future allow between a quarter and a half of US men referred to safely avoid a biopsy and/or improve the detection of clinically significant cancer by 20%.
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Affiliation(s)
- Chris Parker
- The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; University College London, London, United Kingdom
| | - Richard S. Kaplan
- The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; University College London, London, United Kingdom
| | - Rhian Gabe
- The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; University College London, London, United Kingdom
| | - Hashim Uddin Ahmed
- The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; University College London, London, United Kingdom
| | - Khadija Rantell
- The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; University College London, London, United Kingdom
| | - Mark Emberton
- The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; University College London, London, United Kingdom
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Hutchinson A, Coster JE, Cooper KL, McIntosh A, Walters SJ, Bath PA, Pearson M, Rantell K, Campbell MJ, Nicholl J, Irwin P. Assessing quality of care from hospital case notes: comparison of reliability of two methods. Qual Saf Health Care 2010; 19:e2. [PMID: 20511598 DOI: 10.1136/qshc.2007.023911] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine which of the two methods of case note review provide the most useful and reliable information for reviewing quality of care. DESIGN Retrospective, multiple reviews of 692 case notes were undertaken using both holistic (implicit) and criterion-based (explicit) review methods. Quality measures were evidence-based review criteria and a quality of care rating scale. SETTING Nine randomly selected acute hospitals in England. PARTICIPANTS Sixteen doctors, 11 specialist nurses and three clinically trained audit staff, and eight non-clinical audit staff. ANALYSIS METHODS: Intrarater consistency, inter-rater reliability between pairs of staff using intraclass correlation coefficients (ICCs), completeness of criterion data capture and between-staff group comparison. RESULTS A total of 1473 holistic reviews and 1389 criterion-based reviews were undertaken. When the three same staff types reviewed the same record, holistic scale score inter-rater reliability was moderate within each group (ICC 0.46 to 0.52). Inter-rater reliability for criterion-based scores was moderate to good (ICC 0.61 to 0.88). Comparison of holistic review score and criterion-based score of case notes reviewed by doctors and by non-clinical audit staff showed a reasonable level of agreement between the two methods. CONCLUSIONS Using a holistic approach to review case notes, same staff groups can achieve reasonable repeatability within their professional groups. When the same clinical record was reviewed twice by the doctors, and by the non-clinical audit staff, using both holistic and criterion-based methods, there are close similarities between the quality of care scores generated by the two methods. When using retrospective review of case notes to examine quality of care, a clear view is required of the purpose and the expected outputs of the project.
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Affiliation(s)
- A Hutchinson
- Section of Public Health, ScHARR, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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Hutchinson A, Coster JE, Cooper KL, McIntosh A, Walters SJ, Bath PA, Pearson M, Young TA, Rantell K, Campbell MJ, Ratcliffe J. Comparison of case note review methods for evaluating quality and safety in health care. Health Technol Assess 2010; 14:iii-iv, ix-x, 1-144. [DOI: 10.3310/hta14100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Hutchinson
- Section of Public Health, ScHARR, University of Sheffield, UK
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Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, Dallosso HM, Daly H, Doherty Y, Eaton S, Fox C, Oliver L, Rantell K, Rayman G, Khunti K. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ 2008. [PMID: 18276664 DOI: 10.1136/bmj.39474.922025.be.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a structured group education programme on biomedical, psychosocial, and lifestyle measures in people with newly diagnosed type 2 diabetes. DESIGN Multicentre cluster randomised controlled trial in primary care with randomisation at practice level. SETTING 207 general practices in 13 primary care sites in the United Kingdom. PARTICIPANTS 824 adults (55% men, mean age 59.5 years). INTERVENTION A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care. MAIN OUTCOME MEASURES Haemoglobin A(1c) levels, blood pressure, weight, blood lipid levels, smoking status, physical activity, quality of life, beliefs about illness, depression, and emotional impact of diabetes at baseline and up to 12 months. MAIN RESULTS Haemoglobin A(1c) levels at 12 months had decreased by 1.49% in the intervention group compared with 1.21% in the control group. After adjusting for baseline and cluster, the difference was not significant: 0.05% (95% confidence interval -0.10% to 0.20%). The intervention group showed a greater weight loss: -2.98 kg (95% confidence interval -3.54 to -2.41) compared with 1.86 kg (-2.44 to -1.28), P=0.027 at 12 months. The odds of not smoking were 3.56 (95% confidence interval 1.11 to 11.45), P=0.033 higher in the intervention group at 12 months. The intervention group showed significantly greater changes in illness belief scores (P=0.001); directions of change were positive indicating greater understanding of diabetes. The intervention group had a lower depression score at 12 months: mean difference was -0.50 (95% confidence interval -0.96 to -0.04); P=0.032. A positive association was found between change in perceived personal responsibility and weight loss at 12 months (beta=0.12; P=0.008). CONCLUSION A structured group education programme for patients with newly diagnosed type 2 diabetes resulted in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A(1c) levels up to 12 months after diagnosis. TRIAL REGISTRATION Current Controlled Trials ISRCTN17844016 [controlled-trials.com].
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Affiliation(s)
- M J Davies
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW.
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Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, Dallosso HM, Daly H, Doherty Y, Eaton S, Fox C, Oliver L, Rantell K, Rayman G, Khunti K. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ 2008; 336:491-5. [PMID: 18276664 PMCID: PMC2258400 DOI: 10.1136/bmj.39474.922025.be] [Citation(s) in RCA: 542] [Impact Index Per Article: 33.9] [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: 01/19/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a structured group education programme on biomedical, psychosocial, and lifestyle measures in people with newly diagnosed type 2 diabetes. DESIGN Multicentre cluster randomised controlled trial in primary care with randomisation at practice level. SETTING 207 general practices in 13 primary care sites in the United Kingdom. PARTICIPANTS 824 adults (55% men, mean age 59.5 years). INTERVENTION A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care. MAIN OUTCOME MEASURES Haemoglobin A(1c) levels, blood pressure, weight, blood lipid levels, smoking status, physical activity, quality of life, beliefs about illness, depression, and emotional impact of diabetes at baseline and up to 12 months. MAIN RESULTS Haemoglobin A(1c) levels at 12 months had decreased by 1.49% in the intervention group compared with 1.21% in the control group. After adjusting for baseline and cluster, the difference was not significant: 0.05% (95% confidence interval -0.10% to 0.20%). The intervention group showed a greater weight loss: -2.98 kg (95% confidence interval -3.54 to -2.41) compared with 1.86 kg (-2.44 to -1.28), P=0.027 at 12 months. The odds of not smoking were 3.56 (95% confidence interval 1.11 to 11.45), P=0.033 higher in the intervention group at 12 months. The intervention group showed significantly greater changes in illness belief scores (P=0.001); directions of change were positive indicating greater understanding of diabetes. The intervention group had a lower depression score at 12 months: mean difference was -0.50 (95% confidence interval -0.96 to -0.04); P=0.032. A positive association was found between change in perceived personal responsibility and weight loss at 12 months (beta=0.12; P=0.008). CONCLUSION A structured group education programme for patients with newly diagnosed type 2 diabetes resulted in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A(1c) levels up to 12 months after diagnosis. TRIAL REGISTRATION Current Controlled Trials ISRCTN17844016 [controlled-trials.com].
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Affiliation(s)
- M J Davies
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW.
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Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, Dallosso HM, Daly H, Doherty Y, Eaton S, Fox C, Oliver L, Rantell K, Rayman G, Khunti K. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ 2008. [PMID: 18276664 DOI: 10.1136/bmj.39553.528299.ad] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a structured group education programme on biomedical, psychosocial, and lifestyle measures in people with newly diagnosed type 2 diabetes. DESIGN Multicentre cluster randomised controlled trial in primary care with randomisation at practice level. SETTING 207 general practices in 13 primary care sites in the United Kingdom. PARTICIPANTS 824 adults (55% men, mean age 59.5 years). INTERVENTION A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care. MAIN OUTCOME MEASURES Haemoglobin A(1c) levels, blood pressure, weight, blood lipid levels, smoking status, physical activity, quality of life, beliefs about illness, depression, and emotional impact of diabetes at baseline and up to 12 months. MAIN RESULTS Haemoglobin A(1c) levels at 12 months had decreased by 1.49% in the intervention group compared with 1.21% in the control group. After adjusting for baseline and cluster, the difference was not significant: 0.05% (95% confidence interval -0.10% to 0.20%). The intervention group showed a greater weight loss: -2.98 kg (95% confidence interval -3.54 to -2.41) compared with 1.86 kg (-2.44 to -1.28), P=0.027 at 12 months. The odds of not smoking were 3.56 (95% confidence interval 1.11 to 11.45), P=0.033 higher in the intervention group at 12 months. The intervention group showed significantly greater changes in illness belief scores (P=0.001); directions of change were positive indicating greater understanding of diabetes. The intervention group had a lower depression score at 12 months: mean difference was -0.50 (95% confidence interval -0.96 to -0.04); P=0.032. A positive association was found between change in perceived personal responsibility and weight loss at 12 months (beta=0.12; P=0.008). CONCLUSION A structured group education programme for patients with newly diagnosed type 2 diabetes resulted in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A(1c) levels up to 12 months after diagnosis. TRIAL REGISTRATION Current Controlled Trials ISRCTN17844016 [controlled-trials.com].
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Affiliation(s)
- M J Davies
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW.
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Jones S, Rantell K, Stevens K, Colwell B, Ratcliffe JR, Holland P, Rowan K, Parry GJ. Outcome at 6 months after admission for pediatric intensive care: a report of a national study of pediatric intensive care units in the United kingdom. Pediatrics 2006; 118:2101-8. [PMID: 17079584 DOI: 10.1542/peds.2006-1455] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [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: 02/06/2023] Open
Abstract
OBJECTIVE The goal was to measure, by using the Health Utilities Index, the health status of children 6 months after admission to PICUs in the United Kingdom. METHODS All PICUs in the United Kingdom were invited to participate. Children who were > or = 6 months of age at admission and were discharged alive from participating units during a 1-year period were eligible for this study. Children with completed consent forms who had survived to 6 months after admission received the Health Utilities Index questionnaire. RESULTS Admission data on 7214 admissions to 22 units were collected between March 2001 and February 2002. Of those patients, 6786 survived to unit discharge, and consent for follow-up contact was obtained for 2642. At 6 months after admission, the mortality rate was estimated at 11.1% and 2034 children were still alive and contactable. Of those children, Health Utilities Index questionnaires were returned by 1455. No impairment was indicated for 767, 951, 940, 919, 962, and 939 children with respect to the Health Utilities Index sensation, cognition, emotion, pain, mobility, and self-care attributes, respectively. The mean +/- SE Health Utilities Index utility score was 0.73 +/- 0.01, with 397 children (27.3%) in full health. CONCLUSIONS Death after pediatric intensive care in the United Kingdom is uncommon, making assessment of health status important. At 6 months after admission, there is significant morbidity. To assess the impact of strategies to improve or to optimize care on longer-term outcomes, standardized collection of data on preexisting comorbidities and illness severity is required.
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Affiliation(s)
- Samantha Jones
- Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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