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Attar SG, Poustie VJ, Smye SW, Beety JM, Hawcutt DB, Littlewood S, Oni L, Pirmohamed M, Beresford MW. Working together to deliver stratified medicine research effectively. Br Med Bull 2019; 129:107-116. [PMID: 30753334 DOI: 10.1093/bmb/ldz003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION OR BACKGROUND Stratified medicine is an important area of research across all clinical specialties, with far reaching impact in many spheres. Despite recently formulated global policy and research programmes, major challenges for delivering stratified medicine studies persist. Across the globe, clinical research infrastructures have been setup to facilitate high quality clinical research. SOURCES OF DATA This article reviews the literature and summarizes views collated from a workshop held by the UK Pharmacogenetics and Stratified Medicine Network and the NIHR Clinical Research Network in November 2016. AREAS OF AGREEMENT Stratified medicine is an important area of clinical research and health policy, benefitting from substantial international, cross-sector investment and has the potential to transform patient care. However there are significant challenges to the delivery of stratified medicine studies. AREAS OF CONTROVERSY Complex methodology and lack of consistency of definition and agreement on key approaches to the design, regulation and delivery of research contribute to these challenges and would benefit from greater focus. GROWING POINTS Effective partnership and development of consistent approaches to the key factors relating to stratified medicine research is required to help overcome these challenges. AREAS TIMELY FOR DEVELOPING RESEARCH This paper examines the critical contribution clinical research networks can make to the delivery of national (and international) initiatives in the field of stratified medicine. Importantly, it examines the position of clinical research in stratified medicine at a time when pressures on the clinical and social services are mounting.
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Affiliation(s)
- S G Attar
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - V J Poustie
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
| | - S W Smye
- NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
| | - J M Beety
- NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
| | - D B Hawcutt
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - S Littlewood
- NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
| | - L Oni
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Pirmohamed
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M W Beresford
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
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Verghese G, Oni L, Milford D, Holt R. A snapshot of acute kidney injury in tertiary paediatric centres in the United Kingdom. Arch Pediatr 2017. [DOI: 10.1016/j.arcped.2017.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Oni L, Beresford M, Witte D, Chatzitolios A, Sebire N, Abulaban K, Shukla R, Ying J, Brunner H. Inter-observer variability of the histological classification of lupus glomerulonephritis in children. Arch Pediatr 2017. [DOI: 10.1016/j.arcped.2017.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Oni L, Beresford MW, Witte D, Chatzitolios A, Sebire N, Abulaban K, Shukla R, Ying J, Brunner HI. Inter-observer variability of the histological classification of lupus glomerulonephritis in children. Lupus 2017; 26:1205-1211. [PMID: 28478696 DOI: 10.1177/0961203317706558] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The gold standard for the classification of lupus nephritis is renal histology but reporting variation exists. The aim of this study was to assess the inter-observer variability of the 2003 International Society of Nephrology/Royal Pathology Society (ISN/RPS) lupus nephritis histological classification criteria in children. Histopathologists from a reference centre and three tertiary paediatric centres independently reviewed digitalized renal histology slides from 55 children with lupus nephritis. Histological ISN/RPS Class was assigned and features scored; lupus nephritis-activity [scored 0-24], lupus nephritis-chronicity [0-12] and tubulointerstitial activity [0-21]. In the cohort (73% females), the age at the time of biopsy was 15.5 ± 0.39 (mean ± standard error) years. Based on the reference centre, 42% (23/55) had ISN/RPS Class IV with lupus nephritis-activity score 4.23 ± 0.50, lupus nephritis-chronicity 1.81 ± 0.18 and tubulointerstitial activity 4.45 ± 0.35. There were 4-54 (mean 16.7) glomeruli per biopsy. Pathologists had fair agreement for ISN/RPS assignment (kappa; 0.26 ± 0.12), lupus nephritis-chronicity (intra-class correlation 0.36 ± 0.09) and tubulointerstitial activity (0.22 ± 0.09) scores. There was good agreement for lupus nephritis-activity scores (intra-class correlation 0.69 ± 0.06). When categorized into proliferative and non-proliferative disease, poor agreement among sites remained (kappa 0.24 ± 0.11). Despite unified criteria for the interpretation of histological features of lupus nephritis, marked reporting variation remains in clinical practice. As proliferative lupus nephritis is managed more intensively, this may influence renal outcomes.
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Affiliation(s)
- L Oni
- 1 Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.,2 Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M W Beresford
- 2 Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,3 Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - D Witte
- 4 Department of Pediatric Histopathology, Cincinnati Children's Hospital Medical Centre, Cincinnati, USA
| | - A Chatzitolios
- 5 Department of Histopathology, Southmead Hospital, Bristol, UK
| | - N Sebire
- 6 Department of Paediatric Histopathology, Great Ormond Street Hospital, London, UK
| | - K Abulaban
- 7 Department of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Centre, Cincinnati, USA
| | - R Shukla
- 8 Department of Paediatric Histopathology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - J Ying
- 9 Centre for Biostatistical Services, University of Cincinnati College of Medicine, Cincinnati, USA
| | - H I Brunner
- 7 Department of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Centre, Cincinnati, USA
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Patel M, Oni L, Midgley A, Smith E, Tullus K, Marks SD, Jones CA, Pilkington C, Beresford MW. Increased concentration of plasma TNFR1 and TNFR2 in paediatric lupus nephritis. Lupus 2016; 25:1040-4. [PMID: 26854079 DOI: 10.1177/0961203316631634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 08/19/2015] [Accepted: 01/13/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Juvenile-onset systemic lupus erythematous (JSLE) is a debilitating condition that frequently involves the kidneys (lupus nephritis; LN). Tumour necrosis factor alpha (TNF-α), an important pro-inflammatory cytokine, is expressed locally in the kidney and correlates with LN disease activity. The aim of this study was to ascertain whether soluble receptors for TNF-α (sTNFR1/sTNFR2) are significantly increased in children with LN. METHODS Plasma samples were collected from JSLE patients at routine review. Concentrations of sTNFR1 and sTNFR2 were measured (median; interquartile range, IQR) using enzyme-linked immunosorbent assay (ELISA) in 25 JSLE patients (seven LN) and 20 healthy controls (HCs). RESULTS sTNFR2 concentration was significantly increased in JSLE (5149 pg/dl, 3413-8561) compared to HCs (3858 pg/dl, 2254-5165; p = 0.049). sTNFR1 concentration was significantly increased in active LN (n = 7, 1765 pg/dl, IQR 1133-4167) compared to inactive LN (n = 18, 1104 pg/dl, 886-1272; p = 0.018). There was a non-significant increase in sTNFR2 concentration in active LN (9829 pg/dl, 3298-21271) compared to inactive LN (4595 pg/dl, 3345-6993; p = 0.146). sTNFR1 concentration correlated moderately with sTNFR2 (r = 0.66, p < 0.001). sTNFR2 demonstrated strong positive correlations with ESR (r = 0.941, p < 0.01) and anti-dsDNA antibodies (r = 0.998, p = 0.041). Both receptors also positively correlated with creatinine (TNFR1 r = 0.81, p < 0.001; TNFR2 r = 0.50, p = 0.015) and urinary albumin creatinine ratio (TNFR1 r = 0.64, p < 0.01; TNFR2 r = 0.63, p < 0.01). CONCLUSIONS These data indicate that sTNFR1 and sTNFR2 concentrations are elevated in LN and may reflect renal activity. These results provide basis for further investigation into the pathological pathways underlying LN.
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Affiliation(s)
- M Patel
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK
| | - L Oni
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Midgley
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK
| | - E Smith
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - K Tullus
- Department of Paediatric Nephrology, Great Ormond Street Children's NHS Hospital, London, UK
| | - S D Marks
- Department of Paediatric Nephrology, Great Ormond Street Children's NHS Hospital, London, UK
| | - C A Jones
- Department of Paediatric Nephrology, Great Ormond Street Children's NHS Hospital, London, UK
| | - C Pilkington
- Department of Rheumatology, Great Ormond Street Children's NHS Hospital, London, UK
| | - M W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Patel M, Oni L, Jeffers G, Smith E, Midgley A, Tullus K, Pilkington C, Marks S, Beresford M. THU0522 Plasma TNFR1 and TNFR2 in Active Paediatric Lupus Nephritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ekdawy D, Smith E, Oni L, Midgley A, Corkhill R, Jones C, Marks S, Newland P, Pilkington C, Tullus K, Beresford M. FRI0500 Exploring the Relationship of Urinary Vascular Cell Adhesion Molecule-1 with Lupus Nephritis Disease Activity Over Time. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Smith E, Oni L, Midgley A, Ekdawy D, Corkhill R, Jones C, Marks S, Newland P, Pilkington C, Tullus K, Beresford M. THU0373 Demonstration of an “Excellent” Biomarker Panel for Identifying Active Lupus Nephritis in Children. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Aljuburi G, Okoye O, Majeed A, Knight Y, Green S, Banarsee R, Nkohkwo A, Ojeer P, Ndive C, Oni L, Phekoo K. Views of patients about sickle cell disease management in primary care: a questionnaire-based pilot study. JRSM Short Rep 2012; 3:78. [PMID: 23323196 PMCID: PMC3545328 DOI: 10.1258/shorts.2012.011173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine how patients with sickle cell disease (SCD) perceive the quality of care that they receive from their primary healthcare providers. DESIGN A questionnaire-based pilot study was used to elicit the views of patients about the quality of care they have been receiving from their primary healthcare providers and what they thought was the role of primary care in SCD management. SETTING Sickle Cell Society and Sickle Cell and Thalassaemia Centre, in the London Borough of Brent. PARTICIPANTS One hundred questionnaires were distributed to potential participants with SCD between November 2010 and July 2011 of which 40 participants responded. MAIN OUTCOME MEASURES Analysis of 40 patient questionnaires collected over a nine-month period. RESULTS Most patients are generally not satisfied with the quality of care that they are receiving from their primary healthcare providers for SCD. Most do not make use of general practitioner (GP) services for management of their SCD. Collecting prescriptions was the reason most cited for visiting the GP. CONCLUSION GPs could help improve the day-to-day management of patients with SCD. This could be facilitated by local quality improvement schemes in areas with high disease prevalence. The results of the survey have been used to help develop a GP education intervention and a local enhanced service to support primary healthcare clinicians with SCD's ongoing management.
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Affiliation(s)
- G Aljuburi
- Department of Primary Care and Public Health, Imperial College London , London , UK
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Henderson SJ, Fishlock K, Horn ME, Oni L, Bellingham AJ. Neonatal screening for haemoglobin variants using filter paper-dried blood specimens. Clin Lab Haematol 2008; 13:327-34. [PMID: 1773586 DOI: 10.1111/j.1365-2257.1991.tb00295.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neonatal screening for haemoglobinopathies utilizing cord blood samples is well established, although it has a high miss rate and has the inherent problem of possible misdiagnosis from maternal contamination of the sample. The use of dried Guthrie card samples which are taken at six days of age avoids these problems and has the advantage of using an established system of sample collection. Controversy exists as to the method of choice for analysis of dried samples, this study of 2406 samples found that Iso-electric focusing (IEF) analysis of dried specimens gives excellent correlation when compared with cellulose acetate/citrate agar electrophoresis of liquid cord blood samples. The IEF results were clear and relatively simple to interpret even when the samples had been stored at room temperature for 4 weeks. The commercial enzyme linked immunosorbent assay (ELISA) screening test JOSHUA reliably determines the presence or absence of haemoglobin S in dried specimens. It could therefore be used as a relatively cheap and simple method for the confirmation of sickle cell trait in neonatal screening programmes based on dried specimens.
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Affiliation(s)
- S J Henderson
- Haematological Medicine, King's College Hospital, Camberwell, London
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Oni L, Bent S. Sickle cell disease. Nurs Times 1998; 94:50-3. [PMID: 9832789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- L Oni
- Brent Sickle and Thalassaemia Centre
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Oni L. Sickle cell disease and the carer-client relationship. Nurs Times 1998; 94:64-5. [PMID: 9739712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- L Oni
- Brent Sickle Cell and Thalassaemia Centre
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Maxwell K, Streetly A, Oni L. Fair shares for London. Mod Midwife 1997; 7:15-9. [PMID: 9470698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- K Maxwell
- Department of Public Health Medicine, United Medical School, St Thomas' Hospital
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Affiliation(s)
- S C Davies
- Imperial College, School of Medicine, Central Middlesex Hospital, London
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