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Carr RA, Mesiano D, Heffron C, Radonic T, Wiggins J, Tso S, Agrawal R, Cheung E, Slater DN, Nichols L, Craig P. Aberrant p16, p53 and Ki-67 immunohistochemistry staining patterns can distinguish solitary keratoacanthoma from cutaneous squamous cell carcinoma. Pathology 2023; 55:772-784. [PMID: 37573161 DOI: 10.1016/j.pathol.2023.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/09/2022] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 08/14/2023]
Abstract
Keratoacanthoma (KA) is widely considered a benign, usually self-resolving, neoplasm distinct from cutaneous squamous cell carcinoma (cSCC), while some consider KA to be indistinguishable from cSCC. Published studies indicate utility for p16, p53, Ki-67 immunostaining and elastic van Gieson (EVG) in the assessment of KA and cSCC. We compared clinical features and staining patterns for p16, p53, Ki-67 and EVG in fully excised KA, cSCC with KA-like features (cSCC-KAL) and other cSCC (cSCC-OTHER). Significant differences between KA, cSCC-KAL and cSCC-OTHER were found for head and neck location (20%, 86%, 84%), and duration <5 months (95%, 63%, 36%). KA shows both a mosaic pattern for p16 (>25-90% of neoplasm area) and peripheral graded pattern for p53 (up to 50% moderate and strong nuclear staining) in 92% compared with 0% of cSCC-KAL and 0% of cSCC-OTHER. In contrast, a highly aberrant pattern (usually null) for one or both p16 and p53, was present in 0% of KA, 83.8% of cSCC-KAL and 90.9% of cSCC-OTHER. Abnormal distribution of Ki-67 beyond the peripheral 1-3 cells was uncommon in KA (4.2%) and common in cSCC-KAL (67.6%) and cSCC-OTHER (88.4%). Moderate to striking entrapment of elastic and collagen fibres was present in the majority of KA (84%), cSCC-KAL (81%) and cSCC-OTHER (65%). KA are clinically distinct neoplasms typically of short duration occurring preferentially outside the head and neck and generally lacking aberrations of p16, p53 and Ki-67, compared with cSCC that have high rates of aberrant or highly aberrant p16, p53 and Ki-67, but EVG lacked specificity.
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Affiliation(s)
- Richard A Carr
- Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK.
| | - Domenico Mesiano
- Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Cynthia Heffron
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, Netherlands
| | - James Wiggins
- Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Simon Tso
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Rishi Agrawal
- Histopathology Department, New Cross Hospital, Wolverhampton, UK
| | - Elaine Cheung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong
| | | | - Linda Nichols
- Department of Statistics, University of Warwick, Coventry, UK
| | - Paul Craig
- Department of Histopathology, Cheltenham General Hospital, Gloucestershire, UK
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Nichols L, Taverner T, Crowe F, Richardson S, Yau C, Kiddle S, Kirk P, Barrett J, Nirantharakumar K, Griffin S, Edwards D, Marshall T. In simulated data and health records, latent class analysis was the optimum multimorbidity clustering algorithm. J Clin Epidemiol 2022; 152:164-175. [PMID: 36228971 PMCID: PMC7613854 DOI: 10.1016/j.jclinepi.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the reproducibility and validity of latent class analysis (LCA) and hierarchical cluster analysis (HCA), multiple correspondence analysis followed by k-means (MCA-kmeans) and k-means (kmeans) for multimorbidity clustering. METHODS We first investigated clustering algorithms in simulated datasets with 26 diseases of varying prevalence in predetermined clusters, comparing the derived clusters to known clusters using the adjusted Rand Index (aRI). We then them investigated the medical records of male patients, aged 65 to 84 years from 50 UK general practices, with 49 long-term health conditions. We compared within cluster morbidity profiles using the Pearson correlation coefficient and assessed cluster stability using in 400 bootstrap samples. RESULTS In the simulated datasets, the closest agreement (largest aRI) to known clusters was with LCA and then MCA-kmeans algorithms. In the medical records dataset, all four algorithms identified one cluster of 20-25% of the dataset with about 82% of the same patients across all four algorithms. LCA and MCA-kmeans both found a second cluster of 7% of the dataset. Other clusters were found by only one algorithm. LCA and MCA-kmeans clustering gave the most similar partitioning (aRI 0.54). CONCLUSION LCA achieved higher aRI than other clustering algorithms.
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Affiliation(s)
- Linda Nichols
- Research Fellow, Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
| | - Tom Taverner
- Research Fellow, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Francesca Crowe
- Lecturer in Epidemiology and Health Informatics, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Sylvia Richardson
- Emeritus Director, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Christopher Yau
- Professor of Artificial Intelligence, Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Steven Kiddle
- Director, Health Data Science, AstraZeneca, 1 Francis Crick Avenue, Cambridge, Biomedical Campus, Cambridge, CB2 0AA, UK
| | - Paul Kirk
- MRC Investigator, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Jessica Barrett
- MRC Investigator, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Krishnarajah Nirantharakumar
- Professor of Public Health and Health Informatics, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Simon Griffin
- Professor of General Practice, Primary Care Unit, Strangeways Research Laboratory Worts Causeway Cambridge CB1 8RN, UK
| | - Duncan Edwards
- Senior Clinical Research Associate, Primary Care Unit, Primary Care Unit, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Tom Marshall
- Professor of Public Health and Primary Care, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK.
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Nichols L, Olson DM. We Are in This Together. J Neurosci Nurs 2022; 54:144-145. [PMID: 35776516 DOI: 10.1097/jnn.0000000000000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nguyen TP, Stirling C, Nichols L, Chandra RV, Rehman S, Buscot MJ, Smith KL, Blizzard L, Lai L, Asadi H, Arvind D, Froelich J, Thani N, Reeves MJ, Thrift AG, Gall SL. Abstract TMP11: Predictors Of Timely Treatment Of Aneurysmal Subarachnoid Hemorrhage - The Reddish Study. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tmp11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Receiving early treatment for aneurysmal subarachnoid hemorrhage (aSAH) is associated with better outcomes for the patient. However, delays in treatment of aSAH are common but the causes are not well understood. We explored predictors of early treatment within 12.5 hours or 24 hours after aSAH.
Methods:
Consecutive cases of confirmed first-ever aSAH were identified from two Australian tertiary referral centers between 2010 and 2016. We used medical and ambulance records to extract details of participants, including time from onset to definitive treatment of either endovascular coiling or neurosurgical clipping, demographics, severity of aSAH (modified Fisher grade; World Federation of Neurosurgeons Scale [WFNS]), risk factors, pre-hospital care, and presenting symptoms. Factors associated with treatment to secure the aneurysm within 12.5 hours or 24 hours on univariable logistic regression were entered into a multivariable model to identify factors independently associated with (odds ratio [OR], 95% CI) earlier treatment.
Results:
Among 482 patients (mean [SD] age 54.1 [14.5]; 69.9% female) with aSAH, median (IQR) time to treatment was 19.4 (10.6, 31.0) hours, 30% were treated <12.5h and 62% were treated <24h from onset. In multivariable analyses (see figure), arriving by ambulance, urgent triage category (1-2) and severe aSAH (modified Fisher Scale 3-4) predicted treatment <12.5h and <24h. Less severe aSAH (WFNS score 1-3) and arriving overnight (11pm to 7am) were associated with treatment <24h. In contrast, people with no risk factors for aSAH (smoking, hypertension or alcohol use), presenting with a stiff neck or interfacility transfer more often had treatment ≥12.5h.
Conclusions:
A substantial proportion of people after aSAH were not treated within timeframes associated with better outcomes. Recognition of the urgency and severity aSAH cases were associated with more timely treatment of aSAH.
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Affiliation(s)
| | | | | | | | - Sabah Rehman
- Menzies Rsch Institute, Univ of Tasmania, Hobart, Australia
| | | | | | - Leigh Blizzard
- Menzies Institute for Med Rsch, Univ of Tasmania, Hobart, Australia
| | - Leon Lai
- Monash Health, Clayton, Australia
| | - Hamed Asadi
- Austin and Monash Health, Melbourne, Australia
| | | | | | | | | | | | - Seana L Gall
- Menzies Institute for Med Rsch, Univ of Tasmania, Hobart, Australia
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Buscot MJ, Chandra RV, Mainguard J, Nichols L, Blizzard L, Stirling C, Smith K, Lai L, Asadi H, Froelich J, Reeves MJ, Thani N, Thrift A, Gall S. Association of Onset-to-Treatment Time With Discharge Destination, Mortality, and Complications Among Patients With Aneurysmal Subarachnoid Hemorrhage. JAMA Netw Open 2022; 5:e2144039. [PMID: 35061040 PMCID: PMC8783267 DOI: 10.1001/jamanetworkopen.2021.44039] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Rapid access to specialized care is recommended to improve outcomes after aneurysmal subarachnoid hemorrhage (SAH), but understanding of the optimal onset-to-treatment time for aneurysmal SAH is limited. OBJECTIVE To assess the optimal onset-to-treatment time for aneurysmal SAH that maximized patient outcomes after surgery. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed 575 retrospectively identified cases of first-ever aneurysmal SAH occurring within the referral networks of 2 major tertiary Australian hospitals from January 1, 2010, to December 31, 2016. Individual factors, prehospital factors, and hospital factors were extracted from the digital medical records of eligible cases. Data analysis was performed from March 1, 2020, to August 31, 2021. EXPOSURES Main exposure was onset-to-treatment time (time between symptom onset and aneurysm surgical treatment in hours) derived from medical records. MAIN OUTCOMES AND MEASURES Clinical characteristics, complications, and discharge destination were extracted from medical records and 12-month survival obtained from data linkage. The associations of onset-to-treatment time (in hours) with (1) discharge destination of survivors (home vs rehabilitation), (2) 12-month survival, and (3) neurologic complications (rebleed, delayed cerebral ischemia, meningitis, seizure, hydrocephalus, and delayed cerebral injury) were investigated using natural cubic splines in multivariable Cox proportional hazards and logistic regression models. RESULTS Of the 575 patients with aneurysmal SAH, 482 patients (mean [SD] age, 55.0 [14.5] years; 337 [69.9%] female) who received endovascular coiling or neurosurgical clipping were studied. A nonlinear association of treatment delay was found with the odds of being discharged home vs rehabilitation (effective df = 3.83 in the generalized additive model, χ2 test P = .002 for the 4-df cubic spline), with a similar nonlinear association remaining significant after adjustment for sex, treatment modality, severity, Charlson Comorbidity Index, history of hypertension, and hospital transfer (likelihood ratio test: df = 3, deviance = 9.57, χ2 test P = .02). Both unadjusted and adjusted cox regression models showed a nonlinear association between time to treatment and 12-month mortality with the lowest hazard of death with receipt of treatment at 12.5 hours after symptom onset, although the nonlinear term became nonsignificant upon adjustment. The odds of being discharged home were higher with treatment before 20 hours after onset, with the probability of being discharged home compared with rehabilitation or other hospital increased by approximately 10% when treatment was received within the first 12.5 hours after symptom onset and increased by an additional 5% from 12.5 to 20 hours. Time to treatment was not associated with any complications. CONCLUSIONS AND RELEVANCE This cohort study found evidence that more favorable outcomes (discharge home and survival at 12 months) were achieved when surgical treatment occurred at approximately 12.5 hours. These findings provide more clarity around optimal timelines of treatment with people with aneurysmal SAH; however, additional studies are needed to confirm the findings.
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Affiliation(s)
- Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ronil V. Chandra
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Julian Mainguard
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
| | - Linda Nichols
- School of Nursing, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Karen Smith
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Leon Lai
- School of Clinical Sciences Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
| | - Jens Froelich
- NeuroInterventional Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Mathew J. Reeves
- Department of Epidemiology, Michigan State University, East Lansing
| | - Nova Thani
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Amanda Thrift
- School of Clinical Sciences Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Abstract
BACKGROUND Many studies have investigated magnetic field exposure and the risks of motor neuron disease (MND). Meta-analyses have found positive associations but a causal relationship has not been established. AIMS To investigate the risks of MND and occupational exposure to magnetic fields in a large UK cohort. METHODS Mortality of 37 986 employees of the former Central Electricity Generating Board of England and Wales was investigated for the period 1987-2018. Employees were first employed in the period 1942-82 and were still in employment on the 1 November, 1987. Detailed calculations enabled estimates to be made of magnetic field exposures. Observed deaths were compared with expected numbers based on mortality rates for the general population of England and Wales and Poisson regression was used to calculate rate ratios (relative risks) for categories of lifetime, lagged (distant) and lugged (recent) magnetic field exposure. RESULTS Mortality from MND in the total cohort was similar to national rates (observed 69, expected 71.3, SMR 97, 95% CI 76-122). There were no statistically significant trends of risks increasing with lifetime, recent or distant magnetic field exposure, although positive associations were observed for some categories of recent exposure. CONCLUSIONS The study did not find that the cohort had elevated risks of MND as a consequence of occupational lifetime exposure to magnetic fields, although a possible role for recent exposures could usefully be investigated in other datasets.
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Affiliation(s)
- Tom Sorahan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Linda Nichols
- Department of Statistics, Mathematical Sciences Building, University of Warwick, Coventry, UK
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Nichols L, Zuber J, Burns R, Martindale-Adams J. Caring Again: Parent Caregivers for Their Wounded Adult Children Veterans. Innov Aging 2021. [PMCID: PMC8680392 DOI: 10.1093/geroni/igab046.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
With military personnel in Iraq and Afghanistan surviving what were previously fatal injuries, there is ongoing discussion about how to provide care for them and support their families. Parents frequently provide care for their unmarried, injured adult children, especially those returning with polytraumatic injuries, PTSD, or Traumatic Brain Injury (TBI). Parents (n=160) of combat injured adult children who participated in a DoD-funded behavioral intervention study are described. Parents were mainly mothers, average age 60.2 years, with ages ranging from 45 to 79. The veterans had functional limitations, and only 9.2% were employed. Parents, on average, had been caregivers for 6.6 years and daily spent 7.7 hours providing care and 17.2 hours on duty, primarily focused on supervision and daily life management rather than physical care. Average caregiver burden score approached high and was related to veteran TBI diagnosis, aggressive behavior toward others, and functional limitations. Few parents (22.7%) worked full-time; 85.3% had decreased personal spending, 84.0% dipped into personal savings, and 58.9% reduced retirement saving. These findings are similar to those of aging parent caregivers of adult children with serious mental illness or developmental disabilities in amount of care provided to their adult children, their level of burden, financial and career cost to themselves, and concern about their future and their children’s future. As these parents and their adult children age, providing care and resources will present greater challenges for them, for the military and veteran care systems they rely on for support, and for society.
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Affiliation(s)
- Linda Nichols
- VA Medical Center 11H, Memphis, Tennessee, United States
| | - Jeffrey Zuber
- University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Robert Burns
- University of Tennessee Health Science Center, University of Tennessee Health Science Center, Tennessee, United States
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Rehman S, Chandra RV, Lai LT, Asadi H, Dubey A, Froelich J, Thani N, Nichols L, Blizzard L, Smith K, Thrift AG, Stirling C, Callisaya M, Breslin M, Reeves MJ, Gall S. Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH). J Neurol Sci 2021; 428:117613. [PMID: 34418669 DOI: 10.1016/j.jns.2021.117613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is limited research on the provision of evidence-based care and its association with outcomes after aneurysmal subarachnoid hemorrhage (aSAH). AIMS We examined adherence to evidence-based care after aSAH and associations with survival and discharge destination. Also, factors associated with evidence-based care including age, sex, Charlson comorbidity index, severity scores, and delayed cerebral ischemia and infarction were examined for association with survival and discharge destination. METHODS In a retrospective cohort (2010-2016) of all aSAH cases across two comprehensive cerebrovascular centres, we extracted 3 indicators of evidence-based aSAH care from medical records: (1) antihypertensives prior to aneurysm treatment, (2) nimodipine, and (3) aneurysm treatment (coiling/clipping). We defined 'optimal care' as receiving all eligible processes of care. Survival at 1 year was obtained by data linkage. We estimated (1) proportion of patients and characteristics associated with receiving processes of care, (2) associations between processes of care with 1-year mortality using cox-proportional hazard model and discharge destination with log binomial regression adjusting for age, sex, severity of aSAH, delayed cerebral ischemia and/or cerebral infarction and comorbidities. Sensitivity analyses explored effect modification of the association between processes of care and outcome by management type (active versus comfort measures). RESULTS Among 549 patients (69% women), 59% were managed according to the guidelines. Individual indicators were associated with lower 1-year mortality but not discharge destination. Optimal care reduced mortality at 1 year in univariable (HR 0.24 95% CI 0.17-0.35) and multivariable analyses (HR 0.51 95% CI 0.34-0.77) independent of age, sex, severity, comorbidities, and hospital network. CONCLUSION Adherence to processes of care reduced 1-year mortality after aSAH. Many patients with aSAH do not receive evidence-based care and this must be addressed to improve outcomes.
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Affiliation(s)
- Sabah Rehman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ronil V Chandra
- NeuroInterventional Radiology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Leon T Lai
- Neurosurgery, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Hamed Asadi
- NeuroInterventional Radiology, Monash Health, Clayton, Victoria, Australia
| | - Arvind Dubey
- Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Jens Froelich
- NeuroInterventional Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Nova Thani
- Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Linda Nichols
- School of Nursing, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at, Monash Health, Monash University, Clayton, Victoria, Australia
| | | | - Michele Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Peninsula Clinical School, Monash University, Clayton, Victoria, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mathew J Reeves
- Department of Epidemiology, Michigan State University, East Lansing, MI, USA
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Monash University, Clayton, Victoria, Australia.
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BUSCOT MJ, Chandra RV, Nichols L, Blizzard L, Stirling C, Smith KL, Lai L, Asadi H, Reeves MJ, Froelich J, Thani N, Thrift AG, Gall SL. Abstract P37: Impact of Onset-To-Treatment Time on Hospital Discharge Destination After Aneurysmal Subarachnoid Haemorrhage - The REDDISH Study. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aims:
Rapid access to specialised care improves outcomes after aneurysmal subarachnoid haemorrhage (aSAH) but there is limited evidence on the optimal time-to-treatment. We investigated onset-to-treatment time and hospital discharge destination in aSAH.
Methods:
Consecutive first-ever aSAH patients were retrospectively identified from multiple overlapping sources in two comprehensive cerebrovascular referral centres between 2010-2016. Onset-to-treatment time (hours from onset of symptoms to treatment to secure aneurysm), clinical characteristics, and neurological complications (NINDS classifications) were extracted by clinical data collectors from medical records. Among survivors, we estimated the effect of continuous onset-to-treatment on hospital discharge destination (i.e. home vs. rehabilitation/other hospital as proxy for functional recovery) using logistic regression with adjustment for gender, treatment type (clipping or coiling), hospital presentation (direct admission or transfer), and severity (World Federation of Neurosurgical Societies scale, modified Fisher scale). Non-linear effects were investigated using natural cubic splines.
Results:
Among 402 survivors at discharge, there was a strong non-linear effect of onset-to-treatment time on odds of being discharged home compared to discharge to rehabilitation independent of severity, gender, treatment type and transfer (see Figure). The greatest benefit to discharge home was evident with treatment at up to 12.5 hours but the benefit remained at up to 20 hours post-onset.
Conclusions:
aSAH Treatment occurring within 12.5 hours led to greater discharge to home. Our use of continuous modelling provides clarity around optimal treatment times for aSAH to guide clinical practice.
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Affiliation(s)
| | | | - Linda Nichols
- Sch of Nursing, UNIVERSITY OF TASMANIA, Hobart, Australia
| | - Leigh Blizzard
- Menzies Institute for Med Rsch, UNIVERSITY OF TASMANIA, Hobart, Australia
| | | | | | - Leon Lai
- Dept of Neurosurgery, Monash Health, Clayton, Australia
| | - Hamed Asadi
- Austin and Monash Health, Melbourne, Australia
| | | | - Jens Froelich
- Royal Hobart Hosp, Tasmanian Health Service, Hobart, Australia
| | - Nova Thani
- Royal Hobart Hosp, Tasmanian Health Service, Hobart, Australia
| | | | - Seana L Gall
- Menzies Institute for Med Rsch, UNIVERSITY OF TASMANIA, Hobart, Australia
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Nguyen TP, Rehman S, Stirling C, Chandra RV, Nichols L, Gall SL. Abstract P48: Factors Associated With Delay to Treatment of Aneurysmal Subarachnoid Hemorrhage (aSAH) - A Systematic Review. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Delay in treatment of aneurysmal subarachnoid haemorrhage (aSAH) appears to be common, contributing to the poor outcomes of patients. We currently have limited understanding of the causes of these delays. The aim of this systematic review was to identify delays in treatment of patients with aSAH, and to identify factors associated with treatment delay.
Methods:
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. We searched four electronic databases (MEDLINE, EMBASE, Web of Science, and Google Scholar) for manuscripts published from January 1998 to 2020 using pre-designated search terms and search strategy. Main outcomes were duration of delays of any time intervals from onset of aSAH to definitive treatment and/or factors related to delays.
Results:
A total of 64 studies met study entry criteria. We identified 16 different time intervals in the pathway of aSAH patients and 17 groups of predictors to delay in treatment. Most studies measured time intervals between four major time points including time of onset, hospital admission, diagnosis, and receiving coiling or clipping. Methods to measure delay in treatment varied largely between studies, using cut-off timepoints or measured absolute time duration using mean or median. Demographic factors (age, sex, race, or socioeconomic status) were not associated with time to treatment. More severe aSAH reduced treatment delay in most studies. Pre-hospital delays (patients delay, late referral, late arrival of ambulance, being transferred between hospitals or arriving at the hospital outside of office hours) were associated with treatment delay. In-hospital factors (complication, having other procedures before definitive treatment, and type of treatment) had two-way association with treatment delay - both increasing and decreasing time to treatment.
Conclusions:
This review provides the first comprehensive understanding of types and predictors of delays in treatment of aSAH. There is significant opportunity to increase the comparability of aSAH time to treatment data, and to identify pre-hospital and in-hospital factors that currently delay treatment.
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Affiliation(s)
| | | | | | | | - Linda Nichols
- Sch of Nursing, UNIVERSITY OF TASMANIA, Hobart, Australia
| | - Seana L Gall
- Menzies Institute for Med Rsch, UNIVERSITY OF TASMANIA, Hobart, Australia
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Hinton L, Nguyen H, Nguyen HT, Harvey DJ, Nichols L, Martindale‐Adams J, Nguyen BT, Nguyen BTT, Nguyen AN, Nguyen CH, Nguyen TTH, Nguyen TL, Nguyen ATP, Nguyen NB, Tiet QQ, Nguyen TA, Nguyen PQ, Nguyen TA, Pham T. Advancing family dementia caregiver interventions in low- and middle-income countries: A pilot cluster randomized controlled trial of Resources for Advancing Alzheimer's Caregiver Health in Vietnam (REACH VN). Alzheimers Dement (N Y) 2021; 6:e12063. [PMID: 33532542 PMCID: PMC7825546 DOI: 10.1002/trc2.12063] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Low- and middle-income countries have rapidly increasing numbers of people with dementia, yet little evidence on family caregiving interventions. We tested the preliminary efficacy and feasibility of a family caregiving intervention in northern Vietnam. METHODS Nine clusters comprising 60 family caregivers were randomized to a culturally adapted version of a four- to six-session, multicomponent intervention delivered in-home over 2 to 3 months, or enhanced control. Eligible caregivers were ≥18 years of age and scored ≥6 on the Zarit Burden Inventory (ZBI). RESULTS Fifty-one caregivers (85%) completed the study. Using analysis of covariance with 3-month assessment as the outcome and baseline assessment as a covariate, intervention group caregivers had an average ZBI (primary outcome) score 1.2 standard deviation (SD) lower (P = .02) and Patient Health Questionnaire-4 (psychological distress) score 0.7 SD lower (P = .03) than controls. DISCUSSION In the first study of its kind in Vietnam, a culturally adapted, manualized, family caregiver intervention was both efficacious and feasible.
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Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | - Huong Nguyen
- Department of Religious StudiesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Hung Trong Nguyen
- Vietnam National Geriatric HospitalHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | - Danielle J Harvey
- Department of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | - Linda Nichols
- Caregiver CenterVeterans Affairs Medical CenterMemphisTennesseeUSA
- Department of Preventive MedicineUniversity of Tennessee Health Sciences CenterMemphisTennesseeUSA
| | - Jennifer Martindale‐Adams
- Caregiver CenterVeterans Affairs Medical CenterMemphisTennesseeUSA
- Department of Preventive MedicineUniversity of Tennessee Health Sciences CenterMemphisTennesseeUSA
| | | | | | | | | | | | | | | | | | - Quyen Q. Tiet
- California School of Professional Psychology at Alliant International UniversitySan FranciscoCaliforniaUSA
| | | | | | - Trung Anh Nguyen
- Vietnam National Geriatric HospitalHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | - Thang Pham
- Vietnam National Geriatric HospitalHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
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Nichols L, Gall S, Stankovich J, Stirling C. Associations between socioeconomic status and place of residence with survival after aneurysmal subarachnoid haemorrhage. Intern Med J 2020; 51:2095-2103. [PMID: 32893943 DOI: 10.1111/imj.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aims to understand early (< 24 h post ictus) and late (up to 12 months) survival post aneurysmal subarachnoid haemorrhage (aSAH), with a focus on rurality and socioeconomic status. METHODS A statewide population-based cohort of aSAH cases in Tasmania, Australia, was established from 2010-2014 utilising multiple overlapping sources. Clinical data were collected from medical records and the Tasmanian Death Registry, with area-level rurality and socioeconomic status geocoded to participants' residential address. RESULTS From a cohort of 237 (70% women, 36% disadvantaged, 38% rural) individuals over a 5-year period, 12-month mortality was 52.3% with 54.0% of these deaths occurring within 24 h post ictus. In univariable analysis of 12-month survival, outcome was not influenced by socioeconomic status but rural geographical location was associated with a non-significant increase in death (HR 1.22 95% CI 0.85-1.75) along with hypertension (HR 1.78 95% CI 1.07-2.98) and hypercholesterolemia (HR 1.70 95% CI 0.99-2.91). Multivariable analysis demonstrated a statistically significant increase in death to 12 months after aSAH for both hypertension (HR 1.81 95% CI 1.08-3.03) and hypercholesterolemia (HR 1.71 95% CI 1.00-2.94) but not socioeconomic status or geographic location. CONCLUSION We found high early death in this population-based aSAH Australian population. Survival to 12 months after aSAH was not related to either geographical location or socioeconomic status but modifiable risk factors increased the risk of death. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Linda Nichols
- School of Nursing, University of Tasmania, 71 Brooker Ave Glebe, 7001, Hobart, Tasmania, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania
| | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University
| | - Christine Stirling
- School of Nursing, University of Tasmania, 71 Brooker Ave Glebe, 7001, Hobart, Tasmania, Australia
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Nichols L, Stirling C, Stankovich J, Gall S. Time to treatment following an aneurysmal subarachnoid hemorrhage, rural place of residence and inter-hospital transfers. Australas Emerg Care 2020; 23:225-232. [PMID: 32883630 DOI: 10.1016/j.auec.2020.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/14/2020] [Revised: 04/21/2020] [Accepted: 05/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Little is known about how transfers influence time to treatment for cases of aneurysmal subarachnoid hemorrhage (aSAH). We examine the effect of geographical location, socioeconomic status and inter-hospital transfer on time to treatment following an aSAH. METHODS A state-wide retrospective cohort study was established from 2010-2014. Time intervals from ictus to treatment were calculated. Linear regression examined associations between transfer status, place of residence and socioeconomic status and log-transformed times to treatment. RESULTS The median (IQR) time to intervention was 13.78 (6.48-20.63) hours. Socioeconomic disadvantage was associated with a 1.52-fold increase in the time to hospital (p<0.05) and a 1.76-fold increase in time to neurosurgical admission (p<0.05). Residing in an outer regional area was associated with a 2.27-fold increase (p<0.05) in time to neurosurgical admission. Inter-hospital transfers were associated with a 6.26-fold increase in time to neurosurgical admission (p<0.05). CONCLUSIONS The time to treatment was negatively influenced by socioeconomic disadvantage; geographical location and inter-hospital transfers. The urgent transfer of individuals with suspected aSAH is undeniably necessary when neurosurgical services are unavailable locally. The timeliness and organisation of transfers should be reviewed to overcome the potential vulnerability to poor outcomes for people from rural and disadvantaged areas.
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Affiliation(s)
| | | | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania
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Rehman S, Chandra RV, Zhou K, Tan D, Lai L, Asadi H, Froelich J, Thani N, Nichols L, Blizzard L, Smith K, Thrift AG, Stirling C, Callisaya ML, Breslin M, Reeves MJ, Gall S. Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome. Acta Neurochir (Wien) 2020; 162:2271-2282. [PMID: 32607744 DOI: 10.1007/s00701-020-04469-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/15/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women are over-represented in aSAH cohorts, but whether their outcomes differ to men remains unclear. We examined if sex differences in neurological complications and aneurysm characteristics contributed to aSAH outcomes. METHODS In a retrospective cohort (2010-2016) of all aSAH cases across two hospital networks in Australia, information on severity, aneurysm characteristics and neurological complications (rebleed before/after treatment, postoperative stroke < 48 h, neurological infections, hydrocephalus, seizures, delayed cerebral ischemia [DCI], cerebral infarction) were extracted. We estimated sex differences in (1) complications and aneurysm characteristics using chi square/t-tests and (2) outcome at discharge (home, rehabilitation or death) using multinomial regression with and without propensity score matching on prestroke confounders. RESULTS Among 577 cases (69% women, 84% treated) aneurysm size was greater in men than women and DCI more common in women than men. In unadjusted log multinomial regression, women had marginally greater discharge to rehabilitation (RRR 1.15 95% CI 0.90-1.48) and similar likelihood of in-hospital death (RRR 1.02 95% CI 0.76-1.36) versus discharge home. Prestroke confounders (age, hypertension, smoking status) explained greater risk of death in women (rehabilitation RRR 1.13 95% CI 0.87-1.48; death RRR 0.75 95% CI 0.51-1.10). Neurological complications (DCI and hydrocephalus) were covariates explaining some of the greater risk for poor outcomes in women (rehabilitation RRR 0.87 95% CI 0.69-1.11; death RRR 0.80 95% CI 0.52-1.23). Results were consistent in propensity score matched models. CONCLUSION The marginally poorer outcome in women at discharge was partially attributable to prestroke confounders and complications. Improvements in managing complications could improve outcomes.
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Affiliation(s)
- Sabah Rehman
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia
| | - Ronil V Chandra
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Kevin Zhou
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
| | - Darius Tan
- Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Leon Lai
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
| | - Jens Froelich
- NeuroInterventional Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Nova Thani
- Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Linda Nichols
- School of Nursing, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia
| | | | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | | | - Michele L Callisaya
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia
| | - Mathew J Reeves
- Department of Epidemiology, Michigan State University, East Lansing, MI, USA
| | - Seana Gall
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia.
- Monash University, Melbourne, Victoria, Australia.
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Nichols L, Knighton A, Brunisholz K, Elbel R, Smith G, Choberka A, Belnap T, Allen T, Moore M, Srivastava R. Adapting a Complex, Integrated Health and Social Services Intervention in Two Communities. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- L. Nichols
- Intermountain Healthcare Salt Lake City UT United States
| | - A. Knighton
- Intermountain Healthcare Murray UT United States
| | | | - R. Elbel
- SelectHealth Murray UT United States
| | - G. Smith
- Intermountain Healthcare Salt Lake City UT United States
| | - A. Choberka
- Intermountain Healthcare Ogden UT United States
| | - T. Belnap
- Intermountain Healthcare Murray UT United States
| | - T. Allen
- Intermountain Healthcare Salt Lake City UT United States
| | - M. Moore
- Intermountain Healthcare Salt Lake City UT United States
| | - R. Srivastava
- Intermountain Healthcare Salt Lake City UT United States
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Nichols L, Martindale-Adams J. IMPROVING ACCESS AND OUTCOMES FOR RURAL CAREGIVERS USING THE TELEPHONE. Innov Aging 2019. [PMCID: PMC6841582 DOI: 10.1093/geroni/igz038.2265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Many caregivers of older rural veterans have limited access to services. In 2017, VA’s Office of Rural Health and Caregiver Support Program funded the Memphis Caregiver Center to deliver Resources for Enhancing All Caregivers Health (REACH VA) as a national behavioral intervention to improve access to care. To date, 438 caregivers of older Veterans have enrolled. REACH is a proven 4-session caregiver intervention, structured and easily replicated. Rural internet service is often problematic. Offering REACH by telephone provides many benefits, including access to service not available in the rural area, almost universal technology penetration, ease and familiarity of use, and removal of barriers of travel and care for the loved one. Through this enhanced service, caregivers of older veterans with dementia, PTSD, ALS, MS, and other conditions have shown statistically and clinically significant improvements in managing concerns and safety relating to their loved one and their own stress and coping.
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Affiliation(s)
- Linda Nichols
- VA Medical Center, Memphis, Tennessee, United States
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Torlinska B, Nichols L, Mohammed MA, McCabe C, Boelaert K. Patients Treated for Hyperthyroidism Are at Increased Risk of Becoming Obese: Findings from a Large Prospective Secondary Care Cohort. Thyroid 2019; 29:1380-1389. [PMID: 31375059 DOI: 10.1089/thy.2018.0731] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: The most commonly reported symptom of hyperthyroidism is weight loss; successful treatment increases weight. Weight gain faced by patients with hyperthyroidism is widely considered a simple reaccumulation of premorbid weight, whereas many patients feel there is a significant weight "overshoot" attributable to the treatment. We aimed to establish if weight gain seen following treatment for hyperthyroidism represents replenishment of premorbid weight or "overshoot" beyond expected regain and, if there is excessive weight gain, whether this is associated with the applied treatment modality. Methods: We calculated the risk of becoming obese (body mass index [BMI] >30 kg/m2) following treatment for hyperthyroidism by comparing BMI of 1373 patients with overt hyperthyroidism seen in a secondary care setting with the age- and sex-matched background population (Health Survey for England, 2007-2009). Next, we investigated the effect of treatment with an antithyroid drug (ATD) alone in regard to ATD with radioactive iodine (131I) therapy. We modeled the longitudinal weight data in relation to the treatment pathway to thyroid function and the need for long-term thyroxine replacement. Results: During treatment of hyperthyroidism, men gained 8.0 kg (standard deviation ±7.5) and women 5.5 kg (±6.8). At discharge, there was a significantly increased risk of obesity in male (odds ratio = 1.7 [95% confidence interval 1.3-2.2], p < 0.001) and female (1.3, 1.2-1.5, p < 0.001) patients with hyperthyroidism compared with the background population. Treatment with 131I was associated with additional weight gain (0.6 kg, 0.4-0.8, p < 0.001), compared with ATD treatment alone. More weight gain was seen if serum thyrotropin (TSH) was markedly increased (TSH >10 mIU/L; 0.5 kg, 0.3-0.7, p < 0.001) or free thyroxine (fT4) was reduced (fT4 ≤ 10 pmol/L (0.8 ng/dL); 0.3 kg, 0.1-0.4, p < 0.001) during follow-up. Initiation of levothyroxine was associated with further weight gain (0.4 kg, 0.2-0.6, p < 0.001) and the predicted excess weight gain in 131I-induced hypothyroidism was 1.8 kg. Conclusions: Treatment for hyperthyroidism is associated with significant risks of becoming obese. 131I treatment and subsequent development of hypothyroidism were associated with small but significant amounts of excess weight gain compared with ATD alone. We advocate that the discussion over the weight "overshoot" risk forms part of the individualized treatment decision-making process.
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Affiliation(s)
| | - Linda Nichols
- Institute of Applied Health Research; Birmingham, United Kingdom
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | | | - Chris McCabe
- Institute of Metabolism and Systems Research; University of Birmingham, Birmingham, United Kingdom
| | - Kristien Boelaert
- Institute of Metabolism and Systems Research; University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Edgbaston, Birmingham, United Kingdom
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Nichols L. Editorial. Australasian Journal of Neuroscience 2019. [DOI: 10.21307/ajon-2017-013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Nichols L. Lack of understanding. Br Dent J 2019; 226:912. [DOI: 10.1038/s41415-019-0476-3] [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: 11/09/2022]
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Šumilo D, Nichols L, Ryan R, Marshall T. Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records. Br J Gen Pract 2019; 69:e33-e41. [PMID: 30397014 PMCID: PMC6301361 DOI: 10.3399/bjgp18x699833] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/07/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Neither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based is known. AIM To determine the incidence of indications for tonsillectomy in UK children, and the proportion of tonsillectomies meeting evidence-based criteria. DESIGN AND SETTING A retrospective cohort study of electronic medical records of children aged 0-15 years registered with 739 UK general practices contributing to a research database. METHOD Children with recorded indications for tonsillectomy were identified from electronic medical records. Evidence-based indications included documented sore throats of sufficient frequency and severity (Paradise criteria); periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA); or tonsillar tumour. Other indications were considered non-evidence-based. The numbers of children subsequently undergoing tonsillectomy was then identified. The numbers with evidence-based and non-evidence-based indications for surgery among children who had undergone tonsillectomy were determined. RESULTS The authors included 1 630 807 children followed up for 7 200 159 person-years between 2005 and 2016. Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years; 13.6% (2144/15 760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years; 11.7% (2144/18 281) had evidence-based indications, almost all with Paradise criteria. The proportion of evidence-based tonsillectomies was unchanged over 12 years. Most childhood tonsillectomies followed non-evidence-based indications: five to six sore throats (12.4%) in 1 year, two to four sore throats (44.6%) in 1 year, sleep disordered breathing (12.3%), or obstructive sleep apnoea (3.9%). CONCLUSION In the UK, few children with evidence-based indications undergo tonsillectomy and seven in eight of those who do (32 500 of 37 000 annually) are unlikely to benefit.
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Affiliation(s)
- Dana Šumilo
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Linda Nichols
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ronan Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Nichols L, Ryan R, Connor C, Birchwood M, Marshall T. Derivation of a prediction model for a diagnosis of depression in young adults: a matched case-control study using electronic primary care records. Early Interv Psychiatry 2018; 12:444-455. [PMID: 27027490 DOI: 10.1111/eip.12332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/18/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 80 000 children and young people in the UK suffer from depression, but many are untreated because of poor identification of early warning signs and risk factors. AIMS This study aimed to derive and to investigate discrimination characteristics of a prediction model for a first recorded diagnosis of depression in young people aged 15-24 years. METHOD This study used a matched case-control method using electronic primary care records. Stepwise conditional logistic regression modelling investigated 42 potential predictors including symptoms, co-morbidities, social factors and drug and alcohol misuse. RESULTS Of the socio-economic and symptomatic predictors identified, the strongest associations were with depression symptoms and other psychological conditions. School problems and social services involvement were prominent predictors in men aged 15-18 years, work stress in women aged 19-24 years. CONCLUSION Our model is a first step in the development of a predictive model identifying early warning signs of depression in young people in primary care.
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Affiliation(s)
- Linda Nichols
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Ronan Ryan
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Charlotte Connor
- Centre for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Max Birchwood
- WMS - Mental Health and Wellbeing, University of Warwick, Coventry, UK
| | - Tom Marshall
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
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Clegg A, Bates C, Young J, Ryan R, Nichols L, Teale EA, Mohammed MA, Parry J, Marshall T. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing 2018; 47:319. [PMID: 28100452 PMCID: PMC6016616 DOI: 10.1093/ageing/afx001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nichols L, Mulyatsih E. Neuroscience Nursing in Indonesia: Striving for Recognition through Education and Regional Collaboration. Australasian Journal of Neuroscience 2018. [DOI: 10.21307/ajon-2017-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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24
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Evans V, Nichols L. Editorial. Australasian Journal of Neuroscience 2018. [DOI: 10.21307/ajon-2017-119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Vicki Evans
- Neuroscience Nursing Faculty of Health , University of Tasmania , Hobart ; Australia
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Nichols L, Cecula D. Editorial and Guest Editorial. Australasian Journal of Neuroscience 2017. [DOI: 10.21307/ajon-2017-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Taylor CJ, Ryan R, Nichols L, Gale N, Hobbs FDR, Marshall T. Reply to Forsyth et al., commenting on our paper 'Survival following a diagnosis of heart failure in primary care'. Fam Pract 2017; 34:502-503. [PMID: 28854675 DOI: 10.1093/fampra/cmx040] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 11/14/2022] Open
Affiliation(s)
- Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Nicola Gale
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Clegg A, Bates C, Young J, Ryan R, Nichols L, Teale E, Mohammed M, Parry J, Marshall T. 129Development, Internal Validation And Independent External Validation Of An Electronic Frailty Index Using Routine Primary Care Electronic Health Record Data. Age Ageing 2017. [DOI: 10.1093/ageing/afx068.129] [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: 11/14/2022] Open
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Abstract
BACKGROUND Heart failure is a common long term condition affecting around 900 000 people in the UK and patients commonly present to primary care. The prognosis of patients with a code of heart failure in their primary care record is unknown. OBJECTIVE The study sought to determine the overall survival rates for patients with heart failure in a primary care population from the time of diagnosis. METHODS Survival analysis was carried out using UK primary care records from The Health Improvement Network (THIN) between 1 January 1998 and 31 December 2012. Patients age 45 or over with a first diagnostic label of heart failure were matched by age, sex and practice to people without heart failure. Outcome was death in the heart failure and no heart failure cohorts. Kaplan-Meier curves were used to compare survival. Age-specific survival rates at 1, 5 and 10 years were determined for men and women with heart failure. Survival rates by year of diagnosis and case definition were also calculated. RESULTS During the study period, 54313 patients had a first diagnostic code of heart failure. Overall survival rates for the heart failure group were 81.3% (95%CI 80.9-81.6), 51.5% (95%CI 51.0-52.0) and 29.5% (95%CI 28.9-30.2) at 1, 5 and 10 years respectively and did not change over time. CONCLUSIONS In a primary care population, the survival of patients diagnosed with heart failure did not improved over time. Further research is needed to explain these trends and to find strategies to improve outlook.
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Affiliation(s)
- Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ronan Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Linda Nichols
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Clegg A, Bates C, Young J, Ryan R, Nichols L, Ann Teale E, Mohammed MA, Parry J, Marshall T. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing 2016; 45:353-60. [PMID: 26944937 PMCID: PMC4846793 DOI: 10.1093/ageing/afw039] [Citation(s) in RCA: 916] [Impact Index Per Article: 114.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/20/2016] [Indexed: 12/05/2022] Open
Abstract
Background: frailty is an especially problematic expression of population ageing. International guidelines recommend routine identification of frailty to provide evidence-based treatment, but currently available tools require additional resource. Objectives: to develop and validate an electronic frailty index (eFI) using routinely available primary care electronic health record data. Study design and setting: retrospective cohort study. Development and internal validation cohorts were established using a randomly split sample of the ResearchOne primary care database. External validation cohort established using THIN database. Participants: patients aged 65–95, registered with a ResearchOne or THIN practice on 14 October 2008. Predictors: we constructed the eFI using the cumulative deficit frailty model as our theoretical framework. The eFI score is calculated by the presence or absence of individual deficits as a proportion of the total possible. Categories of fit, mild, moderate and severe frailty were defined using population quartiles. Outcomes: outcomes were 1-, 3- and 5-year mortality, hospitalisation and nursing home admission. Statistical analysis: hazard ratios (HRs) were estimated using bivariate and multivariate Cox regression analyses. Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was assessed using pseudo-R2 estimates. Results: we include data from a total of 931,541 patients. The eFI incorporates 36 deficits constructed using 2,171 CTV3 codes. One-year adjusted HR for mortality was 1.92 (95% CI 1.81–2.04) for mild frailty, 3.10 (95% CI 2.91–3.31) for moderate frailty and 4.52 (95% CI 4.16–4.91) for severe frailty. Corresponding estimates for hospitalisation were 1.93 (95% CI 1.86–2.01), 3.04 (95% CI 2.90–3.19) and 4.73 (95% CI 4.43–5.06) and for nursing home admission were 1.89 (95% CI 1.63–2.15), 3.19 (95% CI 2.73–3.73) and 4.76 (95% CI 3.92–5.77), with good to moderate discrimination but low calibration estimates. Conclusions: the eFI uses routine data to identify older people with mild, moderate and severe frailty, with robust predictive validity for outcomes of mortality, hospitalisation and nursing home admission. Routine implementation of the eFI could enable delivery of evidence-based interventions to improve outcomes for this vulnerable group.
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Affiliation(s)
- Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, West Yorkshire, United Kingdom of Great Britain and Northern Ireland
| | - Chris Bates
- ResearchOne, TPP, Leeds, West Yorkshire, United Kingdom of Great Britain and Northern Ireland
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, West Yorkshire, United Kingdom of Great Britain and Northern Ireland
| | - Ronan Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Linda Nichols
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Elizabeth Ann Teale
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, West Yorkshire, United Kingdom of Great Britain and Northern Ireland
| | - Mohammed A Mohammed
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, United Kingdom of Great Britain and Northern Ireland
| | - John Parry
- SystmOne, TPP, Leeds, West Yorkshire, United Kingdom of Great Britain and Northern Ireland
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
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Mather C, Cummings E, Nichols L. Social Media Training for Professional Identity Development in Undergraduate Nurses. Stud Health Technol Inform 2016; 225:344-348. [PMID: 27332219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The growth of social media use has led to tension affecting the perception of professionalism of nurses in healthcare environments. The aim of this cross-sectional study was to explore first and final year undergraduate student use of social media to understand how it was utilised by them during their course. Descriptive statistical analysis was undertaken to compare differences between first and final year student use. No difference indicated there was a lack of development in the use of social media, particularly concerning in relation to expanding their professional networks. There is a need for the curriculum to include opportunities to teach student nurses methods to ensure the appropriate and safe use of social media. Overt teaching and modelling of desired behaviour to guide and support the use of social media to positively promote professional identity formation, which is essential for work-readiness at graduation, is necessary.
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Affiliation(s)
- Carey Mather
- School of Health Sciences, University of Tasmania
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Nichols L, Wright K. Implementing a Primary Healthcare Framework: The Importance of Nursing Leadership in Developing and Maintaining a Brain Tumor Support Group. Clin J Oncol Nurs 2015. [DOI: 10.1188/15.cjon.463-467] [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: 11/17/2022]
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Lycett D, Nichols L, Ryan R, Farley A, Roalfe A, Mohammed MA, Szatkowski L, Coleman T, Morris R, Farmer A, Aveyard P. The association between smoking cessation and glycaemic control in patients with type 2 diabetes: a THIN database cohort study. Lancet Diabetes Endocrinol 2015; 3:423-430. [PMID: 25935880 DOI: 10.1016/s2213-8587(15)00082-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 12/19/2014] [Revised: 03/09/2015] [Accepted: 03/16/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Smoking increases the risk of developing type 2 diabetes. However, several population studies also show a higher risk in people 3-5 years after smoking cessation than in continuing smokers. After 10-12 years the risk equates to that of never-smokers. Small cohort studies suggest diabetes control deteriorates temporarily during the first year after quitting. We examined whether or not quitting smoking was associated with altered diabetes control in a population study, for how long this association persisted, and whether or not this association was mediated by weight change. METHODS We did a retrospective cohort study (Jan 1, 2005, to Dec 31, 2010) of adult smokers with type 2 diabetes using The Health Improvement Network (THIN), a large UK primary care database. We developed adjusted multilevel regression models to investigate the association between a quit event, smoking abstinence duration, change in HbA1c, and the mediating effect of weight change. FINDINGS 10 692 adult smokers with type 2 diabetes were included. 3131 (29%) quit smoking and remained abstinent for at least 1 year. After adjustment for potential confounders, HbA1c increased by 0·21% (95% CI 0·17-0·25; p<0·001; [2·34 mmol/mol (95% CI 1·91-2·77)]) within the first year after quitting. HbA1c decreased as abstinence continued and became comparable to that of continual smokers after 3 years. This increase in HbA1c was not mediated by weight change. INTERPRETATION In type 2 diabetes, smoking cessation is associated with deterioration in glycaemic control that lasts for 3 years and is unrelated to weight gain. At a population level, this temporary rise could increase microvascular complications. FUNDING National Institute for Health Research School for Primary Care Research.
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Affiliation(s)
- Deborah Lycett
- Coventry University, Faculty of Health and Life Sciences, Coventry, UK.
| | - Linda Nichols
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Ronan Ryan
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Amanda Farley
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Andrea Roalfe
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | | | - Lisa Szatkowski
- School of Medicine, University of Nottingham, Division of Epidemiology and Public Health, Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK
| | - Tim Coleman
- School of Medicine, University of Nottingham, Division of Primary Care, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Richard Morris
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, UK
| | - Andrew Farmer
- University of Oxford, Nuffield Department of Primary Care Health Sciences, New Radcliffe House Radcliffe Observatory Quarter, Oxford, UK
| | - Paul Aveyard
- University of Oxford, Nuffield Department of Primary Care Health Sciences, New Radcliffe House Radcliffe Observatory Quarter, Oxford, UK
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Begh R, Munafò MR, Shiffman S, Ferguson SG, Nichols L, Mohammed MA, Holder RL, Sutton S, Aveyard P. Lack of attentional retraining effects in cigarette smokers attempting cessation: a proof of concept double-blind randomised controlled trial. Drug Alcohol Depend 2015; 149:158-65. [PMID: 25697911 PMCID: PMC4961243 DOI: 10.1016/j.drugalcdep.2015.01.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 10/02/2014] [Revised: 01/20/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Observational studies have shown that attentional bias for smoking-related cues is associated with increased craving and relapse. Laboratory experiments have shown that manipulating attentional bias may change craving. Interventions to reduce attentional bias could reduce relapse in smokers seeking to quit. We report a clinical trial of attentional retraining in treatment-seeking smokers. METHODS This was a double-blind randomised controlled trial that took place in UK smoking cessation clinics. Smokers interested in quitting were randomised to five weekly sessions of attentional retraining (N=60) or placebo training (N = 58) using a modified visual probe task from one week prior to quit day. Both groups received 21 mg nicotine patches (from quit day onwards) and behavioural support. Primary outcomes included change in attentional bias reaction times four weeks after quit day on the visual probe task and craving measured weekly using the Mood and Physical Symptoms Scale. Secondary outcomes were changes in withdrawal symptoms, time to first lapse and prolonged abstinence. RESULTS No attentional bias towards smoking cues was found in the sample at baseline (mean difference = 3 ms, 95% CI = -2, 9). Post-training bias was not significantly lower in the retraining group compared with the placebo group (mean difference = -9 ms, 95% CI = -20, 2). There was no difference between groups in change in craving (p = 0.89) and prolonged abstinence at four weeks (risk ratio = 1.00, 95% CI = 0.70, 1.43). CONCLUSIONS Taken with one other trial, there appears to be no effect from clinic-based attentional retraining using the visual probe task. Attentional retraining conducted out of clinic may prove more effective. CLINICAL TRIAL REGISTRATION UK Clinical Trials ISRCTN 54375405.
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Affiliation(s)
- Rachna Begh
- UK Centre for Tobacco and Alcohol Studies, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - Marcus R Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol BS8 2BN, UK
| | - Saul Shiffman
- Department of Psychology, University of Pittsburgh, Sennott Square, 3rd Floor, 210 South Bouquet Street, Pittsburgh, PA 15260, USA
| | - Stuart G Ferguson
- School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS 7001, Australia
| | - Linda Nichols
- Primary Care Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | | | - Roger L Holder
- Primary Care Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge CB2 1TN, UK
| | - Paul Aveyard
- UK Centre for Tobacco and Alcohol Studies, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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Murtagh EM, Nichols L, Mohammed MA, Holder R, Nevill AM, Murphy MH. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med 2015; 72:34-43. [PMID: 25579505 DOI: 10.1016/j.ypmed.2014.12.041] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/24/2014] [Accepted: 12/30/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of randomised control trials that examined the effect of walking on risk factors for cardiovascular disease. METHODS Four electronic databases and reference lists were searched (Jan 1971-June 2012). Two authors identified randomised control trials of interventions ≥ 4 weeks in duration that included at least one group with walking as the only treatment and a no-exercise comparator group. Participants were inactive at baseline. Pooled results were reported as weighted mean treatment effects and 95% confidence intervals using a random effects model. RESULTS 32 articles reported the effects of walking interventions on cardiovascular disease risk factors. Walking increased aerobic capacity (3.04 mL/kg/min, 95% CI 2.48 to 3.60) and reduced systolic (-3.58 mm Hg, 95% CI -5.19 to -1.97) and diastolic (-1.54 mm Hg, 95% CI -2.83 to -0.26) blood pressure, waist circumference (-1.51 cm, 95% CI -2.34 to -0.68), weight (-1.37 kg, 95% CI -1.75 to -1.00), percentage body fat (-1.22%, 95% CI -1.70 to -0.73) and body mass index (-0.53 kg/m(2), 95% CI -0.72 to -0.35) but failed to alter blood lipids. CONCLUSIONS Walking interventions improve many risk factors for cardiovascular disease. This underscores the central role of walking in physical activity for health promotion.
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Affiliation(s)
- Elaine M Murtagh
- Department of Arts Education and Physical Education, Mary Immaculate College, University of Limerick, Limerick, Ireland.
| | - Linda Nichols
- School of Health and Population Sciences, University of Birmingham, Birmingham, England, UK
| | | | - Roger Holder
- School of Health and Population Sciences, University of Birmingham, Birmingham, England, UK
| | - Alan M Nevill
- School of Sports, Performing Arts and Leisure, University of Wolverhampton, Wolverhampton, England, UK
| | - Marie H Murphy
- Sport and Exercise Science Research Institute, University of Ulster, Newtownabbey, Co. Antrim, Northern Ireland, UK
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Macleod J, Tang L, Hobbs FDR, Wharton B, Holder R, Hussain S, Nichols L, Stewart P, Clark P, Luzio S, Holly J, Davey Smith G. Effects of nutritional supplementation during pregnancy on early adult disease risk: follow up of offspring of participants in a randomised controlled trial investigating effects of supplementation on infant birth weight. PLoS One 2013; 8:e83371. [PMID: 24349496 PMCID: PMC3862758 DOI: 10.1371/journal.pone.0083371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 11/01/2013] [Indexed: 01/08/2023] Open
Abstract
Background Observational evidence suggests that improving fetal growth may improve adult health. Experimental evidence from nutritional supplementation trials undertaken amongst pregnant women in the less developed world does not show strong or consistent effects on adult disease risk and no trials from the more developed world have previously been reported. Objective To test the hypothesis that nutritional supplementation during pregnancy influences offspring disease risk in adulthood Design Clinical assessment of a range of established diseases risk markers in young adult offspring of 283 South Asian mothers who participated in two trials of nutritional supplementation during pregnancy (protein/energy/vitamins; energy/vitamins or vitamins only) at Sorrento Maternity Hospital in Birmingham UK either unselected or selected on the basis of nutritional status. Results 236 (83%) offspring were traced and 118 (50%) of these were assessed in clinic. Protein/energy/vitamins supplementation amongst undernourished mothers was associated with increased infant birthweight. Nutritional supplementation showed no strong association with any one of a comprehensive range of markers of adult disease risk and no consistent pattern of association with risk across markers in offspring of either unselected or undernourished mothers. Conclusions We found no evidence that nutritional supplements given to pregnant women are an important influence on adult disease risk however our study lacked power to estimate small effects. Our findings do not provide support for a policy of nutritional supplementation for pregnant women as an effective means to improve adult health in more developed societies.
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Affiliation(s)
- John Macleod
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Department of Primary Care and General Practice, University of Birmingham, Birmingham, United Kingdom
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| | - Lie Tang
- Department of Primary Care and General Practice, University of Birmingham, Birmingham, United Kingdom
| | - F. D. Richard Hobbs
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Brian Wharton
- Institutes of Child Health, University of London and University of Birmingham, London and Birmingham, United Kingdom
| | - Roger Holder
- Department of Primary Care and General Practice, University of Birmingham, Birmingham, United Kingdom
| | - Shakir Hussain
- Department of Primary Care and General Practice, University of Birmingham, Birmingham, United Kingdom
| | - Linda Nichols
- Department of Primary Care and General Practice, University of Birmingham, Birmingham, United Kingdom
| | - Paul Stewart
- Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, United Kingdom
| | - Penny Clark
- Department of Clinical Biochemistry, University Hospital Birmingham, Birmingham, United Kingdom
| | - Steve Luzio
- College of Medicine, Swansea University, Swansea, United Kingdom
| | - Jeff Holly
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Begh R, Munafò MR, Shiffman S, Ferguson SG, Nichols L, Mohammed MA, Holder RL, Sutton S, Aveyard P. Attentional bias retraining in cigarette smokers attempting smoking cessation (ARTS): study protocol for a double blind randomised controlled trial. BMC Public Health 2013; 13:1176. [PMID: 24330656 PMCID: PMC3890623 DOI: 10.1186/1471-2458-13-1176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 10/22/2013] [Accepted: 12/02/2013] [Indexed: 12/05/2022] Open
Abstract
Background Smokers attend preferentially to cigarettes and other smoking-related cues in the environment, in what is known as an attentional bias. There is evidence that attentional bias may contribute to craving and failure to stop smoking. Attentional retraining procedures have been used in laboratory studies to train smokers to reduce attentional bias, although these procedures have not been applied in smoking cessation programmes. This trial will examine the efficacy of multiple sessions of attentional retraining on attentional bias, craving, and abstinence in smokers attempting cessation. Methods/Design This is a double-blind randomised controlled trial. Adult smokers attending a 7-session weekly stop smoking clinic will be randomised to either a modified visual probe task with attentional retraining or placebo training. Training will start 1 week prior to quit day and be given weekly for 5 sessions. Both groups will receive 21 mg transdermal nicotine patches for 8–12 weeks and withdrawal-orientated behavioural support for 7 sessions. Primary outcome measures are the change in attentional bias reaction time and urge to smoke on the Mood and Physical Symptoms Scale at 4 weeks post-quit. Secondary outcome measures include differences in withdrawal, time to first lapse and prolonged abstinence at 4 weeks post-quit, which will be biochemically validated at each clinic visit. Follow-up will take place at 8 weeks, 3 months and 6 months post-quit. Discussion This is the first randomised controlled trial of attentional retraining in smokers attempting cessation. This trial could provide proof of principle for a treatment aimed at a fundamental cause of addiction. Trial registration Current Controlled Trials: ISRCTN54375405.
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Affiliation(s)
- Rachna Begh
- Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, UK Centre for Tobacco and Alcohol Studies, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK.
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Chawla S, Milano M, Nichols L, Dimitroff L, O'Loughlin R, Walker J, Andrews C, Nagel M, Maracle D, Mohile S. Geriatric Assessment in Radiation Oncology Clinic: A Pilot Study. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ford SJ, Obeidy P, Lovejoy DB, Bedford M, Nichols L, Chadwick C, Tucker O, Lui GYL, Kalinowski DS, Jansson PJ, Iqbal TH, Alderson D, Richardson DR, Tselepis C. Deferasirox (ICL670A) effectively inhibits oesophageal cancer growth in vitro and in vivo. Br J Pharmacol 2013; 168:1316-28. [PMID: 23126308 DOI: 10.1111/bph.12045] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/09/2012] [Accepted: 10/15/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND PURPOSE Growing evidence implicates iron in the aetiology of gastrointestinal cancer. Furthermore, studies demonstrate that iron chelators possess potent anti-tumour activity, although whether iron chelators show activity against oesophageal cancer is not known. EXPERIMENTAL APPROACH The effect of the iron chelators, deferoxamine (DFO) and deferasirox, on cellular iron metabolism, viability and proliferation was assessed in two oesophageal adenocarcinoma cell lines, OE33 and OE19, and the squamous oesophageal cell line, OE21. A murine xenograft model was employed to assess the effect of deferasirox on oesophageal tumour burden. The ability of chelators to overcome chemoresistance and to enhance the efficacy of standard chemotherapeutic agents (cisplatin, fluorouracil and epirubicin) was also assessed. KEY RESULTS Deferasirox and DFO effectively inhibited cellular iron acquisition and promoted intracellular iron mobilization. The resulting reduction in cellular iron levels was reflected by increased transferrin receptor 1 expression and reduced cellular viability and proliferation. Treating oesophageal tumour cell lines with an iron chelator in addition to a standard chemotherapeutic agent resulted in a reduction in cellular viability and proliferation compared with the chemotherapeutic agent alone. Both DFO and deferasirox were able to overcome cisplatin resistance. Furthermore, in human xenograft models, deferasirox was able to significantly suppress tumour growth, which was associated with decreased tumour iron levels. CONCLUSIONS AND IMPLICATIONS The clinically established iron chelators, DFO and deferasirox, effectively deplete iron from oesophageal tumour cells, resulting in growth suppression. These data provide a platform for assessing the utility of these chelators in the treatment of oesophageal cancer patients.
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Affiliation(s)
- S J Ford
- School of Cancer Sciences, Department of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
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Tullett J, Murray E, Nichols L, Holder R, Lester W, Rose P, Hobbs FDR, Fitzmaurice D. Trial Protocol: a randomised controlled trial of extended anticoagulation treatment versus routine anticoagulation treatment for the prevention of recurrent VTE and post thrombotic syndrome in patients being treated for a first episode of unprovoked VTE (The ExACT Study). BMC Cardiovasc Disord 2013; 13:16. [PMID: 23497371 PMCID: PMC3602651 DOI: 10.1186/1471-2261-13-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/01/2013] [Indexed: 11/22/2022] Open
Abstract
Background Venous thromboembolism comprising pulmonary embolism and deep vein thrombosis is a common condition with an incidence of approximately 1 per 1,000 per annum causing both mortality and serious morbidity. The principal aim of treatment of a venous thromboembolism with heparin and warfarin is to prevent extension or recurrence of clot. However, the recurrence rate following a deep vein thrombosis remains approximately 10% per annum following treatment cessation irrespective of the duration of anticoagulation therapy. Patients with raised D-dimer levels after discontinuing oral anticoagulation treatment have also been shown to be at high risk of recurrence. Post thrombotic syndrome is a complication of a deep vein thrombosis which can lead to chronic venous insufficiency and ulceration. It has a cumulative incidence after 2 years of around 25% and it has been suggested that extended oral anticoagulation should be investigated as a possible preventative measure. Methods/design Patients with a first idiopathic venous thromboembolism will be recruited through anticoagulation clinics and randomly allocated to either continuing or discontinuing warfarin treatment for a further 2 years and followed up on a six monthly basis. At each visit D-dimer levels will be measured using a Roche Cobas h 232 POC device. In addition a venous sample will be taken for laboratory D-dimer analysis at the end of the study. Patients will be examined for signs and symptoms of PTS using the Villalta scale and complete VEINES and EQ5D quality of life questionnaires. Discussion The primary aim of the study is to investigate whether extending oral anticoagulation treatment (prior to discontinuing treatment) beyond 3–6 months for patients with a first unprovoked proximal deep vein thrombosis or pulmonary embolism prevents recurrence. The study will also determine the role of extending anticoagulation for patients with elevated D-dimer levels prior to discontinuing treatment and identify the potential of D-dimer point of care testing for identification of high risk patients within a primary care setting. Trial registration ISRCTN73819751
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Affiliation(s)
- Jayne Tullett
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Hashem MG, Cleary K, Fishman D, Nichols L, Khalid M. Effect of concurrent prescription antiarthralgia pharmacotherapy on persistence to aromatase inhibitors in treatment-naive postmenopausal females. Ann Pharmacother 2013; 47:29-34. [PMID: 23324501 DOI: 10.1345/aph.1r369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Aromatase inhibitors function by suppressing estrogen biosynthesis in peripheral tissues. The resulting estrogen deprivation is considered the underlying cause for aromatase inhibitor-induced arthralgia, which affects patients' quality of life and may affect their persistence to aromatase inhibitor therapy. The effect of concurrent treatment with aromatase inhibitors and prescription antiarthralgia pharmacotherapy on improving persistence to aromatase inhibitor therapy is unknown. OBJECTIVE To evaluate the effect of concurrent prescription antiarthralgia pharmacotherapy on persistence to aromatase inhibitor therapy in treatment-naïve postmenopausal women. METHODS This retrospective cohort pharmacy claims study examined the drug utilization pattern between July 2008 and October 2009 of postmenopausal females, naïve to aromatase inhibitor therapy, with 18 months of continuous prescription benefit eligibility. Patients were divided into 2 groups: group A (control) included patients who did not have a claim for a prescription antiarthralgia medication in a 1-year follow-up period, while group B (active) included patients with prescription antiarthralgia medications started within the 1-year follow-up period after starting treatment with an aromatase inhibitor. Persistence to aromatase inhibitor therapy was compared between the 2 groups. RESULTS The study population comprised 29,967 patients: 24,804 (82.8%) in group A, and 5163 (17.2%) in group B. Aromatase inhibitor discontinuation rates within the first year of therapy were not statistically significantly different between groups: 40.9% in group A (10,145/24,804) and 34.5% in group B (1781/5163) (HR 1.127; 95% CI 0.900-1.411; p = 0.297). Persistence for the 2 groups did not differ statistically significantly for any of the 3 aromatase inhibitors measured separately. CONCLUSIONS Postmenopausal females treatment-naïve to aromatase inhibitor therapy who also received treatment with a prescription antiarthralgia medication did not have significantly higher persistence with aromatase inhibitor therapy. Further research should focus on other possible causes of poor persistence in patients using aromatase inhibitor therapy.
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Nichols L, Pippins J, Castle L, Cassler M, Fuller C. Molecular monitoring of chronic myeloid leukemia: a personalized approach to optimizing treatment response. Per Med 2012; 9:727-737. [PMID: 29776270 DOI: 10.2217/pme.12.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Personalized medicine is rapidly developing a purposeful niche in the field of oncology. Monitoring the activity of the oncogenic fusion gene BCR-ABL1 in chronic myeloid leukemia (CML) is a good example of individualizing CML treatment for patients using patient-specific genetic information. However, the frequency at which molecular monitoring for BCR-ABL1 transcripts occurs during treatment with tyrosine kinase inhibitors (TKIs) for CML in clinical practice is much lower than that recommended by either the National Cancer Center Network or the European LeukemiaNet guidelines. Adherence, one of the most critical factors affecting response to TKIs, is often less than desirable and rarely communicated to physicians by patients or managed by care providers. Less than optimal molecular monitoring and low adherence to TKI treatment can lead to rising transcripts levels, that when not detected, have been shown to contribute to poor outcomes. This review reports the basis for and describes the design of a state-of-the-art program intended to improve communication with physicians through real-time messaging about sequential test results for BCR-ABL1 and patients' adherence to TKI therapy.
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Affiliation(s)
- Linda Nichols
- Department of Clinical Practices & Therapeutics, Express Scripts, 100 Parsons Pond Drive, B3-MS2, Franklin Lakes, NJ 07417, USA.
| | - Julie Pippins
- Department of Clinical Practices & Therapeutics, Express Scripts, 100 Parsons Pond Drive, B3-MS2, Franklin Lakes, NJ 07417, USA
| | - Lon Castle
- Department of Clinical Innovations, Express Scripts, 100 Parsons Pond Drive, Franklin Lakes, NJ 07417, USA
| | - Mary Cassler
- Department of Clinical Innovations, Express Scripts, 100 Parsons Pond Drive, Franklin Lakes, NJ 07417, USA
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Sebag-Montefiore D, Steele R, Monson J, Couture J, de Metz C, Pugh C, Nichols L, Thompson L, Quirke P. OC-0219 THE MRC CR07 TRIAL NCIC CO16 TRIAL AFTER A MEDIAN FOLLOW UP OF 8 YEARS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70558-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Masdeu J, Mattay V, Chen Q, Kohn P, Muse J, Kolachana B, Nichols L, Weinberger D, Berman K. Age-Related Effect of APOE Genotype on Brain Functional Connectivity during Episodic Memory Encoding (P03.084). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Webber G, Rivas M, Chen Z, Nichols L, El-Rayes B, Kim H. Abstract No. 213: Quality of life assessment after doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE) in patients with hepatocellular carcinoma (HCC). J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Damery S, Smith S, Clements A, Holder R, Nichols L, Draper H, Clifford S, Parker L, Hobbs R, Wilson S. Evaluating the effectiveness of GP endorsement on increasing participation in the NHS Bowel Cancer Screening Programme in England: study protocol for a randomized controlled trial. Trials 2012; 13:18. [PMID: 22348399 PMCID: PMC3305373 DOI: 10.1186/1745-6215-13-18] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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: 11/07/2011] [Accepted: 02/20/2012] [Indexed: 11/20/2022] Open
Abstract
Background The success and cost-effectiveness of bowel cancer screening depends on achieving and maintaining high screening uptake rates. The involvement of GPs in screening has been found to improve patient compliance. Therefore, the endorsement of screening by GPs may increase uptake rates amongst non-responders. Methods/Design A two-armed randomised controlled trial will evaluate the effectiveness of a GP endorsed reminder in improving patient participation in the NHS Bowel Cancer Screening Programme (NHSBCSP). Up to 30 general practices in the West Midlands with a screening uptake rate of less than 50% will be recruited and patients identified from the patient lists of these practices. Eligible patients will be those aged 60 to 74, who have previously been invited to participate in bowel screening but who have been recorded by the Midlands and North West Bowel Cancer Screening Hub as non-responders. Approximately 4,380 people will be randomised in equal numbers to either the intervention (GP letter and duplicate FOBt kit) or control (no additional contact) arms of the trial. The primary outcome measure will be the difference in the uptake rate of FOBt screening for bowel cancer between the intervention and control groups at 13 weeks after the GP endorsed reminder and duplicate FOBt kit are sent. Secondary outcome measures will be subgroup analyses of uptake according to gender, age and deprivation quartile, and the validation of methods for collecting GP, NHSBCSP and patient costs associated with the intervention. Qualitative work (30 to 40 semi-structured interviews) will be undertaken with individuals in the intervention arm who return a FOBt kit, to investigate the relative importance of the duplicate FOBt kit, reminder to participate, and GP endorsement of that reminder in contributing to individuals' decisions to participate in screening. Discussion Implementing feasible, acceptable and cost-effective strategies to improve screening uptake amongst non-responders to invitations to participate is fundamentally important for the success of screening programmes. If this feasibility study demonstrates a significant increase in uptake of FOBt screening in individuals receiving the intervention, a definitive, appropriately powered future trial will be designed. Trial registration number ISRCTN: ISRCTN86784060
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Affiliation(s)
- Sarah Damery
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, West Midlands, B15 2TT, UK.
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Schulz R, Hebert RS, Dew MA, Brown SL, Scheier MF, Beach SR, Czaja SJ, Martire LM, Coon D, Langa KM, Gitlin LN, Stevens AB, Nichols L. Patient Suffering and Caregiver Compassion: New Opportunities for Research, Practice, and Policy. The Gerontologist 2007; 47:4-13. [PMID: 17327535 DOI: 10.1093/geront/47.1.4] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this article is to stimulate discussion and research about patient suffering and caregiver compassion. It is our view that these constructs are central to understanding phenomena such as family caregiving, and that recognizing their unique role in the caregiving experience provides new directions for intervention research, clinical practices, and social policy. We first define and characterize these constructs, review empirical evidence supporting the distinct role of suffering and compassion in the context of caregiving, and then present a conceptual model linking patient suffering with caregiver compassion. We conclude with a discussion of implications and future directions for clinical intervention, research, and policy.
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Affiliation(s)
- Richard Schulz
- University Center for Social and Urban Research, 121 University Place, Pittsburgh, PA 15260, USA.
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de Vocht F, Burstyn I, Straif K, Vermeulen R, Jakobsson K, Nichols L, Peplonska B, Taeger D, Kromhout H. Occupational exposure to NDMA and NMor in the European rubber industry. ACTA ACUST UNITED AC 2007; 9:253-9. [PMID: 17344951 DOI: 10.1039/b615472g] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Many nitrosamines are suspected of being human carcinogens, with the highest concentrations in the environment being measured in the rubber industry. Time trends of personal exposure to N-nitrosodimethylamine (NDMA) and to N-nitrosomorpholine (NMor) during the past two decades in the German rubber industry were analysed and compared with cross-sectional studies in the same period in the Netherlands, Poland, the UK and Sweden. In the majority of the surveyed departments exposures reduced over time, but considerable heterogeneity was present between departments and sectors. Significant reductions were primarily found in curing and post-treating departments and ranged from -3% year(-1) to -19% year(-1). In contrast, NDMA levels increased (+13% year(-1)) in maintenance and engineering in the tyres industry. Average NDMA-levels in general rubber goods (GRG) and NMor-levels in tyre production in Germany did not decrease significantly in the past two decades, whereas NDMA-levels in tyre production (-10% year(-1)) and NMor-levels in GRG (-7% year(-1)) declined significantly after the introduction of an exposure limit for total nitrosamines in Germany in 1988. Confidence intervals of average exposures in other studied countries largely overlap trends observed in Germany. Exposure to N-nitrosamines decreased on average two-to-five fold in the German rubber industry with comparable concentration levels in other European countries. Although average levels are well below the current limits exposure has not been eliminated, and incidental high exposures do still occur.
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Affiliation(s)
- F de Vocht
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Belle SH, Burgio L, Burns R, Coon D, Czaja SJ, Gallagher-Thompson D, Gitlin LN, Klinger J, Koepke KM, Lee CC, Martindale-Adams J, Nichols L, Schulz R, Stahl S, Stevens A, Winter L, Zhang S. Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial. Ann Intern Med 2006; 145:727-38. [PMID: 17116917 PMCID: PMC2585490 DOI: 10.7326/0003-4819-145-10-200611210-00005] [Citation(s) in RCA: 468] [Impact Index Per Article: 26.0] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Caring for a family member with dementia is extremely stressful, contributes to psychiatric and physical illness among caregivers, and increases the risk for caregiver death. Finding better ways to support family caregivers is a major public health challenge. OBJECTIVE To test the effects of a structured multicomponent intervention on quality of life and clinical depression in caregivers and on rates of institutional placement of care recipients in 3 diverse racial or ethnic groups. DESIGN Randomized, controlled trial. SETTING In-home caregivers in 5 U.S. cities. PARTICIPANTS 212 Hispanic or Latino, 219 white or Caucasian, and 211 black or African-American caregivers and their care recipients with Alzheimer disease or related disorders. INTERVENTION Caregivers within each racial or ethnic group were randomly assigned to an intervention or to a control group. The intervention addressed caregiver depression, burden, self-care, and social support and care recipient problem behaviors through 12 in-home and telephone sessions over 6 months. Caregivers in the control group received 2 brief "check-in" telephone calls during the 6-month intervention. MEASUREMENTS The primary outcome was a quality-of-life indicator comprising measures of 6-month caregiver depression, burden, self-care, and social support and care recipient problem behaviors. Secondary outcomes were caregiver clinical depression and institutional placement of the care recipient at 6 months. RESULTS Hispanic or Latino and white or Caucasian caregivers in the intervention group experienced significantly greater improvement in quality of life than those in the control group (P < 0.001 and P = 0.037, respectively). Black or African-American spouse caregivers also improved significantly more (P = 0.003). Prevalence of clinical depression was lower among caregivers in the intervention group (12.6% vs. 22.7%; P = 0.001). There were no statistically significant differences in institutionalization at 6 months. LIMITATIONS The study used only a single 6-month follow-up assessment, combined heterogeneous cultures and ethnicities into a single group, and excluded some ethnic groups. CONCLUSIONS A structured multicomponent intervention adapted to individual risk profiles can increase the quality of life of ethnically diverse dementia caregivers. ClinicalTrials.gov identifier: NCT00177489.
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Affiliation(s)
- Steven H Belle
- University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
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Abstract
The model for end stage liver disease (MELD) system prioritizes deceased donor organs to the sickest patients who historically require higher healthcare expenditures. Limited information exists regarding the association of recipient MELD score with resource use. Adult recipients of a primary liver allograft (n = 222) performed at a single center in the first 27 months of the MELD system were analyzed. Costs were obtained for each recipient for the 12 defined categories of resource utilization from the time of transplant until discharge. True (calculated) MELD scores were used. Inpatient transplant costs were significantly associated with recipient MELD score (r = 0.20; p = 0.002). Overall 1-year patient survival was 85.0% and was not associated with MELD score (p = 0.57, log rank test). Recipient MELD score was significantly associated with costs for pharmacy, laboratories, radiology, dialysis and physical therapy. Multivariate linear regression revealed that MELD score was most strongly associated with cost compared to other demographic and clinical factors. Recipient MELD score is correlated with transplant costs without significantly impacting survival.
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Affiliation(s)
- W K Washburn
- Transplant Center, University of Texas Health Science Center, San Antonio, Texas, USA.
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Abstract
OBJECTIVE To examine cancer risks in a cohort of workers employed in the manufacture of semiconductors. METHODS The mortality (1970-2002) and cancer morbidity (1971-2001) experienced by a cohort of 1807 male and female workforce employees from a semiconductor factory in the West Midlands (UK) have been investigated. Standardized mortality ratios (SMRs) and standardized registration ratios (SRRs) were used to assess mortality and morbidity, respectively. RESULTS Overall mortality was close to expectation in males [SMR 99, 95% (confidence interval) CI 79-122] and significantly below expectation in females (SMR 74, 95% CI 65-85). Incidence of all sites of cancer was somewhat elevated in males (SRR 130, 95% CI 95-173) but close to expectation in females (SRR 94, 95% CI 82-109). There were significant deficits of deaths from cancer of the oesophagus in males and females combined and from cancer of the breast in females. Significantly elevated SRRs were found in males for cancer of the rectum [Observed (Obs) 6, SRR 284, 95% CI 104-619], in females for cancer of the pancreas (Obs 10, SRR 226, 95% CI 108-415) and malignant melanoma (Obs 11, SRR 221, 95% CI 110-396) and in males and females combined for cancer of the rectum (Obs 19, SRR 199, 95% CI 120-310) and malignant melanoma (Obs 12, SRR 217, 95% CI 112-379). Detailed work history data were unavailable for analysis. The finding of excess morbidity was not mirrored in the corresponding mortality findings. CONCLUSIONS The study found elevated morbidity for a number of cancer sites that may be unconnected with occupation. Elimination of all possible occupational causes will, however, require more detailed analyses of cancer risks in relation to exposure histories.
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Affiliation(s)
- Linda Nichols
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham, West Midlands B15 2TT, UK
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