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Al Azzawi M, Kelly O, Welaratne I, McGuire A, Sartini-Bhreathnach A, Stanley E, Kell M, Stokes M, Barry M, Walsh S, Heeney A. Localisation using multiple magnetic seeds in unilateral breast surgery. Ir Med J 2024; 117:924. [PMID: 38526068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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2
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Gibbs J, Power CNT, Böhning D, Warner M, Downie S, Allsopp A, Stokes M, Fallowfield JL. Assessing injury risk in male and female Royal Navy recruits: does the Functional Movement Screen provide understanding to inform effective injury mitigation? BMJ Mil Health 2023:e002416. [PMID: 38053278 DOI: 10.1136/military-2023-002416] [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] [Received: 06/22/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Musculoskeletal injuries (MSKIs) are common during military and other occupational physical training programmes, and employers have a duty of care to mitigate this injury risk. MSKIs account for a high number of working days lost during initial military training, contribute to training attrition and impact training costs. Poorer movement quality may be associated with increased MSKI risk. METHODS The present study evaluated the relationship between the Functional Movement Screen (FMS) Score, as a measure of movement quality, and injury risk in Royal Navy (RN) recruits. A cohort of 957 recruits was assessed using the FMS prior to the 10-week phase I training programme. Injury occurrence, time, type and severity were recorded prospectively during the training period. RESULTS Total FMS Score was associated with injury risk (p≤0.001), where recruits scoring ≥13 were 2.6 times more likely to sustain an injury during training. However, FMS Score accounted for only 10% of the variance in injury risk (R2=0.1). Sex was the only additional variable to significantly affect the regression model. Mean FMS Scores for men (14.6±2.3) and women (14.4±2.4) were similar, but injury occurrence in women was 1.7 times greater than in men. Examining the influence of individual FMS movement tests on injury prediction did not improve the model, where those movements that significantly contributed to injury prediction only accounted for a small amount of the variance (R2=0.01). CONCLUSION There was a weak relationship between FMS and injury risk in RN recruits. Evidence is provided that FMS score alone would not be appropriate to use as an injury prediction tool in military recruits.
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Affiliation(s)
- J Gibbs
- Institute of Naval Medicine, Alverstoke, UK
| | - C N T Power
- Department of Sport and Health, Solent University, Southampton, UK
| | - D Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - M Warner
- University of Southampton, Southampton, Hampshire, UK
| | - S Downie
- Institute of Naval Medicine, Gosport, Hampshire, UK
| | - A Allsopp
- Institute of Naval Medicine, Gosport, Hampshire, UK
| | - M Stokes
- University of Southampton, Southampton, Hampshire, UK
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Hayhurst D, Warner M, Stokes M, Fallowfield J. Musculoskeletal injury in military specialists: a 2-year retrospective study. BMJ Mil Health 2022:e002165. [PMID: 36175032 DOI: 10.1136/military-2022-002165] [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] [Received: 05/24/2022] [Accepted: 09/09/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Military specialists are elite personnel who are trained to work across diverse operational environments where a high level of physical conditioning is a prerequisite for their role. Anecdotally, personnel are acknowledged to be at high risk of developing musculoskeletal injuries (MSKIs). However, there are presently no published data on this UK military population to support this view. This is the first (2-year) retrospective epidemiological study to identify the MSKI sustained by this military population. METHODS All MSKI reported over a 2-year period (January 2018-December 2019) were recorded to identify the incidence, frequency, nature, onset, cause, location and reporting times. Injuries were described using injury count and relative frequency (percentage). Time at risk for each personnel day was calculated as 365 days. RESULTS A total of 199 personnel reported 229 injuries over the reporting periods. The injury incidence rates were 26.8 personnel per 100 person years (2018) and 27.7 personnel per 100 person years (2019), respectively. Military training accounted for the highest number of injuries (32%), followed by 'other injuries' (28%), personal training (28%) and sport (12%). The leading activity associated with injury was weight training (15%), followed by running (11%) and military exercise (10%). Lower extremity injuries accounted for the highest number of injuries (40%), followed by trunk (36%) and upper extremity (24%) injuries. CONCLUSION This study identifies the MSKI profile of a military specialist population over a 2-year period. Areas where modifiable risk factors may be identified to reduce risk of injury are highlighted. Recommendations for further research include investigating injury burden and the impact of injury on operational readiness.
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Affiliation(s)
| | - M Warner
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - M Stokes
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - J Fallowfield
- Head of Applied Physiology, Environmental and Science Division, Institute of Naval Medicine, Gosport, UK
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Bunt S, Didehbani N, Stokes M, Miller S, Bell K, Cullum CM. A-07 Initial Symptoms, Pre-Existing Emotional Factors, and Symptoms of Stress During Recovery from Concussion. Arch Clin Neuropsychol 2022. [DOI: 10.1093/arclin/acac32.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose: Investigate the association of initial symptoms, mechanism of concussion, and emotional state with symptoms of stress reported during recovery from concussion in high school students. Methods: Concussed High School students (n = 183) aged 13–18 were evaluated within 30 days of injury at a North Texas Concussion Registry (ConTex) clinic with 71% (n = 130) sport-related. Subjects completed a medical history, the Sport Concussion Assessment Tool-5 Symptom Evaluation (PCSS), General Anxiety Disorder (GAD-7), and Patient Health Questionnaire-8 (PHQ-8) at initial visit. At three-month follow-up subjects completed the PTSD Checklist for DSM-5 (PCL-5). A linear regression was conducted predicting total scores on the follow up PCL-5. Predictors included initial Total PCSS Symptom Score, GAD-7, PHQ-8, sex, mechanism of injury (sport vs non-sport) and history of treatment for anxiety/depression. Results: A multiple regression model predicting participant’s total PCL-5 score at three month follow-up (R2 = 0.40, p < 0.001) included PHQ-8 (β = 0.34, p < 0.001), GAD-7 (β = 0.20, p = 0.016), history of treatment for depression (β = 0.17, p = 0.015), severity of initial symptoms (β = 0.15, p = 0.045) and mechanism of injury (β = −0.14, p = 0.018). There was no significant difference in PCL-5 scores between sport vs non-sport injury groups. Conclusions: Pre-existing depression and higher levels of self-reported anxiety and/or depression at time of injury may be associated with increased symptoms of stress during concussion recovery. Severity of initial symptoms and mechanism of injury may also be related to feelings of stress during recovery. Further investigations should include baseline measure of stress prior to injury.
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Lickert C, Dufour R, Tilney R, Pruett J, Stokes M. P-326 Current real-world patterns of care for women diagnosed with uterine fibroids (UF) and heavy menstrual bleeding (HMB) in a predominantly African American (AA) population database. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.310] [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: 11/12/2022] Open
Abstract
Abstract
Study question
What are the clinical characteristics and patterns of care in African American women diagnosed with UF and HMB compared to White women?
Summary answer
The majority of the women were African American. Though similar in age, there were significant differences between the groups in multiple comorbidities and therapies.
What is known already
UF (leiomyomas) are common, benign uterine tumors affecting approximately 80% of African American and 70% of White women by age 50. In the United States, marked differences exist in disease presentation, severity, treatment, outcomes, and quality of life for African American women compared with White women. African American women typically develop uterine leiomyomas at a younger age, progress to clinically significant disease at an earlier age, have larger uteri at diagnosis and are more likely to be anemic. Limited data exist on the current clinical real-world characteristics and patterns of care for African American women with UF and HMB.
Study design, size, duration
This retrospective observational study identified women 18-55 years, with UF and HMB from IBM-Watson’s MarketScan® Multi-state Medicaid claims database between 2010-2019. The focus was on women with diagnoses of UF (index) and HMB, appearing on the same or different claims, continuously enrolled for > 12 months pre- and post-index (censored on claim for hysterectomy). A total of ≥ 24 months of observation was available for most patients.
Participants/materials, setting, methods
A total of 27,122 women met the inclusion criteria, 16,776 African Americans, 7,353 Whites, and 2,993 others or race unknown. The statistical analyses were carried out on the African American and White patients only. Descriptive analyses of baseline demographics, pre-index comorbidities and post-index treatment were performed. Chi-square tests analyses were applied to counts and t-tests analyses were applied to means. All tests used an alpha value of 0.05 for significance.
Main results and the role of chance
The majority of the analytical cohort of 24,129 women was African American (AA:69.5%; W:30.5 %). The mean (SD) follow-up time was 40.5 (24.7) months. The mean age was similar for both groups (AA:39.6 ± 7.11 years; W: 40.2 ± 7.23 years, p < 0.1). There were 48 pre-indexed comorbidities identified for analyses. The groups significantly differed on 14(29%) comorbidities. For 11 of the comorbidities, African American women were less likely to be diagnosed than White women (all Ps < 0.0001). Many of these diseases were related to bulk symptoms (e.g., pelvic pressure/pain), anxiety and depression. More African American women had diagnoses for diabetes (p = 0.0143), hypertension, and obesity (Ps < 0.0001). Though bulk symptoms were common in both groups, again fewer African American women were diagnosed than White (AA: 68.4%; W:77.0%, p < 0.0001).
Post-index, African American women were more likely treated with hormone-based therapy (42.4% vs. 38.5%, p < 0.0001). Contraceptives were the most frequent form of hormonal treatment prescribed (AA:39.9%; W:35.6%). African American were on contraceptives slightly longer than White women (AA: 377.3 (522.2 days); W: 323.1 (460.2 days) (p < 0.001). Fewer African American women had a hysterectomy (AA:32.0%; W:46.8%, p < 0.001).
Limitations, reasons for caution
This study was observational and descriptive in nature, which limits the ability to make conclusions regarding causality or identify women beyond the age and time constraints within the study. Additionally, claims data may be subject to reporting errors. This data is specific to Medicaid populations and may not be generalizable.
Wider implications of the findings
In this Medicaid population differences in clinical characteristics and UF treatment were evident between African American and White women. The breakdown of some comorbidities did not match national prevalence by race for these conditions (e.g., depression). Further analyses are needed to determine if these differences are clinically and socially meaningful.
Trial registration number
NA
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Affiliation(s)
- C Lickert
- Myovant Sciences- Inc, Medical Affairs , Brisbane, U.S.A
| | - R Dufour
- Myovant Sciences- Inc, Medical Affairs , Brisbane, U.S.A
| | - R Tilney
- Evidera, real-world evidence , Waltham, U.S.A
| | - J Pruett
- Myovant Sciences- Inc, Medical Affairs , Brisbane, U.S.A
| | - M Stokes
- Evidera, real-world evidence, St.-Laurent Quebec , Canada
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Howes S, Stephenson A, Murphy P, Deutsch J, Stokes M, Pedlow K, McDonough S. Factors influencing the delivery of telerehabilitation for stroke: A systematic review. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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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Gilbert A, Mentzakis E, May C, Stokes M, Brown H, Jones J. What are patient preferences for virtual consultations for orthopaedic rehabilitation? Results from a discrete choice experiment (DCE) and qualitative interviews. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- M Stokes
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - J Hansel
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - A Pinder
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
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Thoi F, Pearson T, Stokes M. HFrEF in a Younger Cohort: Identifying the Clinical Demographics in Patients With Methamphetamine-Induced Cardiomyopathy. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.077] [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: 10/20/2022]
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10
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Thoi F, Scherer D, Teo K, Sanders P, Worthley M, Pearson T, Stokes M. Trends in Cardiac Magnetic Resonance (CMR) Imaging Characteristics in Patients With Methamphetamine-Induced Cardiomyopathy (MA-CMP). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.013] [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: 11/26/2022]
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Presley C, Meredith-Duliba T, Tarkenton T, Stokes M, Miller S, Bell K, Batjer H, Cullum CM. A-32 Acute Concussive Symptom Profiles in Adolescents and Young Adults with History of Depression and Anxiety. Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa036.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The aims of this study are (1) to examine the clinical symptom profiles of individuals with depression and/or anxiety history following a concussion and (2) to compare profile differences across groups.
Method
Participants aged 12-25 (n=129, mean=15.6) with premorbid diagnoses of depression (n=24), anxiety (n=50), or depression+anxiety (n=55) were evaluated within 21 days after sustaining a concussion as part of the North Texas Concussion Registry (ConTex) using the Post-Concussion Symptom Scale (PCSS). Following the model described by Kontos and Collins (2014), symptom clusters were derived from the PCSS to create six domains (cognitive/fatigue, vestibular, ocular, posttraumatic migraine, anxiety/mood, cervical). ANOVAs with Tukey’s post-hoc tests were conducted to compare domain symptom severity and total symptom severity across groups.
Results
There were no demographic differences between groups. A single symptom profile was prominent across each group, with the primary, secondary, and tertiary symptomatic domains being posttraumatic migraine, ocular, and cognitive/fatigue, respectively. Across each domain the depression+anxiety group was most symptomatic, followed in order by the depression and anxiety groups. The depression+anxiety group reported significantly higher anxiety/mood (M=2.0 vs. M=1.3) and cognitive/fatigue (M=2.9 vs M=2.1) symptom severity compared to the anxiety group. Group differences on total symptom severity approached significance (F=2.83, p=.06).
Conclusions
The observed symptom profiles suggest that the acute-concussive response is similar in adolescents and young adults with history of depression and/or anxiety. Multiple premorbid conditions, such as depression and anxiety, appear to magnify overall symptom severity. Further research is warranted to understand the relationship between symptom burden and premorbid mental health factors.
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Quinn EM, Dunne E, Flanagan F, Mahon S, Stokes M, Barry MJ, Kell M, Walsh SM. Radial scars and complex sclerosing lesions on core needle biopsy of the breast: upgrade rates and long-term outcomes. Breast Cancer Res Treat 2020; 183:677-682. [PMID: 32696314 DOI: 10.1007/s10549-020-05806-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 07/11/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Radial scars and complex sclerosing lesions of the breast are part of a group of "indeterminate" breast lesions, which are excised due to risk of coexistent carcinoma. The aim of this study was to assess rate of upgrade of these lesions to invasive and in situ carcinoma and to quantify the risk of development of subsequent cancer in women diagnosed with these lesions. METHODS A retrospective review of a prospectively maintained breast screening database was performed. All patients with radial scar identified at either core biopsy or final excision biopsy between January 2006 and July 2012 were identified. Full pathological reports for both core biopsy and final excision biopsy were reviewed. Patient outcomes were followed for a mean of 117.1 months. RESULTS Of 451 B3 biopsies performed at our screening unit, 95 (22%) were found to have a radial scar or complex sclerosing lesion (CSL) on core needle biopsy. Within this group, 77 had no atypia on CNB, with 7 (9%) upgraded to invasive/in situ carcinoma on final excision. Of nine with definite atypia on CNB, 3 (33%) were upgraded. In those patients without atypia or malignancy on final excision, 7.5% developed cancer during 10-year follow-up. CONCLUSION Patients with radial scar with atypia have a higher risk of upgrade to malignancy. Further research is needed to identify which patients may safely avoid excision of radial scar. Patients with a diagnosis of radial scar on CNB are at increased subsequent risk of breast cancer and may benefit from additional screening.
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Affiliation(s)
- E M Quinn
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland.
| | - E Dunne
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - F Flanagan
- Department of Radiology, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - S Mahon
- Department of Histopathology, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - M Stokes
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - M J Barry
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - M Kell
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
| | - S M Walsh
- Department of Surgery, Breastcheck Eccles Unit, Eccles St, Dublin 7, Ireland
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Lloyd TD, Neal‐Smith G, Fennelly J, Claireaux H, Bretherton C, Carr AJ, Murphy M, Kendrick BJ, Palmer AJR, Wong J, Sharma P, Osei‐Bonsu PK, Ashcroft G, Baigent T, Shirland E, Espey R, Stokes M, Liew I, Dhawal A, Watchorn D, Lum J, Qureshi M, Khaled AS, Kauser S, Hodhody G, Rogers S, Haywood‐Alexander B, Sheikh G, Mahapatra P, Twaij H, Chicco M, Arnaout F, Atherton T, Mutimer J, Sinha P, Oliver E, Stedman T, Gadd R, Kutuzov V, Sattar M, Robiati L, Plastow R, Howe T, Hassan A, Lau B, Collins J, Doshi A, Tan G, Baskaran D, Hari Sunil Kumar K, Agarwal R, Horner M, Gwyn R, Masud S, Beaumont O, Pilarski A, Lebe M, Dawson‐Bowling S, Nolan D, Tsitskaris K, Beamish RE, Jordan C, Alsop S, Hibbert E, Deshpande G, Gould A, Briant‐Evans T, Kilbane L, Crowther I, Ingoe H, Naisbitt A, Gourbault L, Muscat J, Goh EL, Gill J, Elbashir M, Modi N, Archer J, Ismael S, Petrie M, O'Brien H, McCormick M, Koh NP, Lloyd T, King A, Ikram A, Peake J, Yoong A, Rye DS, Newman M, Naraen A, Myatt D, Kapur R, Sgardelis P, Kohli S, Culverhouse‐Mathews M, Haynes S, Boden H, Purmah A, Shenoy R, Raja S, Koh NP, Donovan R, Yeomans D, Ritchie D, Larkin R, Aladwan R, Hughes K, Unsworth R, Cooke R, Samra I, Barrow J, Michael K, Byrne F, Anwar R, Karatzia L, Drysdale H, Wilson H, Jones R, Dass D, Liaw F, Aujla R, Kheiran A, Bell K, Ramavath AL, Telfer R, Nachev K, Lawrence H, Garg V, Shenoy P, Lacey A, Byrom I, Simons M, Manning C, Cheyne N, Williams J. Peri‐operative administration of tranexamic acid in lower limb arthroplasty: a multicentre, prospective cohort study. Anaesthesia 2020; 75:1050-1058. [DOI: 10.1111/anae.15056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
Affiliation(s)
- T. D. Lloyd
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - G. Neal‐Smith
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - J. Fennelly
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - H. Claireaux
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - C. Bretherton
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - A. J. Carr
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
| | - M. Murphy
- University of Oxford UK
- NHS Blood and Transplant Oxford UK
| | - B. J. Kendrick
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
| | - A. J. R. Palmer
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
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Muckelt PE, Roos EM, Stokes M, McDonough S, Grønne DT, Ewings S, Skou ST. Comorbidities and their link with individual health status: A cross-sectional analysis of 23,892 people with knee and hip osteoarthritis from primary care. J Comorb 2020; 10:2235042X20920456. [PMID: 32489945 PMCID: PMC7238776 DOI: 10.1177/2235042x20920456] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/08/2020] [Indexed: 12/20/2022]
Abstract
Objectives: Robust data on the impact of comorbidities on health in people with osteoarthritis (OA) are lacking, despite its potential importance for patient management. Objectives were to determine coexisting conditions in people with OA in primary care and whether more comorbidities were linked with individual health status. Methods: A retrospective analysis of 23,892 patients with knee and hip OA was conducted to determine comorbidities present (number/clusters) and how these linked with pain intensity (0–100), widespread pain (site numbers), medication usage (paracetamol, nonsteroidal anti-inflammatory drugs, opioids), quality of life EuroQol five dimension scale (EQ-5D), and physical function (walking speed) using independent t-tests or χ2 test. Results: Sixty-two percent of people with OA treated in primary care had at least one comorbidity; hypertension (37%), heart disease (8%), and diabetes (7%) being most common. Outcome measures worsened with more comorbidities (0–4+ comorbidities); pain intensity [mean (SD)] 46(22)–57(21); number of painful sites 3.7(3.0)–6.3(5.4); quality of life 0.73(0.10)–0.63(0.15); walking speed 1.57 m/s (0.33)–1.24 m/s (0.31), while the proportion of people using pain medication increased from 0 to 2 comorbidities (58–69%; p < 0.001), with an increase in opioid use from 4.6% to 19.5% with more comorbidities (0–4+ comorbidities). Conclusion: Most people with knee or hip OA in primary care have at least one other long-term condition. A greater number of comorbidities is linked with worsening health, highlighting the importance of screening for comorbidities when treating patients with OA. It is important for clinicians to consider how OA treatments will interact and affect other common comorbidities.
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Affiliation(s)
- Paul Edward Muckelt
- School of Health Sciences, University of Southampton, Southampton, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, UK
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - M Stokes
- School of Health Sciences, University of Southampton, Southampton, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, UK
| | - S McDonough
- School of Health Sciences, Institute of Nursing and Health Research Ulster University.,School of Physiotherapy, University of Otago, Dunedin, New Zealand.,School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - D T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - S Ewings
- School of Health Sciences, University of Southampton, Southampton, UK
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
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Sree Raman K, Stokes M, Shah RJ, Walls AD, Steele PM, Burdeniuk C, De Pasquale CG, Celermajer DS, Selvanayagam JB. P593Oxygen sensitive cardiac magnetic resonance in demonstrating myocardial ischaemia of the right ventricle in patients with pulmonary artery hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Progressive right ventricular (RV) dysfunction is a natural progression of pulmonary arterial hypertension (PAH) which is associated with adverse clinical outcomes. The main contributor to progressive RV dysfunction is RV ischemia. Oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) has been used to determine the in-vivo myocardial oxygenation of the left ventricle (LV).
Purpose
The aim of the present study was to (1) Determine the feasibility of RV targeted rest/stress OS-CMR imaging in PAH patients and normal volunteers; (2) To define the presence and extent of RV myocardial ischaemia in patients with known PAH.
Methods
We prospectively recruited 20 patients with right heart catheter proven PAH and 9 normal (NC), age matched controls with no heart disease. The CMR examination involved standard functional imaging and OS-CMR imaging. OS-CMR images were acquired using a T2* sequence at rest and adenosine-induced stress vasodilatation. The RV was divided into 3 segments - RV anterior, RV free-wall and RV inferior. An OS-CMR signal intensity (SI) index (stress/rest signal intensity) was acquired at RV anterior, RV free-wall and RV inferior segments.
Results
All the PAH patients tolerated and completed the adenosine induced stress OS-CMR without any complications or adverse effects. In NC, reliable OS signal intensity changes was only obtained from the RV inferior segment. As RV dysfunction in PAH is a global process, hence this segment was used in both patients and NC for further comparison. RV OS-CMR signal intensity change between rest and stress in the normal volunteers was 17±4% (mean ± SD). 9 out of twenty (45%) of the PAH patients had a mean BOLD signal intensity change of less than 9% (or 2SD different from the mean values in normal volunteers). Overall, RV OS SI index between the PAH patients and controls was 11±9% vs 17±5% (p-value = 0.045) in RV inferior segment.
Conclusion
Pharmacological induced OS-CMR is a feasible and safe technique to identify and study myocardial oxygenation in the RV of PAH patients.
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Affiliation(s)
- K Sree Raman
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - M Stokes
- Royal Adelaide Hospital, Adelaide, Australia
| | - R J Shah
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - A D Walls
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - P M Steele
- Royal Adelaide Hospital, Adelaide, Australia
| | - C Burdeniuk
- Flinders Medical Centre, Adelaide, Australia
| | - C G De Pasquale
- Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - D S Celermajer
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - J B Selvanayagam
- Flinders Medical Centre and Flinders University, Adelaide, Australia
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Raman KS, Stokes M, Shah R, Walls A, Steele P, Burdeniuk C, De Pasquale C, Celermajer D, Selvanayagam J. Feasibility of Oxygen Sensitive Cardiac Magnetic Resonance in Demonstrating Right Ventricular Myocardial Ischaemia in Patients with Pulmonary Arterial Hypertension. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Elliott A, Verdicchio CV, Linz D, Stokes M, Gallagher C, Mahajan R, Hendriks JML, Lau DH, Sanders P. P983Mechanisms contributing to exercise intolerance in patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Elliott
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C V Verdicchio
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Stokes
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C Gallagher
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - J M L Hendriks
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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18
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Gillard S, Ryan CG, Stokes M, Warner M, Dixon J. Effects of posture and anatomical location on inter-recti distance measured using ultrasound imaging in parous women. Musculoskelet Sci Pract 2018; 34:1-7. [PMID: 29195217 DOI: 10.1016/j.msksp.2017.11.010] [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: 06/15/2017] [Revised: 09/26/2017] [Accepted: 11/18/2017] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN Cross-sectional repeated measures. OBJECTIVES To quantify the effects of posture and measurement site on the inter-recti distance (IRD) and investigate the reliability of IRD measurement using ultrasound imaging in different postures. BACKGROUND The linea alba connects the rectus abdominis muscles anteriorly and the width is known as the IRD. The IRD is usually measured in crook-lying and is the primary outcome measure to assess for a divarication of recti abdominis (DRA). The effects of posture and measurement site on the IRD have not been investigated. METHODS Ultrasound imaging was used to measure IRD in 41 women ≥8 weeks postpartum. The IRD was measured at three sites (superior-umbilicus, umbilicus and inferior-umbilicus), in three postures (crook-lying, sitting and standing), and repeated one-week later. The effects of posture and site were investigated using one-way ANOVAs. Reliability was analysed using Intraclass correlation coefficients (ICCs), Bland Altman analyses, standard error of measurement and minimal detectable change. RESULTS The IRD was wider when standing vs. lying at both the superior-umbilicus and umbilicus by 0.30 cm (95% CI 0.21 to 0.39) and 0.20 cm (0.11-0.30) respectively (p < 0.001). Measurements at the inferior-umbilicus were, on average, 1.6 and 2.1 cm narrower than superior-umbilicus and umbilicus sites, respectively (p < 0.001). There was high intra-rater reliability within-session (ICC3.3) and between-session (ICC3.1) at all sites measured. CONCLUSION The IRD can be measured reliably at all sites and postures. The IRD is wider at superior-umbilicus and umbilicus when upright compared with lying. There is a difference in IRD between all sites measured.
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Affiliation(s)
- S Gillard
- School of Health and Social Care, Teesside University, Middlesbrough, UK.
| | - C G Ryan
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - M Stokes
- University of Southampton, Southampton and Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - M Warner
- University of Southampton, Southampton and Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - J Dixon
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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19
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Khokhar K, Lau D, Mahajan R, Elliott A, Stiles M, Mishima R, Munawar D, Kadhim K, Linz D, Thiyagarajah A, Harrington J, Wilson L, Stokes M, Emami M, Agbaedeng T, Teo K, Nelson A, Gallaghar C, Sanders P. Central Blood Pressure Assessment in Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.050] [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]
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20
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Lagoe C, Stokes M. U.S. Registered Dietitian Nutritionist Crop Protection Attitudes and Knowledge. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Pai S, Cohen E, Lin D, Fountzilas G, Kim E, Mehlhorn H, Baste N, Clayburgh D, Lipworth L, Resteghini C, Shara N, Fujii T, Zhang J, Stokes M, Lawrence D, Khaliq A, Melillo G, Shire N. RetroSpective cohort stUdy of PD-L1 expression in REcurrent and/or MEtastatic squamous cell carcinoma of the head and neck (SUPREME-HN). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Stokes M, Wang R, Wildsmith S, Secrier M, Angell H, Barker C, Walker J, Scorer P, Rebelatto M, Shire N. Relationship between PD-L1 expression and survival in head and neck squamous cell carcinoma (HNSCC) patients (pts). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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23
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Bell J, Galaznik A, Huelin R, Stokes M, Seal B, Fram R, Faller D. Systematic Review of Therapy Used in Higher-Risk (HR) Myelodysplastic Syndromes (MDS) and Chronic Myelomonocytic Leukemia (CMML). Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30244-8] [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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24
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Hung J, Stokes M, Roberts-Thomson R, Parvar S, Nelson A, Williams K, Brown M, Disney P, Teo K. Right Ventricular Remodelling After Pulmonary Valve Replacement in Repaired Tetralogy of Fallot: Assessment With Cardiovascular Magnetic Resonance. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.735] [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: 11/17/2022]
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25
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Nadler E, Ashaye A, Stokes M, Yang S, Xu Y, Berger A, Shaw J, Gilloteau I, Abernethy A. 1222 Long-term clinical experiences of patients (pts) with non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC) or metastatic melanoma (MEL): A SEER-Medicare analysis. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30526-3] [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: 11/25/2022]
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26
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Anton L, Mather AE, Stokes M, Muñoz-Martin A, De Vicente G. Exceptional river gorge formation from unexceptional floods. Nat Commun 2015; 6:7963. [PMID: 26242429 DOI: 10.1038/ncomms8963] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/29/2015] [Indexed: 11/09/2022] Open
Abstract
An understanding of rates and mechanisms of incision and knickpoint retreat in bedrock rivers is fundamental to perceptions of landscape response to external drivers, yet only sparse field data are available. Here we present eye witness accounts and quantitative surveys of rapid, amphitheatre-headed gorge formation in unweathered granite from the overtopping of a rock-cut dam spillway by small-moderate floods (∼100-1,500 m(3) s(-1)). The amount of erosion demonstrates no relationship with flood magnitude or bedload availability. Instead, structural pattern of the bedrock through faults and joints appears to be the primary control on landscape change. These discontinuities facilitate rapid erosion (>270 m headward retreat; ∼100 m incision; and ∼160 m widening over 6 years) principally through fluvial plucking and block topple. The example demonstrates the potential for extremely rapid transient bedrock erosion even when rocks are mechanically strong and flood discharges are moderate. These observations are relevant to perceived models of gorge formation and knickpoint retreat.
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Affiliation(s)
- L Anton
- Departamento de Ciencias Analíticas, Facultad de Ciencias, Universidad Nacional de Educación a Distancia (UNED), Senda del Rey 9, Madrid 20840, Spain
| | - A E Mather
- School of Geography, Earth and Environmental Sciences, Plymouth University, Drake Circus, Devon PL4 8AA, UK
| | - M Stokes
- School of Geography, Earth and Environmental Sciences, Plymouth University, Drake Circus, Devon PL4 8AA, UK
| | - A Muñoz-Martin
- Grupo de Investigación en Tectonofísica Aplicada, Departamento Geodinámica, Universidad Complutense de Madrid, and Instituto de Geociencias (CSIC, UCM), Madrid 28040, Spain
| | - G De Vicente
- Grupo de Investigación en Tectonofísica Aplicada, Departamento Geodinámica, Universidad Complutense de Madrid, and Instituto de Geociencias (CSIC, UCM), Madrid 28040, Spain
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27
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Warwick DJ, Shaikh A, Worsley P, Bain D, Gadola S, Tucker A, Gadola S, Stokes M. Microcirculation in the foot is augmented by neuromuscular stimulation via the common peroneal nerve in different lower limb postures: a potential treatment for leg ulcers. INT ANGIOL 2015:R34Y9999N00A150049. [PMID: 26138236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To examine the effects of the geko™ device (a portable electical nerve stimulator) on microcirculatory flow on the dorsum of the foot, and whether this is influenced by lower limb postures and application of a plaster cast. STUDY DESIGN Cross-sectional, healthy cohort, open label, physiological response study. METHODS In 10 healthy volunteers, aged 19 to 24 years, Laser Doppler Fluxmetry measurements were made on the dorsum of the foot in four postures: standing (weight bearing and non-weight bearing) and supine lying (with the lower limb horizontal and then elevated). Measurements of flux were made both at rest and during stimulation with the geko™ device applied over the common peroneal nerve, at 1Hz for 5 minutes in each posture. Repeat measurement were made after the application of a below knee plaster cast. Measures of flux were compared to basal levels assumed to be in supine with limb horizontal, with no cast and an inactive Geko device. RESULTS The geko™ device was effective in increasing microcirculation on the dorsum of the foot in all four postures (Mean difference =141%, 95% CI 70%-212%, p=0.001). This effect was more pronounced than that of using a plaster alone (Mean increase in Flux of 73%, 95% CI 22%-125%, p=0.01) or variances due to the hydrostatic effects of different postures (Mean difference 17-27.6%, p>0.05). There was a 2 to 3 fold increase in flux when stimulation was delivered in combination with the plaster cast. CONCLUSIONS Stimulation using the geko™ device augments microcirculation in the foot. The response is greater in lying and non-weight bearing than weight bearing standing but the most striking effect is when stimulation is combined with a plaster cast. The geko™ offers a potential means of promoting conditions favourable for wound healing, where treatment using compression may be contraindicated, such as arterial/mixed aetiology ulcers.
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Affiliation(s)
- D J Warwick
- Faculty of Medicine and Musculoskeletal Research Unit, University of Southampton, Southampton, UK -
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28
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Warwick D, Shaikh A, Worsley P, Gadola S, Bain D, Tucker A, Gadola SD, Stokes M. Microcirculation in the foot is augmented by neuromuscular stimulation via the common peroneal nerve in different lower limb postures: a potential treatment for leg ulcers. INT ANGIOL 2015; 34:158-165. [PMID: 25839841] [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: 06/04/2023]
Abstract
AIM Aim of the study was to examine the effects of the geko™ device (a portable electical nerve stimulator) on microcirculatory flow on the dorsum of the foot, and whether this is influenced by lower limb postures and application of a plaster cast. METHODS This was a cross-sectional, healthy cohort, open label, physiological response study. In 10 healthy volunteers, aged 19 to 24 years, laser Doppler fluxmetry measurements were made on the dorsum of the foot in four postures: standing (weight bearing and non-weight bearing) and supine lying (with the lower limb horizontal and then elevated). Measurements of flux were made both at rest and during stimulation with the geko™ device applied over the common peroneal nerve, at 1 Hz for 5 minutes in each posture. Repeat measurement were made after the application of a below knee plaster cast. Measures of flux were compared to basal levels assumed to be in supine with limb horizontal, with no cast and an inactive geko™ device. RESULTS The geko™ device was effective in increasing microcirculation on the dorsum of the foot in all four postures (mean difference =141%, 95% CI 70%-212%, P=0.001). This effect was more pronounced than that of using a plaster alone (Mean increase in flux of 73%, 95% CI 22%-125%, P=0.01) or variances due to the hydrostatic effects of different postures (mean difference 17-27.6%, P>0.05). There was a 2 to 3 fold increase in flux when stimulation was delivered in combination with the plaster cast. CONCLUSION Stimulation using the geko™ device augments microcirculation in the foot. The response is greater in lying and non-weight bearing than weight bearing standing but the most striking effect is when stimulation is combined with a plaster cast. The geko™ offers a potential means of promoting conditions favourable for wound healing, where treatment using compression may be contraindicated, such as arterial/mixed aetiology ulcers.
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Affiliation(s)
- D Warwick
- Musculoskeletal Research Unit, University of Southampton, University Hospital of Southampton, Southampton, UK -
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29
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Barbosa Boucas S, Hislop Lennie K, Dziedzic K, Arden N, Burridge J, Hammond A, Stokes M, Lewis M, Gooberman-Hill R, Coales K, Adams J. SAT0583-HPR Differences between Service Providers and Users when Defining Feasible Optimal NHs Occupational Therapy Treatment for Patients with Thumb Base OA: Results from a Delphi Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.2307] [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: 11/04/2022]
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30
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Warwick DJ, Shaikh A, Gadola S, Stokes M, Worsley P, Bain D, Tucker AT, Gadola SD. Neuromuscular electrostimulation viathe common peroneal nerve promotes lower limb blood flow in a below-kneecast: A potential for thromboprophylaxis. Bone Joint Res 2013; 2:179-85. [PMID: 23999610 PMCID: PMC3763477 DOI: 10.1302/2046-3758.29.2000176] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objectives We aimed to examine the characteristics of deep venous flow in
the leg in a cast and the effects of a wearable neuromuscular stimulator
(geko; FirstKind Ltd) and also to explore the participants’ tolerance
of the stimulator. Methods This is an open-label physiological study on ten healthy volunteers.
Duplex ultrasonography of the superficial femoral vein measured
normal flow and cross-sectional area in the standing and supine
positions (with the lower limb initially horizontal and then elevated).
Flow measurements were repeated during activation of the geko stimulator
placed over the peroneal nerve. The process was repeated after the
application of a below-knee cast. Participants evaluated discomfort
using a questionnaire (verbal rating score) and a scoring index
(visual analogue scale). Results The geko device was effective in significantly increasing venous
blood flow in the lower limb both with a plaster cast (mean difference
11.5 cm/sec-1; p = 0.001 to 0.13) and without a plaster
cast (mean difference 7.7 cm/sec-1; p = 0.001 to 0.75).
Posture also had a significant effect on peak venous blood flow
when the cast was on and the geko inactive (p = 0.003 to 0.69),
although these differences were less pronounced than the effect
of the geko (mean difference 3.1 cm/sec-1 (-6.5 to 10)).
The geko device was well tolerated, with participants generally
reporting only mild discomfort using the device. Conclusion The geko device increases venous blood flow in the lower limb,
offering a potential mechanical thromboprolylaxis for patients in
a cast. Cite this article: Bone Joint Res 2013;2:179–85.
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Affiliation(s)
- D J Warwick
- University Hospital Southampton, SouthamptonS16 6UY, UK
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Cornell P, Trehane A, Thompson P, Rahmeh F, Greenwood M, Baqai TJ, Cambridge S, Shaikh M, Rooney M, Donnelly S, Tahir H, Ryan S, Kamath S, Hassell A, McCuish WJ, Bearne L, Mackenzie-Green B, Price E, Williamson L, Collins D, Tang E, Hayes J, McLoughlin YM, Chamberlain V, Campbell S, Shah P, McKenna F, Cornell P, Westlake S, Thompson P, Richards S, Homer D, Gould E, Empson B, Kemp P, Richards AG, Walker J, Taylor S, Bari SF, Alachkar M, Rajak R, Lawson T, O'Sullivan M, Samant S, Butt S, Gadsby K, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Edwards KR, Rowe I, Sanders T, Dunn K, Konstantinou K, Hay E, Jones LE, Adams J, White P, Donovan-Hall M, Hislop K, Barbosa Boucas S, Nichols VP, Williamson EM, Toye F, Lamb SE, Rodham K, Gavin J, Watts L, Coulson N, Diver C, Avis M, Gupta A, Ryan SJ, Stangroom S, Pearce JM, Byrne J, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Taylor J, Morris M, Dures E, Hewlett S, Wilson A, Adams J, Larkin L, Kennedy N, Gallagher S, Fraser AD, Shrestha P, Batley M, Koduri G, Scott DL, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Kumar K, Raza K, Nightingale P, Horne R, Chapman S, Greenfield S, Gill P, Ferguson AM, Ibrahim F, Scott DL, Lempp H, Tierney M, Fraser A, Kennedy N, Barbosa Boucas S, Hislop K, Dziedzic K, Arden N, Burridge J, Hammond A, Stokes M, Lewis M, Gooberman-Hill R, Coales K, Adams J, Nutland H, Dean A, Laxminarayan R, Gates L, Bowen C, Arden N, Hermsen L, Terwee CB, Leone SS, vd Zwaard B, Smalbrugge M, Dekker J, vd Horst H, Wilkie R, Ferguson AM, Nicky Thomas V, Lempp H, Cope A, Scott DL, Simpson C, Weinman J, Agarwal S, Kirkham B, Patel A, Ibrahim F, Barn R, Brandon M, Rafferty D, Sturrock R, Turner D, Woodburn J, Rafferty D, Paul L, Marshall R, Gill J, McInnes I, Roderick Porter D, Woodburn J, Hennessy K, Woodburn J, Steultjens M, Siddle HJ, Hodgson RJ, Hensor EM, Grainger AJ, Redmond A, Wakefield RJ, Helliwell PS, Hammond A, Rayner J, Law RJ, Breslin A, Kraus A, Maddison P, Thom JM, Newcombe LW, Woodburn J, Porter D, Saunders S, McCarey D, Gupta M, Turner D, McGavin L, Freeburn R, Crilly A, Lockhart JC, Ferrell WR, Goodyear C, Ledingham J, Waterman T, Berkin L, Nicolaou M, Watson P, Lillicrap M, Birrell F, Mooney J, Merkel PA, Poland F, Spalding N, Grayson P, Leduc R, Shereff D, Richesson R, Watts RA, Roussou E, Thapper M, Bateman J, Allen M, Kidd J, Parsons N, Davies D, Watt KA, Scally MD, Bosworth A, Wilkinson K, Collins S, Jacklin CB, Ball SK, Grosart R, Marks J, Litwic AE, Sriranganathan MK, Mukherjee S, Khurshid MA, Matthews SM, Hall A, Sheeran T, Baskar S, Muether M, Mackenzie-Green B, Hetherington A, Wickrematilake G, Williamson L, Daniels LE, Gwynne CE, Khan A, Lawson T, Clunie G, Stephenson S, Gaffney K, Belsey J, Harvey NC, Clarke-Harris R, Murray R, Costello P, Garrett E, Holbrook J, Teh AL, Wong J, Dogra S, Barton S, Davies L, Inskip H, Hanson M, Gluckman P, Cooper C, Godfrey K, Lillycrop K, Anderton T, Clarke S, Rao Chaganti S, Viner N, Seymour R, Edwards MH, Parsons C, Ward K, Thompson J, Prentice A, Dennison E, Cooper C, Clark E, Cumming M, Morrison L, Gould VC, Tobias J, Holroyd CR, Winder N, Osmond C, Fall C, Barker D, Ring S, Lawlor D, Tobias J, Davey Smith G, Cooper C, Harvey NC, Toms TE, Afreedi S, Salt K, Roskell S, Passey K, Price T, Venkatachalam S, Sheeran T, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kingsbury D, Quartier P, Patel G, Arora V, Kupper H, Mozaffarian N, Kearsley-Fleet L, Baildam E, Beresford MW, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Saunders E, Baildam E, Chieng A, Davidson J, Foster H, Gardner-Medwin J, Wedderburn L, Thomson W, Hyrich K, McErlane F, Beresford M, Baildam E, Chieng SE, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Thomson W, Hyrich K, Rooney M, Finnegan S, Gibson DS, Borg FA, Bale PJ, Armon K, Cavelle A, Foster HE, McDonagh J, Bale PJ, Armon K, Wu Q, Pesenacker AM, Stansfield A, King D, Barge D, Abinun M, Foster HE, Wedderburn L, Stanley K, Morrissey D, Parsons S, Kuttikat A, Shenker N, Garrood T, Medley S, Ferguson AM, Keeling D, Duffort P, Irving K, Goulston L, Culliford D, Coakley P, Taylor P, Hart D, Spector T, Hakim A, Arden N, Mian A, Garrood T, Magan T, Chaudhary M, Lazic S, Sofat N, Thomas MJ, Moore A, Roddy E, Peat G, Rees F, Lanyon P, Jordan N, Chaib A, Sangle S, Tungekar F, Sabharwal T, Abbs I, Khamashta M, D'Cruz D, Dzifa Dey I, Isenberg DA, Chin CW, Cheung C, Ng M, Gao F, Qiong Huang F, Thao Le T, Yong Fong K, San Tan R, Yin Wong T, Julian T, Parker B, Al-Husain A, Yvonne Alexander M, Bruce I, Jordan N, Abbs I, D'cruz D, McDonald G, Miguel L, Hall C, Isenberg DA, Magee A, Butters T, Jury E, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Lazarus MN, Isenberg DA, Ehrenstein M, Carter LM, Isenberg DA, Ehrenstein MR, Chanchlani N, Gayed M, Yee CS, Gordon C, Ball E, Rooney M, Bell A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Sutton EJ, Watson KD, Isenberg D, Rahman A, Gordon C, Yee CS, Lanyon P, Jayne D, Akil M, D'Cruz D, Khamashta M, Lutalo P, Erb N, Prabu A, Edwards CJ, Youssef H, McHugh N, Vital E, Amft N, Griffiths B, Teh LS, Zoma A, Bruce I, Durrani M, Jordan N, Sangle S, D'Cruz D, Pericleous C, Ruiz-Limon P, Romay-Penabad Z, Carrera-Marin A, Garza-Garcia A, Murfitt L, Driscoll PC, Giles IP, Ioannou Y, Rahman A, Pierangeli SS, Ripoll VM, Lambrianides A, Heywood WE, Ioannou J, Giles IP, Rahman A, Stevens C, Dures E, Morris M, Knowles S, Hewlett S, Marshall R, Reddy V, Croca S, Gerona D, De La Torre Ortega I, Isenberg DA, Leandro M, Cambridge G, Reddy V, Cambridge G, Isenberg DA, Glennie M, Cragg M, Leandro M, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Artim Esen B, Pericleous C, MacKie I, Ioannou Y, Rahman A, Isenberg DA, Giles I, Skeoch S, Haque S, Pemberton P, Bruce I. BHPR: Audit and Clinical Evaluation * 103. Dental Health in Children and Young Adults with Inflammatory Arthritis: Access to Dental Care. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket196] [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: 11/12/2022] Open
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Worsley P, Warner M, Mottram S, Gadola S, Veeger H, Hermens H, Morrisey D, Little P, Cooper C, Carr A, Stokes M. Motor control retraining exercises for shoulder impingement: effects on function, muscle activation, and biomechanics in young adults. J Shoulder Elbow Surg 2013; 22:e11-9. [PMID: 22947240 PMCID: PMC3654498 DOI: 10.1016/j.jse.2012.06.010] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [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: 02/23/2012] [Revised: 06/18/2012] [Accepted: 06/22/2012] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Evidence for effective management of shoulder impingement is limited. The present study aimed to quantify the clinical, neurophysiological, and biomechanical effects of a scapular motor control retraining for young individuals with shoulder impingement signs. METHOD Sixteen adults with shoulder impingement signs (mean age 22 ± 1.6 years) underwent the intervention and 16 healthy participants (24.8 ± 3.1years) provided reference data. Shoulder function and pain were assessed using the Shoulder Pain and Disability Index (SPADI) and other questionnaires. Electromyography (EMG) and 3-dimensional motion analysis was used to record muscle activation and kinematic data during arm elevation to 90° and lowering in 3 planes. Patients were assessed pre and post a 10-week motor control based intervention, utilizing scapular orientation retraining. RESULTS Pre-intervention, patients reported pain and reduced function compared to the healthy participants (SPADI in patients 20 ± 9.2; healthy 0 ± 0). Post-intervention, the SPADI scores reduced significantly (P < .001) by a mean of 10 points (±4). EMG showed delayed onset and early termination of serratus anterior and lower trapezius muscle activity pre-intervention, which improved significantly post-intervention (P < .05). Pre-intervention, patients exhibited on average 4.6-7.4° less posterior tilt, which was significantly lower in 2 arm elevation planes (P < .05) than healthy participants. Post-intervention, upward rotation and posterior tilt increased significantly (P < .05) during 2 arm movements, approaching the healthy values. CONCLUSION A 10-week motor control intervention for shoulder impingement increased function and reduced pain. Recovery mechanisms were indicated by changes in muscle recruitment and scapular kinematics. The efficacy of the intervention requires further examined in a randomized control trial.
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Affiliation(s)
- Peter Worsley
- Faculty of Health Sciences, University of Southampton
| | - Martin Warner
- Faculty of Health Sciences, University of Southampton
| | - Sarah Mottram
- Faculty of Health Sciences, University of Southampton
| | - Stephan Gadola
- Faculty of Medicine, University of Southampton, Southampton,
| | - H Veeger
- Faculty Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, Netherlands
| | - H Hermens
- University of Twente, Drienerlolaan 5, 7522 NB Enschede, Netherlands
| | - D Morrisey
- Centre for Sports and Exercise Medicine, Queen Mary University of London, UK
| | - P Little
- Faculty of Medicine, University of Southampton, Southampton,
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
| | - A Carr
- Botnar Research Centre, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - M Stokes
- Faculty of Health Sciences, University of Southampton
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Prabhu S, Stokes M, Kras A, Arunothayaraj S, Yi H, Kong L, Peck K, Casan J, Blusztein D, Jackson D, Toogood G. Initial Presentation to a Non-tertiary Hospital Results in a Prolonged Pre-operative Hospital Stay and an Increased Risk of Nosocomial Infections in Patients Requiring In-patient Transfer to a Tertiary Centre for Cardio-Thoracic Surgery: A Multi-centre Analysis in Metropolitan Melbourne. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.611] [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: 11/17/2022]
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Adams J, Ryall C, Pandyan A, Metcalf C, Stokes M, Bradley S, Warwick DJ. Proximal interphalangeal joint replacement in patients with arthritis of the hand: a meta-analysis. ACTA ACUST UNITED AC 2012; 94:1305-12. [PMID: 23015553 DOI: 10.1302/0301-620x.94b10.29035] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We systematically reviewed all the evidence published in the English language on proximal interphalangeal joint (PIPJ) replacement, to determine its effectiveness on the function of the hand and the associated post-operative complications. Original studies were selected if they reported clinical outcome with a minimum of one year's follow-up. Quality was assessed using the Cowley systematic review criteria modified for finger-joint replacements. Of 319 articles identified, only five were adequately reported according to our quality criteria; there were no randomised controlled trials. PIPJ replacements had a substantial effect size on hand pain of -23.2 (95% confidence interval (CI) -27.3 to -19.1) and grip strength 1.2 (95% CI -10.7 to 13.1), and a small effect on range of movement 0.2 (95% CI -0.4 to 0.8). A dorsal approach was most successful. Post-operative loosening occurred in 10% (95% CI 3 to 30) of ceramic and 12.5% (95% CI 7 to 21) of pyrocarbon replacements. Post-operative complications occurred in 27.8% (95% CI 20 to 37). We conclude that the effectiveness of PIPJ replacement has not been established. Small observational case studies and short-term follow-up, together with insufficient reporting of patient data, functional outcomes and complications, limit the value of current evidence. We recommend that a defined core set of patients, surgical and outcome data for this intervention be routinely and systematically collected within the framework of a joint registry.
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Affiliation(s)
- J Adams
- University of Southampton, Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK
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Sharma S, Barry M, Stokes M, Gorey T, Kell M. 28. Surgical management of lobular carcinoma from a national screening program. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Snow L, Warner R, Cheney T, Wearing H, Stokes M, Harris K, Teale C, Coldham N. Risk factors associated with extended spectrum beta-lactamase Escherichia coli (CTX-M) on dairy farms in North West England and North Wales. Prev Vet Med 2012; 106:225-34. [DOI: 10.1016/j.prevetmed.2012.03.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 03/08/2012] [Accepted: 03/17/2012] [Indexed: 11/16/2022]
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Bloudek LM, Stokes M, Buse DC, Wilcox TK, Lipton RB, Goadsby PJ, Varon SF, Blumenfeld AM, Katsarava Z, Pascual J, Lanteri-Minet M, Cortelli P, Martelletti P. Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS). J Headache Pain 2012; 13:361-78. [PMID: 22644214 PMCID: PMC3381065 DOI: 10.1007/s10194-012-0460-7] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/07/2012] [Indexed: 11/26/2022] Open
Abstract
Migraine is a disabling neurological disease that affects 14.7 % of Europeans. Studies evaluating the economic impact of migraine are complex to conduct adequately and with time become outdated as healthcare systems evolve. This study sought to quantify and compare direct medical costs of chronic migraine (CM) and episodic migraine (EM) in five European countries. Cross-sectional data collected via a web-based survey were screened for migraine and classified as CM (≥15 headache days/month) or EM (<15 headache days/month), and included sociodemographics, resource use data and medication use. Unit cost data, gathered using publicly available sources, were analyzed for each type of service, stratified by migraine status. Univariate and multivariate log-normal regression models were used to examine the relationship between various factors and their impact on total healthcare costs. This economic analysis included data from respondents with migraine in the UK, France, Germany, Italy, and Spain. CM participants had higher level of disability and more prevalent psychiatric disorders compared to EM. CM participants had more provider visits, emergency department/hospital visits, and diagnostic tests; the medical costs were three times higher for CM than EM. Per patient annual costs were highest in the UK and Spain and lower in France and Germany. CM was associated with higher medical resource use and total costs compared to EM in all study countries, suggesting that treatments that reduce headache frequency could decrease the clinical and economic burden of migraine in Europe. Comparing patterns of care and outcomes among countries may facilitate the development of more cost-effective care, and bring greater recognition to patients affected by migraine.
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Affiliation(s)
- L M Bloudek
- Allergan Inc., 2525 Dupont Drive, Irvine, CA, 92612, USA.
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Harris C, Remedios D, Aptowitzer T, Keat A, Hamilton L, Guile G, Belkhiri A, Newman D, Toms A, Macgregor A, Gaffney K, Morton L, Jones GT, MacDonald AG, Downham C, Macfarlane GJ, Tillett W, Jadon D, Wallis D, Costa L, Waldron N, Griffith N, Cavill C, Korendowych E, de Vries C, McHugh N, Iaremenko O, Fedkov D, Emery P, Baeten D, Sieper J, Braun J, van der Heijde D, McInnes I, Van Laar J, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Paramarta I, Bertolino A, Wright AM, Hueber W, Sofat N, Smee C, Hermansson M, Wajed J, Sanyal K, Kiely P, Howard M, Howe FA, Barrick TR, Abraham AM, Pearce MS, Mann KD, Francis RM, Birrell F, Carr A, Macleod I, Ng WF, Kavanaugh A, van der Heijde D, Chattopadhyay C, Gladman D, Mease P, McInnes I, Krueger G, Xu W, Goldstein N, Beutler A, Van Laar J, Baraliakos X, Braun J, Laurent DD, Baeten D, van der Heijde D, Sieper J, Emery P, McInnes I, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Wright AM, Gsteiger S, Hueber W, Conaghan PG, Peterfy CG, DiCarlo J, Olech E, Alberts AR, Alper JA, Devenport J, Anisfeld AM, Troum OM, Cooper P, Gimpel M, Deakin G, Jameson K, Godtschailk M, Gadola S, Stokes M, Cooper C, Gordon C, Kalunian K, Petri M, Strand V, Kilgallen B, Barry A, Wallace D, Flurey CA, Morris M, Pollock J, Hughes R, Richards P, Hewlett S. Oral abstracts 1: Spondyloarthropathies * O1. Detecting axial spondyloarthritis amongst primary care back pain referrals. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes118] [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: 11/13/2022] Open
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Campbell R, Hofmann D, Hatch S, Gordon P, Lempp H, Das L, Blumbergs P, Limaye V, Vermaak E, McHugh N, Edwards MH, Jameson K, Sayer AA, Dennison E, Cooper C, Salvador FB, Huertas C, Isenberg D, Jackson EJ, Middleton A, Churchill D, Walker-Bone K, Worsley PR, Mottram S, Warner M, Morrissey D, Gadola S, Carr A, Cooper C, Stokes M, Srivastava RN, Sanghi D, Srivastava RN, Sanghi D, Elbaz A, Mor A, Segal G, Drexler M, Norman D, Peled E, Rozen N, Goryachev Y, Debbi EM, Haim A, Rozen N, Wolf A, Debi R, Mor A, Segal G, Debbi EM, Cohen MS, Igolnikov I, Bar Ziv Y, Benkovich V, Bernfeld B, Rozen N, Elbaz A, Collins J, Moots RJ, Clegg PD, Milner PI, Ejtehadi HD, Nelson PN, Wenham C, Balamoody S, Hodgson R, Conaghan P, Wilkie R, Blagojevic M, Jordan KP, Mcbeth J, Peffers MJ, Beynon RJ, Thornton DJ, Clegg PD, Chapman R, Chapman V, Walsh D, Kelly S, Hui M, Zhang W, Doherty S, Rees F, Muir K, Maciewicz R, Doherty M, Snelling S, Davidson RK, Swingler T, Price A, Clark I, Stockley E, Hathway G, Faas H, Auer D, Chapman V, Hirsch G, Hale E, Kitas G, Klocke R, Abraham A, Pearce MS, Mann KD, Francis RM, Birrell F, Tucker M, Mellon SJ, Jones L, Price AJ, Dieppe PA, Gill HS, Ashraf S, Chapman V, Walsh DA, McCollum D, McCabe C, Grieve S, Shipley J, Gorodkin R, Oldroyd AG, Evans B, Greenbank C, Bukhari M, Rajak R, Bennett C, Williams A, Martin JC, Abdulkader R, MacNicol C, Brixey K, Stephenson S, Clunie G, Andrews RN, Oldroyd AG, Evans B, Greenbank C, Bukhari M, Clark EM, Gould VC, Carter L, Morrison L, Tobias JH, Pye SR, Vanderschueren D, O'Neill TW, Lee DM, Jans I, Billen J, Gielen E, Laurent M, Claessens F, Adams JE, Ward KA, Bartfai G, Casanueva F, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi I, Kula K, Lean ME, Pendleton N, Punab M, Wu FC, Boonen S, Mercieca C, Webb J, Shipley J, Bhalla A, Fairbanks S, Moss KE, Collins C, Sedgwick P, Clark EM, Gould VC, Morrison L, Tobias JH, Parker J, Greenbank C, Evans B, Oldroyd AG, Bukhari M, Harvey NC, Cole ZA, Crozier SR, Ntani G, Mahon PA, Robinson SM, Inskip HM, Godfrey KM, Dennison EM, Cooper C, Bridges M, Ruddick S, Holroyd CR, Mahon P, Crozier SR, Godfrey K, Inskip HM, Cooper C, Harvey NC, Bridges M, Ruddick S, McNeilly T, McNally C, Beringer T, Finch M, Coda A, Davidson J, Walsh J, Fowlie P, Carline T, Santos D, Patil P, Rawcliffe C, Olaleye A, Moore S, Fox A, Sen D, Ioannou Y, Nisar S, Rankin K, Birch M, Finnegan S, Rooney M, Gibson DS, Malviya A, Ferris CM, Rushton SP, Foster HE, Hanson H, Muthumayandi K, Deehan DJ, Birt L, Poland F, MacGregor A, Armon K, Pfeil M, McErlane F, Beresford MW, Baildam EM, Thomson W, Hyrich K, Chieng A, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Gibson DS, Finnegan S, Newell K, Evans A, Manning G, Scaife C, McAllister C, Pennington SR, Duncan M, Moore T, Rooney M, Pericleous C, Croca SC, Giles I, Alber K, Yong H, Isenberg D, Midgely A, Beresford MW, Rahman A, Ioannou Y, Rzewuska M, Mallen C, Strauss VY, Belcher J, Peat G, Byng-Maddick R, Wijendra M, Penn H, Roddy E, Muller S, Hayward R, Mallen C, Kamlow F, Pakozdi A, Jawad A, Green DJ, Muller S, Mallen C, Hider SL, Singh Bawa S, Bawa S, Turton A, Palmer M, Grieve S, Lewis J, Moss T, McCabe C, Goodchild CE, Tang N, Scott D, Salkovskis P, Selvan S, Williamson L, Selvan S, Williamson L, Thalayasingam N, Higgins M, Saravanan V, Rynne M, Hamilton JD, Heycock C, Kelly C, Norton S, Sacker A, Done J, Young A, Smolen JS, Fleischmann RM, Emery P, van Vollenhoven RF, Guerette B, Santra S, Kupper H, Redden L, Kavanaugh A, Keystone EC, van der Heijde D, Weinblatt ME, Mozaffarian N, Guerette B, Kupper H, Liu S, Kavanaugh A, Zhang N, Wilkinson S, Riaz M, Ostor AJ, Nisar MK, Burmester G, Mariette X, Navarro-Blasco F, Oezer U, Kary S, Unnebrink K, Kupper H, Jobanputra P, Maggs F, Deeming A, Carruthers D, Rankin E, Jordan A, Faizal A, Goddard C, Pugh M, Bowman S, Brailsford S, Nightingale P, Tugnet N, Cooper SC, Douglas KM, Edwin Lim CS, Bee Lian Low S, Joy C, Hill L, Davies P, Mukherjee S, Cornell P, Westlake SL, Richards S, Rahmeh F, Thompson PW, Breedveld F, Keystone E, van der Heijde D, Landewe R, Smolen JS, Guerette B, McIlraith M, Kupper H, Liu S, Kavanaugh A, Byng-Maddick R, Penn H, Abdulkader R, Dharmapalaiah C, Shand L, Rose G, Clunie G, Watts R, Eldashan A, Dasgupta B, Borg FA, Bell GM, Anderson AE, Harry RA, Stoop JN, Hilkens CM, Isaacs J, Dickinson A, McColl E, Banik S, Smith L, France J, Bawa S, Rutherford A, Scott Russell A, Smith J, Jassim I, Withrington R, Bacon P, De Lord D, McGregor L, Morrison I, Stirling A, Porter DR, Saunders SA, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Baguley E, Patel Y, Alzabin S, Abraham S, Taher TE, Palfeeman A, Hull D, McNamee K, Jawad A, Pathan E, Kinderlerer A, Taylor P, Williams RO, Mageed RA, Iaremenko O, Mikitenko G, Ferrari M, Kamalati T, Pitzalis C, Tugnet N, Pearce F, Tosounidou S, Obrenovic K, Erb N, Packham J, Sandhu R, White C, Cardy CM, Justice E, Frank M, Li L, Lloyd M, Ahmed A, Readhead S, Ala A, Fittall M, Manson J, Ioannou Y, Sibilia J, Marc Flipo R, Combe B, Gaillez C, Le Bars M, Poncet C, Elegbe A, Westhovens R, Hassanzadeh R, Mangan C, France J, Bawa S, Weinblatt ME, Fleischmann R, van Vollenhoven R, Emery P, Huizinga TWJ, Goldermann R, Duncan B, Timoshanko J, Luijtens K, Davies O, Dougados M, Hewitt J, Owlia M, Dougados M, Gaillez C, Le Bars M, Poncet C, Elegbe A, Schiff M, Alten R, Kaine JL, Keystone E, Nash PT, Delaet I, Qi K, Genovese MC, Clark J, Kardash S, Wong E, Hull R, McCrae F, Shaban R, Thomas L, Young-Min S, Ledingham J, Genovese MC, Covarrubias Cobos A, Leon G, Mysler EF, Keiserman MW, Valente RM, Nash PT, Abraham Simon Campos J, Porawska W, Box JH, Legerton CW, Nasonov EL, Durez P, Pappu R, Delaet I, Teng J, Alten R, Edwards CJ, Arden N, Campbell J, van Staa T, Housden C, Sargeant I, Edwards CJ, Arden N, Campbell J, van Staa T, Housden C, Sargeant I, Choy E, McAuliffe S, Roberts K, Sargeant I, Emery P, Sarzi-Puttini P, Moots RJ, Andrianakos A, Sheeran TP, Choquette D, Finckh A, Desjuzeur ML, Gemmen EK, Mpofu C, Gottenberg JE, Bukhari M, Shah P, Kitas G, Cox M, Nye A, O'Brien A, Jones P, Sargeant I, Jones GT, Paudyal P, MacPherson H, Sim J, Doherty M, Ernst E, Fisken M, Lewith G, Tadman J, Macfarlane GJ, Mariette X, Bertin P, Arendt C, Terpstra I, VanLunen B, de Longueville M, Zhou H, Cai A, Lacy E, Kay J, Keystone E, Matteson E, Hu C, Hsia E, Doyle M, Rahman M, Shealy D, Scott DL, Ibrahim F, Abozaid H, Choy E, Hassell A, Plant M, Richards S, Walker D, Simpson G, Kowalczyk A, Prouse P, Brown A, George M, Kumar N, Mackay K, Marshall S, Nash PT, Ludivico CL, Delaet I, Qi K, Murthy B, Corbo M, Kaine JL, Emery P, Smolen JS, Samborski W, Berenbaum F, Davies O, Ambrugeat J, Bennett B, Burkhardt H, Prouse P, Brown A, George M, Kumar N, Mackay K, Marshall S, Bykerk V, Ostor AJ, Roman Ivorra J, Wollenhaupt J, Stancati A, Bernasconi C, Sibilia J, Scott DGI, Claydon P, Ellis C, Buchan S, Pope J, Fleischmann R, Dougados M, Bingham CO, Massarotti EM, Wollenhaupt J, Duncan B, Coteur G, Weinblatt M, Hull D, Ball C, Abraham S, Ainsworth T, Kermik J, Woodham J, Haq I, Quesada-Masachs E, Carolina Diaz A, Avila G, Acosta I, Sans X, Alegre C, Marsal S, McWilliams D, Kiely PD, Young A, Walsh DA, Fleischmann R, Bolce R, Wang J, Ingham M, Dehoratius R, Decktor D, Rao V, Pavlov A, Klearman M, Musselman D, Giles J, Bathon J, Sattar N, Lee J, Baxter D, McLaren JS, Gordon MM, Thant KZ, Williams EL, Earl S, White P, Williams J, Westlake SL, Ledingham J, Jan AK, Bhatti AI, Stafford C, Carolan M, Ramakrishnan SA. Muscle disorders * 111. The impact of fatigue in patients with idiopathic inflammatory myopathy: a mixed method study. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes109] [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: 11/13/2022] Open
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Palmer S, Stokes M, Judkins C, Williams P, MacIsaac A, Whitbourn R. Enduring Reduction in Blood Pressure in the First Australian Cohort of Patients Treated with Renal Sympathetic Denervation Therapy for Resistant Hypertension. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.044] [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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Ni Mhuircheartaigh NM, Kell M, Flanagan FL, Hargaden GC, Fenlon HM, Gorey TF, Stokes M, Salman RR, Smith CS. Abstract P5-01-04: Preoperative PET-CT Staging of Axillary Node Positive Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-01-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: 18F-FDG PET CT is a powerful diagnostic tool, which has enhanced systemic staging in oncology. Our aim was to evaluate the utility of performing staging PET-CT on patients with biopsy proven metastatic axillary lymph nodes that had clinically occult distant metastatic disease and to assess any change in management arising from it. Materials & Methods: All patients with newly diagnosed breast cancer undergo axillary ultrasound and cytology of suspicious lymph nodes, and those with positive cytology undergo pre operative PET-CT. Nodes were classified on ultrasound according to assessment categories R1-R5. PET-CT images were acquired with a Siemens Biograph High Resolution 16 slice PET/CT scanner using full dose CT and intravenous contrast. Results: Eighty two patients were identified with positive axillary cytology following ultrasound biopsy and underwent PET-CT; 28/82 patients (34%) had extra axillary disease. In total 30 patients (37%) had a change in management due to the PET-CT findings. 2 patients had more extensive surgery than previously planned, 7 patients (8%) had an extended radiation field and 21 patients (26%) were treated for distant metastases. Discussion: The detection of metastatic disease beyond the axilla has important implications for treatment options and survival. We detected clinically overt metastatic disease beyond the axilla and altered management in 37% patients due to the PET/CT findings. On this basis we recommend PET-CT for this preoperative cohort of patients with node positive breast cancer.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-01-04.
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Affiliation(s)
| | - M Kell
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - FL Flanagan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - GC Hargaden
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - HM Fenlon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - TF Gorey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M Stokes
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - RR Salman
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - CS. Smith
- Mater Misericordiae University Hospital, Dublin, Ireland
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Collum J, Harrop J, Stokes M, Kendall D. Patient safety and quality of care continue to improve in NHS North West following early implementation of the European Working Time Directive. QJM 2010; 103:929-40. [PMID: 20739355 PMCID: PMC2990025 DOI: 10.1093/qjmed/hcq139] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES NHS North West aimed to fully implement the European Working Time Directive (EWTD) 1 year ahead of the August 2009 national deadline. Significant debate has taken place concerning the implications of the EWTD for patient safety. This study aims to directly address this issue by comparing parameters of patient safety in NHS North West to those nationally prior to EWTD implementation, and during 'North West-only' EWTD implementation. DESIGN Hospital standardised mortality ratio (HSMR), average length of stay (ALOS) and standardised readmission rate (SRR) in acute trusts across all specialties were calculated retrospectively throughout NHS North West for the three financial years from 2006/2007 to 2008/2009. These figures were compared to national data for the same parameters. RESULTS The analysis of HSMR, ALOS and SRR reveal no significant difference in trend across three financial years when NHS North West is compared to England. HSMR and SRR within NHS North West continued to improve at a similar rate to the England average after August 2008. The ALOS analysis shows that NHS North West performed better than the national average for the majority of the study period, with no significant change in this pattern in the period following August 2008. When the HSMRs for NHS North West and England are compared against a fixed benchmark year (2005), the data shows a continuing decrease. The NHS North West figures follow the national trend closely at all times. CONCLUSION The data presented in this study quantitatively demonstrates, for the first time, that implementation of the EWTD in NHS North West in August 2008 had no obvious adverse impact on key outcomes associated with patient safety and quality of care. Continued efforts will be required to address the challenge posed nationally by the restricted working hour's schedule.
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Affiliation(s)
- J Collum
- Junior Doctors Advisory Team, NHS North West Strategic Health Authority, Manchester, M1 3BN, UK.
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Water M, Stokes M. Inflatable Jumping castles: advocacy in action. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Killian JJ, Water M, Stokes M, Hallett L. Incidence of children left unattended in hot cars in Victoria, Australia. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stokes M. T-6 Rehabilitative Ultrasound Imaging of Muscle in Orthopaedic Conditions. J Biomech 2010. [DOI: 10.1016/s0021-9290(10)70136-6] [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: 10/19/2022]
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Stokes M, Summers C. Managing the current growth in demand for digital forensic services within the metropolitan police service. Sci Justice 2010. [DOI: 10.1016/j.scijus.2009.11.063] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Warner MB, Novellino A, Stokes M, Astill S, Maccione A. Reliability of kinematic parameters during unilateral upper limb reaching tasks using a portable motion tracking system. J Med Eng Technol 2010; 34:200-8. [PMID: 20064107 DOI: 10.3109/03091900903518363] [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: 01/11/2023]
Abstract
The reliability of a portable computer based system (Motor Task Manager; MTM) used for the assessment of motor dysfunction needs to be assessed before being used clinically. Nine healthy males, aged 24-55 years (mean = 31.4, SD +/- 9.84) performed three unilateral MTM-prescribed reaching task paradigms. Tasks were completed three times in random order during three separate testing sessions. Speed characteristics showed excellent (Intra-class correlation coefficient; ICC 0.78-0.92) and inter-session (ICC 0.86-0.92) reliability for all three tasks. Temporal parameters had fair to good reliability in the first session (ICC 0.42-0.78) which improved in sessions 2 and 3 (ICC 0.64-0.96). Inter-session reliability for temporal characteristics was better for movement time (ICC 0.57-0.84) than onset time (ICC 0.14-0.53). Spatial characteristics demonstrated poor intra- (ICC -0.09-0.63) and inter-sessions (ICC 0.15-0.61) reliability. Speed characteristics were the most robust results for the healthy population studied and recommended for measuring performance, particularly if only one test session is possible.
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Affiliation(s)
- M B Warner
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, UK.
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Lang K, Marciniak MD, Faries D, Stokes M, Buesching D, Earle C, Treat J, Thompson D. Temporal trends in first-line chemotherapy treatment among elderly stage IIIB/IV non-small cell lung cancer (NSCLC) patients in the United States: Evidence from SEER-Medicare data. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17002] [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: 11/20/2022] Open
Abstract
17002 Background: Data regarding first-line chemotherapy treatment among advanced-staged NSCLC patients is lacking. The purpose of this analysis was to assess first-line treatment patterns over time among elderly patients with Stage IIIB/IV NSCLC. Methods: Patients aged 65 years and older diagnosed with Stage IIIB/IV NSCLC between 1997 and 2002 were identified and followed over time using the SEER-Medicare database to evaluate temporal trends in first-line chemotherapy treatment. Results: Chemotherapy use increased from approximately 28% of Stage IIIB/IV patients diagnosed in 1997 to 36% of patients diagnosed in 2002. Among identifiable first-line treatments, cisplatin or carboplatin and taxane (C/CT) doublet therapy was the most common treatment in all years (approximately 50% or greater). The use of single-agent taxanes and gemcitabine increased over time (taxane use increased from 3.3% in 1997 to 7.6% in 2002; gemcitabine use increased from 0.6% in 1997 to 5.1% in 2002), while use of single agent cisplatin or carboplatin (C/C) declined (from 10.0% in 1997 to 3.1% in 2002). Use of doublet therapy with C/C and either a taxane or gemcitabine also increased over time (with the largest increase for the gemcitabine combination from 0.3% in 1997 to 11.8% in 2002). Correspondingly, use of doublet C/C and any other therapy declined markedly (from 18.9% in 1997 to 3.7% in 2002). Use of 3 or more agents as first-line treatment was infrequent across study years (<1.0%). Treatment discontinuation was substantial (>60% for all regimens). Conclusions: Our findings indicate relatively low but increasing use of first-line chemotherapy treatment among elderly Stage IIIB/IV NSCLC patients. [Table: see text]
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Affiliation(s)
- K. Lang
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M. D. Marciniak
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Faries
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M. Stokes
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Buesching
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - C. Earle
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - J. Treat
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Thompson
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
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Rowan F, McHugh S, Birido N, Kennedy M, Kell M, Gorey T, Stokes M. 351 POSTER Mixed tubular breast cancer carries a higher rate of nodal disease without increased mortality. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70786-7] [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: 11/17/2022] Open
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