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Hay CRM, Makris M, Shima M, Nagao A, Jiménez-Yuste V, Skinner M, Kessler CM, von Mackensen S. Association of patient, treatment and disease characteristics with patient-reported outcomes: Results of the ECHO Registry. Haemophilia 2024; 30:106-115. [PMID: 38030962 DOI: 10.1111/hae.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) in people living with haemophilia A (PLWHA) are often under-reported. Investigating PROs from a single study with a diverse population of PLWHA is valuable, irrespective of FVIII product or regimen. AIM To report available data from the Expanding Communications on Haemophilia A Outcomes (ECHO) registry investigating the associations of patient, treatment and disease characteristics with PROs and clinical outcomes in PLWHA. METHODS ECHO (NCT02396862), a prospective, multinational, observational registry, enrolled participants aged ≥16 years with moderate or severe haemophilia A using any product or treatment regimen. Data collection, including a variety of PRO questionnaires, was planned at baseline and annually for ≥2 years. Associations between PRO scores and patient, treatment and disease characteristics were determined by statistical analyses. RESULTS ECHO was terminated early owing to logistical constraints. Baseline data were available from 269 PLWHA from Europe, the United States and Japan. Most participants received prophylactic treatment (76.2%), with those using extended-half-life products (10.0%) reporting higher treatment satisfaction. Older age and body weight >30 kg/m2 (>BMI) were associated with poorer joint health. Older age was associated with poorer physical functioning and work productivity. Health-related quality of life and pain interference also deteriorated with age and >BMI; >BMI also increased pain severity scores. CONCLUSION ECHO captured a variety of disease characteristics, treatment patterns, PROs and clinical outcomes obtained in real-world practice with ≤1 year's follow-up. Older age, poorer joint health and >BMI adversely affected multiple aspects of participant well-being.
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Affiliation(s)
- Charles R M Hay
- Manchester University Department of Haematology, Manchester, UK
| | - Michael Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | | | - Mark Skinner
- Institute for Policy Advancement Ltd., Washington, DC, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Burke T, Rodriguez-Santana I, Chowdary P, Curtis R, Khair K, Laffan M, Mclaughlin P, Noone D, O'Mahony B, Pasi J, Skinner M, O'Hara J. Humanistic burden of problem joints for children and adults with haemophilia. Haemophilia 2023; 29:608-618. [PMID: 36574369 DOI: 10.1111/hae.14731] [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: 05/10/2022] [Revised: 11/25/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The "problem joint" (PJ) concept was developed to address patient-centric needs for a more holistic assessment of joint morbidity for people with haemophilia (PwH). AIM To quantify the humanistic burden of PJs in PwH to further support validation of the PJ outcome measure. METHODS Multivariable regression models evaluated the relationship between PJs and health-related quality of life (HRQoL, EQ-5D-5L) and overall work productivity loss (WPL) using data from the 'Cost of HaEmophilia: a Socioeconomic Survey' population studies (adults: CHESS II, CHESS US+; children/adolescents: CHESS-Paeds). Covariates included were haemophilia severity, age, comorbidities and education. RESULTS The CHESS II sample included 292 and 134 PwH for HRQoL and WPL analyses, mean age 38.6 years (39% ≥1 PJ, 61% none). CHESS US+ included 345 and 239 PwH for HRQoL and WPL, mean age 35 years (43% ≥1 PJ, 57% none). CHESS-Paeds included 198 PwH aged 4-17 (HRQoL only), mean age 11.5 years (19% ≥1 PJ, 81% none). In CHESS II and CHESS US+, presence of PJs was associated with worse HRQoL (Both p < .001). Few CHESS-Paeds participants had PJs, with no significant correlation with HRQoL. In CHESS II, upper body PJs were significantly correlated to WPL (p < .05). In CHESS US+, having ≥1 PJ or upper and lower body PJs were significantly correlated to WPL (vs. none; both p < .05). CONCLUSION This study has shown a meaningful burden of PJs on PwH, which should be considered in clinical and health policy assessments of joint health.
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Affiliation(s)
| | | | - Pratima Chowdary
- Katherine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Randall Curtis
- Hematology Utilization Group Study (HUGS), Walnut Creek, USA
| | - Kate Khair
- HCD Economics, Daresbury, UK.,Haemnet, London, UK
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, UK
| | - Paul Mclaughlin
- Katherine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Declan Noone
- HCD Economics, Daresbury, UK.,European Haemophilia Consortium, Brussels, Belgium
| | | | - John Pasi
- Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry, London, UK
| | - Mark Skinner
- McMaster University, Hamilton, Canada.,Institute for Policy Advancement Ltd, Washington, DC
| | - Jamie O'Hara
- HCD Economics, Daresbury, UK.,University of Chester, Chester, UK
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Sullivan C, Ghalehgolabbehbahani A, Parker B, Skinner M. Mortality of various-age larval winter ticks, Dermacentor albipictus, following surface contact with entomopathogenic fungi. Exp Parasitol 2022; 239:108292. [DOI: 10.1016/j.exppara.2022.108292] [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] [Received: 05/25/2021] [Revised: 04/13/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022]
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Burke T, Shaikh A, Ali TM, Li N, Curtis R, Garcia Diego DA, Recht M, Sannie T, Skinner M, O'Hara J. Association of factor expression levels with health-related quality of life and direct medical costs for people with haemophilia B. J Med Econ 2022; 25:386-392. [PMID: 35253589 DOI: 10.1080/13696998.2022.2049552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS Gene therapy trials aim to provide a functional cure for patients with haemophilia B (HB), and treatment impact is analyzed by factor IX expression levels (FELs). We investigated the relationship of FELs with health-related quality of life (HRQoL) and costs. MATERIALS AND METHODS This was a retrospective cross-sectional analysis of the European (CHESS I-II) and US (CHESS-US) CHESS population studies. Physicians recruited consecutive patients and extracted information from the medical records; patients completed questionnaires between 2014 and 2015 (CHESS-I), 2018-2019 (CHESS-II) and 2019 (CHESS US). Patients with inhibitors were excluded. HRQoL was assessed using the EQ-5D-5L. Twelve-month haemophilia-related direct medical costs included office visits and hospitalizations based on country-level unit costs. A Tobit model was used to analyze FELs and HRQoL and generalized linear models for direct medical costs. RESULTS A total of 191 men with HB completed the EQ-5D questionnaire; the mean age was 36.8 years, with a mean FEL of 10.1 IU/dL (median, 4.0). Mean EQ-5D was 0.77 (SD, 0.23). The Tobit model adjusting for age, body mass index and blood-borne viruses showed every 1% increase in FEL was associated with +0.006 points in the mean EQ-5D score (p = .003). Mean haemophilia-related direct medical costs excluding factor replacement therapy were €2,028/year (median, €919) in CHESS I-II (EU, n = 226), and $7,171/year (median, $586) in CHESS US (n = 181). Adjusted EU and US models showed every 1% increase in FEL was associated with a decrease in haemophilia-related direct medical costs of €108/year and $529/year, respectively. LIMITATIONS Direct medical costs were based on physician extraction of encounters from medical records, potentially underestimating costs of care. The voluntary nature of participation may have introduced selection biases. CONCLUSIONS We observed a significant association of increases in FEL with increased HRQoL and decreased costs in Europe and the United States among men with HB and no inhibitors.
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Affiliation(s)
- Tom Burke
- HCD Economics, Daresbury, Cheshire, UK
- Faculty of Health and Social Care, University of Chester, Chester, Cheshire, UK
| | | | | | | | | | | | - Michael Recht
- Oregon Health & Science University, Portland, OR, USA
- American Thrombosis and Hemostasis Network, Rochester, NY, USA
| | - Thomas Sannie
- Association Française des Hémophiles, Paris, Île-de-France, France
| | - Mark Skinner
- Institute for Policy Advancement, Ltd, Washington, DC, USA
- McMaster University, Hamilton, ON, Canada
| | - Jamie O'Hara
- HCD Economics, Daresbury, Cheshire, UK
- Faculty of Health and Social Care, University of Chester, Chester, Cheshire, UK
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McFarlane G, Loch C, Guatelli-Steinberg D, Bayle P, Le Luyer M, Sabel N, Nava A, Floyd B, Skinner M, White S, Pitfield R, Mahoney P. Enamel daily secretion rates of deciduous molars from a global sample of children. Arch Oral Biol 2021; 132:105290. [PMID: 34695672 DOI: 10.1016/j.archoralbio.2021.105290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate and describe the variation in enamel daily secretion rates (DSRs) of naturally exfoliated deciduous molars (n = 345) from five modern-day populations (Aotearoa New Zealand, Britain, Canada, France, and Sweden). DESIGN Each tooth was thin sectioned and examined using a high-powered Olympus BX51 microscope and DP25 digital microscope camera. Mean DSRs were recorded for the inner, mid, and outer regions of cuspal and lateral enamel, excluding enamel nearest the enamel-dentin junction and at the outermost crown surface. RESULTS Mean DSRs did not vary significantly between populations, or by sex. Cuspal enamel grew slightly faster than lateral enamel (mean difference 0.16 µm per day; p < 0.001). The trajectory of DSRs remained relatively constant from inner to outer cuspal enamel and increased slightly in lateral enamel (p = 0.003). CONCLUSIONS The DSRs of deciduous molars from modern-day children are remarkably consistent when compared among populations. While growth rates are faster in cuspal than lateral enamel, the trajectory of enamel formation changes only slightly from inner to outer regions. The trajectory of DSRs for deciduous molars differs to that of permanent molar enamel, which typically display a steep increase in matrix deposition from inner to outer enamel.
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Affiliation(s)
- Gina McFarlane
- Human Osteology Lab, School of Anthropology and Conservation, University of Kent, Canterbury, UK.
| | - Carolina Loch
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | | | | | - Mona Le Luyer
- Univ. Bordeaux, CNRS, MC, UMR 5199 PACEA, Pessac, France
| | - Nina Sabel
- Department of Pedodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Alessia Nava
- Human Osteology Lab, School of Anthropology and Conservation, University of Kent, Canterbury, UK
| | - Bruce Floyd
- School of Social Sciences, University of Auckland, New Zealand
| | - Mark Skinner
- Department of Archaeology, Simon Fraser University, Burnaby, Canada
| | - Sophie White
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Rosie Pitfield
- Human Osteology Lab, School of Anthropology and Conservation, University of Kent, Canterbury, UK
| | - Patrick Mahoney
- Human Osteology Lab, School of Anthropology and Conservation, University of Kent, Canterbury, UK
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Valentino LA, Baker JR, Butler R, Escobar M, Frick N, Karp S, Koulianos K, Lattimore S, Nugent D, Pugliese JN, Recht M, Reding MT, Rice M, Thibodeaux CB, Skinner M. Integrated Hemophilia Patient Care via a National Network of Care Centers in the United States: A Model for Rare Coagulation Disorders. J Blood Med 2021; 12:897-911. [PMID: 34707421 PMCID: PMC8544265 DOI: 10.2147/jbm.s325031] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/15/2021] [Indexed: 01/19/2023] Open
Abstract
Rare, chronic diseases such as hemophilia and other congenital coagulation disorders require coordinated delivery of services for optimal outcomes. Hemophilia Treatment Centers (HTCs) are specialized, multidisciplinary health-care centers providing team-based care to meet the physical, psychosocial, and emotional needs of people with hemophilia (PWH) and may serve as a model for other rare coagulation disorders. Health-care purchasers, as well as the general medical community, may not appreciate the breadth and quality of services provided by HTCs. They exemplify the acculturalization and actualization of integrated care by providing comprehensive diagnostic and treatment services that reduce morbidity, mortality, avoidable emergency room visits, hospitalizations, and overall costs, while promoting a longer lifespan and improved patient functioning and outcomes. This is accomplished by a team-based approach relying upon a shared decision-making model to effectively prevent complications and manage symptoms in PWH, who are dependent on high-cost treatments. This article provides a concise yet comprehensive description of the core components of an HTC and the regional and national networks in the United States, which together achieve their incomparable value for all stakeholders.
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Affiliation(s)
- Leonard A Valentino
- National Hemophilia Foundation, New York, NY, USA
- Departments of Internal Medicine and Pediatrics, Rush University, Chicago, IL, USA
| | | | - Regina Butler
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Miguel Escobar
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Neil Frick
- National Hemophilia Foundation, New York, NY, USA
| | - Susan Karp
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Susan Lattimore
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Diane Nugent
- Center for Inherited Blood Disorders, Orange, CA, USA
| | | | - Michael Recht
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
- American Thrombosis and Hemostasis Network, Rochester, NY, USA
| | - Mark T Reding
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | | | - Constance B Thibodeaux
- Departments of Internal Medicine and Pediatrics, Hemophilia Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mark Skinner
- Institute for Policy Advancement Ltd, Washington, DC, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Gray E, Skinner M, Hale L, Bunton R. Preparation and Support for Physical Activity Engagement Following CABG Surgery: A Survey of Current Practice in New Zealand. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.008] [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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Konkle B, Pierce G, Coffin D, Naccache M, Clark RC, George L, Iorio A, O’Mahony B, Pipe S, Skinner M, Watson C, Peyvandi F, Mahlangu J. Core data set on safety, efficacy, and durability of hemophilia gene therapy for a global registry: Communication from the SSC of the ISTH. J Thromb Haemost 2020; 18:3074-3077. [PMID: 33463024 PMCID: PMC7756325 DOI: 10.1111/jth.15023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/03/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gene therapy for people with hemophilia (PWH) will soon become available outside current clinical trials. The World Federation of Hemophilia (WFH), in collaboration with International Society of Thrombosis and Hemostasis Scientific and Standardization Committee (ISTH SSC), the European Haemophilia Consortium (EHC), the US National Hemophilia Foundation (NHF), the American Thrombosis and Hemostasis Network (ATHN), industry gene therapy development partners and Regulatory liaisons have developed the Gene Therapy Registry (GTR), designed to collect long-term data on all PWH who receive hemophilia gene therapy. OBJECTIVE The objectives of the GTR are to record the long-term safety and efficacy data post gene therapy infusion and to assess the changes in quality of life and burden of disease post-gene-therapy infusion. METHODS The GTR is a prospective, observational, and longitudinal registry developed under the guidance of a multi-stakeholder GTR Steering Committee (GTR SC), composed of health care professionals, patient advocates, industry representatives, and regulatory agency liaisons. All PWH who receive gene therapy by clinical trial or commercial product will be invited to enrol in the registry through their hemophilia treatment centers (HTCs). The registry aims to recruit 100% of eligible post gene therapy PWH globally. Through an iterative process, and following the guidance of the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA), the GTR SC has developed a core set of data to be collected on all patients post gene therapy. RESULTS The core data set includes demographic information, vector infusion details, safety, efficacy, quality of life and burden of disease. CONCLUSIONS The GTR is a global effort to ensure that long term safety and efficacy outcomes are recorded and analysed and rare adverse events, in a small patient population, are identified. Many unknowns on the long-term safety and efficacy of gene therapy for hemophilia may also be addressed.
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Affiliation(s)
- Barbara Konkle
- Bloodworks Northwest, Research InstituteUniversity of WashingtonSeattleWAUSA
| | | | | | | | | | - Lindsey George
- The Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Alfonso Iorio
- Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
| | | | - Steven Pipe
- PediatricsUniversity of MichiganAnn ArborMIUSA
| | - Mark Skinner
- Institute for Policy Advancement LtdWashingtonDCUSA
| | | | - Flora Peyvandi
- Internal MedicineFaculty of Medicine and SurgeryUniversity of MilanMilanItaly
| | - Johnny Mahlangu
- Faculty of Health Sciences and NHLSUniversity of the WitwatersrandJohannesburgSouth Africa
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Colibaba A, Skinner M. RURAL LIBRARIES AS CONTESTED SPACES OF OLDER VOLUNTARISM IN AGING RURAL COMMUNITIES. Innov Aging 2019. [PMCID: PMC6840549 DOI: 10.1093/geroni/igz038.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Recent efforts to better understand voluntarism as fundamental to how rural communities are meeting the challenges of population ageing have highlighted ageing rural volunteers, and the attendant burden of older voluntarism, as key issues for ageing in place of rural residents and ageing rural community sustainability. Drawing on a case study of a volunteer-based rural library in Ontario, Canada, this study examines the experiences of older volunteers, the challenges of sustaining volunteer programs, and the implications of older voluntarism for rural community development. Findings from interviews and focus groups with library volunteers, staff, board members and community stakeholders demonstrate how the experiences of older volunteers and challenges of older voluntarism affect rural community development. The results reveal how participation, well-being, conflict and territoriality associated with older voluntarism contributes to ‘contested spaces of older voluntarism’ whereby older volunteers negotiate their rights and responsibilities associated with ageing and volunteering in rural communities.
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Skinner M, Winterton R, Walsh K. PRODUCTIVE AND ACTIVE RURAL AGING: TOWARD CRITICAL PERSPECTIVES. Innov Aging 2019. [PMCID: PMC6840017 DOI: 10.1093/geroni/igz038.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Despite global trends in rural population ageing, relatively little attention within research and policy has been directed to understanding what it means for rural people, communities and institutions to be at the forefront of twenty-first century demographic change. To build understanding of rural ageing, this symposium draws together papers from four countries to provide insights in the gaps in rural ageing research – specifically the in context of productive and active rural ageing by examining rural work, retirement and volunteering through the critical perspectives of citizenship, contestation and complexity. Winterton and Warburton will explore how active citizenship trends among rural older adults support or hinder the capacity of rural settings to support health ageing. Colibaba and Skinner will discuss the contestation of rural ageing by examining a volunteer-based rural library and the emergent ‘contested spaces of older voluntarism’ whereby older volunteer negotiate their rights and responsibilities associated with ageing and volunteering in rural communities. Duvvury and Ni Leime will examine the interactions between the twin phenomena of feminisation of agriculture and the feminisation of ageing in the consequent implications for rural women’s work and retirement. Skinner and Joseph offer a critical perspective on voluntarism in ageing rural communities by examining volunteer leadership biographies as another means of understanding the contribution of older rural adults.
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Abstract
Despite a growing focus on rural ageing, international literature in this field remains underdeveloped in critical and interdisciplinary perspectives. Reflecting traditional divisions across geographic, gerontological and health literatures, how we understand experiences of growing older in rural settings can still be characterised by a narrow, applied approach. This has implications for our capacity to disentangle multifaceted lived realities from rural contexts, and macro socio-economic and structural environments. There then remains questions about the ways in which the study of rural ageing needs to develop to direct policy, research and practice agendas to be a more critical reflection of these complexities. This symposium aims to draw together interdisciplinary critical perspectives on ageing and rurality as a means to advance this development. It will consider different theoretical approaches and major cross cutting challenges in relation to rural ageing. Burholt and Scharf will examine how critical gerontology has raised awareness of the heterogeneity of rural ageing across social justice elements of demography, resources, recognition and representation. Keogh and Walsh address these same elements in relation to the empirical intersection of exclusion and change in the production of a new rurality for older people. Cutchin and Rowles present a pragmatist theoretical perspective to encapsulate the essence of rural integration within an ever-changing milieu. Poulin et al. offer a critical approach to rural gerontological health that emphasizes intersectionality in the formation and development of older adult health. Herron and Skinner explore the intersectional construction of dementia and mental health in rural settings for older adults.
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McCrillis E, Skinner M, Colibaba A. DEVELOPING RURAL INSIGHTS FOR BUILDING SUSTAINABLE AGE-FRIENDLY COMMUNITIES INITIATIVES. Innov Aging 2019. [PMCID: PMC6845825 DOI: 10.1093/geroni/igz038.3482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Researchers have questioned the focus on describing features of preliminary age-friendly implementation and the absence of program evaluations or analyses of long-term implementation. This lack of knowledge inadvertently simplifies unique pathways to age-friendly sustainability, preventing researchers from conducting in-depth, retrospective examinations of age-friendly and post-age-friendly perspectives. Seeking to address this critique, this research examines the challenges to rural age-friendly program sustainability, and the factors that may help committees overcome these barriers. Data were collected through a succession of qualitative studies, including a provincial age-friendly program evaluation and a series of studies examining sustainability in rural initiatives. Eighty in-depth interviews with age-friendly leaders and older participants from 27 rural Canadian programs were conducted, seeking knowledge about programs’ development and implementation. Key findings include the conceptualization of an implementation gap between early development and long-term viability, the important role played by individual communities, the challenges of capacity and jurisdictional fragmentation, and the inability of rural age-friendly programs to tackle bigger picture issues such as housing and transportation given their necessarily limited scope and reach. Implications relevant for research and practice suggest that drawing on individual, community, and jurisdictional factors will maximize the success and sustainability of rural age-friendly programs, thereby extending the reach and scale of programs to more directly affect older people. From this, we conclude that the sustainability and success of rural age-friendly programs would benefit from consistent, renewable government funding that considers factors relevant to overcoming the implementation gap and challenges created by jurisdictional fragmentation and de-emphasizing community individuality.
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Skinner M, Joseph A. CRITICAL PERSPECTIVES ON VOLUNTARISM IN AGING RURAL COMMUNITIES: VOLUNTEER LEADERSHIP BIOGRAPHIES. Innov Aging 2019. [PMCID: PMC6840562 DOI: 10.1093/geroni/igz038.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Voluntarism has been portrayed as a productive and even transformative process whereby rural communities, households and older residents are able to meet the challenges of changing rural demographics. Yet, little attention has been paid to building a critical perspective on the complex and often-contested expectations placed on older rural volunteers. This paper focuses on the particular gap in understanding the contributions of older rural adults as a crucial resource in creating opportunities for aging in place and sustainable rural community development. Drawing on research into voluntarism in Canada’s aging resource communities, this paper presents qualitative findings from innovative ‘volunteer leadership biographies’ with older residents who were involved in key voluntary sector initiatives to improve community development. The findings show how older volunteer leadership is embedded in both place (residency) and time (life course), revealing new dimensions to the problem of understanding volunteer leadership in an era of rural population change.
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Affiliation(s)
| | - Alun Joseph
- University Of Guelph, Guelph, Ontario, Canada
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Dubuske L, Skinner M, De Kam P. P110 MONOPHOSPHORYL LIPID A USED AS AN ADJUVANT IN SUBCUTANEOUS IMMUNOTHERAPY FURTHER INCREASES ALLERGEN SPECIFIC IGG/IGG4. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.252] [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: 10/25/2022]
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15
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Skinner M, Byra C. Signatures of stress: Pilot study of accentuated laminations in porcine enamel. Am J Phys Anthropol 2019; 169:619-631. [DOI: 10.1002/ajpa.23854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Mark Skinner
- Department of ArchaeologySimon Fraser University Burnaby British Columbia Canada
| | - Chris Byra
- Greenbelt Swine Veterinary Services LtdTechnical Services Veterinarian Chilliwack British Columbia Canada
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Konkle BA, Skinner M, Iorio A. Hemophilia trials in the twenty-first century: Defining patient important outcomes. Res Pract Thromb Haemost 2019; 3:184-192. [PMID: 31011702 PMCID: PMC6462740 DOI: 10.1002/rth2.12195] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/01/2019] [Indexed: 01/19/2023] Open
Abstract
Treatment for hemophilia has advanced dramatically over the past 5 decades. Success of prophylactic therapy in preventing bleeding and decreasing associated complications has established a new standard of care. However, with the advent of gene therapy and treatments that effectively mimic sustained coagulation factor replacement, outcome measures that worked well for assessing factor replacement therapies in past clinical trials need to be reassessed. In addition, while therapies have advanced, so has the science of outcome assessment, including recognition of the importance of patient important and patient reported outcomes. This manuscript reviews strengths and limitations of outcome measures used in hemophilia from both a provider and patient perspective.
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Affiliation(s)
- Barbara A. Konkle
- Bloodworks NorthwestSeattleWashington
- Department of MedicineUniversity of WashingtonSeattleWashington
| | - Mark Skinner
- Institute for Policy Advancement, Ltd.WashingtonDistrict of Columbia
- Department of Health Resource Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
| | - Alfonso Iorio
- Department of Health Resource Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
- Department of MedicineMcMaster UniversityHamiltonCanada
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Ballard R, Lee D, Zielen S, Bullimore A, Skinner M. CONJUNCTIVAL PROVOCATION TESTING IN A DOSE FINDING STUDY WITH SUBCUTANEOUS IMMUNOTHERAPY WITH GRASS + MPL. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.090] [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: 11/16/2022]
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Authier S, Abernathy M, Boulay E, Chui R, Friedrich G, Gendron-Parra N, Greiter-Wilke A, Guillon JM, Leishman D, Nichols J, Pierson J, Skinner M, Pugsley M, Valentin JP, Vargas H, Wisialowsky T. JTp and Tpe as biomarkers of proarrhythmic risk in nonclinical models: Historical data evaluation by the HESI consortium. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.1048] [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: 11/30/2022]
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19
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Davari A, Skinner M, Parker B. Cell electrofusion to improve efficacy and thermotolerance of the entomopathogenic fungus,
Beauveria bassiana. J Appl Microbiol 2018; 125:1482-1493. [DOI: 10.1111/jam.14031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 01/19/2023]
Affiliation(s)
- A. Davari
- Entomology Research Laboratory University of Vermont Burlington VT 05405‐0105 USA
| | - M. Skinner
- Entomology Research Laboratory University of Vermont Burlington VT 05405‐0105 USA
| | - B.L. Parker
- Entomology Research Laboratory University of Vermont Burlington VT 05405‐0105 USA
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Worm M, Higenbottam T, Pfaar O, Mösges R, Aberer W, Gunawardena K, Wessiepe D, Lee D, Kramer MF, Skinner M, Lees B, Zielen S. Randomized controlled trials define shape of dose response for Pollinex Quattro Birch allergoid immunotherapy. Allergy 2018; 73:1812-1822. [PMID: 29779247 PMCID: PMC6175210 DOI: 10.1111/all.13478] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Birch Allergoid, Tyrosine Adsorbate, Monophosphoryl Lipid A (POLLINEX® Quattro Plus 1.0 ml Birch 100%) is an effective, well-tolerated short course subcutaneous immunotherapy. We performed 2 phase II studies to determine its optimal cumulative dose. METHODS The studies were conducted in Germany, Austria and Poland (EudraCT numbers: 2012-004336-28 PQBirch203 and 2015-000984-15 PQBirch204) using a wide range of cumulative doses. In both studies, subjects were administered 6 therapy injections weekly outside the pollen season. Conjunctival Provocation Tests were performed at screening, baseline and 3-4 weeks after completing treatment, to quantify the reduction in Total Symptom Scores (as the primary endpoint) with each cumulative dose. Multiple Comparison Procedure and Modeling analysis was used to test for the dose response, shape of the curve and estimation of the median effective dose (ED50 ), a measure of potency. RESULTS Statistically significant dose responses (P < .01 & .001) were seen, respectively. The highest cumulative dose in PQBirch204 (27 300 standardized units [SU]) approached a plateau. Potency of the PQBirch was demonstrated by an ED50 2723 SU, just over half the current dose. Prevalence of treatment-emergent adverse events was similar for active doses, most being short-lived and mild. Compliance was over 85% in all groups. CONCLUSION Increasing the cumulative dose of PQBirch 5.5-fold from 5100 to 27 300 SU achieved an absolute point difference from placebo of 1.91, a relative difference 32.3% and an increase in efficacy of 50%, without compromising safety. The cumulative dose response was confirmed to be curvilinear in shape.
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Affiliation(s)
- M. Worm
- Department Campus Charité Mitte; Universitätsmedizin Berlin; Berlin Germany
| | | | - O. Pfaar
- Department of Otorhinolaryngology Head and Neck Surgery; University of Medicine, Mannheim, Germany; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Centre for Rhinology and Allergology; Wiesbaden Germany
| | - R. Mösges
- Hospital of the University of Cologne; Cologne Germany
| | - W. Aberer
- University Hospital Clinic; Graz Austria
| | | | - D. Wessiepe
- Metronomia Clinical Research GmbH; Muenchen Germany
| | - D. Lee
- Bencard Allergie; München Germany
| | | | | | - B. Lees
- Allergy Therapeutics; Worthing UK
| | - S. Zielen
- Clinic for Child and Adolescent Medicine, Allergology, Pneumonology and Cystic Fibrosis; Goethe University Frankfurt am Main; Frankfurt Germany
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Konkle BA, Johnsen JM, Wheeler M, Watson C, Skinner M, Pierce GF. Genotypes, phenotypes and whole genome sequence: Approaches from the My Life Our Future haemophilia project. Haemophilia 2018; 24 Suppl 6:87-94. [PMID: 29878652 PMCID: PMC6258054 DOI: 10.1111/hae.13506] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Information from the genes encoding factor VIII (F8) and IX (F9) is used in reproductive planning and to inform inhibitor formation, bleeding severity and response to therapies. Advances in technology and our understanding of the human genome now allows more comprehensive methods to study genomic variation and its impact on haemophilia. AIMS The My Life Our Future (MLOF) programme was begun in 2012 to provide genetic analysis and to expand research in haemophilia through a research repository. METHODS MLOF enrolled haemophilia A and B patients followed at haemophilia treatment centers in the U.S., including, since 2015, known and potential genetic carriers. Initial F8 and F9 DNA analysis was performed utilizing a next generation sequencing approach which allowed simultaneous detection of F8 inversions and other variants. Candidate variants were confirmed using a second method and multiplex ligation-dependent probe amplification was used to detect structural variants. RESULTS The initial phase of MLOF completed enrollment in December 2017 with 11,356 patients, genetic carriers, and potential carriers enrolled. In the 9453 subjects in whom analysis is complete, 687 unique previously unreported variants were found. Simultaneous sequencing of the F8 and F9 genes resulted in identification of non-deleterious variants previously reported as causative in haemophilia. DNA from 5141 MLOF subjects has undergone whole genome sequencing through the NHLBI TOPMed programme of the U.S. NIH. CONCLUSION MLOF has provided genetic information for patients and their families to help inform clinical care and has established a repository of data and biospecimens to further advance haemophilia research.
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Affiliation(s)
- B A Konkle
- Bloodworks Northwest, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - J M Johnsen
- Bloodworks Northwest, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - M Wheeler
- University of Washington, Seattle, WA, USA
| | - C Watson
- American Thrombosis and Hemostasis Network, Chicago, IL, USA
| | - M Skinner
- National Hemophilia Foundation, New York, NY, USA
| | - G F Pierce
- National Hemophilia Foundation, New York, NY, USA
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Affiliation(s)
- Abigail White
- Division of Plant Science and Conservation; Chicago Botanic Garden; Glencoe IL 60022 U.S.A
- Department of Biological Sciences; Northwestern University; Evanston IL 60201 U.S.A
| | - Jeremie B. Fant
- Division of Plant Science and Conservation; Chicago Botanic Garden; Glencoe IL 60022 U.S.A
- Department of Biological Sciences; Northwestern University; Evanston IL 60201 U.S.A
| | - Kayri Havens
- Division of Plant Science and Conservation; Chicago Botanic Garden; Glencoe IL 60022 U.S.A
- Department of Biological Sciences; Northwestern University; Evanston IL 60201 U.S.A
| | - Mark Skinner
- USDA Forest Service, Pacific Northwest Region Regional Office; Portland OR 97204 U.S.A
| | - Andrea T. Kramer
- Division of Plant Science and Conservation; Chicago Botanic Garden; Glencoe IL 60022 U.S.A
- Department of Biological Sciences; Northwestern University; Evanston IL 60201 U.S.A
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Terblanche N, Middleton C, Choi-Lundberg D, Skinner M. Efficacy of a new dual channel laryngeal mask airway, the LMA®Gastro™ Airway, for upper gastrointestinal endoscopy: a prospective observational study. Br J Anaesth 2018; 120:353-360. [DOI: 10.1016/j.bja.2017.11.075] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 01/31/2023] Open
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24
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Affiliation(s)
- M. Skinner
- Trent Centre for Aging & Society, Trent University, Peterborough, Ontario, Canada,
| | - K. Walsh
- Irish Centre for Social Gerontology, National University of Ireland, Galway, Ireland,
| | - T. Scharf
- Institute of Health & Society, and Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom,
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Sorbello M, Pulvirenti GS, Pluchino D, Skinner M. State of the Art in Airway Management During GI Endoscopy: The Missing Pieces. Dig Dis Sci 2017; 62:1385-1387. [PMID: 28194670 DOI: 10.1007/s10620-017-4494-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/07/2017] [Indexed: 12/19/2022]
Affiliation(s)
- M Sorbello
- Anaesthesia and Intensive Care, AOU Policlinico Vittorio Emanuele, Via del Plebiscito 628, 95100, Catania, Italy.
| | - G S Pulvirenti
- Anaesthesia and Intensive Care, AOU Policlinico Vittorio Emanuele, Via del Plebiscito 628, 95100, Catania, Italy
| | - D Pluchino
- Gastroenterology and Endoscopy, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - M Skinner
- Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, TAS, Australia
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Skinner M, Lim M, Tarrega A, Ford R, Linforth R, Thomas A, Hort J. Investigating the oronasal contributions to metallic perception. Int J Food Sci Technol 2017. [DOI: 10.1111/ijfs.13417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Skinner
- Sensory Science Centre; School of Biosciences; Sutton Bonington Campus; University of Nottingham; Loughborough, LE12 5RD UK
| | - M. Lim
- Sensory Science Centre; School of Biosciences; Sutton Bonington Campus; University of Nottingham; Loughborough, LE12 5RD UK
| | - A. Tarrega
- Sensory Science Centre; School of Biosciences; Sutton Bonington Campus; University of Nottingham; Loughborough, LE12 5RD UK
| | - R. Ford
- Sensory Science Centre; School of Biosciences; Sutton Bonington Campus; University of Nottingham; Loughborough, LE12 5RD UK
| | - R. Linforth
- Sensory Science Centre; School of Biosciences; Sutton Bonington Campus; University of Nottingham; Loughborough, LE12 5RD UK
| | - A. Thomas
- Unilever R&D; Port Sunlight; Wirral, CH62 4ZD UK
| | - J. Hort
- Sensory Science Centre; School of Biosciences; Sutton Bonington Campus; University of Nottingham; Loughborough, LE12 5RD UK
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27
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Bagramian R, Abdullah F, Clarkson J, Cutress T, De Liefde B, Dooland M, Evans W, Hargreaves J, Horowitz H, Ish T, King N, Simmelink J, Skinner M, Woltgens J. Workshop on "Epidemiological indices of enamel defects". Adv Dent Res 2016. [DOI: 10.1177/08959374890030020101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Skinner M, McMeeken J, Stewart A, de Caro JX, Sykes C. Raising the standard of physiotherapy education worldwide: WCPT's accreditation service. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.034] [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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29
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Tan B, Mulo B, Skinner M. Discharge documentation improvement project: a pilot study. Intern Med J 2016; 45:1280-5. [PMID: 26348766 DOI: 10.1111/imj.12895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 05/20/2015] [Revised: 08/09/2015] [Accepted: 08/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Discharge summaries remain a critical communication tool with primary care physicians. In a previous study of over 200 general medicine discharge summaries, we demonstrated that only 50% contain information regarding the indication and follow up required of any medicine changes on discharge. AIM In this follow up pilot study, we assess the role of feedback and token incentives in improving discharge documentation. METHODS Over a 14-week period, we randomly audited a selection of discharge summaries on a fortnightly basis. The results of these audits were fed back to the junior medical staff who compiled these summaries. If over 80% of the audited discharge summaries adequately documented the indication, with required follow up for new medication changes, junior doctors were provided with a token, non-monetary incentive for their efforts. At the end of the study period, we then conducted a survey of the junior doctors involved and collected feedback regarding their impressions of the study. RESULTS Over the study period, 722 discharge summaries were completed and eligible for analysis. Over this time, mean appropriate documentation regarding medicine indication improved by 32%, and follow-up documentation improved by 10%. Overall, the participants felt the interventions were beneficial and that they should be continued beyond the study period. CONCLUSIONS Education coupled with regular feedback and non-monetary incentives can potentially lead to improvements in the quality of discharge summaries.
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Affiliation(s)
| | - B Mulo
- Sir Charles Gairdner Hospital, Western Australia, Australia
| | - M Skinner
- Department of General Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Pai M, Key NS, Skinner M, Curtis R, Feinstein M, Kessler C, Lane SJ, Makris M, Riker E, Santesso N, Soucie JM, Yeung CHT, Iorio A, Schünemann HJ. NHF-McMaster Guideline on Care Models for Haemophilia Management. Haemophilia 2016; 22 Suppl 3:6-16. [DOI: 10.1111/hae.13008] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 02/05/2023]
Affiliation(s)
- M. Pai
- Department of Medicine; McMaster University; Hamilton ON Canada
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton ON Canada
- McMaster Centre for Transfusion Research McMaster University; Hamilton ON Canada
| | - N. S. Key
- Department of Medicine; University of North Carolina; Chapel Hill NC USA
| | - M. Skinner
- Institute for Policy Advancement Ltd.; Washington DC USA
| | - R. Curtis
- Factor VIII Computing; Berkeley CA USA
| | | | - C. Kessler
- Georgetown University; Washington DC USA
| | - S. J. Lane
- McMaster Centre for Transfusion Research McMaster University; Hamilton ON Canada
| | - M. Makris
- Department of Infection, Immunity and Cardiovascular Disease; University of Sheffield; Sheffield UK
| | - E. Riker
- National Hemophilia Foundation; New York NY USA
| | - N. Santesso
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - J. M. Soucie
- Centers for Disease Control and Prevention; National Center for Birth Defects and Developmental Disabilities; Division of Blood Disorders; Atlanta GA USA
| | - C. H. T. Yeung
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - A. Iorio
- Department of Medicine; McMaster University; Hamilton ON Canada
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - H. J. Schünemann
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
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Buzzi A, Kelley L, Gregory M, Skinner M, Kalnins W. Improving comprehensive care in the haemophilia community: building on the HERO Study. Haemophilia 2016; 22:e320-2. [PMID: 27170451 DOI: 10.1111/hae.12945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- A Buzzi
- Fondazione Paracelso, Milan, Italy
| | - L Kelley
- LA Kelley Communications, Inc., Georgetown, MA, USA
| | | | - M Skinner
- World Federation of Hemophilia, Washington, DC, USA
| | - W Kalnins
- German Haemophilia Society, Hamburg, Germany
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Giesbrecht M, Crooks VA, Castleden H, Schuurman N, Skinner M, Williams A. Palliating inside the lines: The effects of borders and boundaries on palliative care in rural Canada. Soc Sci Med 2016; 168:273-282. [PMID: 27185391 DOI: 10.1016/j.socscimed.2016.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/04/2016] [Accepted: 04/28/2016] [Indexed: 11/24/2022]
Abstract
We draw lines to divide our world into specific places, territories, and categories. Although borders and boundaries are dynamic and socially constructed, their existence creates many broad impacts on our lives by geographically distinguishing between groups (e.g., us/them; here/there; inside/outside) at various scales from the national down to the personal spaces of the individual. Particularly, borders and boundaries can be used to define a variety of differing spaces such as the familial, social, economic, political, as well as issues of access - including access to health services. Despite the implicit connection between borders, boundaries, and health, little research has investigated this connection from a health geography perspective. As such, this secondary thematic analysis contributes to addressing this notable gap by examining how borders and boundaries are experienced and perceived to impact access to palliative care in rural Canada from the perspectives of the formal and informal providers of such care. Drawing upon data from qualitative interviews (n = 40) with formal and informal palliative caregivers residing in four different rural Canadian communities, five forms of borders and boundaries were found to directly impact care delivery/receipt: political; jurisdictional; geographical; professional; and cultural. Implicitly and explicitly, participants discussed these borders and boundaries while sharing their experiences of providing palliative care in rural Canada. We conclude by discussing the implications of our findings for palliative care in rural Canada, while also emphasizing the need for more health geography, and related social science, researchers to recognize the significance of borders and boundaries in relation to health and healthcare delivery. Lastly, we emphasize the transferability of these findings to other health sectors, geographical settings, and disciplines.
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Affiliation(s)
- Melissa Giesbrecht
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada; School of Geography & Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M1, Canada.
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Heather Castleden
- Department of Geography and Planning, Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Mark Skinner
- Department of Geography, Trent University, 1600 West Bank Drive, Peterborough, Ontario, K9J 7B8, Canada
| | - Allison Williams
- School of Geography & Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M1, Canada
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Marck CH, Neate SL, Skinner M, Dwyer B, Hickey BB, Radford ST, Weiland TJ, Jelinek GA. Potential donor families' experiences of organ and tissue donation-related communication, processes and outcome. Anaesth Intensive Care 2016; 44:99-106. [PMID: 26673595 DOI: 10.1177/0310057x1604400115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to describe the experiences of families of potential organ and tissue donors eligible for donation after circulatory death or brain death. Forty-nine family members of potential donors from four Melbourne hospitals were interviewed to assess their experiences of communication, processes and the outcomes of donation. Interviews were recorded, transcribed verbatim and analysed thematically. Families expressed a range of perspectives on themes of communication, hospital processes and care, the processes of consent and donation and reflected on decisions and outcomes. They expressed satisfaction overall with communication when receiving bad news, discussing death and donation. Honest and frank communication and being kept up-to-date and prepared for potential outcomes were important aspects for families, especially those of post circulatory death donors. Participants reported high levels of trust in healthcare professionals and satisfaction with the level of care received. Many donor families indicated the process was lengthy and stressful, but not significantly enough to adversely affect their satisfaction with the outcome. Both the decision itself and knowing others' lives had been saved provided them with consolation. No consenting families, and only some non-consenting families, regretted their decisions. Many expressed they would benefit from a follow-up opportunity to ask questions and clarify possible misunderstandings. Overall, while experiences varied, Australian families valued frank communication, trusted health professionals, were satisfied with the care their family member received and with donation processes, despite some apparent difficulties. Family satisfaction, infrequently assessed, is an important outcome and these findings may assist education for Australian organ donation professionals.
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Affiliation(s)
- C H Marck
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria
| | - S L Neate
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria
| | - M Skinner
- DonateLife Victoria, Melbourne, Victoria
| | - B Dwyer
- Organ and Tissue Authority, Canberra, Australian Capital Territory
| | - B B Hickey
- Intensive Care unit, St Vincent's Hospital, Melbourne, Victoria
| | - S T Radford
- Intensive Care Unit, Austin Hospital, Melbourne, Victoria
| | - T J Weiland
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria
| | - G A Jelinek
- Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria
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Mooney L, Skinner M, Coker SJ, Currie S. Effects of acute and chronic sunitinib treatment on cardiac function and calcium/calmodulin-dependent protein kinase II. Br J Pharmacol 2015; 172:4342-54. [PMID: 26040813 DOI: 10.1111/bph.13213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/18/2015] [Accepted: 05/27/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Calcium/calmodulin-dependent protein kinase IIδ (CaMKIIδ) is an important regulator of cardiac contractile function and dysfunction and may be an unwanted secondary target for anti-cancer drugs such as sunitinib and imatinib that have been reported to alter cardiac performance. This study aimed to determine whether anti-cancer kinase inhibitors may affect CaMKII activity and expression when administered in vivo. EXPERIMENTAL APPROACH Cardiovascular haemodynamics in response to acute and chronic sunitinib treatment, and chronic imatinib treatment, were assessed in guinea pigs and the effects compared with those of the known positive and negative inotropes, isoprenaline and verapamil. Parallel studies from the same animals assessed CaMKIIδ expression and CaMKII activity following drug treatments. KEY RESULTS Acute administration of sunitinib decreased left ventricular (LV) dP/dtmax. Acute administration of isoprenaline increased LVdP/dtmax dose-dependently, while LVdP/dtmax was decreased by verapamil. CaMKII activity was decreased by acute administration of sunitinib and was increased by acute administration of isoprenaline, and decreased by acute administration of verapamil. CaMKIIδ expression following all acute treatments remained unchanged. Chronic imatinib and sunitinib treatments did not alter fractional shortening; however, both CaMKIIδ expression and CaMKII activity were significantly increased. Chronic administration of isoprenaline and verapamil decreased LV fractional shortening with parallel increases in CaMKIIδ expression and CaMKII activity. CONCLUSIONS AND IMPLICATIONS Chronic sunitinib and imatinib treatment increased CaMKIIδ expression and CaMKII activity. As these compounds are associated with cardiac dysfunction, increased CaMKII expression could be an early indication of cellular cardiotoxicity marking potential progression of cardiac contractile dysfunction.
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Affiliation(s)
- L Mooney
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - M Skinner
- Safety Assessment UK, AstraZeneca R&D, Macclesfield, UK
| | - S J Coker
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - S Currie
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
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Tan B, Mulo B, Skinner M. Transition from hospital to primary care: an audit of discharge summary - medication changes and follow-up expectations. Intern Med J 2015; 44:1124-7. [PMID: 25367726 DOI: 10.1111/imj.12581] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical discharge summary remains a critical, but often poorly implemented tool in communication with primary care. An area of concern is the documentation of medication lists and appropriate follow up of medication changes. AIMS To assesses the accuracy of documentation of medication changes and expectations with regard to follow up from an acute assessment unit (AAU) of a tertiary metropolitan hospital. METHODS All patients who were admitted and discharged directly from the unit during the month of June 2013 were audited. For all admissions, discharge summaries were audited for medication errors and for the appropriate documentation of indications and follow up for prescribed medications. All medications prescribed on discharge were collated using the World Health Organization Anatomical, Therapeutic and Chemical (ATC) classification. RESULTS In total, 219 admissions were analysed. There were 204 out of 219 (93.1%) discharge summaries that had an accurate medication list. Of 219 (74%) patients, 163 had at least one change to their medications during admission. Of 163 discharge summaries, 82 (50%) contained information regarding their indication and outpatient management. The most commonly prescribed classes along with the rates of indication and follow up documentation were anti-infectives (62%), gastrointestinal (51%), cardiovascular (50%) and central nervous system (44%). CONCLUSION Although there were fewer documentation errors in discharge summaries than previously described in the literature, concerns regarding the documentation of medication indication and follow up remain.
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Affiliation(s)
- B Tan
- Department of General Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Bury T, Skinner M, Moffat M, Brown S, Decarlo K, Rebello J, Whiting K, Audette J. Survey of access to physical therapist entry level education and practice for people with disabilities. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.351] [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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Bury T, Skinner M, Stokes E. WCPT's policy implementation project (PIP): are WCPT's international policies valued and used? A survey of WCPT's member organisations. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.350] [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: 10/23/2022]
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Dean E, Umerah G, Dornelas de Andrade A, Söderlund A, Skinner M. The third physical therapy summit on global health: health-based competencies. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sykes C, Moffat M, Skinner M. Physical therapy counts: counting physical therapists worldwide. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eichler HG, Baird LG, Barker R, Bloechl-Daum B, Børlum-Kristensen F, Brown J, Chua R, Del Signore S, Dugan U, Ferguson J, Garner S, Goettsch W, Haigh J, Honig P, Hoos A, Huckle P, Kondo T, Le Cam Y, Leufkens H, Lim R, Longson C, Lumpkin M, Maraganore J, O'Rourke B, Oye K, Pezalla E, Pignatti F, Raine J, Rasi G, Salmonson T, Samaha D, Schneeweiss S, Siviero PD, Skinner M, Teagarden JR, Tominaga T, Trusheim MR, Tunis S, Unger TF, Vamvakas S, Hirsch G. From adaptive licensing to adaptive pathways: delivering a flexible life-span approach to bring new drugs to patients. Clin Pharmacol Ther 2015; 97:234-46. [PMID: 25669457 PMCID: PMC6706805 DOI: 10.1002/cpt.59] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 12/15/2022]
Abstract
The concept of adaptive licensing (AL) has met with considerable interest. Yet some remain skeptical about its feasibility. Others argue that the focus and name of AL should be broadened. Against this background of ongoing debate, we examine the environmental changes that will likely make adaptive pathways the preferred approach in the future. The key drivers include: growing patient demand for timely access to promising therapies, emerging science leading to fragmentation of treatment populations, rising payer influence on product accessibility, and pressure on pharma/investors to ensure sustainability of drug development. We also discuss a number of environmental changes that will enable an adaptive paradigm. A life‐span approach to bringing innovation to patients is expected to help address the perceived access vs. evidence trade‐off, help de‐risk drug development, and lead to better outcomes for patients.
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Zilberman D, Parikh LI, Skinner M, Landy HJ. Prenatal diagnosis of androgen insensitivity syndrome using cell-free fetal DNA testing. Ultrasound Obstet Gynecol 2015; 45:114-115. [PMID: 25291542 DOI: 10.1002/uog.14681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/22/2014] [Indexed: 06/03/2023]
Affiliation(s)
- D Zilberman
- Department of Obstetrics and Gynecology, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
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Thavapalachandran S, Stewart N, Kotlar A, Tan T, Skinner M. Cardiac Myxoma: An unusual presentation. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.507] [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: 11/29/2022]
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Skinner M, Philp K, Lengel D, Coverley L, Lamm Bergström E, Glaves P, Musgrove H, Prior H, Braddock M, Huby R, Curwen JO, Duffy P, Harmer AR. The contribution of VEGF signalling to fostamatinib-induced blood pressure elevation. Br J Pharmacol 2014; 171:2308-20. [PMID: 24329544 DOI: 10.1111/bph.12559] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 07/23/2013] [Revised: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Fostamatinib is an inhibitor of spleen tyrosine kinase (TK). In patients, fostamatinib treatment was associated with increased BP. Some TK inhibitors cause BP elevation, by inhibiting the VEGF receptor 2 (VEGFR2). Here, we have assessed the mechanistic link between fostamatinib-induced BP elevation and inhibition of VEGF signalling. EXPERIMENTAL APPROACH We used conscious rats with automated blood sampling and radio telemetry and anaesthetized rats to measure cardiovascular changes. Rat isolated aorta and isolated hearts, and human resistance vessels in vitro were also used. NO production by human microvascular endothelial cells was measured with the NO-dependent probe, DAF-FM and VEGFR2 phosphorylation was determined in mouse lung, ex vivo. KEY RESULTS In conscious rats, fostamatinib dose-dependently increased BP. The time course of the BP effect correlated closely with the plasma concentrations of R406 (the active metabolite of fostamatinib). In anaesthetized rats, infusion of R406 increased BP and decreased femoral arterial conductance. Endothelial function was unaffected, as infusion of R406 did not inhibit hyperaemia- or ACh-induced vasodilatation in rats. R406 did not affect contraction of isolated blood vessels. R406 inhibited VEGF-stimulated NO production from human endothelial cells in vitro, and treatment with R406 inhibited VEGFR2 phosphorylation in vivo. R406 inhibited VEGF-induced hypotension in anaesthetized rats. CONCLUSIONS AND IMPLICATIONS Increased vascular resistance, secondary to reduced VEGF-induced NO release from endothelium, may contribute to BP increases observed with fostamatanib. This is consistent with the elevated BP induced by other drugs inhibiting VEGF signalling, although the contribution of other mechanisms cannot be excluded.
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Cros C, Skinner M, Moors J, Lainee P, Valentin JP. Detecting drug-induced prolongation of the QRS complex: new insights for cardiac safety assessment. Toxicol Appl Pharmacol 2012; 265:200-8. [PMID: 23073507 DOI: 10.1016/j.taap.2012.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/14/2012] [Accepted: 10/03/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND Drugs slowing the conduction of the cardiac action potential and prolonging QRS complex duration by blocking the sodium current (I(Na)) may carry pro-arrhythmic risks. Due to the frequency-dependent block of I(Na), this study assesses whether activity-related spontaneous increases in heart rate (HR) occurring during standard dog telemetry studies can be used to optimise the detection of class I antiarrhythmic-induced QRS prolongation. METHODS Telemetered dogs were orally dosed with quinidine (class Ia), mexiletine (class Ib) or flecainide (class Ic). QRS duration was determined standardly (5 beats averaged at rest) but also prior to and at the plateau of each acute increase in HR (3 beats averaged at steady state), and averaged over 1h period from 1h pre-dose to 5h post-dose. RESULTS Compared to time-matched vehicle, at rest, only quinidine and flecainide induced increases in QRS duration (E(max) 13% and 20% respectively, P<0.01-0.001) whereas mexiletine had no effect. Importantly, the increase in QRS duration was enhanced at peak HR with an additional effect of +0.7 ± 0.5 ms (quinidine, NS), +1.8 ± 0.8 ms (mexiletine, P<0.05) and +2.8 ± 0.8 ms (flecainide, P<0.01) (calculated as QRS at basal HR-QRS at high HR). CONCLUSION Electrocardiogram recordings during elevated HR, not considered during routine analysis optimised for detecting QT prolongation, can be used to sensitise the detection of QRS prolongation. This could prove useful when borderline QRS effects are detected. Analysing during acute increases in HR could also be useful for detecting drug-induced effects on other aspects of cardiac function.
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Affiliation(s)
- C Cros
- Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R&D, Alderley Park, Macclesfield, SK10 4TG, UK.
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Koerner J, Darpo B, Skinner M, Vargas H, Willard J, Pettit S, Valentin J. Assessment of the concordance between nonclinical repolarization assays and clinical measure of QT interval prolongation. J Pharmacol Toxicol Methods 2012. [DOI: 10.1016/j.vascn.2012.08.073] [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]
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Comenzo RL, Reece D, Palladini G, Seldin D, Sanchorawala V, Landau H, Falk R, Wells K, Solomon A, Wechalekar A, Zonder J, Dispenzieri A, Gertz M, Streicher H, Skinner M, Kyle RA, Merlini G. Consensus guidelines for the conduct and reporting of clinical trials in systemic light-chain amyloidosis. Leukemia 2012; 26:2317-25. [PMID: 22475872 DOI: 10.1038/leu.2012.100] [Citation(s) in RCA: 276] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This manuscript summarizes the recommendations that emerged from the first Roundtable on Clinical Research in Immunoglobulin Light-chain Amyloidosis (AL), a meeting sponsored by the Amyloidosis Foundation (Clarkston, MI, USA) to develop a consensus of experts on a modern framework for clinical trial design and drug development in AL. Recent diagnostic and technical advances in AL, and updated consensus guidelines for assessing hematologic and organ responses, enable us to define study populations, appropriate end points, and other criteria for all phases of clinical research. This manuscript provides a framework for the design and conduct of systematic collaborative clinical research in AL to encourage more rapid testing of therapies and to expedite new drug development and approval.
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Affiliation(s)
- R L Comenzo
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA 02111, USA.
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Stein J, Besley J, Brook C, Hamill M, Klein E, Krewski D, Murphy G, Richardson M, Sirna J, Skinner M, Steiner R, van Aken P, Devine D. Risk-based decision-making for blood safety: preliminary report of a consensus conference. Vox Sang 2011; 101:277-81. [DOI: 10.1111/j.1423-0410.2011.01526.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Seldin DC, Andrea N, Berenbaum I, Berk JL, Connors L, Dember LM, Doros G, Fennessey S, Finn K, Girnius S, Lerner A, Libbey C, Meier-Ewert HK, O'Connell R, O'Hara C, Quillen K, Ruberg FL, Sam F, Segal A, Shelton A, Skinner M, Sloan JM, Wiesman JF, Sanchorawala V. High-dose melphalan and autologous stem cell transplantation for AL amyloidosis: recent trends in treatment-related mortality and 1-year survival at a single institution. Amyloid 2011; 18 Suppl 1:127-9. [PMID: 21838459 PMCID: PMC5601311 DOI: 10.3109/13506129.2011.574354047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Treatment with high-dose melphalan chemotherapy supported by hematopoietic rescue with autologous stem cells produces high rates of hematologic responses and improvement in survival and organ function for patients with AL amyloidosis. Ongoing clinical trials explore pre-transplant induction regimens, post-transplant consolidation or maintenance approaches, and compare transplant to non-transplant regimens. To put these studies into context, we reviewed our recent experience with transplant for AL amyloidosis in the Amyloid Treatment and Research Program at Boston Medical Center and Boston University School of Medicine. Over the past 10 years, there was a steady reduction in rates of treatment-related mortality and improvement in 1-year survival, now approximately 5% and 90%, respectively, based upon an intention-to-treat analysis. Median overall survival of patients treated with this approach at our center exceeds 7.5 years.
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Affiliation(s)
- D C Seldin
- Clinical Trials Office, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA
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Affiliation(s)
- S Girnius
- Boston University School of Medicine, Boston, MA 02118, USA
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Meier-Ewert HK, Sanchorawala V, Berk J, Finn KT, Skinner M, Seldin DC, Ruberg FL. Regression of cardiac wall thickness following chemotherapy and stem cell transplantation for light chain (AL) amyloidosis. Amyloid 2011; 18 Suppl 1:130-1. [PMID: 21838460 DOI: 10.3109/13506129.2011.574354048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 11/13/2022]
Affiliation(s)
- H K Meier-Ewert
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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