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Al Wattar BH, Rogozińska E, Vale C, Fisher D, Petersen I, Nicum S, Bannington D, Talaulikar V, Freemantle N. Effectiveness and safety of menopause treatments: pitfalls of available evidence and future research need. Climacteric 2024; 27:154-158. [PMID: 38275167 DOI: 10.1080/13697137.2023.2297880] [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: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024]
Abstract
By 2050 more than 1.6 billion women worldwide will be of post-reproductive age, with >75% reporting severe menopausal symptoms. The last few years saw a gradual uplift in public awareness reaffirming the health needs of women with menopause. Still, effective translation of available evidence on menopause treatments is hindered by several methodological limitations and poor research conduct. We argue that a paradigm shift is required in menopause research to address the remaining knowledge gap and guide safe evidence-based care provision. A critical misconception across studies on menopause is the assumption that women represent a homogeneous group who respond similarly to a particular therapy irrespective of their exposure and individual risk factors. We highlight potential solutions to optimize the quality of future research in menopause including adopting robust trial methodology, standardize outcome reporting to capture quality-of-life measures, and improve lay patient and public involvement in future research.
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Affiliation(s)
- B H Al Wattar
- Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - E Rogozińska
- MRC CTU, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - C Vale
- MRC CTU, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - D Fisher
- MRC CTU, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - I Petersen
- Primary Care & Population Health, Institute of Epidemiology & Health, University College London Hospitals, London, UK
| | - S Nicum
- Research Department of Oncology, Cancer Institute, University College London Hospitals, London, UK
| | | | - V Talaulikar
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - N Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, UK
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Garattini L, Freemantle N, Nobili A, Mannucci PM. Conceptualizing a model for European health systems: the institutional framework. Intern Emerg Med 2023; 18:1213-1215. [PMID: 37014494 DOI: 10.1007/s11739-023-03261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - N Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - P M Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Schrag A, Carroll C, Duncan G, Molloy S, Grover L, Hunter R, Brown R, Freemantle N, Whipps J, Serfaty MA, Lewis G. Antidepressants Trial in Parkinson's Disease (ADepT-PD): protocol for a randomised placebo-controlled trial on the effectiveness of escitalopram and nortriptyline on depressive symptoms in Parkinson's disease. BMC Neurol 2022; 22:474. [PMID: 36510237 PMCID: PMC9743717 DOI: 10.1186/s12883-022-02988-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depressive symptoms are common in patients with Parkinson's disease and depression is a significant predictor of functional impairment, reduced quality of life and general well-being in Parkinson's disease. Despite the high prevalence of depression, evidence on the effectiveness and tolerability of antidepressants in this population is limited. The primary aim of this trial is to establish the clinical and cost effectiveness of escitalopram and nortriptyline for the treatment of depression in Parkinson's disease. METHODS This is a multi-centre, double-blind, randomised placebo-controlled trial in 408 people with Parkinson's disease with subsyndromal depression, major depressive disorder or persistent depressive disorder and a Beck Depression Inventory-II (BDI-II) score of 14 or above. Participants will be randomised into one of three groups, receiving either escitalopram, nortriptyline or placebo for 12 months. Trial participation is face-to-face, hybrid or remote. The primary outcome measure is the BDI-II score following 8 weeks of treatment. Secondary outcomes will be collected at baseline, 8, 26 and 52 weeks and following withdrawal, including severity of anxiety and depression scores as well as Parkinson's disease motor severity, and ratings of non-motor symptoms, cognitive function, health-related quality of life, levodopa-equivalence dose, changes in medication, overall clinical effectiveness, capability, health and social care resource use, carer health-related quality of life, adverse effects and number of dropouts. DISCUSSION This trial aims to determine the effectiveness of escitalopram and nortriptyline for reducing depressive symptoms in Parkinson's disease over 8 weeks, to provide information on the effect of these medications on anxiety and other non-motor symptoms in PD and on impact on patients and caregivers, and to examine their effect on change in motor severity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03652870 Date of registration - 29th August 2018.
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Affiliation(s)
- A Schrag
- grid.83440.3b0000000121901201Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK ,grid.437485.90000 0001 0439 3380Department of Neurology, Royal Free London NHS Foundation Trust, London, UK
| | - C Carroll
- grid.11201.330000 0001 2219 0747Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - G Duncan
- grid.39489.3f0000 0001 0388 0742NHS Lothian, Edinburgh, UK
| | - S Molloy
- grid.417895.60000 0001 0693 2181Department of Neurosciences, Imperial College Healthcare NHS Trust, London, UK
| | - L Grover
- grid.83440.3b0000000121901201Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - R Hunter
- grid.83440.3b0000000121901201Research Department of Primary Care and Population Health, University College London, London, UK
| | - R Brown
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - N Freemantle
- grid.83440.3b0000000121901201Comprehensive Clinical Trials Unit, University College London, London, UK
| | - J Whipps
- PPI Representative, Plymouth, UK
| | - M. A Serfaty
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, London, UK ,Priory Hospital North London, London, UK
| | - G Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, London, UK
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Freemantle N, Piketty C. Efficacy and Safety of Nemolizumab for Treatment of Adult Atopic Dermatitis. J Investig Allergol Clin Immunol 2021; 31:528-529. [PMID: 34213421 DOI: 10.18176/jiaci.0727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
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Freemantle N, Abou-Alfa G, Cheng AL, Kelley R, Valcheva V, Benzaghou F, Mollon P. Effect of second-line cabozantinib on health states for patients with advanced hepatocellular carcinoma (aHCC) after sorafenib: QTWiST analysis from the CELESTIAL study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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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Walters K, Falcaro M, Freemantle N, King M, Ben-Shlomo Y. Sociodemographic inequalities in the management of depression in adults aged 55 and over: an analysis of English primary care data. Psychol Med 2018; 48:1504-1513. [PMID: 29017624 DOI: 10.1017/s0033291717003014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 12/24/2022]
Abstract
BACKGROUND We do not know how primary care treatment of depression varies by age across both psychotropic medication and psychological therapies. METHODS Cohort study including 19 710 people aged 55+ with GP recorded depression diagnoses and 26 276 people with recorded depression symptoms during the period 2009-2013, from 373 General Practices in The Health Improvement Network (THIN) database in England. Main outcomes were initiation of treatment with anti-depressants, anxiolytics, hypnotics, anti-psychotic drugs, referrals to psychological therapies within 6 months of onset. RESULTS Treatment rates with antidepressants are high for those recorded with new depression diagnoses (87.1%) or symptoms of depression (58.7%). Treatment in those with depression diagnoses varies little by age. In those with depressive symptoms there was a J-shaped pattern with reduced antidepressant treatment in those in their 60s and 70s followed by increased treatment in the oldest age groups (85+ years), compared with those aged 55-59 years. Other psychotropic drug prescribing (hypnotics/anxiolytics, antipsychotics) all increase with increasing age. Recorded referrals for psychological therapies were low, and decreased steadily with increasing age, such that women aged 75-79 years with depression diagnoses had around six times lower odds of referral (OR 0.17, 95% CI 0.1-0.29) than those aged 55-59 years, and men aged 80-84 years had around seven times lower (OR 0.14, 95% CI 0.05-0.36). CONCLUSIONS The oldest age groups with new depression diagnoses and symptoms have fewer recorded referrals to psychological therapies, and higher psychotropic drug treatment rates in primary care. This suggests potential inequalities in access to psychological therapies.
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Affiliation(s)
- K Walters
- Research Department of Primary Care & Population Health,University College London (UCL),Rowland Hill St,London,UK
| | - M Falcaro
- Research Department of Primary Care & Population Health,University College London (UCL),Rowland Hill St,London,UK
| | - N Freemantle
- Research Department of Primary Care & Population Health,University College London (UCL),Rowland Hill St,London,UK
| | - M King
- Division of Psychiatry,UCL,Sixth Floor Maple House,147 Tottenham Court Rd,London,UK
| | - Y Ben-Shlomo
- School of Social and Community Medicine,University of Bristol,39 Whatley Road, Bristol,UK
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7
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Thompson A, Marwaha S, Winsper C, Everard L, Jones PB, Fowler D, Amos T, Freemantle N, Singh SP, Marshall M, Sharma V, Birchwood M. Short-term outcome of substance-induced psychotic disorder in a large UK first episode psychosis cohort. Acta Psychiatr Scand 2016; 134:321-8. [PMID: 27479903 DOI: 10.1111/acps.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The incidence and outcome of first-episode substance-induced psychotic disorder (SIPD) are unclear. The study aimed to compare the 1-year outcomes of those given a SIPD diagnosis by clinicians compared to other psychosis diagnoses in a first-episode cohort. METHOD Data were from a large (n = 1027) cohort of first-episode psychosis (FEP) patients admitted to early intervention services in the UK (National EDEN). Diagnosis, including that of SIPD, was made by treating psychiatrists at baseline using ICD10 criteria. Details on symptoms, functioning, quality of life, relapse and recovery were available at baseline and 12 months. RESULTS There were 67 cases of SIPD (6.5% of the cohort). At baseline, SIPD patients were no different to other psychoses on symptoms, functioning and quality of life. At 12 months, there was no difference in SIPD and other psychoses on functioning, quality of life or relapse and recovery rates. Levels of psychotic and general symptomatology were similar but depressive symptoms were higher in the SIPD group. CONCLUSIONS First-episode psychosis patients with a diagnosis of SIPD do not appear to have better outcomes than those with other primary psychotic diagnoses. The higher levels of depressive symptoms may be a specific marker in these patients.
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Affiliation(s)
- A Thompson
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK. .,North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
| | - S Marwaha
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.,Affective Disorders Service, Tile Hill, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
| | - C Winsper
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - L Everard
- The Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - P B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,CAMEO, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - D Fowler
- School of Medicine, University of East Anglia, Norwich, UK.,Academic Unit of Psychiatry and Department of Psychology, University of Sussex, Brighton, UK
| | - T Amos
- Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - N Freemantle
- Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
| | - S P Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.,The Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - M Marshall
- School of Medicine, The University of Manchester, Manchester, UK
| | - V Sharma
- Early Intervention Service, Cherry Bank Resource Centre, Cheshire and Wirral Partnership NHS Foundation Trust, Ellesmere Port, UK
| | - M Birchwood
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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Abstract
This paper presents an overview of some of the pitfalls and suggests ways of improving the quality of research into rehabilitation after stroke. The aims of rehabilitation are outlined and methodological problems inherent in this area discussed, including spontaneous recovery, multidimensional outcomes, definition of treatment and placebo effects. Major weaknesses found in the rehabilitation literature are identified and recommendations for improvement made, including the need for comparable controls, adequate numbers, appropriate outcome measures, clear definition of therapy, generalizability, and a concern for the cost-effectiveness of stroke rehabilitation packages. The field of rehabilitation is still relatively new and idiosyncratic in form and content. Thus it still provides opportunities for research into its relative effectiveness before current practices in rehabilitation become entrenched in medical practice and folklore. Adequate funding support for improved, multicentre clinical trials in rehabilitation is essential.
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Affiliation(s)
- C. Pollock
- School of Public Health, University of Leeds
| | | | - T. Sheldon
- School of Public Health, University of Leeds
| | - F. Song
- School of Public Health, University of Leeds
| | - JM Mason
- Centre for Health Economics, University of York
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Graham HL, Copello A, Griffith E, Freemantle N, McCrone P, Clarke L, Walsh K, Stefanidou CA, Rana A, Birchwood M. Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in-patient settings. Acta Psychiatr Scand 2016; 133:298-309. [PMID: 26590876 PMCID: PMC5091625 DOI: 10.1111/acps.12530] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This proof of principle study evaluated the effectiveness and feasibility of a brief motivational intervention, delivered in mental health in-patient settings, to improve engagement in treatment for drug and alcohol misuse. METHOD A randomised controlled trial using concealed randomisation, blind, independent assessment of outcome at 3 months. Participants were 59 new adult admissions, to six acute mental health hospital units in one UK mental health service, with schizophrenia related or bipolar disorder diagnoses, users of community mental health services and also misusing alcohol and/or drugs. Participants were randomised to Brief Integrated Motivational Intervention (BIMI) with Treatment As Usual (TAU), or TAU alone. The BIMI took place over a 2-week period and encouraged participants to explore substance use and its impact on mental health. RESULTS Fifty-nine in-patients (BIMI n = 30; TAU n = 29) were randomised, the BIMI was associated with a 63% relative odds increase in the primary outcome engagement in treatment [OR 1.63 (95% CI 1.01-2.65; P = 0.047)], at 3 months. Qualitative interviews with staff and participants indicated that the BIMI was both feasible and acceptable. CONCLUSION Mental health hospital admissions present an opportunity for brief motivational interventions focussed on substance misuse and can lead to improvements in engagement.
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Affiliation(s)
- H L Graham
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - A Copello
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - E Griffith
- School of Psychology, University of Bath, Claverton Down, Bath, UK
| | - N Freemantle
- Department of Primary Care and Population Health, Upper Third Floor, UCL Medical School (Royal Free Campus), London, UK
| | - P McCrone
- Health Service and Population Research Department, Institute of Psychiatry, Kings College London, London, UK
| | - L Clarke
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - K Walsh
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - C A Stefanidou
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - A Rana
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - M Birchwood
- Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
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Freemantle N, Danchin N, Calvi-Gries F, Vincent M, Home PD. Relationship of glycaemic control and hypoglycaemic episodes to 4-year cardiovascular outcomes in people with type 2 diabetes starting insulin. Diabetes Obes Metab 2016; 18:152-8. [PMID: 26511332 PMCID: PMC4738470 DOI: 10.1111/dom.12598] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 10/09/2015] [Accepted: 10/23/2015] [Indexed: 01/27/2023]
Abstract
AIMS To examine the relationships between glycated haemoglobin (HbA1c) and cardiovascular (CV) events in people beginning insulin in routine clinical practice in Europe, North America and Asia in a non-interventional study, the Cardiovascular Risk Evaluation in people with Type 2 Diabetes on Insulin Therapy (CREDIT) study. METHODS Data on 2999 people were collected prospectively over 4 years from physician reports. The primary outcome was the composite of stroke or myocardial infarction (MI) or CV-specific death. Events were blindly adjudicated. The relative hazards of CV events were described from Cox proportional hazards models incorporating patient risk factors, with updated average HbA1c as a time-dependent covariate. The relationship of severe and symptomatic hypoglycaemia (collected during the 6 months before yearly ascertainment) with CV and all-cause mortality was examined. RESULTS A total of 147 primary events were accrued during up to 54 months of follow-up. In all, 60 CV-specific deaths, 44 non-fatal MIs and 57 non-fatal strokes occurred, totalling 161 events. There was a significant positive relationship between updated mean HbA1c and primary outcome: hazard ratio (HR) 1.25 [95% confidence interval (CI) 1.12-1.40; p < 0.0001]. CV death [HR 1.31 (95% CI 1.10-1.57); p = 0.0027] and stroke [HR 1.36 (95% CI 1.17-1.59); p < 0.0001] were both strongly associated with HbA1c, while MI was not [HR 1.05 (95% CI 0.83-1.32)]. One or more severe hypoglycaemic episodes affected 175 participants, while 1508 participants experienced one or more symptomatic hypoglycaemic events. We found no relationship between severe/symptomatic hypoglycaemic events and CV-specific/all-cause death. CONCLUSIONS Ongoing poorer glucose control was associated with CV events; hypoglycaemia was not associated with CV-specific/all-cause death.
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Affiliation(s)
- N Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - N Danchin
- Department of Medicine, University of Paris René Descartes, Paris, France
| | | | | | - P D Home
- Institute of Cellular Medicine-Diabetes, Newcastle University, Newcastle upon Tyne, UK
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Veasey RA, Sugihara C, Sandhu K, Dhillon G, Freemantle N, Furniss SS, Sulke AN. The natural history of atrial fibrillation in patients with permanent pacemakers: is atrial fibrillation a progressive disease? J Interv Card Electrophysiol 2015; 44:23-30. [DOI: 10.1007/s10840-015-0029-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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Wang YY, Hunt K, Nazareth I, Freemantle N. Are there gender differences in survival and the use of primary care prior to diagnosis of non sex-specific cancers: an analysis of routinely collected UK general practice data? Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku151.002] [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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Aktuerk D, Mcnulty D, Barnett V, Freemantle N, Ray D, Pagano D. 025 * NATIONAL ADMINISTRATIVE DATA PRODUCES A VERY ACCURATE RISK PREDICTION MODEL FOR SHORT- AND LONG-TERM MORTALITY FOLLOWING CARDIAC SURGERY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.25] [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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Blomström P, Ekman M, Lundqvist CB, Calvert M, Freemantle N, Lönnerholm S, Wikström G, Jönsson B. Cost effectiveness of cardiac resynchronization therapy in the Nordic region: An analysis based on the CARE-HF trial. Eur J Heart Fail 2014; 10:869-77. [DOI: 10.1016/j.ejheart.2008.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 12/05/2007] [Revised: 05/28/2008] [Accepted: 06/30/2008] [Indexed: 11/16/2022] Open
Affiliation(s)
- P. Blomström
- Department of Cardiology; University Hospital in Uppsala; Stockholm Sweden
| | - M. Ekman
- European Health Economics; Stockholm Sweden
| | | | - M.J. Calvert
- Department of Primary Care and General Practice; University of Birmingham; Edgbaston Birmingham UK
| | - N. Freemantle
- Department of Primary Care and General Practice; University of Birmingham; Edgbaston Birmingham UK
| | - S. Lönnerholm
- Department of Cardiology; University Hospital in Uppsala; Stockholm Sweden
| | - G. Wikström
- Department of Cardiology; University Hospital in Uppsala; Stockholm Sweden
| | - B Jönsson
- Stockholm School of Economics; Stockholm Sweden
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Freemantle N, Balkau B, Home PD. A propensity score matched comparison of different insulin regimens 1 year after beginning insulin in people with type 2 diabetes. Diabetes Obes Metab 2013; 15:1120-7. [PMID: 23782548 PMCID: PMC4237113 DOI: 10.1111/dom.12147] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/28/2013] [Accepted: 06/11/2013] [Indexed: 11/26/2022]
Abstract
AIM To compare using propensity score analysis the outcome of beginning insulin therapy with basal, premix, mealtime + basal or mealtime insulin on the basis of data from 3031 people from the observational CREDIT (Cardiovascular Risk Evaluation in People with Type 2 Diabetes on Insulin Therapy) study. This approach overcomes likely confounding in baseline and unknown characteristics common to observational studies. METHODS Efficacy and safety outcomes were collected at baseline and at 1 year in previously insulin-naïve people. Propensity score matched groups using all available baseline data were defined to compare outcomes by pairs of insulin regimens. RESULTS From 2659 people with available data, propensity score matches were achieved for 686 people starting premix or basal insulin, 542 starting basal + mealtime or premix insulin and 400 starting basal or basal + mealtime. HbA1c reduction did not differ between the three pairs of insulin regimens. However, the relative risk of overall and nocturnal hypoglycaemia was lower (p = 0.010 to p < 0.001) with basal or basal + mealtime compared with premix insulin, and for nocturnal (p = 0.021) but not overall hypoglycaemia for basal compared to basal + mealtime insulin. Body weight increase was less for basal versus premix insulin [-1.3 (95% CI -2.1, -0.6) kg, p < 0.001] or versus basal + mealtime insulin [-1.4 (-2.5, -0.3) kg, p = 0.016], but did not differ between basal + mealtime and premix. Smaller groups matching mealtime insulin had some residual mismatching of HbA1c. CONCLUSION Comparing insulin regimens between individuals matched by propensity scores indicated differences in hypoglycaemia and body weight change, despite similar HbA1c reductions. Our findings are consistent with those from randomized controlled trials.
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Affiliation(s)
- N Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
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Guillemin F, Martinez L, Calvert M, Cooper C, Ganiats T, Gitlin M, Horne R, Marciniak A, Pfeilschifter J, Shepherd S, Tosteson A, Wade S, Macarios D, Freemantle N. Fear of falling, fracture history, and comorbidities are associated with health-related quality of life among European and US women with osteoporosis in a large international study. Osteoporos Int 2013; 24:3001-10. [PMID: 23754200 PMCID: PMC3818139 DOI: 10.1007/s00198-013-2408-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 05/06/2013] [Indexed: 12/21/2022]
Abstract
UNLABELLED We studied 7,897 women with postmenopausal osteoporosis to assess factors that influence health-related quality of life (HRQoL). An increased number of comorbidities, fear of falling, and previous vertebral fracture were associated with significant reductions in HRQoL. Understanding the factors that affect HRQoL may improve management of these patients. INTRODUCTION HRQoL is impaired in women treated for postmenopausal osteoporosis (PMO). The objective of this study was to examine the relationship between clinical characteristics, comorbidities, medical history, patient demographics, and HRQoL in women with PMO. METHODS Baseline data were obtained and combined from two large and similar multinational observational studies: Prospective Observational Scientific Study Investigating Bone Loss Experience in Europe (POSSIBLE EU®) and in the US (POSSIBLE US™) including postmenopausal women in primary care settings initiating or switching bone loss treatment, or who had been on bone loss treatment for some time. HRQoL measured by health utility scores (EQ-5D™) were available for 7,897 women (94 % of study participants). The relationship between HRQoL and baseline clinical characteristics, medical history and patient demographics was assessed using parsimonious, multivariable, mixed-model analyses. RESULTS Median health utility score was 0.80 (interquartile range 0.69-1.00). In multivariable analyses, young age, low body mass index, previous vertebral fracture, increased number of comorbidities, high fear of falling, and depression were associated with reduced HRQoL. Regression-based model estimates showed that previous vertebral fracture was associated with lower health utility scores by 0.08 (10.3 %) and demonstrated the impact of multiple comorbidities and of fear of falling on HRQoL. CONCLUSIONS In this large observational study of women with PMO, there was substantial interindividual variability in HRQoL. An increased number of comorbidities, fear of falling, and previous vertebral fracture were associated with significant reductions in HRQoL.
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Affiliation(s)
- F Guillemin
- Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, Nancy, France,
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Wang Y, Hunt K, Nazareth I, Freemantle N, Peterson I. OP91 Are there Gender Differences in Consultation Patterns Prior to Melanoma, CRC and Lung Cancer Diagnosis and Cancer Survival: An Analysis of Routinely Collected General Practice Data? Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.91] [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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18
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Freemantle N, Cooper C, Diez-Perez A, Gitlin M, Radcliffe H, Shepherd S, Roux C. Response to comments on: Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis. Osteoporos Int 2013; 24:1931-2. [PMID: 23408019 DOI: 10.1007/s00198-013-2299-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 11/27/2022]
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Freemantle N, Evans M, Christensen T, Wolden ML, Bjorner JB. A comparison of health-related quality of life (health utility) between insulin degludec and insulin glargine: a meta-analysis of phase 3 trials. Diabetes Obes Metab 2013; 15:564-71. [PMID: 23451759 PMCID: PMC4298030 DOI: 10.1111/dom.12086] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/15/2013] [Accepted: 02/22/2013] [Indexed: 01/25/2023]
Abstract
AIM To evaluate health-related quality of life (health utility) scores in patients with diabetes receiving insulin degludec (IDeg) or insulin glargine (IGlar). METHODS Patient-level data from six, randomized, controlled, open-label, multicentre, confirmatory, treat-to-target trials of 26- or 52 weeks' duration were pooled in this analysis. The Short Form 36 (SF-36) version-2 health questionnaire was completed by patients at baseline and end-of-trial. SF-36 scores for 4001 individual patients were then mapped onto the EuroQol-5D health utility scale, which has a range from -0.59 (a state worse than death) to 1.00 (perfect health). RESULTS IDeg treatment exhibited a significant improvement in health status of 0.005 (CI: 0.0006; 0.009) points compared with IGlar (p < 0.024). Gender, region, trial and age also had a significant influence on estimated utility scores as did baseline utility scores, p < 0.05. Prior to the removal of interaction variables a difference of 0.008 points was observed, p < 0.045. Previous insulin treatment did not have an impact on the final outcome. CONCLUSION This study shows that IDeg is associated with a modest, but statistically significant, improvement in health utility compared with IGlar in patients with diabetes.
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Affiliation(s)
- N Freemantle
- Department of Primary Care and Population Health, UCL Medical School, London, UK.
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20
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Howell NJ, Head SJ, Freemantle N, van der Meulen TA, Senanayake E, Menon A, Kappetein AP, Pagano D. The new EuroSCORE II does not improve prediction of mortality in high-risk patients undergoing cardiac surgery: a collaborative analysis of two European centres. Eur J Cardiothorac Surg 2013; 44:1006-11; discussion 1011. [DOI: 10.1093/ejcts/ezt174] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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21
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Freemantle N, Meneghini L, Christensen T, Wolden ML, Jendle J, Ratner R. Insulin degludec improves health-related quality of life (SF-36® ) compared with insulin glargine in people with Type 2 diabetes starting on basal insulin: a meta-analysis of phase 3a trials. Diabet Med 2013; 30:226-32. [PMID: 23199058 PMCID: PMC3579236 DOI: 10.1111/dme.12086] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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] [Received: 08/31/2012] [Revised: 10/30/2012] [Accepted: 11/27/2012] [Indexed: 01/20/2023]
Abstract
AIM To compare the effect of insulin degludec and insulin glargine on health-related quality of life in patients with Type 2 diabetes starting on insulin therapy. METHODS Patient-level data from three open-label, randomized, treat-to-target trials of 26 or 52 weeks' duration were pooled using a weighted analysis in conjunction with a fixed-effects model. Insulin-naive patients received either insulin degludec (n = 1290) or insulin glargine (n = 632) once daily, in combination with oral anti-diabetic drugs. Glycaemic control was assessed via HbA(1c) and fasting plasma glucose concentrations. Rates of hypoglycaemia, defined as plasma glucose < 3.1 mmol/l (< 56 mg/dl), were recorded. Health-related quality of life was evaluated using the 36-item Short Form (SF-36(®) ) version 2 questionnaire. Statistical analysis was performed using a generalized linear model with treatment, trial, anti-diabetic therapy at baseline, gender, region and age as explanatory variables. RESULTS Insulin degludec was confirmed as non-inferior to insulin glargine based on HbA(1c) concentrations. In each trial comprising the meta-analysis, fasting plasma glucose and confirmed overall and nocturnal (00.01-05.59 h) hypoglycaemia were all numerically or significantly lower with insulin degludec vs. insulin glargine. At endpoint, the overall physical health component score was significantly higher (better) with insulin degludec vs. insulin glargine [+0.66 (95% CI 0.04-1.28)], largely attributable to a difference [+1.10 (95% CI 0.22-1.98)] in the bodily pain domain score. In the mental domains, vitality was significantly higher with insulin degludec vs. insulin glargine [+0.81 (95% CI 0.01-1.59)]. CONCLUSIONS Compared with insulin glargine, insulin degludec leads to improvements in both mental and physical health status for patients with Type 2 diabetes initiating insulin therapy.
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Affiliation(s)
- N Freemantle
- Department of Primary Care and Population Health, UCL Medical School, London, UK
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Freemantle N, Cooper C, Diez-Perez A, Gitlin M, Radcliffe H, Shepherd S, Roux C. Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis. Osteoporos Int 2013; 24:209-17. [PMID: 22832638 PMCID: PMC3662000 DOI: 10.1007/s00198-012-2068-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 06/04/2012] [Indexed: 11/24/2022]
Abstract
UNLABELLED Network meta-analysis techniques (meta-analysis, adjusted indirect comparison, and mixed treatment comparison [MTC]) allow for treatment comparisons in the absence of head-to-head trials. In this study, conditional estimates of relative treatment efficacy derived through these techniques show important differences in the fracture risk reduction profiles of marketed pharmacologic therapies for postmenopausal osteoporosis. INTRODUCTION This study illustrates how network meta-analysis techniques (meta-analysis, adjusted indirect comparison, and MTC) can provide comparisons of the relative efficacy of postmenopausal osteoporosis therapies in the absence of comprehensive head-to-head trials. METHODS Source articles were identified in MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley Interscience; and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between April 28, 2009 and November 4, 2009. Two reviewers identified English-language articles reporting randomized controlled trials (RCTs) with on-label dosing of marketed osteoporosis agents and fracture endpoints. Trial design, population characteristics, intervention and comparator, fracture outcomes, and adverse events were abstracted for analysis. Primary analyses included data from RCTs with fracture endpoints. Sensitivity analyses also included studies with fractures reported through adverse event reports. Meta-analysis compared fracture outcomes for pharmacological therapies vs. placebo (fixed and random effects models); adjusted indirect comparisons and MTC assessed fracture risk in postmenopausal women treated with denosumab vs. other agents. RESULTS Using data from 34 studies, random effects meta-analysis showed that all agents except etidronate significantly reduced the risk of new vertebral fractures compared with placebo; denosumab, risedronate, and zoledronic acid significantly reduced the risk for nonvertebral and hip fracture, while alendronate, strontium ranelate, and teriparatide significantly reduced the risk for nonvertebral fractures. MTC showed denosumab to be more effective than strontium ranelate, raloxifene, alendronate, and risedronate in preventing new vertebral fractures. CONCLUSIONS The conditional estimates of relative treatment efficacy indicate that there are important differences in fracture risk reduction profiles for marketed pharmacological therapies for postmenopausal osteoporosis.
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Affiliation(s)
- N Freemantle
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
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Freemantle N, Balkau B, Danchin N, Wang E, Marre M, Vespasiani G, Kawamori R, Home PD. Factors influencing initial choice of insulin therapy in a large international non-interventional study of people with type 2 diabetes. Diabetes Obes Metab 2012; 14:901-9. [PMID: 22519930 PMCID: PMC3466417 DOI: 10.1111/j.1463-1326.2012.01613.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 11/27/2011] [Accepted: 04/16/2012] [Indexed: 11/30/2022]
Abstract
AIM To use baseline characteristics of the Cardiovascular Risk Evaluation in people with type 2 Diabetes on Insulin Therapy study population to identify factors that could explain the choice of insulin therapy when beginning insulin. METHODS The source, non-interventional, longitudinal, long-term study involves 314 centres in 12 countries in five regions. People were enrolled having started any insulin regimen in the previous 12 months. To identify factors associated with the choice of insulin regimen, multivariable backward logistic regression was performed on eligible physician and participant explanatory variables. RESULTS Participants (N = 3031) had mean age 62 years, diabetes duration 11 years, body mass index 29.3 kg/m² and an HbA1c of 9.5%. Participants in Japan had less hypertension, smoked more and used fewer concomitant medications than those of other regions. Only physician location (rural or urban) influenced the choice of insulin in Japan. In the other four-regions-combined, physician location, specialty, sex and practice type influenced choice of insulin as did participant location, baseline HbA1c, use of glucose-lowering therapies and prior insulin secretagogue use. CONCLUSION Choice of initial insulin regimen was influenced by several physician and participant characteristics in Canada and Europe, but only by physician location in Japan.
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Affiliation(s)
- N Freemantle
- Department of Primary Care and Population Health, University College London, UK.
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24
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Howell NJ, Freemantle N, Bonser RS, Graham TR, Mascaro J, Rooney SJ, Wilson IC, Pagano D. Subtle changes in renal function are associated with differences in late survival following adult cardiac surgery. Eur J Cardiothorac Surg 2012; 41:e38-42. [DOI: 10.1093/ejcts/ezr329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Freemantle N, Richardson M, Wood J, Ray D, Khosla S, Shahian D, Roche WR, Stephens I, Keogh B, Pagano D. Weekend hospitalization and additional risk of death: an analysis of inpatient data. J R Soc Med 2012; 105:74-84. [PMID: 22307037 DOI: 10.1258/jrsm.2012.120009] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess whether weekend admissions to hospital and/or already being an inpatient on weekend days were associated with any additional mortality risk. DESIGN Retrospective observational survivorship study. We analysed all admissions to the English National Health Service (NHS) during the financial year 2009/10, following up all patients for 30 days after admission and accounting for risk of death associated with diagnosis, co-morbidities, admission history, age, sex, ethnicity, deprivation, seasonality, day of admission and hospital trust, including day of death as a time dependent covariate. The principal analysis was based on time to in-hospital death. PARTICIPANTS National Health Service Hospitals in England. MAIN OUTCOME MEASURES 30 day mortality (in or out of hospital). RESULTS There were 14,217,640 admissions included in the principal analysis, with 187,337 in-hospital deaths reported within 30 days of admission. Admission on weekend days was associated with a considerable increase in risk of subsequent death compared with admission on weekdays, hazard ratio for Sunday versus Wednesday 1.16 (95% CI 1.14 to 1.18; P < .0001), and for Saturday versus Wednesday 1.11 (95% CI 1.09 to 1.13; P < .0001). Hospital stays on weekend days were associated with a lower risk of death than midweek days, hazard ratio for being in hospital on Sunday versus Wednesday 0.92 (95% CI 0.91 to 0.94; P < .0001), and for Saturday versus Wednesday 0.95 (95% CI 0.93 to 0.96; P < .0001). Similar findings were observed on a smaller US data set. CONCLUSIONS Admission at the weekend is associated with increased risk of subsequent death within 30 days of admission. The likelihood of death actually occurring is less on a weekend day than on a mid-week day.
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Affiliation(s)
- N Freemantle
- Department of Primary Care & Population Health, University College London NW3 2PF, UK
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26
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Freemantle N, Satram-Hoang S, Tang ET, Kaur P, Macarios D, Siddhanti S, Borenstein J, Kendler DL. Final results of the DAPS (Denosumab Adherence Preference Satisfaction) study: a 24-month, randomized, crossover comparison with alendronate in postmenopausal women. Osteoporos Int 2012; 23:317-26. [PMID: 21927922 PMCID: PMC3249211 DOI: 10.1007/s00198-011-1780-1] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 08/22/2011] [Indexed: 01/22/2023]
Abstract
UNLABELLED The final analysis of this 2-year, randomized, crossover study showed that postmenopausal women with osteoporosis were more adherent, compliant, and persistent with subcutaneous denosumab injections every 6 months than with once-weekly alendronate tablets. After receiving both treatments, women reported greater satisfaction with injectable denosumab and preferred it over oral alendronate. INTRODUCTION Osteoporosis patients who are non-compliant or non-persistent with therapy may have suboptimal clinical outcomes. This 2-year, randomized, open-label, crossover study compared treatment adherence between subcutaneous denosumab, 60 mg every 6 months, and oral alendronate, 70 mg once weekly. METHODS Postmenopausal women at 25 centers in the USA and Canada with bone mineral density T-scores -4.0 to -2.0 and no prior bisphosphonate use received alendronate then denosumab, or denosumab then alendronate, over successive 12-month periods. Adherence required both compliance (denosumab injections 6 months apart or ≥ 80% of alendronate tablets) and persistence (both denosumab injections or ≥ 2 alendronate doses in the last month and completion of the treatment period). RESULTS Of the 250 women enrolled (124 alendronate, 126 denosumab), 221 entered the second year (106 denosumab, 115 alendronate). Denosumab was associated with less non-adherence than alendronate (first year, 11.9% vs 23.4%; second year, 7.5% vs 36.5%). Risk ratios for non-adherence, non-compliance, and non-persistence favored denosumab in both years (p < 0.05). Of 198 subjects expressing treatment preference, 183 (92.4%) preferred the injections over the oral therapy. BMD improved further when subjects received denosumab after alendronate and remained stable when they received alendronate after denosumab. CONCLUSION Based on the final results of this crossover study after women had received each treatment for up to 1 year, postmenopausal women with osteoporosis were more adherent, compliant, and persistent with subcutaneous denosumab injections every 6 months than with once-weekly alendronate tablets and reported increased treatment preference and satisfaction with injectable denosumab over oral alendronate.
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Basra M, Chowdhury M, Smith E, Freemantle N, Piguet V. Quality of life in psoriasis and chronic hand eczema: the discrepancy in the definition of severity in NICE guidelines and its implications. Br J Dermatol 2011; 166:462-3. [DOI: 10.1111/j.1365-2133.2011.10601.x] [Citation(s) in RCA: 5] [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: 10/17/2022]
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Hong P, Hunt J, Freemantle N, Sulke N. 640 The utilisation of a remotely monitored implantable loop recorder as first line investigation in the diagnosis of syncope: The EaSyAS II study. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.531] [Citation(s) in RCA: 3] [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: 11/29/2022] Open
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Maniadakis N, Ekman M, Calvert MJ, Freemantle N, Karamalis M, Vardas P. Cost effectiveness of cardiac resynchronization therapy in Greece: an analysis based on the CArdiac REsychronization in Heart Failure trial. Europace 2011; 13:1597-603. [PMID: 21821852 DOI: 10.1093/europace/eur188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Health economic considerations have become increasingly important in healthcare. The aim of this study was to investigate the incremental cost effectiveness of cardiac resynchronization therapy (CRT) plus medical therapy compared with medical therapy alone in the Greek health-care system. METHODS AND RESULTS The health economic analysis was based on the CARE-HF trial, a randomized clinical trial estimating the efficacy of adding CRT (n = 409) to optimal pharmacological treatment (n = 404) in patients with moderate-to-severe heart failure with markers of cardiac dyssynchrony. Health care resource use from CArdiac REsychronization in Heart Failure was combined with costs for CRT implantation and hospitalization from publicly available sources. The analysis was based on a lifetime perspective, with the life expectancy estimated from the clinical trial data. Shorter time horizons were explored in the sensitivity analysis. The cost per quality-adjusted life year (QALY) gained with CRT was €6,045 in Greece, with a 95% confidence interval for the cost-effectiveness ratio of €4,292-9,411 per QALY gained. CONCLUSIONS The results of the economic evaluation of CRT in Greek health-care setting indicate that it is a cost-effective treatment compared with traditional pharmacological therapy. Cardiac resynchronization therapy can therefore be recommended for routine use in patients with moderate-to-severe heart failure and markers of dyssynchrony.
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Affiliation(s)
- N Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece.
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Kendler DL, McClung MR, Freemantle N, Lillestol M, Moffett AH, Borenstein J, Satram-Hoang S, Yang YC, Kaur P, Macarios D, Siddhanti S. Adherence, preference, and satisfaction of postmenopausal women taking denosumab or alendronate. Osteoporos Int 2011; 22:1725-35. [PMID: 20827547 DOI: 10.1007/s00198-010-1378-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 08/11/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED In this study, 250 women with osteoporosis were randomized to 12 months with subcutaneous denosumab 60 mg every 6 months or oral alendronate 70 mg once weekly, then crossed over to the other treatment. The primary endpoint, treatment adherence at 12 months, was 76.6% for alendronate and 87.3% for denosumab. INTRODUCTION The purpose of this study is to evaluate treatment adherence with subcutaneous denosumab 60 mg every 6 months or oral alendronate 70 mg once weekly. METHODS In this multicenter, randomized, open-label, 2-year, crossover study, 250 postmenopausal women with low bone mineral density received denosumab or alendronate for 12 months, then the other treatment for 12 months. The alendronate bottle had a medication event monitoring system cap to monitor administration dates. Definitions were as follows: compliance, receiving both denosumab doses 6 (± 1) months apart or 80-100% of alendronate doses; persistence, receiving both denosumab doses and completing the month 12 visit within the visit window or ≥ 2 alendronate doses in the final month; adherence, achieving both compliance and persistence. This report includes data from the first 12 months. RESULTS The primary study endpoint, adherence in the first 12 months, was 76.6% (95/124) for alendronate and 87.3% (110/126) for denosumab. Risk ratios for denosumab compared with alendronate at 12 months were 0.58 (p = 0.043) for non-adherence, 0.48 (p = 0.014) for non-compliance, and 0.54 (p = 0.049) for non-persistence. Subject ratings for treatment necessity, preference, and satisfaction were significantly greater for denosumab and ratings for treatment bother were significantly greater for alendronate. Adverse events were reported by 64.1% of alendronate-treated subjects and 72.0% of denosumab-treated subjects (p = 0.403). The most common adverse events were arthralgia, back pain, pain in extremity, cough, and headache (each in <10% of subjects in each group). CONCLUSIONS Significantly greater treatment adherence was observed for subcutaneous administration of denosumab every 6 months than for oral alendronate once weekly.
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MESH Headings
- Administration, Oral
- Aged
- Alendronate/administration & dosage
- Alendronate/adverse effects
- Alendronate/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Bone Density/drug effects
- Bone Density Conservation Agents/administration & dosage
- Bone Density Conservation Agents/adverse effects
- Bone Density Conservation Agents/therapeutic use
- British Columbia
- Denosumab
- Epidemiologic Methods
- Female
- Humans
- Injections, Subcutaneous
- Medication Adherence/statistics & numerical data
- Middle Aged
- Osteoporosis, Postmenopausal/drug therapy
- Osteoporosis, Postmenopausal/physiopathology
- Osteoporosis, Postmenopausal/psychology
- Patient Preference/statistics & numerical data
- Patient Satisfaction/statistics & numerical data
- Treatment Outcome
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Affiliation(s)
- D L Kendler
- University of British Columbia, 600-1285 West Broadway, V6H 3X8 Vancouver, BC, Canada.
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Nijjer SS, Pabari P, Stegemann B, Palmieri V, Freemantle N, Hughes A, Francis DP. 85 Prediction of response to biventricular pacing from dyssynchrony indices: the absolute limit on predictability, and its clinical implications. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van den Broek MAJ, van Dam RM, van Breukelen GJP, Bemelmans MH, Oussoultzoglou E, Pessaux P, Dejong CHC, Freemantle N, Olde Damink SWM. Development of a composite endpoint for randomized controlled trials in liver surgery. Br J Surg 2011; 98:1138-45. [DOI: 10.1002/bjs.7503] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2011] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The feasibility of randomized controlled trials (RCTs) in liver surgery using a single-component clinical endpoint is low as such endpoints require large sample sizes owing to their low incidence. A liver surgery-specific composite endpoint (CEP) could solve this problem. The aim of this study was to develop a liver surgery-specific CEP with well-defined components.
Methods
Components of a liver surgery-specific CEP were selected based on a systematic literature search and consensus among 28 international hepatopancreatobiliary (HPB) surgeons. As an example, two prospective cohorts of patients who had undergone liver surgery in high-volume HPB centres were used to assess the event rate and effect of implementing a liver surgery-specific CEP.
Results
Components selected for the liver surgery-specific CEP were ascites, postresectional liver failure, bile leakage, intra-abdominal haemorrhage, intra-abdominal abscess and operative mortality, all with a Clavien–Dindo grade of at least 3 and occurring within 90 days after initial surgery. The incidence of this liver surgery-specific CEP was 19·2 per cent in one cohort and 10·7 per cent in the other. These rates led to an approximately twofold reduction in the theoretical sample size required for an adequately powered RCT in liver surgery using the CEP as primary endpoint.
Conclusion
The proposed liver surgery-specific CEP consists of ascites, postresectional liver failure, bile leakage, intra-abdominal haemorrhage, intra-abdominal abscess and operative mortality. It has a considerably higher event rate than any of its components. Its use as the primary endpoint will increase the feasibility and comparability of RCTs in liver surgery.
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Affiliation(s)
- M A J van den Broek
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - R M van Dam
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - G J P van Breukelen
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - M H Bemelmans
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - E Oussoultzoglou
- Division of Hepatopancreatobiliary Surgery, Hautepierre Hospital, Strasbourg, France
| | - P Pessaux
- Division of Hepatopancreatobiliary Surgery, Hautepierre Hospital, Strasbourg, France
| | - C H C Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | - N Freemantle
- Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK
| | - S W M Olde Damink
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Royal Free Hospital, London, UK
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Roux C, Cooper C, Díez-Pérez A, Martinez L, Ortolani S, Gitlin M, Möller G, Shepherd S, Freemantle N. Prevalence of osteoporosis and fractures among women prescribed osteoporosis medication in five European countries: the POSSIBLE EU study. Osteoporos Int 2011; 22:1227-36. [PMID: 20628731 DOI: 10.1007/s00198-010-1321-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 06/03/2010] [Indexed: 01/01/2023]
Abstract
UNLABELLED European observational 1-year study assessed osteoporosis and fracture patterns in 3,402 postmenopausal women prescribed osteoporosis medication. Almost 40% of patients had a previous fracture, while 25% had neither fracture nor dual energy X-ray absorptiometry (DXA) diagnosis and were prescribed medication, probably due to other risk factors. INTRODUCTION This analysis assessed osteoporosis and fracture prevalence in postmenopausal women prescribed osteoporosis treatment in the Prospective Observational Study Investigating Bone Loss Experience in Europe(POSSIBLE EU). METHODS Women in this observational, multicenter 1-year study were categorized by fracture history and location at baseline. Baseline characteristics were analyzed according to no DXA and DXA diagnosis (osteoporosis or osteopenia). Fractures occurring during the 1-year follow-up period were recorded. RESULTS Of the 3,402 women enrolled, 39% had a previous fracture, of whom 30% had ≥ 2 fractures. One thousand seven hundred and eighty-four (52%) patients had a DXA diagnosis (osteoporosis 68%, osteopenia 31%, and unknown 1%). Among the osteoporosis patients, 37% had a previous fracture (hip 2.9%, vertebral 8.8%, and non-hip, non-vertebral 25%) and 35% had fractures associated with major trauma. Of the 3,402 women, 1,476 (43%) had no DXA diagnosis; of these, 57% had no fracture (25% of all women). Risk factors varied across patients with and without DXA diagnosis. During the 1-year follow-up period, the fracture incidence in patients with or without a previous fracture at baseline was 4.7% and 1.6%, respectively. CONCLUSION Almost 40% of patients prescribed osteoporosis medication had a previous fracture, highlighting a population with advanced disease. In contrast, 25% of patients had neither a previous fracture nor DXA diagnosis and were prescribed treatment, probably due to other risk factors. There is a need for continued improvement of disease management in European women.
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Affiliation(s)
- C Roux
- Department of Rheumatology, Paris Descartes University, Cochin Hospital, Paris, France.
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Petty DR, Knapp P, Raynor DK, Zermansky AZ, Freemantle N. Clinical medication review in general practice: what is the benefit of a second review? International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2002.tb00676.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Focal points
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Affiliation(s)
- D R Petty
- Pharmacy Practice and Medicines Management Group, University of Leeds, Leeds LS2 9UT
| | - P Knapp
- Pharmacy Practice and Medicines Management Group, University of Leeds, Leeds LS2 9UT
| | - D K Raynor
- Pharmacy Practice and Medicines Management Group, University of Leeds, Leeds LS2 9UT
| | - A Z Zermansky
- Pharmacy Practice and Medicines Management Group, University of Leeds, Leeds LS2 9UT
| | - N Freemantle
- Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT
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Petty DR, Zermansky AG, Raynor DK, Lowe CJ, Vail A, Freemantle N. Clinical medication review by a pharmacist of patients on repeat prescriptions in general practice. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2001.tb01107.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Focal points
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Affiliation(s)
- D R Petty
- Division of Academic Pharmacy Practice, University of Leeds
| | - A G Zermansky
- Division of Academic Pharmacy Practice, University of Leeds
| | - D K Raynor
- Division of Academic Pharmacy Practice, University of Leeds
| | - C J Lowe
- Division of Academic Pharmacy Practice, University of Leeds
| | - A Vail
- Division of Academic Pharmacy Practice, University of Leeds
| | - N Freemantle
- Department of Primary Care and General Practice, University of Birmingham
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Freemantle N, Lafuente-Lafuente C, Mitchell S, Eckert L, Reynolds M. Mixed treatment comparison of dronedarone, amiodarone, sotalol, flecainide, and propafenone, for the management of atrial fibrillation. Europace 2011; 13:329-45. [DOI: 10.1093/europace/euq450] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [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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Whale R, Terao T, Cowen P, Freemantle N, Geddes J. Pindolol augmentation of serotonin reuptake inhibitors for the treatment of depressive disorder: a systematic review. J Psychopharmacol 2010; 24:513-20. [PMID: 18832428 DOI: 10.1177/0269881108097714] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [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: 11/16/2022]
Abstract
UNLABELLED Adding pindolol to serotonergic antidepressant treatment offers a potential strategy for producing a more rapid onset of action and an enhanced antidepressant effect. This review investigated whether pindolol enhances the efficacy of serotonergic antidepressant treatment in adult patients with depressive disorders at sequential time points up to 6 weeks. SEARCH STRATEGY Cochrane Collaboration Depression, Anxiety and Neurosis-Controlled Trials Register plus unpublished trial data. STUDY SELECTION Randomised trials including depressed patients, comparing serotonergic antidepressants + pindolol with serotonergic antidepressants + placebo and using depressive symptom clinical outcomes scales. DATA EXTRACTION Clinical response at time points up to 6 weeks as defined by >50% depression scale score reduction was extracted for each trial as possible. Eleven studies were identified including unpublished data. The pooled odds ratios for dichotomous response to treatment at time points from 1 to 6 weeks were 2.39 (95% CI 1.40-4.06), 2.39 (1.74-3.29), 1.94 (1.46-2.58), 1.59 (1.16-2.18), 1.42 (0.87-2.31) and 1.28 (0.91-1.81). Time-to-event analysis showed a greater response with pindolol augmentation versus placebo (P = 0.04). There was significant heterogeneity between studies at some time points. Dropout rates did not significantly differ between treatment arms. This review suggests an overall beneficial clinical effect of pindolol augmentation, most clearly up to 4 weeks of treatment.
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Affiliation(s)
- R Whale
- Institute of Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK.
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Silberbauer J, Veasey RA, Freemantle N, Arya A, Boodhoo L, Sulke N. The relationship between high-frequency right ventricular pacing and paroxysmal atrial fibrillation burden. Europace 2009; 11:1456-61. [DOI: 10.1093/europace/eup218] [Citation(s) in RCA: 7] [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: 11/12/2022] Open
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Berger R, Shankar A, Fruhwald F, Fahrleitner-Pammer A, Freemantle N, Tavazzi L, Cleland JG, Pacher R. Relationships between cardiac resynchronization therapy and N-terminal pro-brain natriuretic peptide in patients with heart failure and markers of cardiac dyssynchrony: an analysis from the Cardiac Resynchronization in Heart Failure (CARE-HF) study. Eur Heart J 2009; 30:2109-16. [DOI: 10.1093/eurheartj/ehp210] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pagano D, Freemantle N, Bridgewater B, Howell N, Ray D, Jackson M, Fabri BM, Au J, Keenan D, Kirkup B, Keogh BE. Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years. BMJ 2009; 338:b902. [PMID: 19342410 PMCID: PMC2664869 DOI: 10.1136/bmj.b902] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effects of social deprivation on survival after cardiac surgery and to examine the influence of potentially modifiable risk factors. DESIGN Analysis of prospectively collected data. Prognostic models used to examine the additional effect of social deprivation on the end points. SETTING Birmingham and north west England. PARTICIPANTS 44 902 adults undergoing cardiac surgery, 1997-2007. MAIN OUTCOME MEASURES Social deprivation with census based 2001 Carstairs scores. All cause mortality in hospital and at mid-term follow-up. RESULTS In hospital mortality for all cardiac procedures was 3.25% and mid-term follow-up (median 1887 days; range 1180-2725 days) mortality was 12.4%. Multivariable analysis identified social deprivation as an independent predictor of mid-term mortality (hazard ratio 1.024, 95% confidence interval 1.015 to 1.033; P<0.001). Smoking (P<0.001), body mass index (BMI, P<0.001), and diabetes (P<0.001) were associated with social deprivation. Smoking at time of surgery (1.294, 1.191 to 1.407, P<0.001) and diabetes (1.305, 1.217 to 1.399, P<0.001) were independent predictors of mid-term mortality. The relation between BMI and mid-term mortality was non-linear and risks were higher in the extremes of BMI (P<0.001). Adjustment for smoking, BMI, and diabetes reduced but did not eliminate the effects of social deprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001). CONCLUSIONS Smoking, extremes of BMI, and diabetes, which are potentially modifiable risk factors associated with social deprivation, are responsible for a significant reduction in survival after surgery, but even after adjustment for these variables social deprivation remains a significant independent predictor of increased risk of mortality.
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Affiliation(s)
- D Pagano
- Cardiothoracic Surgical Unit, University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2TH.
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Abstract
BACKGROUND Quantitative evidence on the strength of the association between abdominal obesity and the incidence of type 2 diabetes was assessed. METHODS Systematic review of longitudinal studies assessing the relationship between measures reflecting abdominal obesity and the incidence of type 2 diabetes. RESULTS There was a strong association between measures reflecting abdominal obesity and the incidence of type 2 diabetes, the pooled odds ratio was 2.14 (95% CI: 1.70-2.71; p < 0.0001). Waist circumference (WC) was at least as good as other measures in predicting outcome. CONCLUSIONS There is a strong association between measures reflecting abdominal obesity and the development of type 2 diabetes. Reducing WC may reduce the risk of developing type 2 diabetes.
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Affiliation(s)
- N Freemantle
- School of Primary Care, Occupational and Public Health, University of Birmingham, Birmingham, UK.
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Del Prato S, Blonde L, Martinez L, Göke B, Woo V, Millward A, Gomis R, Canovatchel B, Strack T, Lawrence D, Freemantle N. The effect of the availability of inhaled insulin on glycaemic control in patients with Type 2 diabetes failing on oral therapy: the evaluation of Exubera as a therapeutic option on insulin initiation and improvement in glycaemic control in clinical practice (EXPERIENCE) trial. Diabet Med 2008; 25:662-70. [PMID: 18435781 DOI: 10.1111/j.1464-5491.2008.02438.x] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine the impact of inhaled human insulin (Exubera, EXU) on patient or physician willingness to adopt insulin after oral glucose-lowering agent failure. METHODS During a randomized controlled trial in primary, secondary and tertiary care in Europe and North America, 739 patients using >or= 2 oral glucose-lowering agents with glycated haemoglobin (HbA(1c)) >or= 8.0% were assigned to two treatment groups: Group 1 (standard care with the option of EXU) or Group 2 (standard care only). Standard care included adjusting oral therapy (optimizing current regimen or adding/omitting agents) and/or initiating subcutaneous (s.c.) insulin. The primary endpoint was difference in HbA(1c) between randomized groups at 26 weeks. Secondary outcomes included differences in the rate of uptake of insulin therapy, proportion achieving satisfactory glycaemic control, treatment satisfaction and safety outcomes. RESULTS At baseline, insulin was initiated by more [odds ratio 6.0; 95% confidence interval (CI) 4.2 to 8.8; P < 0.0001] patients in Group 1 (86.2%; 76.7% EXU plus 9.5% s.c.) than Group 2 (50.7%; s.c. insulin only). At 26 weeks, mean (sd) changes in HbA(1c) from baseline were -2.0% (1.2%) and -1.7% (1.3%) in Groups 1 and 2, respectively, a difference of -0.2% (95% CI: -0.1% to -0.4%; P = 0.004). In Group 1, 45% of patients achieved an HbA(1c)<or= 7.0% by 26 weeks compared with 39% in Group 2 (P = 0.02). CONCLUSION The availability of EXU may increase initiation of insulin, thereby contributing to improved overall glycaemic control in patients with Type 2 diabetes inadequately controlled on two or more oral glucose-lowering agents.
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Cleland JGF, Freemantle N, Daubert JC, Toff WD, Leisch F, Tavazzi L. Long-term effect of cardiac resynchronisation in patients reporting mild symptoms of heart failure: a report from the CARE-HF study. Heart 2008; 94:278-83. [DOI: 10.1136/hrt.2007.128991] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis DA, Haynes RB, Harvey EL. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2007; 2007:CD000409. [PMID: 17943742 PMCID: PMC7032679 DOI: 10.1002/14651858.cd000409.pub2] [Citation(s) in RCA: 508] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Educational outreach visits (EOVs) have been identified as an intervention that may improve the practice of healthcare professionals. This type of face-to-face visit has been referred to as university-based educational detailing, academic detailing, and educational visiting. OBJECTIVES To assess the effects of EOVs on health professional practice or patient outcomes. SEARCH STRATEGY For this update, we searched the Cochrane EPOC register to March 2007. In the original review, we searched multiple bibliographic databases including MEDLINE and CINAHL. SELECTION CRITERIA Randomised trials of EOVs that reported an objective measure of professional performance or healthcare outcomes. An EOV was defined as a personal visit by a trained person to healthcare professionals in their own settings. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. We used bubble plots and box plots to visually inspect the data. We conducted both quantitative and qualitative analyses. We used meta-regression to examine potential sources of heterogeneity determined a priori. We hypothesised eight factors to explain variation across effect estimates. In our primary visual and statistical analyses, we included only studies with dichotomous outcomes, with baseline data and with low or moderate risk of bias, in which the intervention included an EOV and was compared to no intervention. MAIN RESULTS We included 69 studies involving more than 15,000 health professionals. Twenty-eight studies (34 comparisons) contributed to the calculation of the median and interquartile range for the main comparison. The median adjusted risk difference (RD) in compliance with desired practice was 5.6% (interquartile range 3.0% to 9.0%). The adjusted RDs were highly consistent for prescribing (median 4.8%, interquartile range 3.0% to 6.5% for 17 comparisons), but varied for other types of professional performance (median 6.0%, interquartile range 3.6% to 16.0% for 17 comparisons). Meta-regression was limited by the large number of potential explanatory factors (eight) with only 31 comparisons, and did not provide any compelling explanations for the observed variation in adjusted RDs. There were 18 comparisons with continuous outcomes, with a median adjusted relative improvement of 21% (interquartile range 11% to 41%). There were eight trials (12 comparisons) in which the intervention included an EOV and was compared to another type of intervention, usually audit and feedback. Interventions that included EOVs appeared to be slightly superior to audit and feedback. Only six studies evaluated different types of visits in head-to-head comparisons. When individual visits were compared to group visits (three trials), the results were mixed. AUTHORS' CONCLUSIONS EOVs alone or when combined with other interventions have effects on prescribing that are relatively consistent and small, but potentially important. Their effects on other types of professional performance vary from small to modest improvements, and it is not possible from this review to explain that variation.
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Affiliation(s)
- M A O'Brien
- Juravinski Cancer Centre, Supportive Cancer Care Research Unit, 699 Concession Street, Hamilton, Ontario, Canada, L8V 5C2. maryann.o'
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Barbui C, Hotopf M, Freemantle N, Boynton J, Churchill R, Eccles MP, Geddes JR, Hardy R, Lewis G, Mason JM. WITHDRAWN: Treatment discontinuation with selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs). Cochrane Database Syst Rev 2007:CD002791. [PMID: 17636706 DOI: 10.1002/14651858.cd002791.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors are thought to have better discontinuation rates (i.e. less people dropping out) than tricyclic and heterocyclic antidepressant drugs. It is important to quantify the drop-out rates of different antidepressant drugs in order to have a better understanding of the relative tolerability of these drugs. OBJECTIVES To assess the comparative tolerability of selective serotonin reuptake inhibitors and tricyclic/heterocyclic antidepressant drugs. SEARCH STRATEGY We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (1997 to 1999), MEDLINE (1966 to 1999), EMBASE (1974 to 1999) We also searched specialist journals, the reference lists of relevant papers and previous systematic reviews, conference abstracts and government documents. Representatives of the pharmaceutical industry were contacted. SELECTION CRITERIA Parallel group randomised controlled trials comparing selective serotonin reuptake inhibitors with tricyclic or heterocyclic antidepressants in people with depression. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and a third reviewer checked any cases of disagreement. MAIN RESULTS We included 136 trials. The selective serotonin reuptake inhibitors showed less participants dropping out compared to the tricyclic/heterocyclic group (odds ratio 1.21, 95% confidence interval 1.12 to 1.30). A statistically significant difference was found in total drop-outs between the selective serotonin reuptake inhibitors and the old tricyclics as well as the newer tricyclics. When the selective serotonin reuptake inhibitors were compared to the heterocyclic antidepressants, there was a non significant difference favouring the selective serotonin reuptake inhibitors. The poor tolerability profile of the old tricyclics was explained by differences in drop-outs for side-effects, but not for inefficacy. AUTHORS' CONCLUSIONS Whilst selective serotonin reuptake inhibitors do appear to show an advantage over tricyclic drugs in terms of total drop-outs, this advantage is relatively modest. This has implications for pharmaco-economic models, some of which may have overestimated the difference of drop-out rates between selective serotonin reuptake inhibitors and tricyclic antidepressants. These results are based on short-term randomised controlled trials, and may not generalise into clinical practice.
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Affiliation(s)
- C Barbui
- University of Verona, Department of Medicine and Public Health, Section of Psychiatry, Ospedale Policlinico, 37134 Verona, Italy.
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Geddes JR, Freemantle N, Mason J, Eccles MP, Boynton J. WITHDRAWN: Selective serotonin reuptake inhibitors (SSRIs) versus other antidepressants for depression. Cochrane Database Syst Rev 2007; 2006:CD001851. [PMID: 17636689 PMCID: PMC10759268 DOI: 10.1002/14651858.cd001851.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The relatively new class of antidepressant, the selective serotonin reputake inhibitors (SSRIs), may be better tolerated than the older tricyclic antidepressants. This review compares the efficacy of SSRIs with other antidepressants. OBJECTIVES To examine the relative efficacy of selective serotonin reuptake inhibitors (SSRIs) compared to other antidepressants. SEARCH STRATEGY The search strategy included a search of (a) Electronic bibliographic databases (MEDLINE, EMBASE); (b) reference lists of related reviews (c) reference lists of all located studies (d) contact with the manufacturer and (e) the Cochrane Group register of controlled trials SELECTION CRITERIA Randomised controlled trials comparing selective serotonin reuptake inhibitors with other kinds of antidepressants in the treatment of patients with depressive disorders. The outcome measures assessed included measures of the severity of depression. DATA COLLECTION AND ANALYSIS Data were collected from each study the main outcome measurefrom each study. These included: mean Hamilton depression rating scale, mean Montgomery & Asberg depression rating scale, Clinical Global Impression rating scale. An analysis of standardised mean difference of these scales was performed using Review Manager 3.1 software. The presence of heterogeneity of treatment effect was assessed MAIN RESULTS Ninety-eight trials contributed data to the analysis of the relative efficacy of SSRIs and related drugs with comparator antidepressants (Figure 3 & Appendix 3). Analysis of efficacy was based upon 5044 patients treated with an SSRI or related drug, and 4510 treated with an alternative antidepressant. The standardised effect size for SSRIs and related drugs together versus alternative antidepressants using a fixed effects model was 0.035 (95% CI -0.006 to 0.076; Q = 149.25, df = 97, p < 0.001). AUTHORS' CONCLUSIONS There are no clinically significant differences in effectiveness between selective serotonin reuptake inhibitors and tricyclic antidepressants. Treatment decisions need to be based on considerations of relative patient acceptability, toxicity and cost.
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Affiliation(s)
- J R Geddes
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK, OX3 7JK.
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Gras D, Böcker D, Lunati M, Wellens HJJ, Calvert M, Freemantle N, Gervais R, Kappenberger L, Tavazzi L, Erdmann E, Cleland JGF, Daubert JC. Implantation of cardiac resynchronization therapy systems in the CARE-HF trial: procedural success rate and safety. ACTA ACUST UNITED AC 2007; 9:516-22. [PMID: 17540662 DOI: 10.1093/europace/eum080] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIMS To assess procedural characteristics and adjudicated procedure-related (<or=30 days) major adverse events among patients who underwent cardiac resynchronization therapy (CRT) implantation in the CARE-HF study. The CARE-HF study shows that CRT improves symptoms and reduces morbidity and mortality in New York Heart Association (NYHA) class III/IV chronic heart failure (CHF) patients. However, safe and proper implantation of pacing systems remains key to effective CRT delivery. METHODS AND RESULTS Generalized linear modeling was used to examine the relationships between first implant success/failure and: NYHA class; beta-adrenergic blocker use; underlying ischemic vs. non-ischemic heart disease; history of coronary artery bypass graft or valve surgery; left ventricular (LV) end-diastolic volume<or=vs. >300 cm(3); and, influence of the participating study-centres. Implantation was attempted in 404/409 patients assigned to CRT, and in 65/404 patients assigned to medical therapy. Among these 469 patients, 450 (95.9%) received a successfully implanted and activated device. Complications occurred within 24 h in 47 patients (10.0%), mainly lead dislodgments (n = 10, 2.1%) and coronary sinus dissection/perforation (n = 10, 2.1%), and between 24 h and 30 days in 26 patients (5.5%), mainly lead dislodgment (n = 13, 2.8%). Mean LV lead stimulation threshold was significantly higher than at the right atrium or right ventricle, though remained stable, delivering effective, and reliable CRT. Implanting experience was the only predictor of procedural outcome. CONCLUSION Transvenous CRT system implantation, using a CS lead designed for long-term LV pacing, was safe and reliable. As implanting centres become more experienced, this success rate is expected to increase further.
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Affiliation(s)
- D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
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Freemantle N, Tharmanathan P, Calvert MJ, Abraham WT, Ghosh J, Cleland JGF. Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction - a systematic review and meta-analysis. Eur J Heart Fail 2006; 8:433-40. [PMID: 16507349 DOI: 10.1016/j.ejheart.2005.11.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 09/08/2005] [Accepted: 11/24/2005] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Randomised controlled trials generally suggest that cardiac resynchronisation improves outcomes in patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. Our objective was to provide a valid synthesis of the effects of CRT on mortality, major morbidity, quality of life and implantation success rates. METHODS Systematic overview and meta-analysis of randomised trials, both blinded and open, comparing cardiac resynchronisation with control. The primary outcome was all-cause mortality, and secondary outcomes included hospitalisation for worsening heart failure, quality of life and implantation success rates. RESULTS We identified 8 randomised trials which included 3380 patients and observed a total of 524 deaths. Follow-up ranged from 1 month to a mean of 29.4 months. Most trials were of high quality, with centrally administered randomisation and few patients lost to follow-up. CRT reduced mortality in these trials (odds ratio 0.72, 95% CI 0.59 to 0.88). In addition CRT reduced hospitalisation for worsening heart failure (odds ratio 0.55, 95% CI 0.44 to 0.68) and improved quality of life as measured by the Minnesota Living with Heart Failure Questionnaire (weighted mean difference -7.1, 95% CI -2.9 to -11.4). Implantation success rates in the trials were 87% or greater. CONCLUSION Cardiac resynchronisation in patients with heart failure characterised by dyssynchrony substantially reduces all-cause mortality, major morbidity and improves quality of life.
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Affiliation(s)
- N Freemantle
- Clinical Epidemiology and Biostatistics, Department of Primary Care and General Practice, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Tharmanathan P, Calvert MJ, Freemantle N. Striding forward or getting too big for their boots? The developing role of data monitoring committees in clinical trials. J Clin Pharm Ther 2006; 31:111-8. [PMID: 16635044 DOI: 10.1111/j.1365-2710.2006.00709.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P Tharmanathan
- Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Freemantle N. Cost effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial: reply. Eur Heart J 2005. [DOI: 10.1093/eurheartj/ehi802] [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: 11/13/2022] Open
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