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Martin DM, Harvey AJ, Baune B, Berk M, Carter GL, Dong V, Glozier N, Glue P, Hood S, Hadzi-Pavlovic D, Hackett M, Mills N, Sarma S, Somogyi A, Rodgers A, Loo CK. Cognitive outcomes from the randomised, active-controlled Ketamine for Adult Depression Study (KADS). J Affect Disord 2024; 352:163-170. [PMID: 38378088 DOI: 10.1016/j.jad.2024.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Due to its rapid antidepressant effect, ketamine has recently been clinically translated for people with treatment-resistant depression. However, its cognitive profile remains unclear, particularly with repeated and higher doses. In the present study, we report the cognitive results from a recent large multicentre randomised controlled trial, the Ketamine for Adult Depression Study (KADS). METHODS In this randomised, double-blind, active-controlled, parallel group, multicentre phase 3 trial study we investigated potential cognitive changes following repeated treatment of subcutaneous racemic ketamine compared to an active comparator, midazolam, over 4 weeks, which involved two cohorts; Cohort 1 involved a fixed dose treatment protocol (0.5 mg/kg ketamine), Cohort 2 involved a dose escalation protocol (0.5-0.9 mg/kg) based on mood outcomes. Participants with treatment-resistant Major Depressive Disorder (MDD) were recruited from 7 mood disorder centres and were randomly assigned to receive ketamine (Cohort 1 n = 33; Cohort 2 n = 53) or midazolam (Cohort 1 n = 35; Cohort 2 n = 53) in a 1:1 ratio. Cognitive measurements were assessed at baseline and at the end of randomised treatment. RESULTS Results showed that in Cohort 1, there were no differences between ketamine and midazolam in cognitive outcomes. For Cohort 2, there was similarly no difference between conditions for cognitive outcomes. LIMITATIONS The study included two Cohorts with different dosing regimes. CONCLUSIONS The findings support the cognitive safety of repeated fixed and escalating doses at least in the short-term in people with treatment resistant MDD.
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Affiliation(s)
- Donel M Martin
- University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia.
| | - Anna J Harvey
- University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | | | | | | | - Vanessa Dong
- University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | - Nick Glozier
- The University of Sydney, Sydney, NSW, Australia
| | - Paul Glue
- University of Otago, Dunedin, New Zealand
| | - Sean Hood
- University of Western Australia, Perth, WA, Australia
| | | | - Maree Hackett
- The George Institute for Global Health, Sydney, NSW, Australia
| | | | - Shanthi Sarma
- Bond University, Southport, QLD, Australia; Mental Health and Special Services, Gold Coast Health, QLD, Australia
| | | | - Anthony Rodgers
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Colleen K Loo
- University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
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Smith V, Delaney H, Hunter A, Torgerson D, Treweek S, Gamble C, Mills N, Stanbury K, Dempsey E, Daly M, O'Shea J, Weatherup K, Deshpande S, Ryan MA, Lowe J, Black G, Devane D. The development and acceptability of an educational and training intervention for recruiters to neonatal trials: the TRAIN project. BMC Med Res Methodol 2023; 23:265. [PMID: 37951890 PMCID: PMC10638723 DOI: 10.1186/s12874-023-02086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 10/28/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Suboptimal or slow recruitment affects 30-50% of trials. Education and training of trial recruiters has been identified as one strategy for potentially boosting recruitment to randomised controlled trials (hereafter referred to as trials). The Training tRial recruiters, An educational INtervention (TRAIN) project was established to develop and assess the acceptability of an education and training intervention for recruiters to neonatal trials. In this paper, we report the development and acceptability of TRAIN. METHODS TRAIN involved three sequential phases, with each phase contributing information to the subsequent phase(s). These phases were 1) evidence synthesis (systematic review of the effectiveness of training interventions and a content analysis of the format, content, and delivery of identified interventions), 2) intervention development using a Partnership (co-design/co-creation) approach, and 3) intervention acceptability assessments with recruiters to neonatal trials. RESULTS TRAIN, accompanied by a comprehensive intervention manual, has been designed for online or in-person delivery. TRAIN can be offered to recruiters before trial recruitment begins or as refresher sessions during a trial. The intervention consists of five core learning outcomes which are addressed across three core training units. These units are the trial protocol (Unit 1, 50 min, trial-specific), understanding randomisation (Unit 2, 5 min, trial-generic) and approaching and engaging with parents (Unit 3, 70 min, trial-generic). Eleven recruiters to neonatal trials registered to attend the acceptability assessment training workshops, although only four took part. All four positively valued the training Units and resources for increasing recruiter preparedness, knowledge, and confidence. More flexibility in how the training is facilitated, however, was noted (e.g., training divided across two workshops of shorter duration). Units 2 and 3 were considered beneficial to incorporate into Good Clinical Practice Training or as part of induction training for new staff joining neonatal units. CONCLUSION TRAIN offers a comprehensive co-produced training and education intervention for recruiters to neonatal trials. TRAIN was deemed acceptable, with minor modification, to neonatal trial recruiters. The small number of recruiters taking part in the acceptability assessment is a limitation. Scale-up of TRAIN with formal piloting and testing for effectiveness in a large cluster randomised trial is required.
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Affiliation(s)
- V Smith
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Dublin, Ireland.
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland.
| | - H Delaney
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Dublin, Ireland
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
| | - A Hunter
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - D Torgerson
- York Trials Unit, University of York, York, YO10 5DD, UK
| | - S Treweek
- Health Services Research Unit, Trial Forge, University of Aberdeen, Aberdeen, UK
| | - C Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - N Mills
- QuinteT, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - K Stanbury
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E Dempsey
- INFANT Centre, University College Cork, Cork, Ireland
| | - M Daly
- Irish Neonatal Health Alliance, Public and Patient Involvement Contributor, Bray, Co-Wicklow, Ireland
| | - J O'Shea
- Public and Patient Involvement Contributor, Royal Hospital for Children, Glasgow, UK
| | - K Weatherup
- Public and Patient Involvement Contributor, Oxford, UK
| | | | - M A Ryan
- INFANT Centre, University College Cork, Cork, Ireland
| | - J Lowe
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - G Black
- Royal Hospital for Children and Young People, Edinburgh, UK
| | - D Devane
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
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Lowry M, Doudesis D, Kimenai D, Bularga A, Taggart C, Wereski R, Ferry A, Stewart S, Tuck C, Lee K, Chapman A, Shah A, Newby D, Anand A, Mills N. Impact of time from symptom onset on the diagnostic performance of high-sensitivity cardiac troponin for type 1 myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High-sensitivity cardiac troponin has enabled the rapid rule-out and rule-in of myocardial infarction at presentation. However, increases in cardiac troponin may not be detectable early after symptom onset, and uncertainty remains as to how time of symptom onset influences diagnostic performance.
Purpose
To evaluate the impact of time from symptom onset on the diagnostic performance of high-sensitivity cardiac troponin for type 1 myocardial infarction.
Methods
In a secondary analysis of a prospective multicentre randomised controlled trial of consecutive patients with suspected acute coronary syndrome, we evaluated the diagnostic performance of high-sensitivity cardiac troponin I measurements at presentation stratified by time of symptom onset to blood sampling. Diagnostic performance was evaluated in four groups (≤3 hours, 4–6 hours, 7–12 hours and >12 hours from symptom onset) for recommended thresholds to rule-out (sex-specific 99th centile and optimised threshold [64 ng/L]) type 1 myocardial infarction.
Results
This analysis included 41,104 patients (median 60 [interquartile range 49–74] years, 46% female) of which 12,595 (31%), 10,298 (25%), 7,171 (17%) and 11,040 (27%) presented ≤3 hours, 4–6 hours, 7–12 hours and >12 hours, respectively. Type 1 myocardial infarction was the adjudicated diagnosis in 3,692 (9%) patients. For the rule-out of type 1 myocardial infarction, sensitivity was highest in those tested 7–12 hours from symptom onset and lowest in those tested ≤3 hours. In early presenters, a threshold of <2 ng/L had greater sensitivity and negative predictive value (99.4% [95% CI 98.9 to 99.7%] and 99.7% [95% CI 99.5 to 99.9%]) compared to <5 ng/L (96.7% [95% CI 95.7 to 97.6%] and 99.3% [95% CI 99.1 to 99.5%], respectively). In those tested >3 hrs from symptom onset, the sensitivity and negative predictive value for both thresholds were similar, but a threshold of <5 ng/L correctly ruled out more patients (60% [17,056/28,506] versus 29% [8,316/28,506]). For the rule-in of myocardial infarction, the sensitivity of the 99th centile and 64 ng/L was lowest in patients tested within 3 hours (71.7% [95% CI 69.3 to 74.1%] and 46.5% [95% CI 44.1 to 49.2%], respectively), and increased in those tested later from symptom onset. The specificity and positive predictive value were highest when testing was performed 7–12 hours from symptom onset for the sex-specific 99th centile (92.4% [95% CI 91.8 to 93.0%] and 51.3% [95% CI 48.2–54.5%]) and 64 ng/L (96.2% [95% CI 95.7 to 96.7%] and 61.2% [95% CI 57.3 to 65.2%]).
Conclusions
The diagnostic performance of cardiac troponin for myocardial infarction is strongly influenced by the time from symptom onset to testing. In early presenters the limit of detection may facilitate immediate rule-out of myocardial infarction, but otherwise testing at least 3 hours from symptom onset is needed with the optimal time to rule-in myocardial infarction being 7–12 hours from the onset of symptoms.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation (BHF)Medical Research council UK (MRC)
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Affiliation(s)
- M Lowry
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Doudesis
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Kimenai
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Bularga
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Taggart
- University of Edinburgh , Edinburgh , United Kingdom
| | - R Wereski
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Ferry
- University of Edinburgh , Edinburgh , United Kingdom
| | - S Stewart
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Tuck
- University of Edinburgh , Edinburgh , United Kingdom
| | - K Lee
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Chapman
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Shah
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Newby
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Anand
- University of Edinburgh , Edinburgh , United Kingdom
| | - N Mills
- University of Edinburgh , Edinburgh , United Kingdom
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Lee K, Doudesis D, Bing R, Astengo F, Perez J, Anand A, McIntyre S, Bloor N, Sandler B, Lister S, Pollock K, Qureshi A, McAllister D, Shah A, Mills N. Sex-differences in oral anticoagulation therapy in patients hospitalised with atrial fibrillation: a nationwide cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Important disparities in the treatment and outcomes of women and men with atrial fibrillation are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain.
Methods
All patients who had an incident hospitalization from 2010 to 2019 with non-valvular atrial fibrillation in Scotland were included in this cohort study. Community drug dispensing data were used to determine prescribed oral anticoagulation therapy and comorbidity status. Logistic regression modelling was used to evaluate patient factors associated with treatment with vitamin K antagonists and direct oral anticoagulants.
Results
A total of 172,989 patients (48% women [82,833/172,989]) had an incident hospitalization with non-valvular atrial fibrillation in Scotland between 2010 and 2019. The proportion of patients with thromboembolic risk factors (CHA2DS2VASc score >0 in men and >1 in women) treated with oral anticoagulation therapy increased from 36.8% to 66.3% over this 10-year period. By 2019, factor Xa inhibitors accounted for 83.6% of all oral anticoagulants prescribed, while treatment with vitamin K antagonists and direct thrombin inhibitors declined to 15.9% and 0.6%, respectively. Women were less likely to be prescribed any oral anticoagulation therapy compared to men (adjusted odds ratio, aOR 0.68 [95% CI, CI 0.67–0.70]). This disparity was mainly attributed to vitamin K antagonists (aOR 0.68 [95% CI 0.66–0.70]), whilst there was less disparity in use of factor Xa inhibitors between women and men (aOR 0.92 [95% CI 0.90–0.95]). At 1 year following hospitalization with atrial fibrillation, patients not prescribed oral anticoagulation therapy were more likely to have subsequent major adverse cardiovascular events compared to those prescribed with oral anticoagulation therapy (38.8% [15,380/39,608] versus 17.0% [6,761/39,671] in women and 35.2% [12,977/36,868] versus 16.4% [7,395/45,093] in men).
Conclusions
Women with non-valvular atrial fibrillation were significantly less likely to be prescribed vitamin K antagonists compared to men. Most patients admitted to hospital in Scotland with incident non-valvular atrial fibrillation are now treated with factor Xa inhibitors and this is associated with less treatment disparities between women and men.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by the British Heart Foundation through a Clinical Research Training Fellowship (FS/18/25/33454), Intermediate Clinical Research Fellowship (FS/19/17/34172), Senior Clinical Research Fellowship (FS/16/14/32023) and a Research Excellence Award (RE/18/5/34216), and a research grant to NHS Lothian from Bristol Myers Squibb Pharmaceuticals Ltd and Pfizer UK Ltd.
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Affiliation(s)
- K Lee
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Doudesis
- University of Edinburgh , Edinburgh , United Kingdom
| | - R Bing
- University of Edinburgh , Edinburgh , United Kingdom
| | - F Astengo
- University of Edinburgh , Edinburgh , United Kingdom
| | - J Perez
- University of Glasgow , Glasgow , United Kingdom
| | - A Anand
- University of Edinburgh , Edinburgh , United Kingdom
| | - S McIntyre
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - N Bloor
- Pfizer Ltd , Tadworth , United Kingdom
| | - B Sandler
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - S Lister
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - K Pollock
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - A Qureshi
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - D McAllister
- University of Glasgow , Glasgow , United Kingdom
| | - A Shah
- London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - N Mills
- University of Edinburgh , Edinburgh , United Kingdom
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Ng TL, Taljaard M, Savard MF, Stober C, Nicholls S, Vandermeer L, Thavorn K, Hampel C, Shamess J, Mills N, Hilton JF, Clemons M. Abstract OT2-21-01: A randomized, multicenter pragmatic trial comparing bone pain from a single dose of pegfilgrastim to 5 doses of daily filgrastim in breast cancer patients receiving neoadjuvant/adjuvant chemotherapy (REaCT-5G). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-21-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Current guidelines recommend the use of granulocyte colony-stimulating factors (G-CSF) as primary prophylaxis to prevent febrile neutropenia (FN) associated with commonly used breast cancer chemotherapy regimens. Filgrastim (FIL) is a short-acting G-CSF injection that requires daily subcutaneous injection starting 24-72 hours after chemotherapy for 5 to 10 days. Pegfilgrastim (PEG) is a long-acting, pegylated formulation that requires a single injection 24-72 hours after chemotherapy. G-CSF causes bone pain in approximately 70% of patients, which can be severe in over 25% of cases. While registration trials for PEG showed bone pain from PEG was comparable to FIL when given for a median duration of 11 days, many oncologists are now only prescribing FIL for 5 days based on a multicenter RCT showing that 5 days of FIL is non-inferior to 7 or 10 days of FIL in terms of FN and treatment-related hospitalizations. Furthermore, the cost of 5 days of FIL ($CA 721.55 for 300 mcg dose) is half of the price of a single dose of PEG ($CA 1424.63). Therefore, if 5 days of FIL leads to significantly less bone pain, this may improve health-related quality of life (HR-QoL) for patients, improve adherence to G-CSF, and improve cost-effectiveness. Methods: Patients receiving neo-/adjuvant chemotherapy for early stage breast cancer requiring primary FN prophylaxis with G-CSF will be approached for this pragmatic, multicenter, open-label superiority RCT. Using the Rethinking Clinical Trials (REaCT) methodology that incorporates an integrated oral consent model, eligible and consented patients will be randomized to either 5 days of FIL or one day of PEG with each cycle of chemotherapy. The primary endpoint is bone pain during the first 5 days after G-CSF injection using area under the curve (AUC) of the daily pain score from days 1-5 (AUC score 0 to 40) of the Bone Pain Diary. Secondary endpoints include incidence of FN and treatment-related hospitalizations, incidence of chemotherapy delay, dose-reduction, or discontinuation, incidence of chemotherapy-related mortality, rate of G-CSF compliance, healthcare resource utilization, HR-QoL, and cost-effectiveness. Participants will also complete a Treatment Preference Questionnaire (TPQ) exploring the relative importance of different factors in deciding between PEG vs. 5 days of FIL both before randomization and at the end of the study. To achieve 80% power in an ANCOVA analysis and assuming 5% are loss to follow-up, the planned sample size is 232 patients (116 per arm). The randomization (1:1 ratio) will be stratified by treatment center (4 centers) and chemotherapy regimen (taxane-based vs. anthracycline-based in the first 4 cycles). Results: The study opened for enrollment on June 9, 2021. As of July 6, 2021, the study has opened at one site, and 13 patients have been randomized.Conclusion: This will be the first RCT using a patient-reported Bone Pain Diary that was co-developed by patient partners to measure bone pain between 5 days of FIL vs. PEG. In collaboration with patient partners, the study incorporates a tool (TPQ) that explores factors that may be important in deciding between PEG and FIL, with the aim of translating the findings of this study into real world clinical practice.
Citation Format: Terry L. Ng, Monica Taljaard, Marie-France Savard, Carol Stober, Stuart Nicholls, Lisa Vandermeer, Kednapa Thavorn, Claudia Hampel, Jennifer Shamess, Natalie Mills, John F. Hilton, Mark Clemons. A randomized, multicenter pragmatic trial comparing bone pain from a single dose of pegfilgrastim to 5 doses of daily filgrastim in breast cancer patients receiving neoadjuvant/adjuvant chemotherapy (REaCT-5G) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-21-01.
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Affiliation(s)
| | | | | | - Carol Stober
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Pitman B, Lim M, Margaritis C, Mills N, Wong C, Sanders P, Lau D. Characterisation Of Implantable Cardioverter Defibrillator (ICD) Patients Receiving Elective In-hospital Palliative Device Deactivation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Doudesis D, Lee KK, Anwar M, Astengo F, Newby D, Japp A, Tsanas A, Shah A, Richards M, McMurray J, Mueller C, Januzzi J, Mills N. Machine learning to aid in the diagnosis of acute heart failure in the emergency department. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MRproANP) testing are recommended to aid in the diagnosis of acute heart failure. However, the application of these biomarkers for optimal diagnostic performance is uncertain.
Methods
We performed a systematic review and harmonised individual patient-level data to evaluate the diagnostic performance of BNP and MRproANP for the diagnosis of acute heart failure using random-effects meta-analysis. We subsequently developed and externally validated a decision-support tool called CoDE-HF for both BNP and MRproANP that combines the natriuretic peptide concentrations with clinical variables using machine learning to report the probability of acute heart failure for an individual patient.
Results
Fourteen studies from 12 countries provided individual patient-level data in 8,493 patients for BNP and 3,847 patients for MRproANP, in whom, 48.3% (4,105/8,493) and 41.3% (1,611/3899) had an adjudicated diagnosis of acute heart failure, respectively. The negative and positive predictive values of guideline-recommended thresholds for BNP (100 pg/mL) and MR-proANP (120 pg/mL) were 93.6% (95% confidence interval 88.4–96.6%) and 68.8% (62.9–74.2%), and 95.6% (92.2–97.6%) and 64.8% (56.3–72.5%), respectively. However, we observed significant heterogeneity in the diagnostic performance across important patient subgroups (Figure 1). In the external validation cohort, CoDE-HF was well calibrated with excellent discrimination in those without prior acute heart failure for both BNP and MRproANP (area under the curve of 0.946 [0.933–0.958] and 0.943 [0.921–0.964], and Brier scores of 0.105 and 0.073, respectively). CoDE-HF performed consistently across all subgroups for both BNP and MRproANP, and identified 30% and 65.7% at low-probability (negative predictive value of 99.1% [98.8–99.3%] and 99.1% [98.8–99.4%]), and 30% and 17.3% at high-probability (positive predictive value of 91.3% [90.7–91.9%] and 70.0% [68.5–71.4%]) in those without prior heart failure, respectively (Figure 2).
Conclusion
In an international collaborative analysis, we observed that guideline-recommended thresholds for BNP and MRproANP to diagnose acute heart failure varied significantly across patient subgroups. A decision-support tool using machine learning to combine natriuretic peptides as a continuous measure and other clinical variables provides a more accurate and individualised approach.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Medical Research Council and British Heart Foundation Figure 1. NPV of BNP threshold (100 pg/mL)Figure 2. NPV of the CoDE-HF rule-out score
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Affiliation(s)
- D Doudesis
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - K K Lee
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - M Anwar
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - F Astengo
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - D Newby
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - A Japp
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - A Tsanas
- University of Edinburgh, Usher Institute, Edinburgh, United Kingdom
| | - A Shah
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - M Richards
- University of Otago, Christchurch Heart Institute, Christchurch, New Zealand
| | - J McMurray
- University of Glasgow, BHF Cardiovascular Research Centre, Glasgow, United Kingdom
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute of Basel, Basel, Switzerland
| | - J Januzzi
- Massachusetts General Hospital, Division of Cardiology, Boston, Massachusetts, United States of America
| | - N Mills
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
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Tzolos E, Williams M, McElhinney P, Lin A, Grodecki K, Guadalupe F, Cadet S, Kwiecinski J, Doris M, Adamson P, Moss A, Alam S, Hunter A, Shah A, Mills N, Pawade T, Wang C, Weir-McCall J, Roditi G, van Beek E, Shaw L, Nicol E, Berman D, Slomka P, Dweck M, Newby D, Dey D. Pericoronary Adipose Tissue Attenuation, Low Attenuation Plaque Burden And 5-year Risk Of Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.198] [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: 11/27/2022]
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Williams M, Kwiecinski J, Doris M, McElhinney P, Cadet S, Adamson P, Moss A, Alam S, Hunter A, Shah A, Mills N, Pawade T, Wang C, Weir-McCall J, Roditi G, van Beek E, Shaw L, Nicol E, Berman D, Slomka P, Newby D, Dweck M, Dey D. Sex-specific CT Coronary Plaque Characterization And Risk Of Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.254] [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: 11/16/2022]
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Mehra A, Keller C, Zhang T, Tosca N, McLennan S, Sperling E, Farrell U, Brocks J, Canfield D, Cole D, Crockford P, Cui H, Dahl T, Dewing K, Emmings J, Gaines R, Gibson T, Gilleaudeau G, Guilbaud R, Hodgkiss M, Jarrett A, Kabanov P, Kunzmann M, Li C, Loydell D, Lu X, Miller A, Mills N, Mouro L, O’Connell B, Peters S, Poulton S, Ritzer S, Smith E, Wilby P, Woltz C, Strauss J. Curation and Analysis of Global Sedimentary Geochemical Data to Inform Earth History. ACTA ACUST UNITED AC 2021. [DOI: 10.1130/gsatg484a.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anand A, Tew YY, Chan JH, Keeling P, Shenkin SD, MacLullich A, Mills N, Denvir MA. 29 Predicting Unplanned Readmission and Death After Hospital Discharge: How Do Frailty Tools Compare to Electronic Health Record Frailty Markers? Age Ageing 2021. [DOI: 10.1093/ageing/afab029.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Numerous frailty tools and definitions have been described. Amongst hospitalised patients, the validity of face-to-face instruments may be confounded by acute illness. However, patient assessment after recovery at the point of hospital discharge, or recognition of electronic health record (EHR) frailty markers, may overcome this issuep.
Methods
In a consented, prospective observational cohort study, we recruited patients ≥70 years old within 24 hours of expected discharge from the cardiology ward of the Royal Infirmary of Edinburgh. Three established frailty instruments were tested: the Fried phenotype, Short Physical Performance Battery and nurse-administered Clinical Frailty Scale (CFS). An unweighted 32-item EHR score was generated using frailty markers (e.g. falls risk, continence, cognition) recorded within mandated admission documentation. Comorbidity was assessed by count of chronic health conditions. Outcomes were a 90-day composite of unplanned readmission or death and 12-month mortality. Adjusted Cox modelling determined the hazard ratio (HR) per standard deviation increase in each frailty score.
Results
186 patients (mean age 79 ± 6 years, 64% male) were included, of whom 55 (30%) had a 90-day composite outcome, and 21 (11%) died within 12 months. All four frailty tools were moderately correlated with age and comorbidity (Pearson’s r 0.21 to 0.43, all p < 0.05). The Fried phenotype (HR 1.47, 95% CI 1.18–1.81), CFS (HR 1.24, 95% CI 1.01–1.51) and EHR score (HR 1.26, 95% CI 1.03–1.55) independently predicted 90-day readmission or death, after adjustment for age, sex and comorbidity. All frailty instruments were independent predictors of 12-month mortality, with age, sex and comorbidity losing predictive power (p > 0.05) once frailty was included in modelling.
Conclusions
At hospital discharge, the Fried phenotype and CFS added to age and comorbidity in risk prediction for future unplanned readmission or death. EHR frailty markers appeared comparable to face-to-face assessment. An automated trigger for high-risk patients using routine EHR data merits prospective evaluation.
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Affiliation(s)
- A Anand
- BHF Centre for Cardiovascular Science, University of Edinburgh
- Geriatric Medicine Research Group, University of Edinburgh
| | | | | | - P Keeling
- University of Edinburgh Medical School
| | - S D Shenkin
- Geriatric Medicine Research Group, University of Edinburgh
- Usher Institute, University of Edinburgh
| | - A MacLullich
- Geriatric Medicine Research Group, University of Edinburgh
- Usher Institute, University of Edinburgh
| | - N Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh
- Usher Institute, University of Edinburgh
| | - M A Denvir
- BHF Centre for Cardiovascular Science, University of Edinburgh
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12
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Doudesis D, Yang J, Tsanas A, Stables C, Shah A, Anand A, Lee K, Strachan F, Pickering J, Than M, Mills N. Validation of a machine learned model to predict the diagnosis of myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The myocardial-ischemic-injury-index (MI3) is a promising machine learned algorithm that predicts the likelihood of myocardial infarction in patients with suspected acute coronary syndrome. Whether this algorithm performs well in unselected patients or predicts recurrent events is unknown.
Methods
In an observational analysis from a multi-centre randomised trial, we included all patients with suspected acute coronary syndrome and serial high-sensitivity cardiac troponin I measurements without ST-segment elevation myocardial infarction. Using gradient boosting, MI3 incorporates age, sex, and two troponin measurements to compute a value (0–100) reflecting an individual's likelihood of myocardial infarction, and estimates the negative predictive value (NPV) and positive predictive value (PPV). Model performance for an index diagnosis of myocardial infarction, and for subsequent myocardial infarction or cardiovascular death at one year was determined using previously defined low- and high-probability thresholds (1.6 and 49.7, respectively).
Results
In total 20,761 of 48,282 (43%) patients (64±16 years, 46% women) were eligible of whom 3,278 (15.8%) had myocardial infarction. MI3 was well discriminated with an area under the receiver-operating-characteristic curve of 0.949 (95% confidence interval 0.946–0.952) identifying 12,983 (62.5%) patients as low-probability (sensitivity 99.3% [99.0–99.6%], NPV 99.8% [99.8–99.9%]), and 2,961 (14.3%) as high-probability (specificity 95.0% [94.7–95.3%], PPV 70.4% [69–71.9%]). At one year, subsequent myocardial infarction or cardiovascular death occurred more often in high-probability compared to low-probability patients (17.6% [520/2,961] versus 1.5% [197/12,983], P<0.001).
Conclusions
In unselected consecutive patients with suspected acute coronary syndrome, the MI3 algorithm accurately estimates the likelihood of myocardial infarction and predicts probability of subsequent adverse cardiovascular events.
Performance of MI3 at example thresholds
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Medical Research Council
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Affiliation(s)
- D Doudesis
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - J Yang
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - A Tsanas
- University of Edinburgh, Usher Institute, Edinburgh, United Kingdom
| | - C Stables
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - A Shah
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - A Anand
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - K Lee
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - F Strachan
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - J Pickering
- Christchurch Hospital, Emergency Department, Christchurch, New Zealand
| | - M Than
- Christchurch Hospital, Emergency Department, Christchurch, New Zealand
| | - N Mills
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
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13
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Davis TRC, Tan W, Harrison EF, Hollingworth W, Karantana A, Mills N, Hepburn T, Sprange K, Duley L, Blazeby JM, Bainbridge CG, Murali SR, Montgomery AA. A randomised feasibility trial comparing needle fasciotomy with limited fasciectomy treatment for Dupuytren's contractures. Pilot Feasibility Stud 2020; 6:7. [PMID: 32021696 PMCID: PMC6993423 DOI: 10.1186/s40814-019-0546-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study is to assess the feasibility of conducting a large, multicentre randomised controlled trial (RCT) comparing needle fasciotomy with limited fasciectomy for treatment of Dupuytren’s contractures. Design The design of this study is a parallel, two-arm, multicentre, randomised feasibility trial with embedded QuinteT Recruitment Intervention. Participants Patients aged 18 years or over who were referred from primary to secondary care for treatment of a hand with Dupuytren’s contractures of one or more fingers of more than 30° at the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints and well-defined cord(s). Patients were excluded if they had undergone previous Dupuytren’s contracture surgery on the same hand. Methods Potential participants were screened for eligibility. Recruited participants randomised (1:1) to treatment with either needle fasciotomy or limited fasciectomy and followed-up for up to 6 months after treatment. Data on recruitment rates, completion of follow-up, and procedure costs were collected. Four patient reported outcome measures (PROMs) and objective outcome measures were collected before intervention and 6 weeks and 6 months afterwards. Results One hundred and fifty-three of 267 (57%) primary-care referrals for Dupuytren’s contractures met the eligibility criteria for the study. Seventy-one of the 153 (46%) agreed to participate and were randomly allocated to treatment with needle fasciotomy or limited fasciectomy. Sixty-seven of these underwent their allocated treatment, two were crossovers from limited fasciectomy to needle fasciotomy, and two (both allocated limited fasciectomy) received no treatment. Fifty-nine participants (85%) completed 6-month follow-up PROMs. Participants felt the MYMOP, PEM and URAM PROMs allowed them to better describe how their treatment affected their hand function than the DASH PROM. The estimated costs of limited fasciectomy (in an operating theatre) and needle fasciotomy (in a clinic room) were £777 and £111 respectively. Conclusion A large RCT comparing treatment of Dupuytren’s contractures by needle fasciotomy and limited fasciectomy is feasible. Data from this study will help determine the number of sites and duration of recruitment required to complete an adequately powered RCT and will assist the selection of PROMs in future studies on the treatment of Dupuytren’s contractures. (Level 1 feasibility study). Trial registration Trial registered with ISRCTN (registration number: ISRCTN11164292), date assigned - 28/08/2015.
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Affiliation(s)
- T R C Davis
- 1Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH UK
| | - W Tan
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - E F Harrison
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - W Hollingworth
- 3Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - A Karantana
- 4Centre for Evidence Based Hand Surgery, Academic Orthopaedics Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
| | - N Mills
- 3Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - T Hepburn
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - K Sprange
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - L Duley
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - J M Blazeby
- 3Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - C G Bainbridge
- 5Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE UK
| | - S R Murali
- 6Wrightington, Wigan and Leigh NHS Foundation Trust, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP UK
| | - A A Montgomery
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
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14
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Shah A, McAllister D, Astengo F, Perez J, Lee KK, Gallacher P, Hall J, Bing R, Anand A, Newby D, Mills N, Cruden N. 3325Incidence, outcomes and microbiology in patients with infective endocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Despite recent improvements in management, infective endocarditis remains associated with high morbidity and mortality. Over the last few decades, several factors have impacted on both the incidence and outcomes following infective endocarditis.
Purpose
Using a national linkage approach, we describe the changing age- and sex-stratified incidence and outcomes of infective endocarditis in Scotland over the last 25 years.
Methods
We conducted a consecutive retrospective individual patient linkage study across multiple national databases. Using data extracted from the Scottish hospital discharge dataset held by the Information Services Division of NHS National Services Scotland, we extracted episodes for all patients aged 20 years or older who were admitted with infective endocarditis between January 1, 1990, and December 31, 2014 in Scotland, UK. Patient episodes with infective endocarditis were linked to national prescribing and microbiology databases. The primary outcome was 1-year mortality following the index presentation. Generalised additive models were constructed to estimate the crude and age- and sex-stratified incidence rates (using a poison distribution) as well as trends in mortality (using a binomial distribution) adjusted for age, sex and comorbidity.
Results
Across 12,446 individual patients, there were a total of 12,667 hospitalisations (mean age 68±17 years, 55% females) with infective endocarditis using a 5-year look back period. The estimated crude rate of hospitalisation increased from 7.38 per 100,000 (95% CI 6.58 to 8.28) in 1990 to 15.09 per 100,000 (95% CI 13.90 to 16.39) in 2014 (p<0.001). Over the period of the study, 31% (3,877/12,667) of people admitted to hospital with infective endocarditis died within one year of admission. Case fatality fell markedly in both men and women from 1990 to 2014 (Figure). Microbiology was status was available for 34% of all hospitalisations with staphylococcus cultures associated with worse outcomes.
Conclusions
Despite the crude incidence of infective endocarditis doubling over the last 25 years and case fatality remaining high, the risk of death has markedly fallen over the last two decades. Staphylococcus cultures remain an independent marker of poor prognosis in this cohort.
Acknowledgement/Funding
British Heart Foundation
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Affiliation(s)
- A Shah
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | | | - F Astengo
- University of Edinburgh, Edinburgh, United Kingdom
| | - J Perez
- University of Glasgow, Glasgow, United Kingdom
| | - K K Lee
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - P Gallacher
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - J Hall
- University of Edinburgh, Edinburgh, United Kingdom
| | - R Bing
- University of Edinburgh, Edinburgh, United Kingdom
| | - A Anand
- University of Edinburgh, Edinburgh, United Kingdom
| | - D Newby
- University of Edinburgh, Edinburgh, United Kingdom
| | - N Mills
- University of Edinburgh, Edinburgh, United Kingdom
| | - N Cruden
- University of Edinburgh, Edinburgh, United Kingdom
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15
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Ni G, Amare AT, Zhou X, Mills N, Gratten J, Lee SH. The genetic relationship between female reproductive traits and six psychiatric disorders. Sci Rep 2019; 9:12041. [PMID: 31427629 PMCID: PMC6700195 DOI: 10.1038/s41598-019-48403-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/31/2019] [Indexed: 12/31/2022] Open
Abstract
Female reproductive behaviours have important implications for evolutionary fitness and health of offspring. Here we used the second release of UK Biobank data (N = 220,685) to evaluate the association between five female reproductive traits and polygenic risk scores (PRS) projected from genome-wide association study summary statistics of six psychiatric disorders (N = 429,178). We found that the PRS of attention-deficit/hyperactivity disorder (ADHD) were strongly associated with age at first birth (AFB) (genetic correlation of -0.68 ± 0.03), age at first sexual intercourse (AFS) (-0.56 ± 0.03), number of live births (NLB) (0.36 ± 0.04) and age at menopause (-0.27 ± 0.04). There were also robustly significant associations between the PRS of eating disorder (ED) and AFB (0.35 ± 0.06), ED and AFS (0.19 ± 0.06), major depressive disorder (MDD) and AFB (-0.27 ± 0.07), MDD and AFS (-0.27 ± 0.03) and schizophrenia and AFS (-0.10 ± 0.03). These associations were mostly explained by pleiotropic effects and there was little evidence of causal relationships. Our findings can potentially help improve reproductive health in women, hence better child outcomes. Our findings also lend partial support to the evolutionary hypothesis that causal mutations underlying psychiatric disorders have positive effects on reproductive success.
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Affiliation(s)
- Guiyan Ni
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, 4072, Australia
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, SA, 5000, Australia
- School of Environmental and Rural Science, University of New England, Armidale, NSW, 2351, Australia
| | - Azmeraw T Amare
- South Australian Academic Health Science and Translation centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Xuan Zhou
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, SA, 5000, Australia
| | - Natalie Mills
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Jacob Gratten
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, 4072, Australia
- Mater Research Institute, University of Queensland, Brisbane, Queensland, 4072, Australia
| | - S Hong Lee
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, SA, 5000, Australia.
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16
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Beasant L, Brigden A, Parslow R, Apperley H, Keep T, Northam A, Wray C, King H, Langdon R, Mills N, Young B, Crawley E. Treatment preference and recruitment to pediatric RCTs: A systematic review. Contemp Clin Trials Commun 2019; 14:100335. [PMID: 30949611 PMCID: PMC6430075 DOI: 10.1016/j.conctc.2019.100335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/25/2019] [Accepted: 02/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recruitment to pediatric randomised controlled trials (RCTs) can be a challenge, with ethical issues surrounding assent and consent. Pediatric RCTs frequently recruit from a smaller pool of patients making adequate recruitment difficult. One factor which influences recruitment and retention in pediatric trials is patient and parent preferences for treatment. PURPOSE To systematically review pediatric RCTs reporting treatment preference. METHODS Database searches included: MEDLINE, CINAHL, EMBASE, and COCHRANE.Qualitative or quantitative papers were eligible if they reported: pediatric population, (0-17 years) recruited to an RCT and reported treatment preference for all or some of the participants/parents in any clinical area. Data extraction included: Number of eligible participants consenting to randomisation arms, number of eligible patients not randomised because of treatment preference, and any further information reported on preferences (e.g., if parent preference was different from child). RESULTS Fifty-two studies were included. The number of eligible families declining participation in an RCT because of preference for treatment varied widely (between 2 and 70%) in feasibility, conventional and preference trial designs. Some families consented to trial involvement despite having preferences for a specific treatment. Data relating to 'participant flow and recruitment' was not always reported consistently, therefore numbers who were lost to follow-up or withdrew due to preference could not be extracted. CONCLUSIONS Families often have treatment preferences which may affect trial recruitment. Whilst children appear to hold treatment preferences, this is rarely reported. Further investigation is needed to understand the reasons for preference and the impact preference has on RCT recruitment, retention and outcome.
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Affiliation(s)
- L. Beasant
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - A. Brigden
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - R.M. Parslow
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - H. Apperley
- Department of Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton and Sussex University Hospitals, UK
| | - T. Keep
- NHS Greater Glasgow and Clyde, UK
| | - A. Northam
- Department of Primary Care and Public Health, Royal Sussex County Hospital, Brighton and Sussex Medical School, UK
| | - C. Wray
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - H. King
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Trust, UK
| | - R. Langdon
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - N. Mills
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - B. Young
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - E. Crawley
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
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17
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Apple F, Mills N. Laboratory and clinical practice guides for improved diagnostics and risk assessment outcomes: Let's talk about high-sensitivity cardiac troponin I. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Harvey K, Potter S, Mills N, Holcombe C. #11 The Pre-Bra Study (oral presentation). Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Cambridge OR, Knight MJ, Mills N, Baune BT. The clinical relationship between cognitive impairment and psychosocial functioning in major depressive disorder: A systematic review. Psychiatry Res 2018; 269:157-171. [PMID: 30149273 DOI: 10.1016/j.psychres.2018.08.033] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [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: 02/26/2018] [Revised: 08/12/2018] [Accepted: 08/12/2018] [Indexed: 11/18/2022]
Abstract
Cognitive deficits are frequently observed in major depressive disorder (MDD), as well as impaired long-term psychosocial functioning. However, the relationship between cognitive deficits and psychosocial functioning in MDD is under-investigated. We aim to systematically review the literature on the relationship between specific cognitive impairments and psychosocial functioning in MDD. We systematically reviewed English-language literature in PubMed, PsychINFO, Scopus and Web of Science using search terms related to psychosocial functioning. Additional studies were identified by searching reference lists. Following our inclusion/exclusion criteria, 28 studies were reviewed. Inclusion criteria included age (> 18), MDD diagnosed by standard tools (e.g., DSM-IV), use of cognitive and psychosocial assessments. Cross-sectional studies indicated that cognitive deficits in domains of executive functioning, attention, memory, and global cognition are associated with psychosocial dysfunction in domains of as quality of life, and social, occupational, and global functioning. The cognition-functioning relationship was also observed in longitudinal studies, showing that only specific cognitive domains affected psychosocial outcomes over the long-term course of illness. Older age and greater MDD symptom severity appear to enhance cognition-psychosocial dysfunction relationship, however little is known regarding the role of a number of other clinical factors (e.g., psychosis, illness duration).
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Affiliation(s)
- Olivia R Cambridge
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, AUSTRALIA
| | - Matthew J Knight
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, AUSTRALIA
| | - Natalie Mills
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, AUSTRALIA
| | - Bernhard T Baune
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, AUSTRALIA.
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20
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Adamson P, Pilbrow A, Pickering J, Poppe K, Mills N, Newby D, Troughton R, Doughty R, Richards M. 1093Prognostic value of convalescent high-sensitivity troponin I concentrations following acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Adamson
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A Pilbrow
- University of Otago Christchurch, Department of Medicine, Christchurch, New Zealand
| | - J Pickering
- University of Otago Christchurch, Department of Medicine, Christchurch, New Zealand
| | - K Poppe
- The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - N Mills
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D Newby
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - R Troughton
- University of Otago Christchurch, Department of Medicine, Christchurch, New Zealand
| | - R Doughty
- The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - M Richards
- University of Otago Christchurch, Department of Medicine, Christchurch, New Zealand
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21
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Couvy-Duchesne B, O’Callaghan V, Parker R, Mills N, Kirk KM, Scott J, Vinkhuyzen A, Hermens DF, Lind PA, Davenport TA, Burns JM, Connell M, Zietsch BP, Scott J, Wright MJ, Medland SE, McGrath J, Martin NG, Hickie IB, Gillespie NA. Nineteen and Up study (19Up): understanding pathways to mental health disorders in young Australian twins. BMJ Open 2018; 8:e018959. [PMID: 29550775 PMCID: PMC5875659 DOI: 10.1136/bmjopen-2017-018959] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The Nineteen and Up study (19Up) assessed a range of mental health and behavioural problems and associated risk factors in a genetically informative Australian cohort of young adult twins and their non-twin siblings. As such, 19Up enables detailed investigation of genetic and environmental pathways to mental illness and substance misuse within the Brisbane Longitudinal Twin Sample (BLTS). PARTICIPANTS Twins and their non-twin siblings from Queensland, Australia; mostly from European ancestry. Data were collected between 2009 and 2016 on 2773 participants (age range 18-38, 57.8% female, 372 complete monozygotic pairs, 493 dizygotic pairs, 640 non-twin siblings, 403 singleton twins). FINDINGS TO DATE A structured clinical assessment (Composite International Diagnostic Interview) was used to collect lifetime prevalence of diagnostic statistical manual (4th edition) (DSM-IV) diagnoses of major depressive disorder, (hypo)mania, social anxiety, cannabis use disorder, alcohol use disorder, panic disorder and psychotic symptoms. Here, we further describe the comorbidities and ages of onset for these mental disorders. Notably, two-thirds of the sample reported one or more lifetime mental disorder.In addition, the 19Up study assessed general health, drug use, work activity, education level, personality, migraine/headaches, suicidal thoughts, attention deficit hyperactivity disorder (ADHD) symptomatology, sleep-wake patterns, romantic preferences, friendships, familial environment, stress, anorexia and bulimia as well as baldness, acne, asthma, endometriosis, joint flexibility and internet use.The overlap with previous waves of the BLTS means that 84% of the 19Up participants are genotyped, 36% imaged using multimodal MRI and most have been assessed for psychological symptoms at up to four time points. Furthermore, IQ is available for 57%, parental report of ADHD symptomatology for 100% and electroencephalography for 30%. FUTURE PLANS The 19Up study complements a phenotypically rich, longitudinal collection of environmental and psychological risk factors. Future publications will explore hypotheses related to disease onset and development across the waves of the cohort. A follow-up study at 25+years is ongoing.
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Affiliation(s)
- Baptiste Couvy-Duchesne
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Victoria O’Callaghan
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Richard Parker
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Natalie Mills
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Katherine M Kirk
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jan Scott
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Anna Vinkhuyzen
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Penelope A Lind
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Tracey A Davenport
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jane M Burns
- Young and Well CRC, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Connell
- UQCCR, The University of Queensland, Brisbane, Queensland, Australia
| | - Brendan P Zietsch
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - James Scott
- UQCCR, The University of Queensland, Brisbane, Queensland, Australia
| | - Margaret J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - John McGrath
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nathan A Gillespie
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
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Van der Auwera S, Peyrot WJ, Milaneschi Y, Hertel J, Baune BT, Breen G, Byrne EM, Dunn EC, Fisher HL, Homuth G, Levinson DF, Lewis CM, Mills N, Mullins N, Nauck M, Pistis G, Preisig M, Rietschel M, Ripke S, Sullivan PF, Teumer A, Völzke H, Boomsma DI, Wray NR, Penninx BWJH, Grabe HJ. Genome-wide gene-environment interaction in depression: A systematic evaluation of candidate genes: The childhood trauma working-group of PGC-MDD. Am J Med Genet B Neuropsychiatr Genet 2018; 177:40-49. [PMID: 29159863 PMCID: PMC5726923 DOI: 10.1002/ajmg.b.32593] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/28/2017] [Accepted: 08/08/2017] [Indexed: 12/16/2022]
Abstract
Gene by environment (GxE) interaction studies have investigated the influence of a number of candidate genes and variants for major depressive disorder (MDD) on the association between childhood trauma and MDD. Most of these studies are hypothesis driven and investigate only a limited number of SNPs in relevant pathways using differing methodological approaches. Here (1) we identified 27 genes and 268 SNPs previously associated with MDD or with GxE interaction in MDD and (2) analyzed their impact on GxE in MDD using a common approach in 3944 subjects of European ancestry from the Psychiatric Genomics Consortium who had completed the Childhood Trauma Questionnaire. (3) We subsequently used the genome-wide SNP data for a genome-wide case-control GxE model and GxE case-only analyses testing for an enrichment of associated SNPs. No genome-wide significant hits and no consistency among the signals of the different analytic approaches could be observed. This is the largest study for systematic GxE interaction analysis in MDD in subjects of European ancestry to date. Most of the known candidate genes/variants could not be supported. Thus, their impact on GxE interaction in MDD may be questionable. Our results underscore the need for larger samples, more extensive assessment of environmental exposures, and greater efforts to investigate new methodological approaches in GxE models for MDD.
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Affiliation(s)
| | - S Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - WJ Peyrot
- Department of Psychiatry, Vrije Universiteit Medical Center and GGZ in Geest, Amsterdam, The Netherlands
| | - Y Milaneschi
- Department of Psychiatry, Vrije Universiteit Medical Center and GGZ in Geest, Amsterdam, The Netherlands
| | - J Hertel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - BT Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
| | - G Breen
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Great Britain,NIHR BRC for Mental Health, King's College London, London, Great Britain
| | - EM Byrne
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - EC Dunn
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, US,Department of Psychiatry, Massachusetts General Hospital, Boston, US,Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Massachusetts General Hospital, Boston, US
| | - HL Fisher
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Great Britain
| | - G Homuth
- Interfaculty Institute for Genetics and Functional Genomics, Department of Functional Genomics, University Medicine and Ernst Moritz Arndt University Greifswald, Greifswald, Germany
| | - DF Levinson
- Psychiatry & Behavioral Sciences, Stanford University, Stanford, US
| | - CM Lewis
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Great Britain,Department of Medical & Molecular Genetics, King's College London, London, Great Britain
| | - N Mills
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
| | - N Mullins
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Great Britain
| | - M Nauck
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - G Pistis
- Department of Psychiatry, University Hospital of Lausanne, Prilly, Switzerland
| | - M Preisig
- Department of Psychiatry, University Hospital of Lausanne, Prilly, Switzerland
| | - M Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - S Ripke
- Medical and Population Genetics, Broad Institute, Cambridge, US,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, US,Department of Psychiatry and Psychotherapy, University medicine Berlin Campus Charité Mitte, Berlin, Germany
| | - PF Sullivan
- Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, US,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, US
| | - A Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - DI Boomsma
- Dept of Biological Psychology & EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - NR Wray
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia,Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - BWJH Penninx
- Department of Psychiatry, Vrije Universiteit Medical Center and GGZ in Geest, Amsterdam, The Netherlands
| | - HJ Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
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Choflet A, Mills N, Anderson R. Optimized Radiation Oncology Nurse Orientation Program. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Shah A, Stelzle D, Lee K, Alam S, Clifford S, Longenecker C, Strachan F, Bagchi S, Whiteley W, Rajagopalan S, Kottilil S, Nair H, Newby D, McAllister D, Mills N. P448Global burden of cardiovascular disease in people living with the human immunodeficiency virus. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p448] [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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Adamson P, Hunter A, Shah A, McAllister D, Pawade T, Williams M, Dweck M, Mills N, Berry C, Flather M, Forbes J, Roditi G, Van Beek E, Timmis A, Newby D. 1013Diagnostic and prognostic benefits of CTCA using the updated NICE guidance: An analysis of the Scottish computed tomography of the heart (SCOT-HEART) trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P. Adamson
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A. Hunter
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A. Shah
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D. McAllister
- University of Glasgow, Public Health Medicine, Glasgow, United Kingdom
| | - T. Pawade
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M. Williams
- University of Edinburgh, Edinburgh Imaging, QMRI, Edinburgh, United Kingdom
| | - M. Dweck
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - N. Mills
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - C. Berry
- University of Glasgow, Institute of Clinical Sciences, Glasgow, United Kingdom
| | - M. Flather
- University of East Anglia, Norwich Medical School, Norwich, United Kingdom
| | - J. Forbes
- University of Limerick, Limerick, Ireland
| | - G. Roditi
- University of Glasgow, Institute of Clinical Sciences, Glasgow, United Kingdom
| | - E. Van Beek
- University of Edinburgh, Edinburgh Imaging, QMRI, Edinburgh, United Kingdom
| | - A. Timmis
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - D. Newby
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
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Criquet A, Mai E, Saucourt C, Vogt S, Giganti P, Baron S, Roncalli J, Lairez O, Lagente C, Lebrin M, Ioannides K, Manrique A, Saloux E, Leroux L, Goin V, Roubille F, Lefèvre T, Hovasse T, Vanzetto G, Derenne S, Tertrais K, Newby D, Cruden N, Mills N, Greenwood J, Wheatcroft S, Dickinson A, Black A, Henon P. Challenges between clinical sites and cell therapy facilities in the excellent trial (expanded cell endocardiac transplantation), a phase I/IIb clinical trial. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Adamson P, Hunter A, Williams M, Shah A, McAllister D, Pawade T, Dweck M, Mills N, Berry C, van Beek E, Timmis A, Newby D. Diagnostic and Prognostic Benefits of CTCA Using the Updated NICE Guidance: An Analysis of the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Mills N. When impatience is a virtue. Curr Oncol 2016; 23:e436-e438. [PMID: 27803602 DOI: 10.3747/co.23.3337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There can be few paradoxes quite like the life and death of the former mayor of Toronto, Rob Ford[...]
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Affiliation(s)
- N Mills
- Office of the Chief Coroner-Ontario, Laurier Medical Clinic, Rockland, and University of Ottawa, Ottawa, ON
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Violato M, Dakin H, Chakravarthy U, Reeves BC, Peto T, Hogg RE, Harding SP, Scott LJ, Taylor J, Cappel-Porter H, Mills N, O'Reilly D, Rogers CA, Wordsworth S. Cost-effectiveness of community versus hospital eye service follow-up for patients with quiescent treated age-related macular degeneration alongside the ECHoES randomised trial. BMJ Open 2016; 6:e011121. [PMID: 27797985 PMCID: PMC5093395 DOI: 10.1136/bmjopen-2016-011121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of optometrist-led follow-up monitoring reviews for patients with quiescent neovascular age-related macular degeneration (nAMD) in community settings (including high street opticians) compared with ophthalmologist-led reviews in hospitals. DESIGN A model-based cost-effectiveness analysis with a 4-week time horizon, based on a 'virtual' non-inferiority randomised trial designed to emulate a parallel group design. SETTING A virtual internet-based clinical assessment, conducted at community optometry practices, and hospital ophthalmology clinics. PARTICIPANTS Ophthalmologists with experience in the age-related macular degeneration service; fully qualified optometrists not participating in nAMD shared care schemes. INTERVENTIONS The participating optometrists and ophthalmologists classified lesions from vignettes and were asked to judge whether any retreatment was required. Vignettes comprised clinical information, colour fundus photographs and optical coherence tomography images. Participants' classifications were validated against experts' classifications (reference standard). Resource use and cost information were attributed to these retreatment decisions. MAIN OUTCOME MEASURES Correct classification of whether further treatment is needed, compared with a reference standard. RESULTS The mean cost per assessment, including the subsequent care pathway, was £411 for optometrists and £397 for ophthalmologists: a cost difference of £13 (95% CI -£18 to £45). Optometrists were non-inferior to ophthalmologists with respect to the overall percentage of lesions correctly assessed (difference -1.0%; 95% CI -4.5% to 2.5%). CONCLUSIONS In the base case analysis, the slightly larger number of incorrect retreatment decisions by optometrists led to marginally and non-significantly higher costs. Sensitivity analyses that reflected different practices across eye hospitals indicate that shared care pathways between optometrists and ophthalmologists can be identified which may reduce demands on scant hospital resources, although in light of the uncertainty around differences in outcome and cost it remains unclear whether the differences between the 2 care pathways are significant in economic terms. TRIAL REGISTRATION NUMBER ISRCTN07479761; Pre-results.
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Affiliation(s)
- M Violato
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, University of Oxford, Oxford, UK
| | - H Dakin
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - U Chakravarthy
- Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK
| | - B C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - T Peto
- NIHR BMRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - R E Hogg
- Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK
| | - S P Harding
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - L J Scott
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - J Taylor
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - H Cappel-Porter
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - N Mills
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D O'Reilly
- Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK
| | - C A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - S Wordsworth
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
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Adam Z, Turley A, Mason J, Kasim A, Newby D, Mills N, Padfield G, Thompson L, Morley R, Hall J, Wright R, Muir D, Sutton A, Swanson N, Carter J, Bilous R, Jones S, de Belder M. The SSTARS (STeroids and Stents Against Re-Stenosis) Trial: Different stent alloys and the use of peri-procedural oral corticosteroids to prevent in-segment restenosis after percutaneous coronary intervention. Int J Cardiol 2016; 216:1-8. [DOI: 10.1016/j.ijcard.2016.04.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/11/2016] [Indexed: 12/26/2022]
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Blencowe NS, Mills N, Cook JA, Donovan JL, Rogers CA, Whiting P, Blazeby JM. Standardizing and monitoring the delivery of surgical interventions in randomized clinical trials. Br J Surg 2016; 103:1377-84. [PMID: 27462835 PMCID: PMC5132147 DOI: 10.1002/bjs.10254] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/15/2016] [Accepted: 05/25/2016] [Indexed: 12/04/2022]
Abstract
Background The complexity of surgical interventions has major implications for the design of RCTs. Trials need to consider how and whether to standardize interventions so that, if successful, they can be implemented in practice. Although guidance exists for standardizing non‐pharmaceutical interventions in RCTs, their application to surgery is unclear. This study reports new methods for standardizing the delivery of surgical interventions in RCTs. Methods Descriptions of 160 surgical interventions in existing trial reports and protocols were identified. Initially, ten reports were scrutinized in detail using a modified framework approach for the analysis of qualitative data, which informed the development of a preliminary typology. The typology was amended with iterative sequential application to all interventions. Further testing was undertaken within ongoing multicentre RCTs. Results The typology has three parts. Initially, the overall technical purpose of the intervention is described (exploration, resection and/or reconstruction) in order to establish its constituent components and steps. This detailed description of the intervention is then used to establish whether and how each component and step should be standardized, and the standards documented within the trial protocol. Finally, the typology provides a framework for monitoring the agreed intervention standards during the RCT. Pilot testing within ongoing RCTs enabled standardization of the interventions to be agreed, and case report forms developed to capture deviations from these standards. Conclusion The typology provides a framework for use during trial design to standardize the delivery of surgical interventions and document these details within protocols. Application of this typology to future RCTs may clarify details of the interventions under evaluation and help successful interventions to be implemented. Design a perfect study
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Affiliation(s)
- N S Blencowe
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - N Mills
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J A Cook
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - J L Donovan
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C A Rogers
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - P Whiting
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - J M Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
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Kanaan M, Mdege ND, Keding A, Parker RA, Mills N, Shah A, Strachan F, Keerie C, Weir CJ, Forbes A, Hemming K, Lawton SA, Healey E, Lewis M, Nicholls E, Jinks C, Tan V, Finney A, Mallen CD, Lenguerrand E, MacLennan G, Norrie J, Bhattacharya S, Draycott T, Hooper R, Teerenstra S, de Hoop E, Eldridge S, Girling A, Taljaard M, Di Tanna GL, Gasparrini A, Casula A, Caskey F, Lenguerrand E, Methven S, MacNeill S, May M, Selby N, Danon L, Christensen H, Finn A, May M, Takanashi F, Keding A, Crouch S, Kanaan M, Kristunas CA, Smith KL, Gray LJ, Matthews JN, Salman RAS, Parker RA, Maxwell A, Dennis M, Rudd A, Weir CJ, Thompson JA, Fielding KL, Davey C, Aiken AM, Hargreaves JR, Hayes RJ, Lyons VH, Li L, Hughes J, Rowhani-Rahbar A, Hemming K, Taljaard M, Forbes A. Proceedings of the First International Conference on Stepped Wedge Trial Design. Trials 2016; 17 Suppl 1:311. [PMID: 27454562 PMCID: PMC4959349 DOI: 10.1186/s13063-016-1436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
I1 Introduction Mona Kanaan, Noreen Dadirai Mdege, Ada Keding O1 The HiSTORIC trial: a hybrid before-and-after and stepped wedge design RA Parker, N Mills, A Shah, F Strachan, C Keerie, CJ Weir O2 Stepped wedge trials with non-uniform correlation structure Andrew Forbes, Karla Hemming O3 Challenges and solutions for the operationalisation of the ENHANCE study: a pilot stepped wedge trial within a general practice setting Sarah A Lawton, Emma Healey, Martyn Lewis, Elaine Nicholls, Clare Jinks, Valerie Tan, Andrew Finney, Christian D Mallen, on behalf of the ENHANCE Study Team O4 Early lessons from the implementation of a stepped wedge trial design investigating the effectiveness of a training intervention in busy health care settings: the Thistle study Erik Lenguerrand, Graeme MacLennan, John Norrie, Siladitya Bhattacharya, Tim Draycott, on behalf of the Thistle group O5 Sample size calculation for longitudinal cluster randomised trials: a unified framework for closed cohort and repeated cross-section designs Richard Hooper, Steven Teerenstra, Esther de Hoop, Sandra Eldridge O6 Restricted randomisation schemes for stepped-wedge studies with a cluster-level covariate Alan Girling, Monica Taljaard O7 A flexible modelling of the time trend for the analysis of stepped wedge trials: results of a simulation study Gian Luca Di Tanna, Antonio Gasparrini P1 Tackling acute kidney injury – a UK stepped wedge clinical trial of hospital-level quality improvement interventions Anna Casula, Fergus Caskey, Erik Lenguerrand, Shona Methven, Stephanie MacNeill, Margaret May, Nicholas Selby P2 Sample size considerations for quantifying secondary bacterial transmission in a stepped wedge trial of influenza vaccine Leon Danon, Hannah Christensen, Adam Finn, Margaret May P3 Sample size calculation for time-to-event data in stepped wedge cluster randomised trials Fumihito Takanashi, Ada Keding, Simon Crouch, Mona Kanaan P4 Sample size calculations for stepped-wedge cluster randomised trials with unequal cluster sizes Caroline A. Kristunas, Karen L. Smith, Laura J. Gray P5 The design of stepped wedge trials with unequal cluster sizes John N.S. Matthews P6 Promoting Recruitment using Information Management Efficiently (PRIME): a stepped wedge SWAT (study-within-a-trial) R Al-Shahi Salman, RA Parker, A Maxwell, M Dennis, A Rudd, CJ Weir P7 Implications of misspecified mixed effect models in stepped wedge trial analysis: how wrong can it be? Jennifer A Thompson, Katherine L Fielding, Calum Davey, Alexander M Aiken, James R Hargreaves, Richard J Hayes S1 Stepped Wedge Designs with Multiple Interventions Vivian H Lyons, Lingyu Li, James Hughes, Ali Rowhani-Rahbar S2 Analysis of the cross-sectional stepped wedge cluster randomised trial Karla Hemming, Monica Taljaard, Andrew Forbes
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Shah A, Mills N, Zhang R, McAllister D, Strachan F, Caslake M, Newby D, Packard C, Ford I. High-sensitivity cardiac troponin, statin threapy and risk of cardiovascular disease. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mills N, Sheppard L. Integrating technology to enhance the assessment of competence to practice and accreditation of courses in physiotherapy. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Townsend D, Reeves BC, Taylor J, Chakravarthy U, O'Reilly D, Hogg RE, Mills N. Health professionals' and service users' perspectives of shared care for monitoring wet age-related macular degeneration: a qualitative study alongside the ECHoES trial. BMJ Open 2015; 5:e007400. [PMID: 25900465 PMCID: PMC4410127 DOI: 10.1136/bmjopen-2014-007400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore the views of eye health professionals and service users on shared community and hospital care for wet or neovascular age-related macular degeneration (nAMD). METHOD Using maximum variation sampling, 5 focus groups and 10 interviews were conducted with 23 service users and 24 eye health professionals from across the UK (consisting of 8 optometrists, 6 ophthalmologists, 6 commissioners, 2 public health representatives and 2 clinical eye care advisors to local Clinical Commissioning Groups). Data were transcribed verbatim and analysed thematically using constant comparative techniques derived from grounded theory methodology. RESULTS The needs and preferences of those with nAMD appear to be at odds with the current service being provided. There was enthusiasm among health professionals and service users about the possibility of shared care for nAMD as it was felt to have the potential to relieve hospital eye service burden and represent a more patient-centred option, but there were a number of perceived barriers to implementation. Some service users and ophthalmologists voiced concerns about optometrist competency and the potential for delays with referrals to secondary care if stable nAMD became active again. The health professionals were divided as to whether shared care was financially more efficient than the current model of care. Specialist training for optometrists, under the supervision of ophthalmologists, was deemed to be the most effective method of training and was perceived to have the potential to improve the communication and trust that shared care would require. CONCLUSIONS While shared care is perceived to represent a promising model of nAMD care, voiced concerns suggest that there would need to be greater collaboration between ophthalmology and optometry, in terms of interprofessional trust and communication. TRIAL REGISTRATION NUMBER ISRCTN07479761.
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Affiliation(s)
- D Townsend
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - B C Reeves
- School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - J Taylor
- School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - U Chakravarthy
- Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK
| | - D O'Reilly
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast, UK
| | - R E Hogg
- Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK
| | - N Mills
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Mills N, Pearce P, Farrow J, Thorpe RB, Kirkby NF. Environmental & economic life cycle assessment of current & future sewage sludge to energy technologies. Waste Manag 2014; 34:185-195. [PMID: 24060290 DOI: 10.1016/j.wasman.2013.08.024] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 08/11/2013] [Accepted: 08/15/2013] [Indexed: 06/02/2023]
Abstract
The UK Water Industry currently generates approximately 800GWh pa of electrical energy from sewage sludge. Traditionally energy recovery from sewage sludge features Anaerobic Digestion (AD) with biogas utilisation in combined heat and power (CHP) systems. However, the industry is evolving and a number of developments that extract more energy from sludge are either being implemented or are nearing full scale demonstration. This study compared five technology configurations: 1 - conventional AD with CHP, 2 - Thermal Hydrolysis Process (THP) AD with CHP, 3 - THP AD with bio-methane grid injection, 4 - THP AD with CHP followed by drying of digested sludge for solid fuel production, 5 - THP AD followed by drying, pyrolysis of the digested sludge and use of the both the biogas and the pyrolysis gas in a CHP. The economic and environmental Life Cycle Assessment (LCA) found that both the post AD drying options performed well but the option used to create a solid fuel to displace coal (configuration 4) was the most sustainable solution economically and environmentally, closely followed by the pyrolysis configuration (5). Application of THP improves the financial and environmental performance compared with conventional AD. Producing bio-methane for grid injection (configuration 3) is attractive financially but has the worst environmental impact of all the scenarios, suggesting that the current UK financial incentive policy for bio-methane is not driving best environmental practice. It is clear that new and improving processes and technologies are enabling significant opportunities for further energy recovery from sludge; LCA provides tools for determining the best overall options for particular situations and allows innovation resources and investment to be focused accordingly.
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Affiliation(s)
- N Mills
- Innovation Department, Thames Water Utilities Limited, Reading, UK; Department of Chemical and Process Engineering, University of Surrey, Guildford, UK.
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Skinner E, Brittan M, Tura O, Fletcher J, Burton P, Baker A, Mountford J, Hadoke P, Wilmut I, Mills N. 193 THE IMPORTANCE OF CELL SOURCE FOR SOMATIC TISSUE REPROGRAMMING: ENDOTHELIAL CELL-DERIVED IPS CELLS HAVE ENHANCED CAPACITY TO DIFFERENTIATE INTO FUNCTIONAL ENDOTHELIAL CELLS. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.193] [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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Medine C, Perez G, Sendfeld F, Scornik F, Mills N, Wilmut I, Tura O. 264 CHARACTERISATION OF CARDIOMYOCYTES DERIVED FROM HUMAN INDUCED PLURIPOTENT STEM (IPS) CELLS. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.264] [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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Fletcher J, Sendfeld F, Mills N, Wilmut I, Medine C. 231 ISOLATION OF HUMAN C-KIT+ CARDIAC PROGENITOR CELLS TO IMPROVE OUR UNDERSTANDING OF CARDIAC TRANSCRIPTIONAL REGULATION. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.231] [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: 11/04/2022]
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Raval R, Richardson M, Kumar R, Mills N, Katulis L, Quon H. Gabapentin Therapy for Prevention and Management of the Pain Syndrome in Oropharyngeal Carcinoma Patients Treated With Radiation: A Retrospective Study. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McAllister D, Wild S, Maclay J, Robson A, Newby D, MacNee W, Innes A, Zamvar V, Mills N. P2-180 FEV1 predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brown M, Lees S, Law S, Mills N, McCalmont C. Using support workers to release time for qualified midwives in maternity care. Nurs Times 2010; 106:22-24. [PMID: 21155500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Maternity services must meet the demands of an increasingly diverse and rapidly growing population. Recent policy changes mean midwives are taking on roles formerly performed by doctors, leaving maternity support workers to undertake many traditional midwifery tasks. This article discusses how MSWs can facilitate choice by helping midwives deliver a flexible, personalised service to childbearing women and how the MSW role has developed.
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Trzonkowski P, Dębska-Ślizień A, Jankowska M, Wardowska A, Carvalho-Gaspar M, Hak Ł, Moszkowska G, Bzoma B, Mills N, Wood KJ, Myśliwska J, Rutkowski B. Immunosenescence increases the rate of acceptance of kidney allotransplants in elderly recipients through exhaustion of CD4+ T-cells. Mech Ageing Dev 2010; 131:96-104. [DOI: 10.1016/j.mad.2009.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/04/2009] [Accepted: 12/18/2009] [Indexed: 12/11/2022]
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McCalmont C, Brown M, Mills N, Lees S. Maternal mental health: a Cinderella service? Pract Midwife 2010; 13:27-28. [PMID: 20162886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Carmel McCalmont
- Women Service, University Hospitals Coventry and Warwickshire NHS Trust
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Van Poznak C, Morris P, D'Andrea G, Schott A, Griggs J, Fornier M, Smerage J, Henry N, Hurria A, Drullinsky P, Mills N, Hayes D, Hudis C. Bone Mineral Density (BMD) Changes at 1 Year in Postmenopausal Women Who Are Not Receiving Adjuvant Endocrine Therapy for Breast Cancer (BCA). Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1066] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Abstract
Background: Adjuvant therapy for breast cancer (BCA) may be associated with an increased risk for osteoporosis. This prospective, observational study evaluates BMD changes in postmenopausal women undergoing adjuvant chemotherapy (CTX) for early stage BCA, in the absence of endocrine therapy.Methods: Women who have been postmenopausal for at least 5 years, and who were recently diagnosed with Stage 0-III BCA were eligible to undergo serial BMD if adjuvant endocrine therapy was not recommended. Study BMDs were performed at baseline, 1 and 2 years. All patients (pts) were counseled on calcium, vitamin D and weight bearing exercise. This study was designed to assess serial changes in BMD in the individual and to compare changes in those treated with CTX to those who received no systemic therapy (observation). The study was closed prior to reaching target sample size due to slow accrual.Results: Sixteen pts enrolled. Eleven pts received CTX with a dose dense anthracycline and taxane containing regimen and 5 pts received no systemic adjuvant therapy. Twelve pts, median age 63 (range 52-80), have completed the 1 year assessment and are reported here. Two pts treated with CTX and 1 pt on observation were on bisphosphonates at study entry. Baseline BMD mean in gm/cm2 at the lumbar spine (LS) was 1.112 (range 0.807-1.389) and total hip (TH) was 0.989 (range 0.760-1.213). At 1 year, mean BMD at LS was 1.078 (range 0.767-1.347) and TH was 0.956 (range 0.753-1.210). For all 12 pts at 1 year, the individual BMD changes in LS & TH BMD ranged from 10% loss to 2% gain, with 8 of the 9 CTX treated pts losing 1-10% of BMD and the 3 pts on observation staying within 2% of baseline. The mean dosage of dexamethasone used during CTX by the 9 CTX pts was 230 mg (range 156-288mg). The 3 observation pts had no exposure to steroids during the parallel time period.Conclusions: This prospective, observational study supports the hypothesis that adjuvant CTX, and/or its supportive medications, may be associated with acute changes in BMD in postmenopausal women. Patient follow up continues.Funded by Susan G. Komen for the Cure POP0402593
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1066.
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Affiliation(s)
| | - P. Morris
- 2Memorial Sloan-Kettering Cancer Center, NY,
| | - G. D'Andrea
- 2Memorial Sloan-Kettering Cancer Center, NY,
| | | | | | - M. Fornier
- 2Memorial Sloan-Kettering Cancer Center, NY,
| | | | | | | | | | - N. Mills
- 2Memorial Sloan-Kettering Cancer Center, NY,
| | | | - C. Hudis
- 2Memorial Sloan-Kettering Cancer Center, NY,
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Xu Q, Meng L, Li B, Mills N. Influence of host size variation on the development of a koinobiont aphid parasitoid, Lysiphlebus ambiguus Haliday (Braconidae, Hymenoptera). Bull Entomol Res 2008; 98:389-395. [PMID: 18294414 DOI: 10.1017/s0007485308005683] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
To determine whether host body size is the currency used by the aphidiine parasitoid, Lysiphlebus ambiguus Haliday (Hymenoptera: Braconidae), in assessing host quality, the aphid, Aphis fabae Scopoli (Homoptera: Aphididae), was reared at either high or low temperature to yield hosts of the same instar with different body sizes. Cohorts of A. fabae raised at 15 degrees C and 30 degrees C and exposed to individual female L. ambiguus in no-choice tests were successfully parasitized in all host stages from 1st instar nymphs to adults. However, younger and smaller aphids were more susceptible to parasitism than older and larger nymphs or adults, as measured by the number of mummies produced. For aphid cohorts reared at 15 degrees C, the proportion of female progeny, progeny adult size, and development time all increased linearly with aphid size at the time of attack. In contrast, for aphid cohorts raised at 30 degrees C, the proportion of female progeny and progeny adult size declined with aphid size, while development time remained unaffected. Through manipulation of host rearing temperature, we have shown that at cooler temperatures the koinobiont parasitoid, L. ambiguus, responds to host size in the same way as an idiobiont parasitoid, but that this response is compromised at higher temperatures. Our results suggest that differential mortality during development is likely to influence the observed secondary sex ratio in relation to aphid size for aphid cohorts raised at higher temperatures due to disruption of the activity of the host's primary endosymbiont and that such reduced nutritional quality of aphids cannot be compensated by increased development time.
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Affiliation(s)
- Q Xu
- Department of Entomology, Nanjing Agricultural University, Weigang #1, Nanjing, China
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Low N, McCarthy A, Macleod J, Salisbury C, Campbell R, Roberts TE, Horner P, Skidmore S, Sterne JAC, Sanford E, Ibrahim F, Holloway A, Patel R, Barton PM, Robinson SM, Mills N, Graham A, Herring A, Caul EO, Davey Smith G, Hobbs FDR, Ross JDC, Egger M. Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection. Health Technol Assess 2007; 11:iii-iv, ix-xii, 1-165. [PMID: 17311735 DOI: 10.3310/hta11080] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To investigate epidemiological, social, diagnostic and economic aspects of chlamydia screening in non-genitourinary medicine settings. METHODS Linked studies around a cross-sectional population-based survey of adult men and women invited to collect urine and (for women) vulvovaginal swab specimens at home and mail these to a laboratory for testing for Chlamydia trachomatis. Specimens were used in laboratory evaluations of an amplified enzyme immunoassay (PCE EIA) and two nucleic acid amplification tests [Cobas polymerase chain reaction (PCR), Becton Dickinson strand displacement amplification (SDA)]. Chlamydia-positive cases and two negative controls completed a risk factor questionnaire. Chlamydia-positive cases were invited into a randomised controlled trial of partner notification strategies. Samples of individuals testing negative completed psychological questionnaires before and after screening. In-depth interviews were conducted at all stages of screening. Chlamydia transmission and cost-effectiveness of screening were investigated in a transmission dynamic model. SETTING AND PARTICIPANTS General population in the Bristol and Birmingham areas of England. In total, 19,773 women and men aged 16-39 years were randomly selected from 27 general practice lists. RESULTS Screening invitations reached 73% (14,382/19,773). Uptake (4731 participants), weighted for sampling, was 39.5% (95% CI 37.7, 40.8%) in women and 29.5% (95% CI 28.0, 31.0%) in men aged 16-39 years. Chlamydia prevalence (219 positive results) in 16-24 year olds was 6.2% (95% CI 4.9, 7.8%) in women and 5.3% (95% CI 4.4, 6.3%) in men. The case-control study did not identify any additional factors that would help target screening. Screening did not adversely affect anxiety, depression or self-esteem. Participants welcomed the convenience and privacy of home-sampling. The relative sensitivity of PCR on male urine specimens was 100% (95% CI 89.1, 100%). The combined relative sensitivities of PCR and SDA using female urine and vulvovaginal swabs were 91.8% (86.1, 95.7, 134/146) and 97.3% (93.1, 99.2%, 142/146). A total of 140 people (74% of eligible) participated in the randomised trial. Compared with referral to a genitourinary medicine clinic, partner notification by practice nurses resulted in 12.4% (95% CI -3.7, 28.6%) more patients with at least one partner treated and 22.0% (95% CI 6.1, 37.8%) more patients with all partners treated. The health service and patients costs (2005 prices) of home-based postal chlamydia screening were 21.47 pounds (95% CI 19.91 pounds, 25.99) per screening invitation and 28.56 pounds (95% CI 22.10 pounds, 30.43) per accepted offer. Preliminary modelling found an incremental cost-effectiveness ratio (2003 prices) comparing screening men and women annually to no screening in the base case of 27,000 pounds/major outcome averted at 8 years. If estimated screening uptake and pelvic inflammatory disease incidence were increased, the cost-effectiveness ratio fell to 3700 pounds/major outcome averted. CONCLUSIONS Proactive screening for chlamydia in women and men using home-collected specimens was feasible and acceptable. Chlamydia prevalence rates in men and women in the general population are similar. Nucleic acid amplification tests can be used on first-catch urine specimens and vulvovaginal swabs. The administrative costs of proactive screening were similar to those for opportunistic screening. Using empirical estimates of screening uptake and incidence of complications, screening was not cost-effective.
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Affiliation(s)
- N Low
- Department of Preventive Medicine, University of Bristol, UK
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Ariyaratne S, Kim I, Mills N, Mason I, Mendis-Handagama C. Effects of ethane dimethane sulfonate on the functional structure of the adult rat testis. Arch Androl 2003; 49:313-26. [PMID: 12851034 DOI: 10.1080/01485010390204922] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In ethane dimethane sulfonate (EDS)-treated adult Sprague Dawley rats, Leydig cells (LC) were not present up to 14 days but seen at 21 days. They increased in number thereafter and reached the values of age-matching controls (i.e., 150-day-old untreated) at day 60. Mesenchymal cell number per testis also increased and reached a peak at day 21, and remained at a higher (p<.05) value than the controls at days 28-60. LC were smaller at day 21, but were larger at days 28-60 (compared to untreated 90- and 150-day-old rats) and secreted more testosterone at day 60 compared to both control groups. Testes of treated rats had greater numbers of macrophages (except at day 28) and they were smaller than those in untreated rats and 60-day EDS rats. Immunolabeling studies on 3beta-HSD, 11beta-HSD1, and LH receptor activity and androgen data agreed with morphological findings. The relationship between mesenchymal and LC numbers during LC differentiation following EDS treatment is reminiscent of this process in prepubertal testis. The presence of increased numbers of macrophages in treated testes agreed with the role of macrophages on LC differentiation. The absence of aging signs in LC of 60-day treated rats who were 150 days of age can be attributed at least in part to their newly differentiated status in older rats (i.e., equivalent to pubertal LC and not to aged LC). Larger LC observed in EDS rats at days 28-60 and their increased testosterone secretory capacity at day 60 (compared to controls) are attributed to elevated plasma LH levels and locally produced factors in EDS rats.
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Affiliation(s)
- S Ariyaratne
- Department of Animal Science, University of Tennessee, Knoxville, TN 37996, USA
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