1
|
Augustin M, Misery L, Kobyletzski LV, Mealing S, Redding M, Chuang CC, Massey R, Cawkwell M, Bego Le-Bagousse G, Haddy L, Rout R. Systematic literature review assessing the overall costs and societal impacts of moderate-to-severe atopic dermatitis in Europe. J Eur Acad Dermatol Venereol 2022; 36:2316-2324. [PMID: 35920758 DOI: 10.1111/jdv.18481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease, driven by type 2 inflammation. The condition manifests as moderate-to-severe disease in approximately 20% of adults with AD across Europe, and is associated with a substantial burden on patients, society, and healthcare systems. However, systematic assessments capturing the totality of disease burden associated with moderate-to-severe AD are limited; therefore, the overall impacts of the disease may be underestimated. A systematic literature review was carried out to assess the overall costs of moderate-to-severe AD across Europe, including the financial, societal, and humanistic impacts. PubMed, Embase and Cochrane databases were searched to identify relevant studies published between 1 January 2010 and 2 June 2020. Scientific conference proceedings, health technology assessment websites and patient association group websites were also searched for relevant information. Twenty-seven publications, corresponding to 22 unique studies, were included in the analysis. Total costs (direct and productivity losses) reached €20 695 per-person-per-year (PPPY) for adults with uncontrolled symptoms of moderate-to-severe AD. Direct medical costs ranged between €307 and €6993 PPPY; prescription medications and specialist dermatologist visits were the main contributors. Costs increased with disease severity or with uncontrolled disease. Patients with AD also incurred personal costs of €927 per year for healthcare items not reimbursed, which increased by 9% for those with moderate-to-severe forms. Annual work productivity losses comprised most of the total costs reported for adults with moderate-to-severe AD (up to 60.8% of the total burden) and were highest in those with uncontrolled disease (€13 702 PPPY). Patients with moderate-to-severe disease also experienced physical, emotional, and social impacts. The overall costs of moderate-to-severe AD greatly impact on healthcare systems, patients, and society. Sustained control of moderate-to-severe AD, through effective treatment and care management, is essential to limit the burden caused by the disease.
Collapse
Affiliation(s)
- M Augustin
- University Medical Center Hamburg, Hamburg, Germany
| | - L Misery
- University Hospital of Brest, Brest, France
| | | | - S Mealing
- York Health Economics Consortium (YHEC), York, UK
| | - M Redding
- Eczema Outreach Support, Linlithgow, Scotland
| | | | | | | | | | - L Haddy
- Aixial on behalf of Sanofi, Chilly-Mazarin, France
| | | |
Collapse
|
2
|
Hudson RDA, Ameen M, George SMC, Harwood CA, Weller RB, Lear JT, Rout R, Surendranathan T, Petrovic M, Bewley AP. A Real-World Data Study on the Healthcare Resource Use for Uncontrolled Moderate-to-Severe Atopic Dermatitis in Secondary Care in the United Kingdom Prior to the Introduction of Biologic Treatment. CEOR 2022; 14:167-177. [PMID: 35399649 PMCID: PMC8992740 DOI: 10.2147/ceor.s333847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Whilst there is international evidence around the high healthcare resource utilization (HRU) associated with atopic dermatitis (AD), there is a lack of published data from the United Kingdom (UK). Methods A retrospective, descriptive, observational study was conducted to evaluate the burden of moderate-to-severe AD on the National Health Service (NHS) in an adult UK population treated with traditional standard of care prior to the introduction of biologics. Patients (n=59) were recruited from 6 UK NHS Hospital Trusts and observed over three years. Results 707 dermatology clinic visits were recorded over the observation period, amounting to 6.6 visits per patient-year, most commonly for routine check-ups most of which involved dermatology consultants (n=469, 66%). Physicians were the most consulted healthcare professional (n=652, 92%); emollients were the most common treatment (n=80 courses). 174 flares requiring additional medical advice were recorded in total (1.6 per patient-year). Discussion/Conclusions Complex treatment pathways for adult patients in the UK with moderate-to-severe AD incur considerable HRU, particularly for those patients non-responsive to systemic therapies with broad immunosuppressant action. Recent advances in biologics-based AD management could possibly have a significant positive impact on HRU through significant reduction in the number of NHS touch points identified in this study.
Collapse
Affiliation(s)
- Richard D A Hudson
- Sanofi, Berkshire, UK
- Correspondence: Richard DA Hudson, Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, RG6 1PT, UK, Email
| | | | | | | | - Richard B Weller
- NHS Lothian, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - John T Lear
- Salford Royal NHS Foundation Trust, Salford, UK
- Manchester Academic Health Science Centre, Manchester University, Manchester, UK
| | | | | | | | | |
Collapse
|
3
|
Hopkins C, Conlon S, Chavda S, Hudson R, Rout R. Investigating the secondary care system burden of CRSwNP in sinus surgery patients with clinically relevant comorbidities using the HES database. Rhinology 2022; 60:252-260. [PMID: 35230356 DOI: 10.4193/rhin21.264] [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: 11/08/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic condition that can adversely affect quality of life for patients. There is no cure for CRSwNP, and patients may require intermittent systemic corticosteroids (SCS) and surgery in addition to intranasal treatment throughout their lifetime. This places a significant burden on the NHS which can be compounded by comorbid conditions such as asthma or NSAID-exacerbated respiratory disease (NERD). Patients with comorbidities are likely to experience higher rates of surgery and more secondary care visits. The aim of this study was to evaluate revision rates and the associated burden for patients with CRSwNP undergoing surgery and compare this to sub-cohorts of patients with comorbidities. MATERIALS AND METHODS This study has utilised the Hospital Episodes Statistics (HES) database across a ten-year time period (April 2010 to March 2020) to investigate the NHS resource use attributable to CRSwNP for all patients with the condition who have undergone sinus surgery, and to examine the burden of clinically relevant sub-groups. RESULTS Our results showed that 101,054 patients underwent at least one sinus surgery in relation to their nasal polyps, with Kaplan Meier survival analysis estimating that the 10-year probability of revision is between 71-90% for comorbid patients, and 51% for non-comorbid patients. Patients with a relevant comorbid condition in addition to their CRSwNP were up to 4.7 times more likely to undergo at least one revision surgery during the ten-year analytical time window when compared to patients without a comorbidity. Further to this, comorbid patients had a higher tariff associated with their CRSwNP care across the analytical time window and were therefore likely to be more costly to the healthcare system. CONCLUSIONS In conclusion, this study demonstrates that there is a high burden attached to CRSwNP-related sinus surgery and that comorbidities are a key driver of NHS resource use.
Collapse
Affiliation(s)
- C Hopkins
- Guy's and St. Thomas' Hospital, Kings college, London, UK
| | | | | | | | - R Rout
- Sanofi Genzyme UK, Reading, UK
| |
Collapse
|
4
|
O’Kane D, Davis L, Ardern-Jones M, Laws P, Shaw L, Cork M, Velangi S, Cooper HL, Hudson R, Smith AB, Rout R. Treatment outcomes of patients with Atopic Dermatitis (AD) treated with dupilumab through the Early Access to Medicines Scheme (EAMS) in the UK. Ulster Med J 2021; 90:70-76. [PMID: 34276083 PMCID: PMC8278937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dupilumab, a monoclonal antibody against interleukin (IL)-4 receptor alpha that inhibits IL-4/IL-13 signalling is indicated in dermatology for the treatment of moderate-to-severe atopic dermatitis (AD) in adult and adolescent patients 12 years and older and severe AD in children 6-11 years, who are candidates for systemic therapy. Dupilumab received Early Access to Medicines Scheme (EAMS) approval for adults in March 2017. OBJECTIVES The purpose of this study was to assess the efficacy outcomes of treatment with dupilumab in EAMS. METHODS A retrospective analysis of adult patients enrolled in the dupilumab EAMS in the UK. Scores were assessed at baseline and follow up, including the Eczema Area and Severity Index (EASI), Investigator's Global Assessment Score (IGA) and Dermatology Life Quality Index (DLQI). RESULTS Data were available for 57 adult patients treated with dupilumab for at least 12 weeks; 73.6% of patients had received prior treatment with 3 or 4 immunosuppressants. Baseline scores for the EASI and DLQI were 27.93 (standard deviation, SD 13.09) and 18.26 (SD 6.18) respectively. AD severity scores showed statistically significant improvement at week 16±4 weeks (p <0.001 for all). The mean change in EASI was 14.13 points with 66.7% and 36.7% achieving a 50% (EASI-50) and 75% (EASI-75) improvement in EASI, respectively at 16+/- 4 weeks. IGA scores improved by at least two categories for 75% patients. DLQI scores decreased by a mean of 9.0 points, with 80% patients demonstrating a MCID 4-point improvement. For 85% patients, clinicians rated the treatment response as being either 'better' (19%) or 'much better' (65%). CONCLUSIONS Dupilumab is associated with a significant and clinically relevant improvements in AD as measured by patient- and physician-reported outcome measures. Importantly, the clinical efficacy, despite the refractory disease of this EAMS cohort, is comparable to that previously reported in clinical trials.
Collapse
|
5
|
Hopkins C, Wagenmann M, Bachert C, Desrosiers M, Han JK, Hellings PW, Lee SE, Msihid J, Radwan A, Rowe P, Amin N, Deniz Y, Ortiz B, Mannent LP, Rout R. Efficacy of dupilumab in patients with a history of prior sinus surgery for chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2021; 11:1087-1101. [PMID: 33611847 PMCID: PMC8359289 DOI: 10.1002/alr.22780] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 08/14/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 12/15/2022]
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease treated with sinus surgery when refractory to medical intervention. However, recurrence postsurgery is common. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor for interleukin 4 (IL‐4) and IL‐13, key and central drivers of type 2 inflammation. We report the efficacy of dupilumab in patients with CRSwNP from the SINUS‐24/SINUS‐52 trials (NCT02912468/NCT02898454), by number of prior surgeries and time since last surgery. Methods Patients were randomized to placebo or dupilumab 300 mg every 2 weeks. Post hoc subgroup analyses were performed for patients with 0, ≥1, 1/2, or ≥3 prior surgeries, and for patients who had surgery within <3, 3 to <5, 5 to <10, or ≥10 years. Efficacy outcomes at 24 weeks included co‐primary endpoints nasal polyp score (NPS) and nasal congestion (NC), and Lund‐Mackay (LMK), 22‐item Sino‐Nasal Outcome Test (SNOT‐22), and smell scores. Results Of 724 patients randomized, 459 (63.4%) had ≥1 prior surgery. Baseline sinus disease (NPS, NC, LMK) and olfactory dysfunction (University of Pennsylvania Smell Identification Test [UPSIT] and loss of smell) scores were worse for patients with ≥3 prior surgeries vs no surgery. Baseline NPS and LMK were worse in patients with <3 years since last surgery than in patients with ≥5 years since last surgery. Dupilumab significantly improved all outcome measures vs placebo in all subgroups by number of surgeries and by time since last surgery. Improvements in NPS and LMK were greater in patients with <3 years since last surgery than patients with ≥5 years. Safety results were consistent with the known dupilumab safety profile. Conclusion Dupilumab improved CRSwNP outcomes irrespective of surgery history, with greater improvements in endoscopic outcomes in patients with shorter duration since last surgery.
Collapse
Affiliation(s)
- Claire Hopkins
- ENT Department, Guy's and St Thomas' Hospitals, London, UK
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Düsseldorf University Hospital (UKD), Düsseldorf, Germany
| | - Claus Bachert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.,Division of ENT diseases, Karolinska Institutet, Stockholm, Sweden.,First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Martin Desrosiers
- Department of Otorhinolaryngology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Joseph K Han
- Division of Allergy, Rhinology and Skull Base Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Peter W Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - Stella E Lee
- Department of Otorhinolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Amr Radwan
- Regeneron Pharmaceuticals, Inc., Uxbridge, London, UK
| | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | |
Collapse
|
6
|
Mishra R, Joshi M, Meisenberg O, Gierl S, Prajith R, Kanse SD, Rout R, Sapra BK, Mayya YS, Tschiersch J. Deposition and spatial variation of thoron decay products in a thoron experimental house using the Direct Thoron Progeny Sensors. J Radiol Prot 2017; 37:379-389. [PMID: 28418936 DOI: 10.1088/1361-6498/aa6408] [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: 06/07/2023]
Abstract
Experiments have been carried out using the deposition-based Direct Thoron Progeny Sensors (DTPS) in a thoron experimental house. The objective was to study the thoron decay product characteristics such as the deposition velocities, spatial variability and dependence on aerosol particle concentrations. Since the deposition velocity is an important characteristic in the calibration of the DTPS, it is very important to study its dependence on aerosol concentration in a controlled environment. At low aerosol concentration (1500 particles/cm3) the mean effective deposition velocity was measured to be 0.159 ± 0.045 m h-1; at high aerosol concentration (30 000 particles/cm3) it decreased to 0.079 ± 0.009 m h-1. The deposition velocity for the attached fraction of the thoron decay products did not change with increasing aerosol concentration, showing measurement results of 0.048 ± 0.005 m h-1 and 0.043 ± 0.014 m h-1, respectively. At low particle concentration, the effective deposition velocity showed large scattering within the room at different distances from center. The attached fraction deposition velocity remained uniform at different distances from the wall. The measurements in the thoron experimental house can be used as a sensitivity test of the DTPS in an indoor environment with changing aerosol concentration. The uniform spatial distribution of thoron decay products was confirmed within the experimental house. This indicates that direct measurement of thoron decay product concentration should be carried out instead of inferring it from thoron gas concentration, which is very inhomogeneous within the experimental house.
Collapse
Affiliation(s)
- R Mishra
- Bhabha Atomic Research Centre, Radiological Physics and Advisory Division, Mumbai 400 085, India
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Bottomley N, Jones LD, Rout R, Alvand A, Rombach I, Evans T, Jackson WFM, Beard DJ, Price AJ. A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty: a comparison between consultant and trainee surgeons. Bone Joint J 2017; 98-B:22-27. [PMID: 27694512 PMCID: PMC5047132 DOI: 10.1302/0301-620x.98b10.bjj-2016-0483.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 01/30/2023]
Abstract
Aims The aim of this to study was to compare the previously unreported
long-term survival outcome of the Oxford medial unicompartmental
knee arthroplasty (UKA) performed by trainee surgeons and consultants. Patients and Methods We therefore identified a previously unreported cohort of 1084
knees in 947 patients who had a UKA inserted for anteromedial knee
arthritis by consultants and surgeons in training, at a tertiary
arthroplasty centre and performed survival analysis on the group
with revision as the endpoint. Results The ten-year cumulative survival rate for revision or exchange
of any part of the prosthetic components was 93.2% (95% confidence
interval (CI) 86.1 to 100, number at risk 45). Consultant surgeons
had a nine-year cumulative survival rate of 93.9% (95% CI 90.2 to
97.6, number at risk 16). Trainee surgeons had a cumulative nine-year
survival rate of 93.0% (95% CI 90.3 to 95.7, number at risk 35).
Although there was no differences in implant survival between consultants
and trainees (p = 0.30), there was a difference in failure pattern
whereby all re-operations performed for bearing dislocation (n =
7), occurred in the trainee group. This accounted for 0.6% of the
entire cohort and 15% of the re-operations. Conclusion This is the largest single series of the Oxford UKA ever reported
and demonstrates that good results can be achieved by a heterogeneous
group of surgeons, including trainees, if performed within a high-volume
centre with considerable experience with the procedure. Cite this article: Bone Joint J 2016;(10 Suppl
B):22–7.
Collapse
Affiliation(s)
- N Bottomley
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - L D Jones
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - R Rout
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - A Alvand
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - I Rombach
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - T Evans
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - W F M Jackson
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - D J Beard
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - A J Price
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| |
Collapse
|
8
|
Mishra R, Rout R, Prajith R, Jalalluddin S, Sapra BK, Mayya YS. INNOVATIVE EASY-TO-USE PASSIVE TECHNIQUE FOR 222RN AND 220RN DECAY PRODUCT DETECTION. Radiat Prot Dosimetry 2016; 171:181-186. [PMID: 27009245 DOI: 10.1093/rpd/ncw053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The decay products of radon and thoron are essentially the radioisotopes of polonium, bismuth and lead, and are solid particulates, which deposit in different parts of the respiratory tract upon inhalation, subsequently emitting high-energy alpha particles upon their radioactive decay. Development of passive deposition-based direct progeny sensors known as direct radon and thoron progeny sensors have provided an easy-to-use technique for time-integrated measurements of the decay products only. These dosemeters are apt for large-scale population dosimetry to assign inhalation doses to the public. The paper gives an insight into the technique, the calibration, comparison with the prevalently used active grab filter paper sampling technique, alpha track diameter analysis in these progeny sensors, progeny deposition velocity measurements carried out using these detector systems in the indoor as well as outdoor environment, and applications of these sensors for time-integrated unattached fraction estimation.
Collapse
Affiliation(s)
- Rosaline Mishra
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - R Rout
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - R Prajith
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - S Jalalluddin
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - B K Sapra
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - Y S Mayya
- Indian Institute of Technology, Bombay, India
| |
Collapse
|
9
|
Snelling S, Rout R, Davidson R, Clark I, Carr A, Hulley P, Price A. A gene expression study of normal and damaged cartilage in anteromedial gonarthrosis, a phenotype of osteoarthritis. Osteoarthritis Cartilage 2014; 22:334-43. [PMID: 24361742 PMCID: PMC3988961 DOI: 10.1016/j.joca.2013.12.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 11/27/2013] [Accepted: 12/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify osteoarthritis (OA) relevant genes and pathways in damaged and undamaged cartilage isolated from the knees of patients with anteromedial gonarthrosis (AMG) - a specific form of knee OA. DESIGN Cartilage was obtained from nine patients undergoing unicompartmental knee replacement (UKR) for AMG. AMG provides a spatial representation of OA progression; showing a reproducible and histologically validated pattern of cartilage destruction such that damaged and undamaged cartilage from within the same knee can be consistently isolated and examined. Gene expression was analysed by microarray and validated using real-time PCR. RESULTS Damaged and undamaged cartilage showed distinct gene expression profiles. 754 genes showed significant up- or down-regulation (non-False discovery rate (FDR) P < 0.05) with enrichment for genes involved in cell signalling, Extracellular Matrix (ECM) and inflammatory response. A number of genes previously unreported in OA showed strongly altered expression including RARRES3, ADAMTSL2 and DUSP10. Confirmation of genes previously identified as modulated in OA was also obtained e.g., SFRP3, MMP3 and IGF1. CONCLUSIONS This is the first study to examine a common and consistent phenotype of OA to allow direct comparison of damaged and undamaged cartilage from within the same joint compartment. We have identified specific gene expression profiles in damaged and undamaged cartilage and have determined relevant genes and pathways in OA progression. Importantly this work also highlights the necessity for phenotypic and microanatomical characterization of cartilage in future studies of OA pathogenesis and therapeutic development.
Collapse
Affiliation(s)
- S. Snelling
- The Botnar Research Centre, University of Oxford, UK,Address correspondence and reprint requests to: S. Snelling. The Botnar Research Centre, University of Oxford, UK.
| | - R. Rout
- The Botnar Research Centre, University of Oxford, UK
| | - R. Davidson
- Biomedical Research Unit, University of East Anglia, UK
| | - I. Clark
- Biomedical Research Unit, University of East Anglia, UK
| | - A. Carr
- The Botnar Research Centre, University of Oxford, UK
| | - P.A. Hulley
- The Botnar Research Centre, University of Oxford, UK
| | - A.J. Price
- The Botnar Research Centre, University of Oxford, UK
| |
Collapse
|
10
|
Garner A, Beard D, Ostlere S, Price A, Rout R. Morel-Lavallée lesions of the knee: a closed degloving injury: a report of two cases. ANZ J Surg 2013; 84:789-91. [DOI: 10.1111/ans.12328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Amy Garner
- Orthopaedics; Nuffield Orthopaedic Centre; Oxford UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; University of Oxford; Oxford UK
| | - Simon Ostlere
- Orthopaedics; Nuffield Orthopaedic Centre; Oxford UK
| | - Andrew Price
- Orthopaedics; Nuffield Orthopaedic Centre; Oxford UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; University of Oxford; Oxford UK
| | - Rajesh Rout
- Orthopaedics; Nuffield Orthopaedic Centre; Oxford UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; University of Oxford; Oxford UK
| |
Collapse
|
11
|
Rout R, McDonnell S, Benson R, Athanasou N, Carr A, Doll H, Gill HS, Murray DW, Hulley PA, Price AJ. The histological features of anteromedial gonarthrosis--the comparison of two grading systems in a human phenotype of osteoarthritis. Knee 2011; 18:172-6. [PMID: 20570154 DOI: 10.1016/j.knee.2010.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 04/27/2010] [Accepted: 04/29/2010] [Indexed: 02/02/2023]
Abstract
Anteromedial gonarthrosis (AMG) displays a well recognised pattern of cartilage damage on the medial tibial plateau. Anteriorly there is a full thickness cartilage defect, with transition to a partial thickness defect, becoming full thickness cartilage in the posterior third of the tibial plateau. The retained posterior cartilage is macroscopically normal. This study characterises the histological changes of AMG and examines the usefulness of two histological assessment tools. Sixteen unicompartmental resection specimens of patients with primary AMG were assessed. Samples were stained with Haematoxylin and Eosin and Safranin-O stains and scored using the modified Mankin grade, and the OOCHAS assessment tool. Each specimen was assessed at five regions along the antero-posterior axis starting from the exposed bone to the region of macroscopically normal cartilage. From anterior to posterior the staining showed a consistent increase in structural integrity and cellularity of the cartilage, matched by a qualitative increase in GAG content. Mean modified Mankin and OOCHAS scores showed a progressive decrease in grade (p < 0.001). The OOCHAS grade had a good correlation with the modified Mankin grade (ρ = 0.886) and there was good intra- and inter-observer variability with both assessment tools. We conclude that there is progressive decrease in histological score from anterior to posterior in AMG and that the macroscopically normal cartilage seen posteriorly is histologically normal. Both the modified Mankin and OOOCHAS assessment tools are useful in histological grading but we found the OOCHAS easier and quicker to use. We propose that AMG represents a spatial model of progressive cartilage damage.
Collapse
Affiliation(s)
- Rajesh Rout
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Headington, Oxford, OX3 7LD, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
McDonnell SM, Bottomley NJ, Hollinghurst D, Rout R, Thomas G, Pandit H, Ostlere S, Murray DW, Beard DJ, Price AJ. Skyline patellofemoral radiographs can only exclude late stage degenerative changes. Knee 2011; 18:21-3. [PMID: 19897370 DOI: 10.1016/j.knee.2009.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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] [Received: 08/18/2009] [Revised: 10/16/2009] [Accepted: 10/19/2009] [Indexed: 02/02/2023]
Abstract
Accurate preoperative assessment of the patellofemoral joint is especially important in compartment specific knee arthritis. This study aims to show the actual intraoperative grade of patellofemoral cartilage damage that may be reliably detected or excluded by preoperative standard radiographic views. 100 consecutive knees awaiting arthroplasty underwent preoperative lateral and skyline radiographs and were scored using the Ahlback score. Intraoperative cartilage damage was assessed using the Collins score. The sensitivity and specificity were calculated for each grade of cartilage damage. Preoperative anterior knee pain and function were assessed and correlated to the degree of cartilage damage. The lateral radiograph shows poor sensitivity for all grades of disease (0.05-0.23). The skyline shows good sensitivity for grade 4 (large full thickness) damage (0.90) but decreases substantially for grades 1-3 (0.19-0.46). Significantly more people with skyline radiograph joint space narrowing complained of anterior knee pain than those with a normal radiograph (p<0.001). There was only a poor correlation between preoperative anterior pain and intraoperative patellofemoral cartilage damage (r=0.24). The lateral radiograph cannot exclude even large areas of full thickness cartilage damage whereas a normal skyline radiograph can reliably exclude significant (grade 4) patellofemoral disease and should be used in addition to the lateral view.
Collapse
Affiliation(s)
- S M McDonnell
- Nuffield Orthopaedic Centre NIHR Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kendrick BJL, Rout R, Bottomley NJ, Pandit H, Gill HS, Price AJ, Dodd CAF, Murray DW. The implications of damage to the lateral femoral condyle on medial unicompartmental knee replacement. ACTA ACUST UNITED AC 2010; 92:374-9. [DOI: 10.1302/0301-620x.92b3.23561] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With medial unicompartmental osteoarthritis (OA) there is occasionally a full-thickness ulcer of the cartilage on the medial side of the lateral femoral condyle. It is not clear whether this should be considered a contraindication to unicompartmental knee replacement (UKR). The aim of this study was to determine why these ulcers occur, and whether they compromise the outcome of UKR. Case studies of knees with medial OA suggest that cartilage lesions on the medial side of the lateral condyle are caused by impingement on the lateral tibial spine as a result of the varus deformity and tibial subluxation. Following UKR the varus and the subluxation are corrected, so that impingement is prevented and the damaged part of the lateral femoral condyle is not transmitting load. An illustrative case report is presented. Out of 769 knees with OA of the medial compartment treated with the Oxford UKR, 59 (7.7%) had partial-thickness cartilage loss and 20 (2.6%) had a full-thickness cartilage deficit on the medial side of the lateral condyle. The mean Oxford Knee Score (OKS) at the last follow-up at a mean of four years was 41.9 (13 to 48) in those with partial-thickness cartilage loss and 41.0 (20 to 48) in those with full-thickness loss. In those with normal or superficially damaged cartilage the mean was 39.5 (5 to 48) and 39.7 (8 to 48), respectively. There were no statistically significant differences between the pre-operative OKS, the final review OKS or of change in the score in the various groups. We conclude that in medial compartment OA, damage to the medial side of the lateral femoral condyle is caused by impingement on the tibial spine and should not be considered a contraindication to an Oxford UKR, even if there is extensive full-thickness ulceration of the cartilage.
Collapse
Affiliation(s)
- B. J. L. Kendrick
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - R. Rout
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - N. J. Bottomley
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - H. Pandit
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - H. S. Gill
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - A. J. Price
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - C. A. F. Dodd
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - D. W. Murray
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| |
Collapse
|
14
|
Rout R, Tedd H, Lloyd R, Ostlere S, Lavis GJ, Cooke PH, Sharp RJ. Morton's neuroma: diagnostic accuracy, effect on treatment time and costs of direct referral to ultrasound by primary care physicians. Qual Prim Care 2009; 17:277-282. [PMID: 19807961] [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: 05/28/2023]
Abstract
BACKGROUND The first-line treatment for symptomatic Morton's neuroma in our hospital is a perineural ultrasound-guided injection of corticosteroid and local anaesthetic (USI). The NHS has recently implemented 18-week referral-to-treatment targets. When GPs specifically suggest a diagnosis of Morton's neuroma there are two referral pathways in our hospital: direct referral to radiology for USI (limited slots) or referral to the specialist foot and ankle clinic. Patients with less specific referral letters are also evaluated in clinic and referred for USI as appropriate. METHODS A retrospective audit was performed reviewing referral letters from general practitioners (GPs) in 2005-2006. A comparison was made between the referral pathways for time-to-treatment (TTT), accuracy of GP diagnosis, and cost implications. RESULTS In the directly referred group, the median TTT was 99 days, compared to 206 days for patients who went via a foot and ankle clinic (P < 0.001). Of 57 patients with a GP diagnosis of Morton's neuroma, 40 (70%) had the diagnosis confirmed on USI compared to 44 of 64 (69%) patients referred by a foot and ankle surgeon, showing no significant difference between the groups (P = 0.87). CONCLUSION For patients with features highly suggestive of a Morton's neuroma, direct referral from primary care for USI had a similar accuracy to referral from a specialist hospital clinic and the time-to-treatment was significantly shorter. The mean waiting time of this group was within the 18-week government target without any changes to our current radiology protocols.
Collapse
Affiliation(s)
- Rajesh Rout
- Royal College of Surgeons of England, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, UK.
| | | | | | | | | | | | | |
Collapse
|
15
|
Rout U, Rout R, Rout J. Stress, mental health and satisfaction among women doctors in England. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.694] [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: 10/22/2022] Open
|
16
|
Abstract
Closure of laparoscopic trocar sites can be difficult, particularly in the obese patient. We have begun using a spring-loaded needle to facilitate closure of these sites. We have found that the device allows for accurate suture placement, the potential of decreased closure time, reduced risk for trocar site dehiscence, and can be used in obtaining hemostasis of abdominal wall vessels.
Collapse
Affiliation(s)
- M G Garzotto
- Department of Surgery, University of Florida, Gainesville
| | | | | | | | | |
Collapse
|