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Goacher E, Mathew R, Fayaye O, Chakrabarty A, Feltbower R, Loughrey C, Roberts P, Chumas P. Can quantifying the extent of 'high grade' features help explain prognostic variability in anaplastic astrocytoma? Br J Neurosurg 2024; 38:314-321. [PMID: 33377401 DOI: 10.1080/02688697.2020.1866163] [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] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Both phenotypic and genotypic variations now underpin glioma classification, thus helping to more accurately guide their clinical management. However, WHO Grade III anaplastic astrocytoma (AA) remains an unpredictable, heterogeneous entity; displaying a variable prognosis, clinical course and treatment response. This study aims to examine whether additional tumour characteristics influence either overall survival (OS) or 3-year survival in AA. MATERIALS AND METHODS Data were collected on all newly diagnosed cases of AA between 2003 and 2014, followed up for a minimum of 3 years. Molecular information was obtained from case records and if missing, was re-analysed. Histological slides were independently examined for Ki-67 proliferation index, cellularity and number of mitotic figures. Kaplan-Meier and Cox regression analyses were used to assess OS. RESULTS In total, 50 cases were included with a median OS of 14.5 months (range: 1-150 months). Cumulative 3-year survival was 31.5%. Median age was 50 years (range: 24 - 77). Age, IDH1 mutation status, lobar location, oncological therapy and surgical resection were significant independent prognostic indicators for OS. In cases demonstrating an OS ≥ 3 years (n = 15), Ki-67 index, number of mitotic figures and percentage areas of 'high cellularity' were significantly reduced, i.e. more characteristic of lower-grade/WHO Grade II glioma. CONCLUSIONS IDH1 status, age, treatment and location remain the most significant prognostic indicators for patients with AA. However, Ki-67 index, mitotic figures and cellularity may help identify AA cases more likely to survive < 3 years, i.e. AA cases more similar to glioblastoma and those cases more likely to survive > 3 years, i.e. more similar to a low-grade glioma.
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Affiliation(s)
- Edward Goacher
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Ryan Mathew
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Aruna Chakrabarty
- Department of Histopathology, St. James's University Hospital, Leeds, UK
| | | | - Carmel Loughrey
- Department of Oncology, St. James's University Hospital, Leeds, UK
| | - Paul Roberts
- Department of Cytogenetics, St. James's University Hospital, Leeds, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
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2
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Brown A, Ferrando-Vivas P, Popa M, de la Fuente GM, Pappachan J, Cuthbertson BH, Drikite L, Feltbower R, Gouliouris T, Sale I, Shulman R, Tume LN, Myburgh J, Woolfall K, Harrison DA, Mouncey PR, Rowan K, Pathan N. Use of selective gut decontamination in critically ill children: PICnIC a pilot RCT and mixed-methods study. Health Technol Assess 2024; 28:1-84. [PMID: 38421007 PMCID: PMC11017160 DOI: 10.3310/hdkv1008] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Background Healthcare-associated infections are a major cause of morbidity and mortality in critically ill children. In adults, data suggest the use of selective decontamination of the digestive tract may reduce the incidence of healthcare-associated infections. Selective decontamination of the digestive tract has not been evaluated in the paediatric intensive care unit population. Objectives To determine the feasibility of conducting a multicentre, cluster-randomised controlled trial in critically ill children comparing selective decontamination of the digestive tract with standard infection control. Design Parallel-group pilot cluster-randomised controlled trial with an integrated mixed-methods study. Setting Six paediatric intensive care units in England. Participants Children (> 37 weeks corrected gestational age, up to 16 years) requiring mechanical ventilation expected to last for at least 48 hours were eligible for the PICnIC pilot cluster-randomised controlled trial. During the ecology periods, all children admitted to the paediatric intensive care units were eligible. Parents/legal guardians of recruited patients and healthcare professionals working in paediatric intensive care units were eligible for inclusion in the mixed-methods study. Interventions The interventions in the PICnIC pilot cluster-randomised controlled trial included administration of selective decontamination of the digestive tract as oro-pharyngeal paste and as a suspension given by enteric tube during the period of mechanical ventilation. Main outcome measures The decision as to whether a definitive cluster-randomised controlled trial is feasible is based on multiple outcomes, including (but not limited to): (1) willingness and ability to recruit eligible patients; (2) adherence to the selective decontamination of the digestive tract intervention; (3) acceptability of the definitive cluster-randomised controlled trial; (4) estimation of recruitment rate; and (5) understanding of potential clinical and ecological outcome measures. Results A total of 368 children (85% of all those who were eligible) were enrolled in the PICnIC pilot cluster-randomised controlled trial across six paediatric intensive care units: 207 in the baseline phase (Period One) and 161 in the intervention period (Period Two). In sites delivering selective decontamination of the digestive tract, the majority (98%) of children received at least one dose of selective decontamination of the digestive tract, and of these, 68% commenced within the first 6 hours. Consent for the collection of additional swabs was low (44%), though data completeness for potential outcomes, including microbiology data from routine clinical swab testing, was excellent. Recruited children were representative of the wider paediatric intensive care unit population. Overall, 3.6 children/site/week were recruited compared with the potential recruitment rate for a definitive cluster-randomised controlled trial of 3 children/site/week, based on data from all UK paediatric intensive care units. The proposed trial, including consent and selective decontamination of the digestive tract, was acceptable to parents and staff with adaptations, including training to improve consent and communication, and adaptations to the administration protocol for the paste and ecology monitoring. Clinical outcomes that were considered important included duration of organ failure and hospital stay, healthcare-acquired infections and survival. Limitations The delivery of the pilot cluster-randomised controlled trial was disrupted by the COVID-19 pandemic, which led to slow set-up of sites, and a lack of face-to face training. Conclusions PICnIC's findings indicate that a definitive cluster-randomised controlled trial in selective decontamination of the digestive tract in paediatric intensive care units is feasible with the inclusion modifications, which would need to be included in a definitive cluster-randomised controlled trial to ensure that the efficiency of trial processes is maximised. Future work A definitive trial that incorporates the protocol adaptations and outcomes arising from this study is feasible and should be conducted. Trial registration This trial is registered as ISRCTN40310490. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/152/01) and is published in full in Health Technology Assessment; Vol. 28, No. 8. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Alanna Brown
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | | | - Mariana Popa
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - John Pappachan
- Paediatric Intensive Care Unit, Southampton Children's Hospital, University of Southampton, Southampton, UK
| | - Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Laura Drikite
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | | | - Theodore Gouliouris
- Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Robert Shulman
- Department of Pharmacy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lyvonne N Tume
- Intensive Care Unit, Alder Hey Children's NHS Foundation Trust Liverpool, Liverpool, UK
| | - John Myburgh
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Kathryn Rowan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Nazima Pathan
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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3
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Bedendo A, Hinde S, Beresford B, Papworth A, Phillips B, Vasudevan C, McLorie E, Walker G, Peat G, Weatherly H, Feltbower R, Hewitt C, Haynes A, Murtagh F, Noyes J, Hackett J, Hain R, Oddie S, Subramanian G, Fraser L. Consultant-led UK paediatric palliative care services: professional configuration, services, funding. BMJ Support Palliat Care 2023:spcare-2023-004172. [PMID: 37558392 DOI: 10.1136/spcare-2023-004172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES To systematically gather information on the professional team members, services provided, funding sources and population served for all consultant-led specialised paediatric palliative care (SPPC) teams in the UK. METHODS Two-part online survey. RESULTS Survey 1: All 17 medical leads from hospital-based or hospice-based SPPC teams responded to the survey (100% response rate).Only six services met the NICE guidance for minimum SPPC team.All services reported providing symptom management, specialist nursing care, end-of-life planning and care, and supporting discharges and transfers to home or hospice for the child's final days-hours. Most services also provided care coordination (n=14), bereavement support (n=13), clinical psychology (n=10) and social work-welfare support (n=9). Thirteen had one or more posts partially or fully funded by a charity.Survey 2: Nine finance leads provided detailed resource/funding information, finding a range of statutory and charity funding sources. Only one of the National Health Service (NHS)-based services fully funded by the NHS. CONCLUSIONS One-third of services met the minimum criteria of professional team as defined by NICE. Most services relied on charity funding to fund part or all of one professional post and only one NHS-based service received all its funding directly from the NHS.
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Affiliation(s)
- Andre Bedendo
- Department of Health Sciences, University of York, York, UK
| | | | | | - Andrew Papworth
- School for Business and Society, University of York, York, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Emma McLorie
- The Paediatric Palliative Care & Medical Complexities Group, Department of Health Sciences, University of York, York, UK
| | | | - George Peat
- The Paediatric Palliative Care & Medical Complexities Group, Department of Health Sciences, University of York, York, UK
| | | | | | | | - Andrew Haynes
- The Paediatric Palliative Care & Medical Complexities Group, Department of Health Sciences, University of York, York, UK
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Julia Hackett
- The Paediatric Palliative Care & Medical Complexities Group, Department of Health Sciences, University of York, York, UK
| | - Richard Hain
- All-Wales Paediatric Palliative Care Network, Cardiff and Vale University Health Board, Cardiff, UK
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Sam Oddie
- Bradford Hospitals National Health Service Trust, Bradford, UK
| | | | - Lorna Fraser
- Cicely Saunders Institute and Dept of Women's and Children's Health, King's College London, London, UK
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4
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Milner SH, Feltbower R, Absolom KL, Glaser A. Social outcomes after childhood illness: the missing measure. Arch Dis Child 2023; 108:e8. [PMID: 35361611 DOI: 10.1136/archdischild-2021-323513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/11/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Sarah H Milner
- Leeds Institute for Data Analytics, University of Leeds School of Medicine, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds School of Medicine, Leeds, UK
- Paediatric Oncology and Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Richard Feltbower
- Leeds Institute for Data Analytics, University of Leeds School of Medicine, Leeds, UK
| | - Kate L Absolom
- Leeds Institute of Medical Research, University of Leeds School of Medicine, Leeds, UK
| | - Adam Glaser
- Leeds Institute for Data Analytics, University of Leeds School of Medicine, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds School of Medicine, Leeds, UK
- Paediatric Oncology and Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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5
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Hughes N, Feltbower R, Stark D. The use of healthcare datasets to investigate the impact of dose intensity in the adolescent and young adult cancer population. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Objectives
To investigate whether the dose intensity of chemotherapy received by Adolescent and Young Adult (AYA) cancer patients impacts on their survival.
To assess and compare the utility of existing healthcare data available at a regional, national and international level to answer this question.
ApproachA regional dataset has been created through linkage of the Yorkshire Specialist Register of Cancer in Children and Young People to electronic chemotherapy prescribing data from Leeds Teaching Hospitals NHS Trust, providing a detailed dataset. The national dataset comprises of data from the National Cancer Registry and Analysis Service (NCRAS) linked to the Systemic Anti-Cancer Therapy (SACT) dataset which collects chemotherapy prescribing data from all hospitals in England. This dataset provides bigger patient numbers but data at a pseudonymised level. The international dataset comprises of anonymised data from clinical trials.
ResultsThe data has being linked, cleaned and validated. Survival analysis is being carried out using a causal inference framework.
ConclusionThis study will describe the value of existing healthcare care sets in the AYA cancer population. Identification of areas in which the datasets are lacking will help inform data controllers regarding ways in which data collection can be optimised for this important patient group.
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6
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Papworth A, Hackett J, Beresford B, Murtagh F, Weatherly H, Hinde S, Bedendo A, Walker G, Noyes J, Oddie S, Vasudevan C, Feltbower R, Phillips B, Hain R, Subramanian G, Haynes A, Fraser LK. End of life care for infants, children and young people (ENHANCE): Protocol for a mixed methods evaluation of current practice in the United Kingdom [version 1; peer review: 2 approved]. NIHR Open Res 2022; 2:37. [PMID: 35935675 PMCID: PMC7613236 DOI: 10.3310/nihropenres.13273.1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/22/2022]
Abstract
Background Although child mortality has decreased over the last few decades, around 4,500 infants and children die in the UK every year, many of whom require palliative care. There is, however, little evidence on paediatric end-of-life care services. The current National Institute for Health and Care Excellence (NICE) guidance provides recommendations about what should be offered, but these are based on low quality evidence. The ENHANCE study aims to identify and investigate the different models of existing end-of-life care provision for infants, children, and young people in the UK, including an assessment of the outcomes and experiences for children and parents, and the cost implications to families and healthcare providers. Methods This mixed methods study will use three linked workstreams and a cross-cutting health economics theme to examine end-of-life care models in three exemplar clinical settings: infant, children and young adult cancer services (PTCs), paediatric intensive care units (PICUs), and neonatal units (NNUs).Workstream 1 (WS1) will survey current practice in each setting and will result in an outline of the different models of care used. WS2 is a qualitative comparison of the experiences of staff, parents and patients across the different models identified. WS3 is a quantitative assessment of the outcomes, resource use and costs across the different models identified. Discussion Results from this study will contribute to an understanding of how end-of-life care can provide the greatest benefit for children at the end of their lives. It will also allow us to understand the likely benefits of additional funding in end-of-life care in terms of patient outcomes.
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Affiliation(s)
- Andrew Papworth
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Julia Hackett
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Bryony Beresford
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
- Social Policy Research Unit, University of York, Heslington, York, YO10 5DD, UK
| | - Fliss Murtagh
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Helen Weatherly
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Andre Bedendo
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | | | - Jane Noyes
- School of Health Sciences, Bangor University, Fron Heulog, Bangor, LL57 2EF, UK
| | - Sam Oddie
- Bradford Hospitals National Health Service Trust, Bradford, BD9 6RJ, UK
| | | | - Richard Feltbower
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9NL, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, UK, York, YO10 5DD, UK
| | - Richard Hain
- All-Wales Paediatric Palliative Care Network, Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK
- College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
| | - Gayathri Subramanian
- Manchester University National Health Service Foundation Trust, Manchester, M13 9WL, UK
| | - Andrew Haynes
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Lorna K Fraser
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
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7
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Schlehofer B, Blettner M, Moissonnier M, Deltour I, Giles GG, Armstrong B, Siemiatycki J, Parent ME, Krewski D, Johansen C, Auvinen A, Lahkola A, Hours M, Berg-Beckhoff G, Sadetzki S, Lagorio S, Takebayashi T, Yamaguchi N, Woodward A, Cook A, Tynes T, Klaboe L, Feychting M, Feltbower R, Swerdlow A, Schoemaker M, Cardis E, Schüz J. Association of allergic diseases and epilepsy with risk of glioma, meningioma and acoustic neuroma: results from the INTERPHONE international case-control study. Eur J Epidemiol 2022; 37:503-512. [PMID: 35118581 DOI: 10.1007/s10654-022-00843-y] [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: 10/04/2021] [Accepted: 01/16/2022] [Indexed: 11/03/2022]
Abstract
We investigated the association of allergic diseases and epilepsy with risk of brain tumours, in Interphone, a 13-country case-control study. Data were obtained from 2693 glioma cases, 2396 meningioma cases, and 1102 acoustic neuroma cases and their 6321 controls. Conditional logistic regression models were used to estimate pooled odds ratios (ORs) and their respective 95% confidence intervals (CIs), adjusted for education and time at interview. Reduced ORs were observed for glioma in relation to physician-diagnosed asthma (OR = 0.73; CI 0.58-0.92), hay fever (OR 0.72; CI 0.61-0.86), and eczema (OR 0.78, CI 0.64-0.94), but not for meningioma or acoustic neuroma. Previous diagnosis of epilepsy was associated with an increased OR for glioma (2.94; CI 1.87-4.63) and for meningioma (2.12; CI 1.27-3.56), but not for acoustic neuroma. This large-scale case-control study adds to the growing evidence that people with allergies have a lower risk of developing glioma, but not meningioma or acoustic neuroma. It also supports clinical observations of epilepsy prior to the diagnosis of glioma and meningioma.
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Affiliation(s)
- Brigitte Schlehofer
- Leimen, Germany (retired); formerly: Unit of Environmental Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
| | - Monika Moissonnier
- International Agency for Research On Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Isabelle Deltour
- International Agency for Research On Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Bruce Armstrong
- School of Public Health, University of Sydney, Sydney, Australia
| | | | | | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | | | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- STUK Radiation and Nuclear Safety Authority, Environmental Radiation Surveillance, Helsinki, Finland
| | - Anna Lahkola
- STUK Radiation and Nuclear Safety Authority, Environmental Radiation Surveillance, Helsinki, Finland
| | | | - Gabriele Berg-Beckhoff
- Unit for Health Promotion Research, Department of Public Health, and Hospital South West Jutland Esbjerg, University of Southern Denmark, Odense, Denmark
| | - Siegal Sadetzki
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ministry of Health, Jerusalem, Israel
| | - Susanna Lagorio
- Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Naohito Yamaguchi
- Department of Public Health, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Alistair Woodward
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Angus Cook
- Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Tore Tynes
- National Institute of Occupational Health, Oslo, Norway
| | - Lars Klaboe
- Norwegian Radiation Protection Authority, Østerås; The Cancer Registry of Norway, Oslo, Norway
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Elisabeth Cardis
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiologia Y Salud Pública, Madrid, Spain
| | - Joachim Schüz
- International Agency for Research On Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France.
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8
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Brown A, Ferrando P, Popa M, de la Fuente GM, Pappachan J, Cuthbertson B, Drikite L, Feltbower R, Gouliouris T, Sale I, Shulman R, Tume LN, Myburgh J, Woolfall K, Harrison DA, Mouncey PR, Rowan KM, Pathan N. Use of selective gut decontamination in critically ill children: protocol for the Paediatric Intensive Care and Infection Control (PICnIC) pilot study. BMJ Open 2022; 12:e061838. [PMID: 35277414 PMCID: PMC8919465 DOI: 10.1136/bmjopen-2022-061838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Healthcare-associated infections (HCAIs) are a major cause of morbidity and mortality in critically ill children. In critically ill adults, there are data that suggest the use of Selective Decontamination of the Digestive tract (SDD), alongside standard infection control measures reduce mortality and the incidence of HCAIs. SDD-enhanced infection control has not been compared directly with standard infection prevention strategies in the Paediatric Intensive Care Unit (PICU) population. The aim of this pilot study is to determine the feasibility of conducting a multicentre cluster randomised controlled trial (cRCT) in critically ill children comparing SDD with standard infection control. METHODS AND ANALYSIS Paediatric Intensive Care and Infection Control is a parallel group pilot cRCT, with integrated mixed-methods study, comparing incorporation of SDD into infection control procedures to standard care. After a 1-week pretrial ecology surveillance period, recruitment to the cRCT will run for a period of 18 weeks, comprising: (1) baseline control period (2) pre, mid and post-trial ecology surveillance periods and (3) intervention period. Six PICUs (in England, UK) will begin with usual care in period 1, then will be randomised 1:1 by the trial statistician using computer-based randomisation, to either continue to deliver usual care or commence delivery of the intervention (SDD) in period 2. Outcomes measures include parent and healthcare professionals' views on trial feasibility, adherence to the SDD intervention, estimation of recruitment rate and understanding of potential patient-centred primary and secondary outcome measures for the definitive trial. The planned recruitment for the cRCT is 324 participants. ETHICS AND DISSEMINATION The trial received favourable ethical opinion from West Midlands-Black Country Research Ethics Committee (reference: 20/WM/0061) and approval from the Health Research Authority (IRAS number: 239324). Informed consent is not required for SDD intervention or anonymised data collection but is sought for investigations as part of the study, any identifiable data collected and monitoring of medical records. Results will be disseminated via publications in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER ISRCTN40310490.
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Affiliation(s)
- Alanna Brown
- Intensive Care National Audit and Research Centre, London, UK
| | - Paloma Ferrando
- Intensive Care National Audit and Research Centre, London, UK
| | - Mariana Popa
- Institute of Life and Human Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Brian Cuthbertson
- Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laura Drikite
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | | | | | | | - Robert Shulman
- Department of Pharmacy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lyvonne N Tume
- School of Health and Society, University of Salford, Salford, UK
| | - John Myburgh
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | | | | | - Paul R Mouncey
- Intensive Care National Audit and Research Centre, London, UK
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | - Nazima Pathan
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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9
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Millen GC, Arnold R, Cazier JB, Curley H, Feltbower R, Gamble A, Glaser A, Grundy RG, Kirton L, Lee LYW, McCabe MG, Palles C, Phillips B, Stiller CA, Varnai C, Kearns P. COVID-19 in children with haematological malignancies. Arch Dis Child 2022; 107:186-188. [PMID: 34301621 PMCID: PMC8785070 DOI: 10.1136/archdischild-2021-322062] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Children with cancer are not at increased risk of severe SARS-CoV-2 infection; however, adults with haematological malignancies have increased risk of severe infections compared with non-haematological malignancies. METHODS We compared patients with haematological and non-haematological malignancies enrolled in the UK Paediatric Coronavirus Cancer Monitoring Project between 12 March 2020 and 16 February 2021. Children who received stem cell transplantation were excluded. RESULTS Only 2/62 patients with haematological malignancy had severe/critical infections, with an OR of 0.5 for patients with haematological compared with non-haematological malignancies. INTERPRETATION Children with haematological malignancies are at no greater risk of severe SARS-CoV-2 infection than those with non-haematological malignancies.
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Affiliation(s)
- Gerard Cathal Millen
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Helen Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Richard Feltbower
- Leeds Institute for Data Analytics (LIDA), University of Leeds School of Medicine, Leeds, West Yorkshire, UK
| | - Ashley Gamble
- CCLG Executive, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Adam Glaser
- Leeds Institute for Data Analytics (LIDA), University of Leeds School of Medicine, Leeds, West Yorkshire, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Richard G Grundy
- CCLG Executive, Children's Cancer and Leukaemia Group, Leicester, UK
- School of Medicine, University of Nottingham Children's Brain Tumour Research Centre, Nottingham, UK
| | - Laura Kirton
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Martin G McCabe
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
- Paediatric Oncology, Leeds Children's Hospital, Leeds, West Yorkshire, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Csilla Varnai
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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10
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Alvarado N, McVey L, Elshehaly M, Greenhalgh J, Dowding D, Ruddle R, Gale CP, Mamas M, Doherty P, West R, Feltbower R, Randell R. Analysis of a Web-Based Dashboard to Support the Use of National Audit Data in Quality Improvement: Realist Evaluation. J Med Internet Res 2021; 23:e28854. [PMID: 34817384 PMCID: PMC8663683 DOI: 10.2196/28854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/15/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Dashboards can support data-driven quality improvements in health care. They visualize data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices needs further investigation. Objective This paper reports the findings of a realist evaluation of a web-based quality dashboard (QualDash) developed to support the use of national audit data in quality improvement. Methods QualDash was co-designed with data users and installed in 8 clinical services (3 pediatric intensive care units and 5 cardiology services) across 5 health care organizations (sites A-E) in England between July and December 2019. Champions were identified to support adoption. Data to evaluate QualDash were collected between July 2019 and August 2021 and consisted of 148.5 hours of observations including hospital wards and clinical governance meetings, log files that captured the extent of use of QualDash over 12 months, and a questionnaire designed to assess the dashboard’s perceived usefulness and ease of use. Guided by the principles of realist evaluation, data were analyzed to understand how, why, and in what circumstances QualDash supported the use of national audit data in quality improvement. Results The observations revealed that variation across sites in the amount and type of resources available to support data use, alongside staff interactions with QualDash, shaped its use and impact. Sites resourced with skilled audit support staff and established reporting systems (sites A and C) continued to use existing processes to report data. A number of constraints influenced use of QualDash in these sites including that some dashboard metrics were not configured in line with user expectations and staff were not fully aware how QualDash could be used to facilitate their work. In less well-resourced services, QualDash automated parts of their reporting process, streamlining the work of audit support staff (site B), and, in some cases, highlighted issues with data completeness that the service worked to address (site E). Questionnaire responses received from 23 participants indicated that QualDash was perceived as useful and easy to use despite its variable use in practice. Conclusions Web-based dashboards have the potential to support data-driven improvement, providing access to visualizations that can help users address key questions about care quality. Findings from this study point to ways in which dashboard design might be improved to optimize use and impact in different contexts; this includes using data meaningful to stakeholders in the co-design process and actively engaging staff knowledgeable about current data use and routines in the scrutiny of the dashboard metrics and functions. In addition, consideration should be given to the processes of data collection and upload that underpin the quality of the data visualized and consequently its potential to stimulate quality improvement. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-033208
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Affiliation(s)
- Natasha Alvarado
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Lynn McVey
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Mai Elshehaly
- Wolfson Centre for Applied Health Research, Bradford, United Kingdom.,Faculty of Engineering and Informatics, University of Bradford, Bradford, United Kingdom
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, United Kingdom
| | - Dawn Dowding
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Roy Ruddle
- School of Computing, University of Leeds, Leeds, United Kingdom.,Leeds Institute for Data Analytics, Leeds, United Kingdom
| | - Chris P Gale
- Leeds Institute for Data Analytics, Leeds, United Kingdom.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Group, School of Medicine, Keele University, Keele, United Kingdom
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, United Kingdom
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Richard Feltbower
- Leeds Institute for Data Analytics, Leeds, United Kingdom.,School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
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11
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Taylor RM, Fern LA, Barber J, Gibson F, Lea S, Patel N, Morris S, Alvarez-Galvez J, Feltbower R, Hooker L, Martins A, Stark D, Raine R, Whelan JS. Specialist cancer services for teenagers and young adults in England: BRIGHTLIGHT research programme. Programme Grants Appl Res 2021. [DOI: 10.3310/pgfar09120] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
When cancer occurs in teenagers and young adults, the impact is far beyond the physical disease and treatment burden. The effect on psychological, social, educational and other normal development can be profound. In addition, outcomes including improvements in survival and participation in clinical trials are poorer than in younger children and older adults with similar cancers. These unique circumstances have driven the development of care models specifically for teenagers and young adults with cancer, often focused on a dedicated purpose-designed patient environments supported by a multidisciplinary team with expertise in the needs of teenagers and young adults. In England, this is commissioned by NHS England and delivered through 13 principal treatment centres. There is a lack of evaluation that identifies the key components of specialist care for teenagers and young adults, and any improvement in outcomes and costs associated with it.
Objective
To determine whether or not specialist services for teenagers and young adults with cancer add value.
Design
A series of multiple-methods studies centred on a prospective longitudinal cohort of teenagers and young adults who were newly diagnosed with cancer.
Settings
Multiple settings, including an international Delphi study of health-care professionals, qualitative observation in specialist services for teenagers and young adults, and NHS trusts.
Participants
A total of 158 international teenage and young adult experts, 42 health-care professionals from across England, 1143 teenagers and young adults, and 518 caregivers.
Main outcome measures
The main outcomes were specific to each project: key areas of competence for the Delphi survey; culture of teenagers and young adults care in the case study; and unmet needs from the caregiver survey. The primary outcome for the cohort participants was quality of life and the cost to the NHS and patients in the health economic evaluation.
Data sources
Multiple sources were used, including responses from health-care professionals through a Delphi survey and face-to-face interviews, interview data from teenagers and young adults, the BRIGHTLIGHT survey to collect patient-reported data, patient-completed cost records, hospital clinical records, routinely collected NHS data and responses from primary caregivers.
Results
Competencies associated with specialist care for teenagers and young adults were identified from a Delphi study. The key to developing a culture of teenage and young adult care was time and commitment. An exposure variable, the teenagers and young adults Cancer Specialism Scale, was derived, allowing categorisation of patients to three groups, which were defined by the time spent in a principal treatment centre: SOME (some care in a principal treatment centre for teenagers and young adults, and the rest of their care in either a children’s or an adult cancer unit), ALL (all care in a principal treatment centre for teenagers and young adults) or NONE (no care in a principal treatment centre for teenagers and young adults). The cohort study showed that the NONE group was associated with superior quality of life, survival and health status from 6 months to 3 years after diagnosis. The ALL group was associated with faster rates of quality-of-life improvement from 6 months to 3 years after diagnosis. The SOME group was associated with poorer quality of life and slower improvement in quality of life over time. Economic analysis revealed that NHS costs and travel costs were similar between the NONE and ALL groups. The ALL group had greater out-of-pocket expenses, and the SOME group was associated with greater NHS costs and greater expense for patients. However, if caregivers had access to a principal treatment centre for teenagers and young adults (i.e. in the ALL or SOME groups), then they had fewer unmet support and information needs.
Limitations
Our definition of exposure to specialist care using Hospital Episode Statistics-determined time spent in hospital was insufficient to capture the detail of episodes or account for the variation in specialist services. Quality of life was measured first at 6 months, but an earlier measure may have shown different baselines.
Conclusions
We could not determine the added value of specialist cancer care for teenagers and young adults as defined using the teenage and young adult Cancer Specialism Scale and using quality of life as a primary end point. A group of patients (i.e. those defined as the SOME group) appeared to be less advantaged across a range of outcomes. There was variation in the extent to which principal treatment centres for teenagers and young adults were established, and the case study indicated that the culture of teenagers and young adults care required time to develop and embed. It will therefore be important to establish whether or not the evolution in services since 2012–14, when the cohort was recruited, improves quality of life and other patient-reported and clinical outcomes.
Future work
A determination of whether or not the SOME group has similar or improved quality of life and other patient-reported and clinical outcomes in current teenage and young adult service delivery is essential if principal treatment centres for teenagers and young adults are being commissioned to provide ‘joint care’ models with other providers.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- National Cancer Research Institute, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nishma Patel
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
| | - Richard Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dan Stark
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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12
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Elsharif M, Roche M, Wilson D, Basak S, Rowe I, Vijayanand D, Feltbower R, Treanor D, Roberts L, Guthrie A, Prasad R, Gilthorpe MS, Attia M, Sourbron S. Hepatectomy risk assessment with functional magnetic resonance imaging (HEPARIM). BMC Cancer 2021; 21:1139. [PMID: 34688256 PMCID: PMC8541801 DOI: 10.1186/s12885-021-08830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/04/2021] [Indexed: 11/14/2022] Open
Abstract
Background Post hepatectomy liver failure (PHLF) remains a significant risk in patients undergoing curative liver resection for cancer, however currently available PHLF risk prediction investigations are not sufficiently accurate. The Hepatectomy risk assessment with functional magnetic resonance imaging trial (HEPARIM) aims to establish if quantitative MRI biomarkers of liver function & perfusion can be used to more accurately predict PHLF risk and FLR function, measured against indocyanine green (ICG) liver function test. Methods HEPARIM is an observational cohort study recruiting patients undergoing liver resection of 2 segments or more, prior to surgery patients will have both Dynamic Gadoxetate-enhanced (DGE) liver MRI and ICG testing. Day one post op ICG testing is repeated and R15 compared to the Gadoxetate Clearance (GC) of the future liver remnant (FLR-GC) as measure by preoperative DGE- MRI which is the primary outcome, and preoperative ICG R15 compared to GC of whole liver (WL-GC) as a secondary outcome. Data will be collected from medical records, biochemistry, pathology and radiology reports and used in a multi-variate analysis to the value of functional MRI and derive multivariant prediction models for future validation. Discussion If successful, this test will potentially provide an efficient means to quantitatively assess FLR function and PHLF risk enabling surgeons to push boundaries of liver surgery further while maintaining safe practice and thereby offering chance of cure to patients who would previously been deemed inoperable. MRI has the added benefit of already being part of the routine diagnostic pathway and as such would have limited additional burden on patients time or cost to health care systems. (Hepatectomy Risk Assessment With Functional Magnetic Resonance Imaging - Full Text View -ClinicalTrials.gov, n.d.) Trial registration ClinicalTrials.gov, ClinicalTrials.gov NCT04705194 - Registered 12th January 2021 – Retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08830-4.
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Affiliation(s)
- Mohamed Elsharif
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England.
| | - Matthew Roche
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England
| | - Daniel Wilson
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England
| | - Susmita Basak
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories, University of Leeds, Leeds, LS2 9JT, England
| | - Ian Rowe
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England
| | - Dhakshina Vijayanand
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England
| | - Richard Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, England
| | - Darren Treanor
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England.,Department of Clinical Pathology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Level 4, Welcome Trust Brenner Building, St. James's University Hospital, Leeds, LS9 7TF, England
| | - Lee Roberts
- Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories, University of Leeds, LS2 9JT, Leeds, England
| | - Ashley Guthrie
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England
| | - Raj Prasad
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England
| | - Mark S Gilthorpe
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England
| | - Magdy Attia
- Leeds Teaching Hospitals NHS Trust, St James University teaching Hospital, Level 6, Bexley Wing. St James's Hospital, Beckett Street, Leeds, LS9 7TF, England
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13
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McVey L, Alvarado N, Greenhalgh J, Elshehaly M, Gale CP, Lake J, Ruddle RA, Dowding D, Mamas M, Feltbower R, Randell R. Hidden labour: the skilful work of clinical audit data collection and its implications for secondary use of data via integrated health IT. BMC Health Serv Res 2021; 21:702. [PMID: 34271925 PMCID: PMC8284699 DOI: 10.1186/s12913-021-06657-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Secondary use of data via integrated health information technology is fundamental to many healthcare policies and processes worldwide. However, repurposing data can be problematic and little research has been undertaken into the everyday practicalities of inter-system data sharing that helps explain why this is so, especially within (as opposed to between) organisations. In response, this article reports one of the most detailed empirical examinations undertaken to date of the work involved in repurposing healthcare data for National Clinical Audits. Methods Fifty-four semi-structured, qualitative interviews were carried out with staff in five English National Health Service hospitals about their audit work, including 20 staff involved substantively with audit data collection. In addition, ethnographic observations took place on wards, in ‘back offices’ and meetings (102 h). Findings were analysed thematically and synthesised in narratives. Results Although data were available within hospital applications for secondary use in some audit fields, which could, in theory, have been auto-populated, in practice staff regularly negotiated multiple, unintegrated systems to generate audit records. This work was complex and skilful, and involved cross-checking and double data entry, often using paper forms, to assure data quality and inform quality improvements. Conclusions If technology is to facilitate the secondary use of healthcare data, the skilled but largely hidden labour of those who collect and recontextualise those data must be recognised. Their detailed understandings of what it takes to produce high quality data in specific contexts should inform the further development of integrated systems within organisations.
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Affiliation(s)
- Lynn McVey
- Faculty of Health Studies, University of Bradford, Bradford, UK. .,Wolfson Centre for Applied Health Research, Bradford, UK.
| | - Natasha Alvarado
- Faculty of Health Studies, University of Bradford, Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Mai Elshehaly
- Wolfson Centre for Applied Health Research, Bradford, UK.,Faculty of Engineering and Informatics, University of Bradford, Bradford, UK
| | - Chris P Gale
- School of Medicine, University of Leeds, Leeds, UK
| | - Julia Lake
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK
| | - Roy A Ruddle
- School of Computing, University of Leeds, Leeds, UK
| | - Dawn Dowding
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Mamas Mamas
- School of Primary, Community & Social Care, Keele University, Keele, UK
| | | | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
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14
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Sinha R, Aramburo A, Deep A, Bould EJ, Buckley HL, Draper ES, Feltbower R, Mitting R, Mahoney S, Alexander J, Playfor S, Chan-Dominy A, Nadel S, Suntharalingam G, Fraser J, Ramnarayan P. Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future. Arch Dis Child 2021; 106:548-557. [PMID: 33509793 PMCID: PMC7844931 DOI: 10.1136/archdischild-2020-320962] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/30/2020] [Accepted: 01/14/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic. DESIGN Descriptive study. SETTING Seven PICUs in England. MAIN OUTCOME MEASURES (1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs. RESULTS Seven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280-307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50-62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%). CONCLUSION In a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.
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Affiliation(s)
- Ruchi Sinha
- Department of Paediatric Intensive Care, Division of Women and Children's Services, Imperial College Healthcare NHS Trust, London, UK
| | - Angela Aramburo
- Paediatric Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Akash Deep
- Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Emma-Jane Bould
- Paediatric Intensive Care Unit, Barts Health NHS Trust, London, UK
| | | | | | | | - Rebecca Mitting
- Department of Paediatric Intensive Care, Division of Women and Children's Services, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Mahoney
- Paediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - John Alexander
- Paediatric Intensive Care Unit, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | | | - Amy Chan-Dominy
- Paediatric Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Simon Nadel
- Department of Paediatric Intensive Care, Division of Women and Children's Services, Imperial College Healthcare NHS Trust, London, UK
| | - Ganesh Suntharalingam
- Adult Intensive Care Unit, North West London Hospitals NHS Trust, Harrow, UK
- Intensive Care Society, London, UK
| | - James Fraser
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK
- Paediatric Intensive Care Society, London, UK
| | - Padmanabhan Ramnarayan
- Department of Paediatric Intensive Care, Division of Women and Children's Services, Imperial College Healthcare NHS Trust, London, UK
- Paediatric Intensive Care Society, London, UK
- Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR Biomedical Research Centre, London, UK
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15
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Mustafa K, Buckley H, Feltbower R, Kumar R, Scholefield BR. Epidemiology of Cardiopulmonary Resuscitation in Critically Ill Children Admitted to Pediatric Intensive Care Units Across England: A Multicenter Retrospective Cohort Study. J Am Heart Assoc 2021; 10:e018177. [PMID: 33899512 PMCID: PMC8200770 DOI: 10.1161/jaha.120.018177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Cardiopulmonary arrests are a major contributor to mortality and morbidity in pediatric intensive care units (PICUs). Understanding the epidemiology and risk factors for CPR may inform national quality improvement initiatives. Methods and Results A retrospective cohort analysis using prospectively collected data from the Paediatric Intensive Care Audit Network database. The Paediatric Intensive Care Audit Network contains data on all PICU admissions in the United Kingdom. We identified children who received cardiopulmonary resuscitation (CPR) in 23 PICUs in England (2013-2017). Incidence rates of CPR and associated factors were analyzed. Logistic regression was used to estimate the size and precision of associations. Cumulative incidence of CPR was 2.2% for 68 114 admissions over 5 years with an incidence rate of 4.9 episodes/1000 bed days. Cardiovascular diagnosis (odds ratio [OR], 2.30; 95% CI, 2.02-2.61), age <1 year (OR, 1.84; 95% CI, 1.65-2.04), the Paediatric Index of Mortality 2 score on admission (OR, 1.045; 95% CI, 1.042-1.047) and longer length of stay (OR, 1.013; 95% CI, 1.012-1.014) were associated with increased odds of receiving CPR. We also found a higher risk of CPR associated with a history of preadmission cardiac arrest (OR, 20.69; [95% CI, 18.16-23.58) and for children with a cardiac condition admitted to a noncardiac PICU (OR, 2.75; 95% CI, 1.91-3.98). Children from Black (OR, 1.68; 95% CI, 1.36-2.07) and Asian (OR, 1.49; 95% CI, 1.28-1.74) racial/ethnic backgrounds were at higher risk of receiving CPR in PICU than White children. Conclusions Data from this first multicenter study from England provides a foundation for further research and evidence for benchmarking and quality improvement for prevention of cardiac arrests in PICU.
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Affiliation(s)
- Khurram Mustafa
- Paediatric Intensive Care Leeds Children's Hospital United Kingdom
| | | | | | - Ramesh Kumar
- Paediatric Intensive Care Leeds Children's Hospital United Kingdom
| | - Barnaby R Scholefield
- Birmingham Acute Care Research Group Institute of Inflammation and AgeingUniversity of Birmingham United Kingdom.,Paediatric Intensive Care Birmingham Women and Children's Hospital NHS Foundation Trust United Kingdom
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16
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Fern LA, Taylor RM, Barber J, Alvarez-Galvez J, Feltbower R, Lea S, Martins A, Morris S, Hooker L, Gibson F, Raine R, Stark DP, Whelan J. Processes of care and survival associated with treatment in specialist teenage and young adult cancer centres: results from the BRIGHTLIGHT cohort study. BMJ Open 2021; 11:e044854. [PMID: 33827838 PMCID: PMC8031022 DOI: 10.1136/bmjopen-2020-044854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Survival gains in teenagers and young adults (TYA) are reported to be lower than children and adults for some cancers. Place of care is implicated, influencing access to specialist TYA professionals and research.Consequently, age-appropriate specialist cancer care is advocated for TYA although systematic investigation of associated outcomes is lacking. In England, age-appropriate care is delivered through 13 Principal Treatment Centres (TYA-PTC). BRIGHTLIGHT is the national evaluation of TYA cancer services to examine outcomes associated with differing places and levels of care. We aimed to examine the association between exposure to TYA-PTC care, survival and documentation of clinical processes of care. DESIGN Prospective cohort study. SETTING 109 National Health Service (NHS) hospitals across England. PARTICIPANTS 1114 TYA, aged 13-24, newly diagnosed with cancer between 2012 and 2014. INTERVENTION Participants were assigned a TYA-PTC category dependent on the proportion of care delivered in a TYA-PTC in the first year after diagnosis: all care in a TYA-PTC (ALL-TYA-PTC, n=270), no care in a TYA-PTC (NO-TYA-PTC, n=359), and some care in a TYA-PTC with additional care in a children's/adult unit (SOME-TYA-PTC, n=419). PRIMARY OUTCOME Data were collected on documented processes indicative of age-appropriate care using clinical report forms, and survival through linkage to NHS databases. RESULTS TYA receiving NO-TYA-PTC care were less likely to have documentation of molecular diagnosis, be reviewed by a children's or TYA multidisciplinary team, be assessed by supportive care services or have a fertility discussion. There was no significant difference in survival according to category of care. There was weak evidence that the association between care category and survival differed by age (p=0.08) with higher HRs for those over 19 receiving ALL or SOME-TYA-PTC compared with NO-TYA-PTC. CONCLUSION TYA-PTC care was associated with better documentation of clinical processes associated with age-appropriate care but not improved survival.
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Affiliation(s)
- Lorna A Fern
- Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cadiz, Spain
| | | | - Sarah Lea
- Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Martins
- Cancer Clinical Trials, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Morris
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Faith Gibson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Institute of Epidemiology & Health, University College London, London, UK
| | - Dan P Stark
- Leeds Insitute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Jeremy Whelan
- Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
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17
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Amin N, Kraft J, Fishlock A, White A, Holton C, Kinsey S, Feltbower R, James B. Surgical management of symptomatic osteonecrosis and utility of core decompression of the femoral head in young people with acute lymphoblastic leukaemia recruited into UKALL 2003. Bone Joint J 2021; 103-B:589-596. [PMID: 33641424 DOI: 10.1302/0301-620x.103b3.bjj-2020-0239.r3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Osteonecrosis (ON) can cause considerable morbidity in young people who undergo treatment for acute lymphoblastic leukaemia (ALL). The aims of this study were to determine the operations undertaken for ON in this population in the UK, along with the timing of these operations and any sequential procedures that are used in different joints. We also explored the outcomes of those patients treated by core decompression (CD), and compared this with conservative management, in both the pre- or post-collapse stages of ON. METHODS UK treatment centres were contacted to obtain details regarding surgical interventions and long-term outcomes for patients who were treated for ALL and who developed ON in UKALL 2003 (the national leukaemia study which recruited patients aged 1 to 24 years at diagnosis of ALL between 2003 and 2011). Imaging of patients with ON affecting the femoral head was requested and was used to score all lesions, with subsequent imaging used to determine the final grade. Kaplan-Meier failure time plots were used to compare the use of CD with non surgical management. RESULTS Detailed information was received for 85 patients who had developed ON during the course of their ALL treatment. A total of 206 joints were affected by ON. Of all joints affected by ON, 21% required arthroplasty, and 43% of all hips affected went on to be replaced. CD was performed in 30% of hips affected by ON. The majority of the hips were grade 4 or 5 at initial diagnosis of ON. There was no significant difference in time to joint collapse between those joints in which CD was performed, compared with no joint-preserving surgical intervention. CONCLUSION There is a high incidence of surgery in young people who have received treatment for ALL and who have developed ON. Our results suggest that CD of the femoral head in this group of patients does not delay or improve the rates of femoral head survival. Cite this article: Bone Joint J 2021;103-B(3):589-596.
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Affiliation(s)
| | | | | | | | | | - Sally Kinsey
- Leeds Children's Hospital, Leeds, UK.,University of Leeds, Leeds, UK
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18
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Almossawi O, Friend A, Palla L, Feltbower R, De Stavola B. Is there a sex difference in mortality rates for deaths occurring in paediatric intensive care units? Systematic literature review protocol. BMJ Open 2021; 11:e046794. [PMID: 33550270 PMCID: PMC7925908 DOI: 10.1136/bmjopen-2020-046794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In the general population, female children have been reported to have a survival advantage. For children admitted to paediatric intensive care units (PICUs), mortality has been reported to be lower in males despite the higher admission rates for males into intensive care. This apparent sex reversal in PICU mortality is not well studied. To address this, we propose to conduct a systematic literature review to summarise the available evidence. Our review will study the reported differences in mortality between males and females aged 0-17, who died in a PICU, to examine if there is a difference between the two sexes in PICU mortality, and if so, to describe the magnitude and direction of this difference. METHODS AND ANALYSIS Studies that directly or indirectly addressed the association between sex and mortality in children admitted to intensive care will be eligible for inclusion. Studies that directly address the association will be eligible for data extraction. The search strings were based on terms related to the population (children in intensive care), the exposure (sex) and the outcome (mortality). We used the databases MEDLINE (1946-2020), Embase (1980-2020) and Web of Science (1985-2020) as these cover relevant clinical publications. We will assess the reliability of included studies using the risk of bias in observational studies of exposures tool. We will consider a pooled effect if we have at least three studies with similar periods of follow up and adjustment variables. ETHICS AND DISSEMINATION Ethical approval is not required for this review as it will synthesise data from existing studies. This manuscript is a part of a larger data linkage study, for which Ethical approval was granted. Dissemination will be via peer-reviewed journals and via public and patient groups. PROSPERO REGISTRATION NUMBER CRD42020203009.
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Affiliation(s)
- Ofran Almossawi
- Department of Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Amanda Friend
- Department of Paediatrics, Leeds Children's Hospital, Leeds, UK
| | - Luigi Palla
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Rome, Italy
- Department of Medical Statistics, LSHTM, London, UK
- Department of Global Health, Nagasaki University Institute of Tropical Medicine, Nagasaki, Japan
| | | | - Bianca De Stavola
- Department of Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
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19
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McVey L, Alvarado N, Keen J, Greenhalgh J, Mamas M, Gale C, Doherty P, Feltbower R, Elshehaly M, Dowding D, Randell R. Institutional use of National Clinical Audits by healthcare providers. J Eval Clin Pract 2021; 27:143-150. [PMID: 32307857 DOI: 10.1111/jep.13403] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/06/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 01/26/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Healthcare systems worldwide devote significant resources towards collecting data to support care quality assurance and improvement. In the United Kingdom, National Clinical Audits are intended to contribute to these objectives by providing public reports of data on healthcare treatment and outcomes, but their potential for quality improvement in particular is not realized fully among healthcare providers. Here, we aim to explore this outcome from the perspective of hospital boards and their quality committees: an under-studied area, given the emphasis in previous research on the audits' use by clinical teams. METHODS We carried out semi-structured, qualitative interviews with 54 staff in different clinical and management settings in five English National Health Service hospitals about their use of NCA data, and the circumstances that supported or constrained such use. We used Framework Analysis to identify themes within their responses. RESULTS We found that members and officers of hospitals' governing bodies perceived an imbalance between the benefits to their institutions from National Clinical Audits and the substantial resources consumed by participating in them. This led some to question the audits' legitimacy, which could limit scope for improvements based on audit data, proposed by clinical teams. CONCLUSIONS Measures to enhance the audits' perceived legitimacy could help address these limitations. These include audit suppliers moving from an emphasis on cumulative, retrospective reports to real-time reporting, clearly presenting the "headline" outcomes important to institutional bodies and staff. Measures may also include further negotiation between hospitals, suppliers and their commissioners about the nature and volume of data the latter are expected to collect; wider use by hospitals of routine clinical data to populate audit data fields; and further development of interactive digital technologies to help staff explore and report audit data in meaningful ways.
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Affiliation(s)
- Lynn McVey
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Justin Keen
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Mamas Mamas
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Chris Gale
- School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Mai Elshehaly
- Faculty of Engineering and Informatics, University of Bradford, Bradford, UK
| | - Dawn Dowding
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, UK
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20
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Baranidharan G, Feltbower R, Bretherton B, Crowther T, Cooper L, Castino P, Radford H. One-Year Results of Prospective Research Study Using 10 kHz Spinal Cord Stimulation in Persistent Nonoperated Low Back Pain of Neuropathic Origin: Maiden Back Study. Neuromodulation 2020; 24:479-487. [PMID: 33351230 DOI: 10.1111/ner.13345] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Spinal cord stimulation (SCS) is a recommended treatment for chronic neuropathic pain. Persistent nonoperative low back pain of neuropathic origin has profound negative impacts on patient's lives. This prospective, open label, research study aimed to explore the use of SCS in patients with associated features of central sensitisation such as allodynia and hyperalgesia. MATERIALS AND METHODS Twenty-one patients with back pain and hyperalgesia or allodynia who had not had prior spinal surgery underwent a SCS trial followed by full implantation. SCS comprised administering electrical impulses epidurally at a frequency of 10 kHz and pulse width of 30 μsec. Patients attended follow-up visits after 6 and 12 months of SCS. Repeated measure ANOVAs/Friedman tests explored change after 6 and 12 months of 10 kHz SCS. Independent sample t-tests/Mann-Whitney U tests examined differences in response after 12 months of 10 kHz SCS. RESULTS Back and leg pain, quality of life (QoL), pain-related disability, and morphine equivalence significantly improved compared with baseline following 6 and 12 months of 10 kHz SCS. There were no increases in the consumption of opioids, amitriptyline, gabapentin or pregabalin in any patient. After 12 months of treatment, 52% encountered ≥50% improvement in back pain, 44% achieved remission (0-3 cm back pain VAS), 40% reported ODI scores between 0 and 40 and 60% experienced a reduction of at least 10 ODI points. Patients reporting ≥10-point improvement in ODI had significantly longer pain history durations and experienced significantly greater improvements in back pain, leg pain and QoL than those reporting <10-point improvement in ODI. CONCLUSION The 10 kHz SCS improved back and leg pain, QoL, pain-related disability and medication consumption in patients with nonoperative back pain of neuropathic origin. With further research incorporating a sham control arm, the efficacy of 10 kHz SCS in this patient cohort will become more established.
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Affiliation(s)
- Ganesan Baranidharan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.,School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Richard Feltbower
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Beatrice Bretherton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.,School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | | | | | | | - Helen Radford
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.,School of Medicine, Leeds Institute of Clinical Trials Research, Faculty of Medicine & Health, University of Leeds, Leeds, UK
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21
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Taylor RM, Fern LA, Barber J, Alvarez-Galvez J, Feltbower R, Lea S, Martins A, Morris S, Hooker L, Gibson F, Raine R, Stark DP, Whelan J. Longitudinal cohort study of the impact of specialist cancer services for teenagers and young adults on quality of life: outcomes from the BRIGHTLIGHT study. BMJ Open 2020; 10:e038471. [PMID: 33243793 PMCID: PMC7692812 DOI: 10.1136/bmjopen-2020-038471] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 02/07/2023] Open
Abstract
OBJECTIVES In England, healthcare policy advocates specialised age-appropriate services for teenagers and young adults (TYA), those aged 13 to 24 years at diagnosis. Specialist Principal Treatment Centres (PTC) provide enhanced TYA age-specific care, although many still receive care in adult or children's cancer services. We present the first prospective structured analysis of quality of life (QOL) associated with the amount of care received in a TYA-PTC DESIGN: Longitudinal cohort study. SETTING Hospitals delivering inpatient cancer care in England. PARTICIPANTS 1114 young people aged 13 to 24 years newly diagnosed with cancer. INTERVENTION Exposure to the TYA-PTC defined as patients receiving NO-TYA-PTC care with those receiving ALL-TYA-PTC and SOME-TYA-PTC care. PRIMARY OUTCOME Quality of life measured at five time points: 6, 12, 18, 24 and 36 months after diagnosis. RESULTS Group mean total QOL improved over time for all patients, but for those receiving NO-TYA-PTC was an average of 5.63 points higher (95% CI 2.77 to 8.49) than in young people receiving SOME-TYA-PTC care, and 4·17 points higher (95% CI 1.07 to 7.28) compared with ALL-TYA-PTC care. Differences were greatest 6 months after diagnosis, reduced over time and did not meet the 8-point level that is proposed to be clinically significant. Young people receiving NO-TYA-PTC care were more likely to have been offered a choice of place of care, be older, from more deprived areas, in work and have less severe disease. However, analyses adjusting for confounding factors did not explain the differences between TYA groups. CONCLUSIONS Receipt of some or all care in a TYA-PTC was associated with lower QOL shortly after cancer diagnosis. The NO-TYA-PTC group had higher QOL 3 years after diagnosis, however those receiving all or some care in a TYA-PTC experienced more rapid QOL improvements. Receipt of some care in a TYA-PTC requires further study.
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Affiliation(s)
- Rachel M Taylor
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Barber
- Department of Statistical Science, University College, London, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cadiz, Spain
| | | | - Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Dan P Stark
- Leeds Insitute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Jeremy Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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22
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Scholefield BR, Martin J, Penny-Thomas K, Evans S, Kool M, Parslow R, Feltbower R, Draper ES, Hiley V, Sitch AJ, Kanthimathinathan HK, Morris KP, Smith F. NEUROlogical Prognosis After Cardiac Arrest in Kids (NEUROPACK) study: protocol for a prospective multicentre clinical prediction model derivation and validation study in children after cardiac arrest. BMJ Open 2020; 10:e037517. [PMID: 32978195 PMCID: PMC7520830 DOI: 10.1136/bmjopen-2020-037517] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Currently, we are unable to accurately predict mortality or neurological morbidity following resuscitation after paediatric out of hospital (OHCA) or in-hospital (IHCA) cardiac arrest. A clinical prediction model may improve communication with parents and families and risk stratification of patients for appropriate postcardiac arrest care. This study aims to the derive and validate a clinical prediction model to predict, within 1 hour of admission to the paediatric intensive care unit (PICU), neurodevelopmental outcome at 3 months after paediatric cardiac arrest. METHODS AND ANALYSIS A prospective study of children (age: >24 hours and <16 years), admitted to 1 of the 24 participating PICUs in the UK and Ireland, following an OHCA or IHCA. Patients are included if requiring more than 1 min of cardiopulmonary resuscitation and mechanical ventilation at PICU admission Children who had cardiac arrests in PICU or neonatal intensive care unit will be excluded. Candidate variables will be identified from data submitted to the Paediatric Intensive Care Audit Network registry. Primary outcome is neurodevelopmental status, assessed at 3 months by telephone interview using the Vineland Adaptive Behavioural Score II questionnaire. A clinical prediction model will be derived using logistic regression with model performance and accuracy assessment. External validation will be performed using the Therapeutic Hypothermia After Paediatric Cardiac Arrest trial dataset. We aim to identify 370 patients, with successful consent and follow-up of 150 patients. Patient inclusion started 1 January 2018 and inclusion will continue over 18 months. ETHICS AND DISSEMINATION Ethical review of this protocol was completed by 27 September 2017 at the Wales Research Ethics Committee 5, 17/WA/0306. The results of this study will be published in peer-reviewed journals and presented in conferences. TRIAL REGISTRATION NUMBER NCT03574025.
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Affiliation(s)
- Barnaby Robert Scholefield
- Birmingham Acute Care Research Group, University of Birmingham College of Medical and Dental Sciences, Birmingham, West Midlands, UK
- Paediatric Intensive Care Unit, Birmingham Women and Children's NHS Foundation Trust, Birmingham, West Midlands, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Kate Penny-Thomas
- Paediatric Intensive Care Unit, Birmingham Women and Children's NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Sarah Evans
- Paediatric Intensive Care Unit, Birmingham Women and Children's NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Mirjam Kool
- Birmingham Acute Care Research Group, University of Birmingham College of Medical and Dental Sciences, Birmingham, West Midlands, UK
- Paediatric Intensive Care Unit, Birmingham Women and Children's NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Roger Parslow
- Leeds Institute for Data Analytics, University of Leeds, Leeds, West Yorkshire, UK
| | - Richard Feltbower
- Leeds Institute for Data Analytics, University of Leeds, Leeds, West Yorkshire, UK
| | - Elizabeth S Draper
- Health Sciences, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
| | - Victoria Hiley
- Leeds Institute for Data Analytics, University of Leeds, Leeds, West Yorkshire, UK
| | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Hari Krishnan Kanthimathinathan
- Birmingham Acute Care Research Group, University of Birmingham College of Medical and Dental Sciences, Birmingham, West Midlands, UK
- Paediatric Intensive Care Unit, Birmingham Women and Children's NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Kevin P Morris
- Paediatric Intensive Care Unit, Birmingham Women and Children's NHS Foundation Trust, Birmingham, West Midlands, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Fang Smith
- Birmingham Acute Care Research Group, University of Birmingham College of Medical and Dental Sciences, Birmingham, West Midlands, UK
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23
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Richards-Belle A, Davis P, Drikite L, Feltbower R, Grieve R, Harrison DA, Lester J, Morris KP, Mouncey PR, Peters MJ, Rowan KM, Sadique Z, Tume LN, Ramnarayan P. FIRST-line support for assistance in breathing in children (FIRST-ABC): a master protocol of two randomised trials to evaluate the non-inferiority of high-flow nasal cannula (HFNC) versus continuous positive airway pressure (CPAP) for non-invasive respiratory support in paediatric critical care. BMJ Open 2020; 10:e038002. [PMID: 32753452 PMCID: PMC7406113 DOI: 10.1136/bmjopen-2020-038002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/12/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Even though respiratory support is a common intervention in paediatric critical care, there is no randomised controlled trial (RCT) evidence regarding the effectiveness of two commonly used modes of non-invasive respiratory support (NRS), continuous positive airway pressure (CPAP) and high-flow nasal cannula therapy (HFNC). FIRST-line support for assistance in breathing in children is a master protocol of two pragmatic non-inferiority RCTs to evaluate the clinical and cost-effectiveness of HFNC (compared with CPAP) as the first-line mode of support in critically ill children. METHODS AND ANALYSIS We will recruit participants over a 30-month period at 25 UK paediatric critical care units (paediatric intensive care units/high-dependency units). Patients are eligible if admitted/accepted for admission, aged >36 weeks corrected gestational age and <16 years, and assessed by the treating clinician to require NRS for an acute illness (step-up RCT) or within 72 hours of extubation following a period of invasive ventilation (step-down RCT). Due to the emergency nature of the treatment, written informed consent will be deferred to after randomisation. Randomisation will occur 1:1 to CPAP or HFNC, stratified by site and age (<12 vs ≥12 months). The primary outcome is time to liberation from respiratory support for a continuous period of 48 hours. A total sample size of 600 patients in each RCT will provide 90% power with a type I error rate of 2.5% (one sided) to exclude the prespecified non-inferiority margin of HR of 0.75. Primary analyses will be undertaken separately in each RCT in both the intention-to-treat and per-protocol populations. ETHICS AND DISSEMINATION This master protocol received favourable ethical opinion from National Health Service East of England-Cambridge South Research Ethics Committee (reference: 19/EE/0185) and approval from the Health Research Authority (reference: 260536). Results will be disseminated via publications in peer-reviewed medical journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN60048867.
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Affiliation(s)
- Alvin Richards-Belle
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Peter Davis
- Paediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
| | - Laura Drikite
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | | | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | | | - Kevin P Morris
- Paediatric Intensive Care Unit, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Mark J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital For Children NHS Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Lyvonne N Tume
- School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service, Great Ormond Street Hospital For Children NHS Trust, London, UK
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24
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Randell R, Alvarado N, McVey L, Greenhalgh J, West RM, Farrin A, Gale C, Parslow R, Keen J, Elshehaly M, Ruddle RA, Lake J, Mamas M, Feltbower R, Dowding D. How, in what contexts, and why do quality dashboards lead to improvements in care quality in acute hospitals? Protocol for a realist feasibility evaluation. BMJ Open 2020; 10:e033208. [PMID: 32102812 PMCID: PMC7044920 DOI: 10.1136/bmjopen-2019-033208] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION National audits are used to monitor care quality and safety and are anticipated to reduce unexplained variations in quality by stimulating quality improvement (QI). However, variation within and between providers in the extent of engagement with national audits means that the potential for national audit data to inform QI is not being realised. This study will undertake a feasibility evaluation of QualDash, a quality dashboard designed to support clinical teams and managers to explore data from two national audits, the Myocardial Ischaemia National Audit Project (MINAP) and the Paediatric Intensive Care Audit Network (PICANet). METHODS AND ANALYSIS Realist evaluation, which involves building, testing and refining theories of how an intervention works, provides an overall framework for this feasibility study. Realist hypotheses that describe how, in what contexts, and why QualDash is expected to provide benefit will be tested across five hospitals. A controlled interrupted time series analysis, using key MINAP and PICANet measures, will provide preliminary evidence of the impact of QualDash, while ethnographic observations and interviews over 12 months will provide initial insight into contexts and mechanisms that lead to those impacts. Feasibility outcomes include the extent to which MINAP and PICANet data are used, data completeness in the audits, and the extent to which participants perceive QualDash to be useful and express the intention to continue using it after the study period. ETHICS AND DISSEMINATION The study has been approved by the University of Leeds School of Healthcare Research Ethics Committee. Study results will provide an initial understanding of how, in what contexts, and why quality dashboards lead to improvements in care quality. These will be disseminated to academic audiences, study participants, hospital IT departments and national audits. If the results show a trial is feasible, we will disseminate the QualDash software through a stepped wedge cluster randomised trial.
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Affiliation(s)
- Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Natasha Alvarado
- Wolfson Centre for Applied Health Research, Bradford, UK
- School of Healthcare, University of Leeds, Leeds, West Yorkshire, UK
| | - Lynn McVey
- Wolfson Centre for Applied Health Research, Bradford, UK
- School of Healthcare, University of Leeds, Leeds, West Yorkshire, UK
| | | | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Chris Gale
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Justin Keen
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mai Elshehaly
- Faculty of Engineering & Informatics, University of Bradford, Bradford, UK
| | - Roy A Ruddle
- School of Computing, University of Leeds, Leeds, West Yorkshire, UK
| | - Julia Lake
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mamas Mamas
- Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
| | | | - Dawn Dowding
- School of Health Sciences, University of Manchester, Manchester, Greater Manchester, UK
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Longbotham D, Young A, Nana G, Feltbower R, Hidalgo E, Toogood G, Lodge PA, Attia M, Rajendra Prasad K. The impact of age on post-operative liver function following right hepatectomy: a retrospective, single centre experience. HPB (Oxford) 2020; 22:151-160. [PMID: 31337601 DOI: 10.1016/j.hpb.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 01/29/2019] [Revised: 05/30/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND An increasing number of patients undergoing liver resection are of advancing age. The impact of ageing on liver regeneration and post-operative outcomes following a major resection are uncertain. We aimed to investigate risk factors for patients who developed Post Hepatectomy Liver Failure (PHLF) following right hepatectomy with age as the primary risk-factor. METHOD Patients undergoing right hepatectomy between July 2004-July 2018 were included. ROC analysis was performed to identify at which age PHLF development-risk increased. Secondary endpoints were length of stay (LOS), complications, and cost. RESULTS 332-patients were included. ROC demonstrated a cut-off age of 75-years in which PHLF risk increased. >75 there was an increased risk of PHLF (35% >75yrs vs. 7% <75yrs (p = <0.001), OR = 8.8 (95% CI = 3.6-21)) There was no difference between the age groups for any other PHLF risk factor. Patients >75yrs had longer LOS (11-days vs. 7-days (p = 0.04). Patients who developed PHLF had increased hospital costs: £10,987.50 (£6175-£46,050) vs. £2575 (£900-£46,050 p = 0.01). CONCLUSIONS Patients >75yrs have increased risk of developing PHLF after right hepatectomy, contributing to increased mortality and economic burden. Pre-operatively identifying patients at-risk of PHLF is important to consider liver volume optimization strategies and improve outcomes.
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Affiliation(s)
- David Longbotham
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Alastair Young
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Gael Nana
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Richard Feltbower
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Ernest Hidalgo
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Giles Toogood
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Peter A Lodge
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Magdy Attia
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom.
| | - K Rajendra Prasad
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
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Robson E, Feltbower R, Lee T. P252 Real world ivacaftor efficacy in children: five years on …. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Amin N, Kinsey S, Feltbower R, Kraft J, Whitehead E, Velangi M, James B. British OsteoNEcrosis Study (BONES) protocol: a prospective cohort study to examine the natural history of osteonecrosis in older children, teenagers and young adults with acute lymphoblastic leukaemia and lymphoblastic lymphoma. BMJ Open 2019; 9:e027204. [PMID: 31122988 PMCID: PMC6538027 DOI: 10.1136/bmjopen-2018-027204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/24/2023] Open
Abstract
INTRODUCTION Osteonecrosis is a well-recognised treatment-related morbidity risk in patients diagnosed with acute lymphoblastic leukaemia (ALL) and lymphoblastic lymphoma (LBL), with a high rate of affected patients requiring surgical intervention. Patients may have asymptomatic changes on imaging studies that spontaneously regress, and little is known about the natural history of osteonecrotic changes seen. The main aim of the British OsteoNEcrosis Study (BONES) is to determine the incidence of symptomatic and asymptomatic osteonecrosis in the lower extremities of survivors of ALL or LBL diagnosed aged 10-24 years in the UK at different time points in their treatment. This study also aims to identify risk factors for progression and the development of symptomatic osteonecrosis in this population, as well as specific radiological features that predict for progression or regression in those with asymptomatic osteonecrosis METHODS AND ANALYSIS: BONES is a prospective, longitudinal cohort study based at principal treatment centres around the UK. Participants are patients aged 10-24 years diagnosed with ALL or LBL under standard criteria. Assessment for osteonecrosis will be within 4 weeks of diagnosis, at the end of delayed intensification and 1, 2 and 3 years after the start of maintenance therapy. Assessment will consist of MRI scans of the lower limbs and physiotherapy assessment. Clinical and biochemical data will be collected at each of the time points. Bone mineral density data and vertebral fracture assessment using dual-energy X-ray absorptiometry will be collected at diagnosis and annually for 3 years after diagnosis of malignancy. ETHICS AND DISSEMINATION Ethical approval has been obtained through the Yorkshire and Humber Sheffield Research Ethics Committee (reference number: 16/YH/0206). Study results will be published on the study website, in peer-reviewed journals and presented at relevant conferences and via social media. TRIAL REGISTRATION NUMBER NCT02598401; Pre-results.
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Affiliation(s)
- Nadia Amin
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sally Kinsey
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Paediatric Haematology, Leeds Children’s Hospital, Leeds, UK
| | | | - Jeannette Kraft
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | - Mark Velangi
- Department of Paediatric Haematology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Beki James
- Department of Paediatric Haematology, Leeds Children’s Hospital, Leeds, UK
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28
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Taylor RM, Fern LA, Barber J, Alvarez-Galvez J, Feltbower R, Morris S, Hooker L, McCabe MG, Gibson F, Raine R, Stark DP, Whelan JS. Description of the BRIGHTLIGHT cohort: the evaluation of teenage and young adult cancer services in England. BMJ Open 2019; 9:e027797. [PMID: 31005941 PMCID: PMC6500338 DOI: 10.1136/bmjopen-2018-027797] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/23/2022] Open
Abstract
OBJECTIVE International recognition of the unique needs of young people with cancer is growing. Many countries have developed specialist age-appropriate cancer services believing them to be of value. In England, 13 specialist principal treatment centres (PTCs) deliver cancer care to young people. Despite this expansion of specialist care, systematic investigation of associated outcomes and costs has, to date, been lacking. The aim of this paper is to describe recruitment and baseline characteristics of the BRIGHTLIGHT cohort and the development of the bespoke measures of levels of care and disease severity, which will inform the evaluation of cancer services in England. DESIGN Prospective, longitudinal, observational study. SETTING Ninety-seven National Health Service hospitals in England. PARTICIPANTS A total of 1114 participants were recruited and diagnosed between July 2012 and December 2014: 55% (n=618) were men, mean age was 20.1 years (SD=3.3), most (86%) were white and most common diagnoses were lymphoma (31%), germ cell tumour (19%) and leukaemia (13%). RESULTS At diagnosis, median quality of life score was significantly lower than a published control threshold (69.7 points); 40% had borderline to severe anxiety, and 21% had borderline to severe depression. There was minimal variation in other patient-reported outcomes according to age, diagnosis or severity of illness. Survival was lower in the cohort than for young people diagnosed during the same period who were not recruited (cumulative survival probability 4 years after diagnosis: 88% vs 92%). CONCLUSIONS Data collection was completed in March 2018. Longitudinal comparisons will determine outcomes and costs associated with access/exposure to PTCs. Findings will inform international intervention and policy initiatives to improve outcomes for young people with cancer.
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Affiliation(s)
- Rachel M Taylor
- Cancer Clinical Trials, University College Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | | | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southhamptom, Southampton, UK
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Faith Gibson
- ORCHID, Great Ormond Street Hospital For Children NHS Trust, London, UK
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Rosalind Raine
- Institute of Epidemiology & Health, University College London, London, UK
| | - Dan P Stark
- Leeds Insitute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Jeremy S Whelan
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
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Newton HL, Friend AJ, Feltbower R, Hayden CJ, Picton HM, Glaser AW. Survival from cancer in young people: An overview of late effects focusing on reproductive health. Acta Obstet Gynecol Scand 2019; 98:573-582. [DOI: 10.1111/aogs.13584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/06/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Hannah L. Newton
- Reproduction and Early Development Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine School of Medicine and Health, University of Leeds Leeds UK
- Leeds Institute of Health Research School of Medicine and Health University of Leeds Leeds UK
- Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Amanda J. Friend
- Leeds Institute of Health Research School of Medicine and Health University of Leeds Leeds UK
- Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Richard Feltbower
- Department of Clinical and Population Sciences, School of Medicine and Health University of Leeds Leeds UK
- Leeds Institute for Data Analytics University of Leeds Leeds UK
| | | | - Helen M. Picton
- Reproduction and Early Development Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine School of Medicine and Health, University of Leeds Leeds UK
- Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Adam W. Glaser
- Leeds Institute of Health Research School of Medicine and Health University of Leeds Leeds UK
- Leeds Teaching Hospitals NHS Trust Leeds UK
- Leeds Institute for Data Analytics University of Leeds Leeds UK
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Goacher E, Mathew R, Fayeye O, Chakrabarty A, Loughrey C, Feltbower R, Chumas P. PATH-20. ANAPLASTIC ASTROCYTOMA: WHY DOES SURVIVAL DIFFER SO MUCH FOR THE SAME HISTOLOGICAL GRADE? Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.676] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Edward Goacher
- Addenbrookes Hospital, Cambridge, England, United Kingdom
| | - Ryan Mathew
- Leeds General Infirmary, Leeds, England, United Kingdom
| | | | | | - Carmel Loughrey
- Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom
| | | | - Paul Chumas
- University of Leeds & Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom
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Smith L, Pini S, Ferrari A, Yeomanson D, Hough R, Olsen PR, Gofti-Laroche L, Fleming T, Elliott M, Feltbower R, Kertesz G, Stark D. Pathways to Diagnosis for Teenagers and Young Adults with Cancer in European Nations: A Pilot Study. J Adolesc Young Adult Oncol 2018; 7:604-611. [PMID: 30036113 DOI: 10.1089/jayao.2018.0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The diagnosis of cancer is often prolonged in teenagers and young adults (TYA). There may be lessons in improving this from international comparisons. However, international studies are complex and so we conducted a pilot study to examine the key barriers to large-scale research in this field. METHODS We provided translated questionnaires covering key aspects of presentation and clinical management within 60 days of a confirmed cancer diagnosis, to patients 13-29 years of age inclusive, to their primary care physicians and to the cancer specialists managing their cancer. We conducted descriptive analyses of the data and also the process of study implementation. RESULTS For our pilot, collecting triangulated data was feasible, but varying regulatory requirements and professional willingness to contribute data were key barriers. The time of data collection and the method for collecting symptom reports were important for timely and accurate data synthesis. Patients reported more symptoms than professionals recorded. We observed substantial variation in pathways to cancer diagnosis to explore definitively in future studies. CONCLUSION Focused research upon the mechanisms underpinning complex cancer pathways, and focusing that research upon specific cancer types within TYA may be the next key areas of study.
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Affiliation(s)
- Lesley Smith
- 1 Clinical and Population Science Department, Leeds Institute for Data Analytics, School of Medicine, University of Leeds , Leeds, United Kingdom
| | - Simon Pini
- 2 Patient-Centered Outcomes Research Group, Bexley Wing, St. James's University Hospital and University of Leeds , Leeds, United Kingdom
| | - Andrea Ferrari
- 3 Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy
| | - Daniel Yeomanson
- 4 Sheffield Children's Hospital , Western Bank, Sheffield, United Kingdom
| | - Rachael Hough
- 5 Department of Adolescent Hematology, University College Hospitals NHS Foundation Trust , London, United Kingdom
| | - Pia Riis Olsen
- 6 Department of Oncology, Aarhus University Hospital , Aarhus, Denmark
| | - Leila Gofti-Laroche
- 7 Teenagers and Young Adults with Cancer Team, University of Grenoble Alpes , CHU Grenoble Alpes, Grenoble, France
| | - Thomas Fleming
- 1 Clinical and Population Science Department, Leeds Institute for Data Analytics, School of Medicine, University of Leeds , Leeds, United Kingdom
| | - Martin Elliott
- 8 Second Department of Pediatrics, Semmelweis University , Budapest, Hungary
| | - Richard Feltbower
- 1 Clinical and Population Science Department, Leeds Institute for Data Analytics, School of Medicine, University of Leeds , Leeds, United Kingdom
| | - Gabriella Kertesz
- 8 Second Department of Pediatrics, Semmelweis University , Budapest, Hungary
| | - Dan Stark
- 9 Teenage and Young Adult Cancer Services, Institute of Oncology , Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Hough R, Sandhu S, Khan M, Moran A, Feltbower R, Stiller C, Stevens MCG, Rowntree C, Vora A, McCabe MG. Are survival and mortality rates associated with recruitment to clinical trials in teenage and young adult patients with acute lymphoblastic leukaemia? A retrospective observational analysis in England. BMJ Open 2017; 7:e017052. [PMID: 28982824 PMCID: PMC5639992 DOI: 10.1136/bmjopen-2017-017052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Participation rates in clinical trials are low in teenagers and young adults (TYA) with cancer. Whilst the importance of clinical trials in informing best practice is well established, data regarding individual patient benefit are scarce. We have investigated the association between overall survival and trial recruitment in TYA patients with acute lymphoblastic leukaemia (ALL). DESIGN Retrospective. SETTING National (England) TYA patients treated for ALL. PARTICIPANTS 511 patients aged 15-24 years diagnosed with ALL between 2004 and 2010 inclusive, of whom 239 (46.7%) participated in the UKALL2003 trial. OUTCOME MEASURES Patients were identified using National Clinical Trial (UKALL2003) and Cancer Registry (National Cancer Data Repository, English National Cancer Online Registration Environment) Databases. Relative survival rates were calculated for trial and non-trial patients and observed differences were modelled using a multiple regression approach. The numbers and percentages of deaths in those patients included in the survival analysis were determined for each 3-month period, p values were calculated using the two-tailed z-test for difference between proportions and 95% CIs for percentage deaths were derived using the binomial distribution based on the Wilson Score method. RESULTS Patients treated on the trial had a 17.9% better 2-year survival (85.4% vs 67.5%, p<0.001) and 8.9% better 1-year survival (90.8% vs 81.9%, p=0.004) than those not on the trial. 35 (14.6%) patients recruited to the trial died in the 2 years following diagnosis compared with 86 (32.6%) of those not recruited (p<0.001). CONCLUSIONS TYA patients recruited to the clinical trial UKALL 2003 in England had a lower risk of mortality and a higher overall survival than contemporaneous non-trial patients. These data underline the potential for individual patient benefit in participating in a clinical trial and the importance of international efforts to increase trial participation in the TYA age group. TRIAL REGISTRATION NUMBER ISRCTN07355119.
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Affiliation(s)
| | - Sabrina Sandhu
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Maria Khan
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Anthony Moran
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Richard Feltbower
- Division of Epidemiology & Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | | | | | - Ajay Vora
- Sheffield Children’s Hospital, Western Bank, London, UK
| | - Martin G McCabe
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Amin NL, Feltbower R, Kinsey S, Vora A, James B. Osteonecrosis in patients with acute lymphoblastic leukaemia: a national questionnaire study. BMJ Paediatr Open 2017; 1:e000122. [PMID: 29637145 PMCID: PMC5862222 DOI: 10.1136/bmjpo-2017-000122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/30/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To establish prevalence, management and long-term outcomes of osteonecrosis (ON) in young people diagnosed with acute lymphoblastic leukaemia (ALL) between 2003 and 2011. DESIGN SETTING PARTICIPANTS This study assessed ON in 3113 patients aged 1-24 years who participated in the UK national leukaemia study UKALL 2003. UKALL 2003 recruited patients in 40 UK hospitals between 2003 and 2011 and included patients between ages 1 and 25 diagnosed with ALL. RESULTS 170 patients were diagnosed with ON, giving a prevalence of 5.5%. The multivariable analysis showed that the risk of ON was highest for children aged between 10 and 20 years (ages 10-15 years, OR 23.7, 95% CI 14.8 to 38.0; ages 16-20 years, OR 22.5, 95% CI 12.7 to 39.8, compared with age <10 years). Among ethnic groups, Asian patients had the highest risk of ON (OR 1.92, 95% CI 1.1 to 3.6, compared with White patients). Eighty-five per cent of patients with ON had multifocal ON. Thirty-eight per cent of patients with ON required surgery and 19% of patients with ON required a hip replacement. Fifteen per cent of patients who had surgery still describe significant disability or use of a wheelchair. CONCLUSIONS ON has considerable morbidity for patients being treated for ALL, with a high burden of surgery. Age and ethnicity were found to be the most significant risk factors for development of ON, with Asian patients and patients aged 10-20 years at diagnosis of ALL at greatest risk. These results will help risk stratify patients at diagnosis of ALL, and help tailor future prospective studies in this area.
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Affiliation(s)
- Nadia Laila Amin
- Paediatric haematology, Leeds Children's Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | | | - Sally Kinsey
- Paediatric haematology, Leeds Children's Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | - Ajay Vora
- Paediatric haematology, Great Ormond Street Hospital, London, UK
| | - Beki James
- Paediatric haematology, Leeds Children's Hospital, Leeds, UK
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Launay E, Cohen JF, Bossuyt PM, Buekens P, Deeks J, Dye T, Feltbower R, Ferrari A, Kramer M, Leeflang M, Moher D, Moons KG, von Elm E, Ravaud P, Chalumeau M. Reporting studies on time to diagnosis: proposal of a guideline by an international panel (REST). BMC Med 2016; 14:146. [PMID: 27677259 PMCID: PMC5039933 DOI: 10.1186/s12916-016-0690-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/12/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies on time to diagnosis are an increasing field of clinical research that may help to plan corrective actions and identify inequities in access to healthcare. Specific features of time to diagnosis studies, such as how participants were selected and how time to diagnosis was defined and measured, are poorly reported. The present study aims to derive a reporting guideline for studies on time to diagnosis. METHODS Each item of a list previously used to evaluate the completeness of reporting of studies on time to diagnosis was independently evaluated by a core panel of international experts (n = 11) for relevance and readability before an open electronic discussion allowed consensus to be reached on a refined list. The list was then submitted with an explanatory document to first, last and/or corresponding authors (n = 98) of published systematic reviews on time to diagnosis (n = 45) for relevance and readability, and finally approved by the core expert panel. RESULTS The refined reporting guideline consists of a 19-item checklist: six items are about the process of participant selection (with a suggested flowchart), six about the definition and measurement of time to diagnosis, and three about optional analyses of associations between time to diagnosis and participant characteristics and health outcomes. Of 24 responding authors of systematic reviews, more than 21 (≥88 %) rated the items as relevant, and more than 17 (≥70 %) as readable; 19 of 22 (86 %) authors stated that they would potentially use the reporting guideline in the future. CONCLUSIONS We propose a reporting guideline (REST) that could help authors, reviewers, and editors of time to diagnosis study reports to improve the completeness and the accuracy of their reporting.
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Affiliation(s)
- Elise Launay
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Maternité de Port-Royal, 53 Avenue de l'Observatoire, 75014, Paris, France. .,CHU de Nantes, Hôpital Mère-Enfant, Services de Pédiatrie Générale et d'Urgences Pédiatriques, Nantes, France.
| | - Jérémie F Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Maternité de Port-Royal, 53 Avenue de l'Observatoire, 75014, Paris, France.,Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jonathan Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Dye
- Biomedical Informatics, Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Richard Feltbower
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Michael Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Mariska Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - David Moher
- Centre for Practice Changing Research, Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Karel G Moons
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Philippe Ravaud
- Inserm UMR 1153, METHODS Team, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, AP-HP, Paris, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Maternité de Port-Royal, 53 Avenue de l'Observatoire, 75014, Paris, France.,Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
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Alabas OA, Brogan RA, Hall M, Almudarra S, Rutherford MJ, Dondo TB, Feltbower R, Curzen N, de Belder M, Ludman P, Gale CP. Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention. Heart 2016; 102:1287-95. [PMID: 27056968 DOI: 10.1136/heartjnl-2015-308739] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/09/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE For percutaneous coronary intervention (PCI) to the unprotected left main stem (UPLMS), there are limited long-term outcome data. We evaluated 5-year survival for UPLMS PCI cases taking into account background population mortality. METHODS A population-based registry of 10 682 cases of chronic stable angina (CSA), non-ST-segment elevation acute coronary syndrome (NSTEACS), ST-segment elevation myocardial infarction with (STEMI+CS) and without cardiogenic shock (STEMI-CS) who received UPLMS PCI from 2005 to 2014 were matched by age, sex, year of procedure and country to death data for the UK populace of 56.6 million people. Relative survival and excess mortality were estimated. RESULTS Over 26 105 person-years follow-up, crude 5-year relative survival was 93.8% for CSA, 73.1% for NSTEACS, 77.5% for STEMI-CS and 28.5% for STEMI+CS. The strongest predictor of excess mortality among CSA was renal failure (EMRR 6.73, 95% CI 4.06 to 11.15), and for NSTEACS and STEMI-CS was preprocedural ventilation (6.25, 5.05 to 7.75 and 6.92, 4.25 to 11.26, respectively). For STEMI+CS, the strongest predictor of excess mortality was preprocedural thrombolysis in myocardial infarction (TIMI) 0 flow (2.78, 1.87 to 4.13), whereas multivessel PCI was associated with improved survival (0.74, 0.61 to 0.90). CONCLUSIONS Long-term survival following UPLMS PCI for CSA was high, approached that of the background populace and was significantly predicted by co-morbidity. For NSTEACS and STEMI-CS, the requirement for preprocedural ventilation was the strongest determinant of excess mortality. By contrast, among STEMI+CS, in whom survival was poor, the strongest determinant was preprocedural TIMI flow. Future cardiovascular cohort studies of long-term mortality should consider the impact of non-cardiovascular deaths.
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Affiliation(s)
- O A Alabas
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - R A Brogan
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - M Hall
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - S Almudarra
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - M J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - T B Dondo
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - R Feltbower
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - N Curzen
- Department of Cardiology, University Hospital Southampton NHS FT & Faculty of Medicine, University of Southampton, Southampton, UK
| | - M de Belder
- Department of Cardiology, South Tees Hospitals NHS Foundation Trust, UK
| | - P Ludman
- Department of Cardiology Queen Elizabeth Hospital, Birmingham, UK
| | - C P Gale
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK
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Stark D, Bowen D, Dunwoodie E, Feltbower R, Johnson R, Moran A, Stiller C, O'Hara C. Survival patterns in teenagers and young adults with cancer in the United Kingdom: Comparisons with younger and older age groups. Eur J Cancer 2015; 51:2643-54. [PMID: 26321503 DOI: 10.1016/j.ejca.2015.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 07/27/2015] [Accepted: 08/12/2015] [Indexed: 01/15/2023]
Abstract
AIMS We aimed to describe and compare survival in teenagers and young adults (TYAs) with cancer to that of younger children and older adults, to identify sub-populations at greater or lesser risk of death. METHODS We compared survival in cancer patients diagnosed in the United Kingdom aged 13-24 years (TYAs) to those aged 0-12 (children) and 25-49 years (adults) using the National Cancer Data Repository. All cases had a first cancer diagnosis between 1st January 2001 and 31st December 2005 with censor date 31st December 2010 or death if earlier. RESULTS We found six distinct statistically significant survival patterns. In pattern 1, the younger the age-group the better the 1- and 5-year survival (acute lymphoid leukaemia, carcinoma of ovary and melanoma). In pattern 2, TYAs had a worse 5-year survival than both children and young adults (bone and soft tissues sarcomas). In pattern 3, TYAs had a worse 1-year survival but no difference at 5-years (carcinoma of cervix and female breast). In pattern 4, TYAs had better 1-year survival than adults, but no difference at 5 years (carcinoma of liver and intrahepatic bile ducts, germ cell tumours of extra-gonadal sites). In pattern 5, the younger the age-group the better the 5-year survival, but the difference developed after 1-year (acute myeloid leukaemia, carcinoma of colon and rectum). In pattern 6, there was no difference in 1- and 5-year survival between TYAs and adults (testicular germ cell tumours, ovarian germ cell tumours and carcinoma of thyroid). CONCLUSION TYAs with specific cancer diagnoses can be grouped according to 1- and 5-year survival patterns compared to children and young adults. To further improve survival for TYAs, age-specific biology, pharmacology, proteomics, genomics, clinician and patient behaviour studies embedded within clinical trials are required.
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Affiliation(s)
- Dan Stark
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds LS9 7TF, UK.
| | - David Bowen
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds LS9 7TF, UK.
| | - Elaine Dunwoodie
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds LS9 7TF, UK.
| | - Richard Feltbower
- Division of Epidemiology and Biostatistics, University of Leeds, Worsley Building, Clarendon Way, Leeds LS2 9JT, UK.
| | - Rod Johnson
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds LS9 7TF, UK.
| | - Anthony Moran
- Public Health England, The Palatine Centre, 63-65 Palatine Road, Manchester M20 3LJ, UK.
| | - Charles Stiller
- Public Health England, 4150 Chancellor Court, Oxford Business Park South, Oxford OX4 2GX, UK.
| | - Catherine O'Hara
- Clinical Outcomes Unit, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester M20 4BX, UK.
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Taylor RM, Fern LA, Solanki A, Hooker L, Carluccio A, Pye J, Jeans D, Frere-Smith T, Gibson F, Barber J, Raine R, Stark D, Feltbower R, Pearce S, Whelan JS. Development and validation of the BRIGHTLIGHT Survey, a patient-reported experience measure for young people with cancer. Health Qual Life Outcomes 2015. [PMID: 26216214 PMCID: PMC4517652 DOI: 10.1186/s12955-015-0312-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient experience is increasingly used as an indicator of high quality care in addition to more traditional clinical end-points. Surveys are generally accepted as appropriate methodology to capture patient experience. No validated patient experience surveys exist specifically for adolescents and young adults (AYA) aged 13-24 years at diagnosis with cancer. This paper describes early work undertaken to develop and validate a descriptive patient experience survey for AYA with cancer that encompasses both their cancer experience and age-related issues. We aimed to develop, with young people, an experience survey meaningful and relevant to AYA to be used in a longitudinal cohort study (BRIGHTLIGHT), ensuring high levels of acceptability to maximise study retention. METHODS A three-stage approach was employed: Stage 1 involved developing a conceptual framework, conducting literature/Internet searches and establishing content validity of the survey; Stage 2 confirmed the acceptability of methods of administration and consisted of four focus groups involving 11 young people (14-25 years), three parents and two siblings; and Stage 3 established survey comprehension through telephone-administered cognitive interviews with a convenience sample of 23 young people aged 14-24 years. RESULT Stage 1: Two-hundred and thirty eight questions were developed from qualitative reports of young people's cancer and treatment-related experience. Stage 2: The focus groups identified three core themes: (i) issues directly affecting young people, e.g. impact of treatment-related fatigue on ability to complete survey; (ii) issues relevant to the actual survey, e.g. ability to answer questions anonymously; (iii) administration issues, e.g. confusing format in some supporting documents. Stage 3: Cognitive interviews indicated high levels of comprehension requiring minor survey amendments. CONCLUSION Collaborating with young people with cancer has enabled a survey of to be developed that is both meaningful to young people but also examines patient experience and outcomes associated with specialist cancer care. Engagement of young people throughout the survey development has ensured the content appropriately reflects their experience and is easily understood. The BRIGHTLIGHT survey was developed for a specific research project but has the potential to be used as a TYA cancer survey to assess patient experience and the care they receive.
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Affiliation(s)
- Rachel M Taylor
- Cancer Clinical Trials Unit University College London Hospitals NHS Foundation Trust, London, UK. .,School of Health & Social Care, London South Bank University, London, UK.
| | - Lorna A Fern
- NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Anita Solanki
- Cancer Clinical Trials Unit University College London Hospitals NHS Foundation Trust, London, UK.
| | - Louise Hooker
- University Hospitals of Southampton NHS Foundation Trust, Southampton, UK.
| | | | - Julia Pye
- Social Research Institute, Ipsos MORI, London, UK.
| | - David Jeans
- Social Research Institute, Ipsos MORI, London, UK.
| | | | - Faith Gibson
- School of Health & Social Care, London South Bank University, London, UK. .,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK.
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK.
| | - Dan Stark
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.
| | - Richard Feltbower
- Division of Epidemiology & Biostatistics, School of Medicine, University of Leeds, Leeds, UK.
| | - Susie Pearce
- NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Jeremy S Whelan
- NIHR University College London Hospitals Biomedical Research Centre, London, UK.
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Affiliation(s)
- Samuel Manda
- Biostatistics Unit, South African Medical Research Council, South Africa
| | - Richard Feltbower
- Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics and Therapeutics, University of Leeds, Leeds, United Kingdom
| | - Mark Gilthorpe
- Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics and Therapeutics, University of Leeds, Leeds, United Kingdom
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Downing A, Morris EJA, Richards M, Corner J, Wright P, Sebag-Montefiore D, Finan P, Kind P, Wood C, Lawton S, Feltbower R, Wagland R, Vernon S, Thomas J, Glaser AW. Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis. J Clin Oncol 2015; 33:616-24. [PMID: 25559806 DOI: 10.1200/jco.2014.56.6539] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This population-level study was conducted to define the health-related quality of life (HRQL) of individuals living with and beyond colorectal cancer (CRC) and to identify factors associated with poor health outcomes. PATIENTS AND METHODS All individuals diagnosed with CRC in England in 2010 and 2011 who were alive 12 to 36 months after diagnosis were sent a questionnaire. This included questions related to treatment, disease status, other long-term conditions (LTCs), generic HRQL (EuroQol-5D), and cancer-specific outcomes (Functional Assessment of Cancer Therapy and Social Difficulties Inventory items). RESULTS The response rate was 63.3% (21,802 of 34,467 patients). One or more generic health problems were reported by 65% of respondents, with 10% of patients reporting problems in all five domains. The reporting of problems was higher than in the general population and was most marked in those age less than 55 years. Certain subgroups reported a higher number of problems, notably those with one or more other LTCs, those with active or recurrent disease, those with a stoma, and those at the extremes of the age range (< 55 and > 85 years). Of respondents without a stoma, 16.3% reported no bowel control. Reversal of a stoma resulted in fewer severe bowel problems but more moderate problems than those who had never had a stoma. A quarter of rectal cancer respondents (25.1%) reported difficulties with sexual matters (compared with 11.2% of colon cancer respondents). CONCLUSION This study demonstrates the success of a national patient-reported outcomes survey. The results have the potential to support system-wide improvement in health outcomes through the identification of particular challenges faced by individuals after treatment for CRC.
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Affiliation(s)
- Amy Downing
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Eva J A Morris
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Mike Richards
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Jessica Corner
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Penny Wright
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - David Sebag-Montefiore
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Paul Finan
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Paul Kind
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Charlotte Wood
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Sarah Lawton
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Richard Feltbower
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Richard Wagland
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Sally Vernon
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - James Thomas
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Adam W Glaser
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom.
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Alabas OA, Allan V, McLenachan JM, Feltbower R, Gale CP. Age-dependent improvements in survival after hospitalisation with acute myocardial infarction: an analysis of the Myocardial Ischemia National Audit Project (MINAP). Age Ageing 2014; 43:779-85. [PMID: 24362555 DOI: 10.1093/ageing/aft201] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND recent studies report an age-dependent decline in mortality after acute myocardial infarction (AMI). OBJECTIVE to investigate age-dependent improvements in survival after hospitalisation with AMI. DESIGN population-based cohort study using data from the Myocardial Ischaemia National Audit Project. SUBJECTS a total of 583,466 patients with AMI admitted to 247 hospitals between 1 January 2003 and 31 December 2010. METHODS six-month relative survival (RS) was calculated from the ratio of observed to expected survival using an age-, sex- and biennial year-matched population from the Office for National Statistics. Risk-adjusted mortality rates (RMAR) were estimated using shared frailty regression. Data were stratified by age group, AMI phenotype [(ST-elevation myocardial infarction, (STEMI) and non-STEMI, (NSTEMI)] and period of admission to hospital. RESULTS for STEMI, there was an increase in RS for patients aged 65-80 years (84.8 versus 89.2%) and those over 80 years (68.0 versus 71.8%), but not for patients aged 18 to <65 years (96.4 versus 96.9%). For NSTEMI patients aged 18 to <65 years RS was higher, but stable (95.5 versus 96.8%) and improved for patients aged 65-80 years (83.2 versus 88.5%) and patients aged >80 years (68.3% versus 75.5%). Likewise, RMAR improved for patients aged ≥65 years, were stable and higher for patients <65 years. CONCLUSIONS there were significant improvements in survival after hospitalisation with AMI in the older but not younger patients. The scope for further reductions in mortality is likely to be much greater for older than younger patients with AMI.
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Affiliation(s)
- Oras A Alabas
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Victoria Allan
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Jim M McLenachan
- Department of Cardiology, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - Richard Feltbower
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Chris P Gale
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK
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Geller T, Prakash V, Batanian J, Guzman M, Duncavage E, Gershon T, Crowther A, Wu J, Liu H, Fang F, Davis I, Tripolitsioti D, Ma M, Kumar K, Grahlert J, Egli K, Fiaschetti G, Shalaby T, Grotzer M, Baumgartner M, Braoudaki M, Lambrou GI, Giannikou K, Millionis V, Papadodima SA, Settas N, Sfakianos G, Stefanaki K, Kattamis A, Spiliopoulou CA, Tzortzatou-Stathopoulou F, Kanavakis E, Gholamin S, Mitra S, Feroze A, Zhang M, Esparza R, Kahn S, Richard C, Achrol A, Volkmer A, Liu J, Volkmer J, Majeti R, Weissman I, Cheshier S, Bhatia K, Brown N, Teague J, Lo P, Challis J, Beshay V, Sullivan M, Mechinaud F, Hansford J, Arifin MZ, Dahlan RH, Sobana M, Saputra P, Tisell MT, Danielsson A, Caren H, Bhardwaj R, Chakravadhanula M, Hampton C, Ozals V, Georges J, Decker W, Kodibagkar V, Nguyen A, Legrain M, Gaub MP, Pencreach E, Chenard MP, Guenot D, Entz-Werle N, Kanemura Y, Ichimura K, Shofuda T, Nishikawa R, Yamasaki M, Shibui S, Arai H, Xia J, Brian A, Prins R, Pennell C, Moertel C, Olin M, Bie L, Zhang X, Liu H, Olsson M, Kling T, Nelander S, Biassoni V, Bongarzone I, Verderio P, Massimino M, Magni R, Pizzamiglio S, Ciniselli C, Taverna E, De Bortoli M, Luchini A, Liotta L, Barzano E, Spreafico F, Visse E, Sanden E, Darabi A, Siesjo P, Jackson S, Cohen K, Lin D, Burger P, Rodriguez F, Yao X, Liucheng R, Qin L, Na T, Meilin W, Zhengdong Z, Yongjun F, Pfeifer S, Nister M, de Stahl TD, Basmaci E, Orphanidou-Vlachou E, Brundler MA, Sun Y, Davies N, Wilson M, Pan X, Arvanitis T, Grundy R, Peet A, Eden C, Ju B, Phoenix T, Nimmervoll B, Tong Y, Ellison D, Lessman C, Taylor M, Gilbertson R, Folgiero V, del Bufalo F, Carai A, Cefalo MG, Citti A, Rutella S, Locatelli F, Mastronuzzi A, Maher O, Khatua S, Zaky W, Lourdusamy A, Meijer L, Layfield R, Grundy R, Jones DTW, Capper D, Sill M, Hovestadt V, Schweizer L, Lichter P, Zagzag D, Karajannis MA, Aldape KD, Korshunov A, von Deimling A, Pfister S, Chakrabarty A, Feltbower R, Sheridon E, Hassan H, Shires M, Picton S, Hatziagapiou K, Braoudaki M, Lambrou GI, Tsorteki F, Tzortzatou-Stathopoulou F, Bethanis K, Gemou-Engesaeth V, Chi SN, Bandopadhayay P, Janeway K, Pinches N, Malkin H, Kieran MW, Manley PE, Green A, Goumnerova L, Ramkissoon S, Harris MH, Ligon KL, Kahlert U, Suarez M, Maciaczyk J, Bar E, Eberhart C, Kenchappa R, Krishnan N, Forsyth P, McKenzie B, Pisklakova A, McFadden G, Kenchappa R, Forsyth P, Pan W, Rodriguez L, Glod J, Levy JM, Thompson J, Griesinger A, Amani V, Donson A, Birks D, Morgan M, Handler M, Foreman N, Thorburn A, Lulla RR, Laskowski J, Fangusaro J, DiPatri AJ, Alden T, Tomita T, Vanin EF, Goldman S, Soares MB, Remke M, Ramaswamy V, Wang X, Jorgensen F, Morrissy AS, Marra M, Packer R, Bouffet E, Pfister S, Jabado N, Taylor M, Cole B, Rudzinski E, Anderson M, Bloom K, Lee A, Leary S, Leprivier G, Remke M, Rotblat B, Agnihotri S, Kool M, Derry B, Pfister S, Taylor MD, Sorensen PH, Dobson T, Busschers E, Taylor H, Hatcher R, Fangusaro J, Lulla R, Goldman S, Rajaram V, Das C, Gopalakrishnan V. TUMOUR BIOLOGY. Neuro Oncol 2014; 16:i137-i145. [PMCID: PMC4046298 DOI: 10.1093/neuonc/nou082] [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: 07/22/2023] Open
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Gale CP, Allan V, Cattle BA, Hall AS, West RM, Timmis A, Gray HH, Deanfield J, Fox KAA, Feltbower R. Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003–2010: a multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR). Heart 2014; 100:582-9. [DOI: 10.1136/heartjnl-2013-304517] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Richardson CC, McLaughlin KA, Brown TJ, Morgan D, Feltbower R, Powell M, Furmaniak J, Rees Smith B, Christie MR. Failure to detect anti-idiotypic antibodies in the autoimmune response to IA-2 in Type 1 diabetes. Autoimmunity 2013; 46:375-81. [PMID: 24001205 DOI: 10.3109/08916934.2013.773978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The concept that immune responses to self antigens are regulated by anti-idiotypic networks has attracted renewed interest following reports of circulating factors within IgG fractions of serum that impair detection of autoantibodies with autoantigen. Thus, preclearance of sera with bead-immobilised monoclonal autoantibodies to the Type 1 diabetes autoantigen GAD65, or prebinding of serum antibodies to protein A Sepharose prior to addition of antigen, increases immunoreactivity detected in serum samples consistent with the trapping on the beads of anti-idiotypic antibodies that block antibody binding to the autoantigen. The aim of this study was to investigate the presence of anti-idiotypic antibodies to another major target of autoantibodies in Type 1 diabetes, IA-2. As previously observed for GAD65, preadsorption of serum samples with immobilised monoclonal IA-2 autoantibody, or prebinding to protein A Sepharose, resulted in substantial increases in subsequent immunoprecipitation of radiolabeled IA-2 in a proportion of samples. However, control experiments indicated that the increases seen on pre-incubation with immobilized autoantibodies were caused by displacement of the antibody by serum IgG, whereas impaired detection of immunoreactivity in liquid-phase radiobinding assays was the result of formation of insoluble complexes that bind poorly to protein A. The results emphasise the importance of direct demonstration of specific binding of antibodies to the idiotype in the study of idiotypic networks in autoimmunity. Variability between patients in formation of insoluble immune complexes has implications for the design and standardization of autoantibody assays for diabetes prediction.
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Affiliation(s)
- Carolyn C Richardson
- Division of Diabetes and Nutritional Sciences, King's College London, United Kingdom
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44
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Gale CP, Allan V, Cattle BA, Hall AS, West RM, Timmis A, Gray HH, Deanfield JE, Fox KAA, Feltbower R. 026 TRENDS IN IN-HOSPITAL TREATMENTS, INCLUDING REVASCULARISATION, FOLLOWING ACUTE MYOCARDIAL INFARCTION, 2003–2010: A MULTI-LEVEL AND RELATIVE SURVIVAL ANALYSIS FOR THE NATIONAL INSTITUTE FOR CARDIOVASCULAR OUTCOMES RESEARCH (NICOR). Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.26] [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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45
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Glaser AW, Fraser LK, Corner J, Feltbower R, Morris EJA, Hartwell G, Richards M, Wagland R. Patient-reported outcomes of cancer survivors in England 1-5 years after diagnosis: a cross-sectional survey. BMJ Open 2013; 3:bmjopen-2012-002317. [PMID: 23578682 PMCID: PMC3641492 DOI: 10.1136/bmjopen-2012-002317] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To determine the feasibility of collecting population-based patient-reported outcome measures (PROMs) in assessing quality of life (QoL) to inform the development of a national PROMs programme for cancer and to begin to describe outcomes in a UK cohort of survivors. DESIGN Cross-sectional postal survey of cancer survivors using a population-based sampling approach. SETTING English National Health Service. PARTICIPANTS 4992 breast, colorectal, prostate and non-Hodgkin's lymphoma (NHL) survivors 1-5 years from diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES Implementation issues, response rates, cancer-specific morbidities utilising items including the EQ5D, tumour-specific subscales of the Functional Assessment of Cancer Therapy and Social Difficulties Inventory. RESULTS 3300 (66%) survivors returned completed questionnaires. The majority aged 85+ years did not respond and the response rates were lower for those from more deprived area. Response rates did not differ by gender, time since diagnosis or cancer type. The presence of one or more long-term conditions was associated with significantly lower QoL scores. Individuals from most deprived areas reported lower QoL scores and poorer outcomes on other measures, as did those self-reporting recurrent disease or uncertainty about disease status. QoL scores were comparable at all time points for all cancers except NHL. QoL scores were lower than those from the general population in Health Survey for England (2008) and General Practice Patient Survey (2012). 47% of patients reported fear of recurrence, while 20% reported moderate or severe difficulties with mobility or usual activities. Bowel and urinary problems were common among colorectal and prostate patients. Poor bowel and bladder control were significantly associated with lower QoL. CONCLUSIONS This method of assessing QoL of cancer survivors is feasible and acceptable to most survivors. Routine collection of national population-based PROMs will enable the identification of, and the support for, the specific needs of survivors while allowing for comparison of outcome by service provider.
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Affiliation(s)
- Adam W Glaser
- Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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46
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Fassihi M, McElhone S, Feltbower R, Rudolf M. Which factors predict unsuccessful outcome in a weight management intervention for obese children? J Hum Nutr Diet 2012; 25:453-9. [PMID: 22515879 DOI: 10.1111/j.1365-277x.2012.01246.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many obese children attending weight management interventions experience positive changes; however, not all are successful and little is known about what factors influence treatment outcome. The present study aimed to assess which baseline characteristics may predict unsuccessful treatment outcome in a weight management intervention for obese children. METHODS WATCH IT is a community weight management intervention for obese children and their families. Data collected during the pilot phase were visited retrospectively and secondary analysis was performed on the dataset. Inclusion criterion prioritised independent variables for the statistical model aiming to detect those that were exerting a significant effect. Logistic regression was used to assess the ability of these independent variables to predict unsuccessful treatment outcome. RESULTS Seventy-eight children (mean age 11.9 years) who attended the WATCH IT weight management intervention for at least 6 months were included in the analysis. Multivariable regression analysis showed that children from families where both parents reported having a weight problem were six times more likely to be unsuccessful compared to children from families where neither parent reported weight problems (odds ratio = 6.1; 95% confidence interval = 1.2-32.0; P = 0.032). Age, gender, severity of obesity and duration of previous weight management attempts were not predictive of treatment outcome. CONCLUSIONS To increase the overall success rate of children's weight management interventions such as WATCH IT, current approaches to behaviour change may need to be adapted or tailored for those families who are less likely to be successful. Supporting overweight parents to make their own successful lifestyle changes may be one way of improving the child's likelihood of weight management success.
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Affiliation(s)
- M Fassihi
- NHS Airedale, Bradford & Leeds, Bradford, UK.
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47
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Blakey K, Feltbower R, Parslow R, James P, Pozo BG, Stiller C, Vincent T, Norman P, McKinney P, Murphy M, Craft A, McNally R. P1-96 Primary bone cancer in 0-49 year olds in great britain, 1980-2005 and fluoride in drinking water: a case of inequalities? Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976c.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Fern L, Davies S, Eden T, Feltbower R, Grant R, Hawkins M, Lewis I, Loucaides E, Rowntree C, Stenning S, Whelan J. Rates of inclusion of teenagers and young adults in England into National Cancer Research Network clinical trials: report from the National Cancer Research Institute (NCRI) Teenage and Young Adult Clinical Studies Development Group. Br J Cancer 2008; 99:1967-74. [PMID: 19034273 PMCID: PMC2607227 DOI: 10.1038/sj.bjc.6604751] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Poor inclusion rates into clinical trials for teenagers and young adults (TYA; aged 13-24 years) have been assumed but not systematically investigated in England. We analysed accrual rates (AR) from 1 April 2005 up to 31 March 2007 to National Cancer Research Network (NCRN) Phase III trials for the commonest tumour types occurring in TYA and children: leukaemia, lymphoma, brain and central nervous system, bone sarcomas and male germ cell tumours. AR for 2005-2007 were 43.2% for patients aged 10-14 years, 25.2% for patients aged 15-19 years, and 13.1% for patients aged 20-24 years in the tumour types analysed. Compared with accrual from 1 April 2005 to 31 March 2006, AR between 1 April 2006 and 31 March 2007 increased for those aged 10-14 and 15-19 years, but fell for those aged 20-24 years. AR varied considerably among cancer types. Despite four trials being available, patients over 16 years with central nervous system tumours were not recruited. Rates of participation in clinical trials in England from 2005 to 2007 were much lower for TYA older than 15 years compared with children and younger teenagers. The variations in open trials, trial age eligibility criteria and extent of trial activation in treatment centres in part explain this observation. Other possible influences, such as difficulties associated with the consent of TYA require further evaluation. Closer dialogue between those involved in planning and running trials for children and for adults is necessary to improve trial availability and recruitment. Further research is required to identify trends in trial availability and accrual for those tumours constituting the remaining 26% of TYA cancers.
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Affiliation(s)
- L Fern
- 1Department of Oncology, University College London Hospitals NHS trust, London NW1 2PG, UK
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Abstract
We sought to determine if there are differences in the incidence of seizure disorders between the children of the indigenous and immigrant (predominantly Pakistani) populations of Bradford, United Kingdom. Annual incidence rates per 100,000 for new onset seizures were calculated along with Townsend deprivation scores. The incidence of seizures (including febrile and single) was 153 (95%CI 104-139). The rate was significantly higher in south Asians (SA) (220; 184-255) compared to non-south Asians (non-SA) (121; 104-139), mainly because of febrile seizures whose incidence was 87 (136-169) overall and 142 (114-170) and 61 (49-74) in SA and non-SA, respectively. There were no significant differences in the rates of nonfebrile seizures (non-FebSz) overall and of idiopathic non-FebSz between racial groups but the rate for symptomatic/cryptogenic non-FebSz was significantly higher in SA (22; 10-34) compared to non-SA (6; 2-10). The occurrence of seizure disorders correlated with social deprivation.
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50
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Abstract
AIMS The government has set a target to halt the rise in childhood obesity in those aged under 11 by 2010, but no system is in place to ascertain if this has been achieved. We aimed to develop a simple and reproducible methodology to monitor trends in childhood obesity. METHODS A purposive sample of 10 primary schools and three secondary schools was selected. Children were measured with parental "opt out" consent in reception class, year 4, and year 8 (ages 5, 9, and 13 years, respectively). Measurements were compared with those obtained locally in 1996-2001. Calculations were then performed to ascertain the sample size required to confidently identify a halt in the rise in obesity using three growth measures. RESULTS A total of 999 children were measured with ascertainment of 95% in primary and 85% in secondary schools. The proportion of overweight and obese children aged 9 and 13 years had increased since 1996-2001, although only 9 year olds showed a significant rise. A general trend of an increase in obesity was observed with increasing age. Calculations showed that 1900-2400 children per age group are needed to detect a halt in the rise in obesity based on mean body mass index (BMI) standard deviation scores (SDS) by 2010 with 90% power, whereas 4200-10 500 children are needed for other measures. CONCLUSION We have developed a simple, cost effective methodology for accurately measuring the epidemic and recommend the use of mean BMI SDS for demonstrating if a halt has been achieved.
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Affiliation(s)
- M C J Rudolf
- University of Leeds and East Leeds PCT, Leeds, UK.
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