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Cotton S, Andrews JS, Nichols RM, Jackson J, Tockhorn-Heidenreich A, Milligan G, Martinez JM. Clinical characteristics and treatment patterns of patients with episodic cluster headache: results from the United States, United Kingdom and Germany. Curr Med Res Opin 2023; 39:1637-1647. [PMID: 37615206 DOI: 10.1080/03007995.2023.2237741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To describe clinical characteristics and regional treatment patterns of episodic cluster headache (CH). METHODS A point-in-time survey of physicians and their patients with CH was conducted in the United States, United Kingdom and Germany in 2017. RESULTS Overall, 1012 patients with episodic CH were analyzed. Demographic and clinical findings were generally consistent across regions. Most patients were men (66.6%) and the mean age was 40.9 years. The greatest proportion of patients (38.3%) had ≤1 attack per day. The mean number of attacks per day (APD) was 2.4 and mean number of cluster periods per year was 2.6; the mean cluster period duration was 30.8 days. Most patients (69.3%) did not report a specific or predicable time when cluster periods occurred. Acute treatment was prescribed for 47.6% of patients, 10.3% of patients received preventive treatment, and 37.9% of patients received combined acute and preventive treatment; 4.2% of patients were not receiving treatment. Frequently prescribed acute treatments were sumatriptan, oxygen, and zolmitriptan; oxygen use varied considerably across countries and was prescribed least often in the United States. Frequently prescribed preventive treatments were verapamil, topiramate, and lithium. Lack of efficacy and tolerability were the most common reasons for discontinuing preventive treatment. CONCLUSIONS We observed high use of acute treatments, but only half of patients used preventive treatments despite experiencing several cluster periods per year with multiple cluster APD. Further studies about the need for and benefits of preventive treatment for episodic CH are warranted.
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Zhang L, Novick D, Zhong S, Li J, Walker C, Harrison L, Jackson J, Barlow S, Cotton S. Real-World Analysis of Clinical Characteristics, Treatment Patterns, and Patient-Reported Outcomes of Insufficient Responders and Responders to Prescribed Acute Migraine Treatment in China. Pain Ther 2023; 12:751-769. [PMID: 36944864 PMCID: PMC10199977 DOI: 10.1007/s40122-023-00494-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/27/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Migraine is a common disabling primary headache disorder characterized by attacks of severe pain, sometimes accompanied by symptoms including nausea and photo-/phono-phobia. Real-world data of patients with migraine who sufficiently (responders) and insufficiently (insufficient responders) respond to acute treatment (AT) are limited in China. This analysis explored whether responders to AT differ from insufficient responders in terms of clinical characteristics, treatment patterns, and patient-reported outcomes in China. METHODS Data were drawn from the Adelphi Migraine Disease Specific Programme™, a point-in-time survey of internists/neurologists and their consulting patients with migraine, conducted in a real-world setting in China, January-June 2014. Responders and insufficient responders to prescribed AT were patients who typically achieved headache pain freedom within 2 h of AT in ≥ 4 and ≤ 3 of five migraine attacks, respectively. Responders were compared with insufficient responders; logistic regression was used to identify factors associated with insufficient response. RESULTS Of 777 patients currently receiving AT, 44.0% were insufficient responders. Significantly fewer responders than insufficient responders had migraine with aura (13.1 vs. 23.8%; p = 0.0001). Responders reported a significantly lower mean Migraine Disability Assessment (MIDAS) total score (5.5 vs. 6.6; p = 0.0325). Responders reported a lower mean impairment while working (50.0 vs. 63.9%; p < 0.0001), overall work impairment (52.6 vs. 66.0%; p < 0.0001), and activity impairment (48.9 vs. 59.0%; p < 0.0001). Statistically significant factors associated with insufficient response to AT included diabetes, unilateral pain, vomiting, sensitivity to smell, visual aura/sight disturbance, and an increase in MIDAS total score. However, there were no statistically significant differences in ATs received by responders and insufficient responders at any regimen of therapy. CONCLUSIONS Many patients with migraine in China are insufficient responders to AT, experiencing worse symptoms that lead to overall poorer quality of life than responders. This unmet need suggests that new effective treatment options are required for migraine.
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Cotton S, McHugh MP, Dewar R, Haas JG, Templeton K. Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes. J Hosp Infect 2023; 135:28-36. [PMID: 36906180 PMCID: PMC9997060 DOI: 10.1016/j.jhin.2023.02.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND The first epidemic wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over a third of care homes reported an outbreak while there was limited testing of hospital patients discharged to care homes. AIM Investigate hospital discharges as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. METHODS A clinical review was performed for all discharges from hospitals to care homes starting 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease (COVID-19) test history, clinical assessment at discharge, whole genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis by cluster investigation and virus epidemiological tool (CIVET). Patient timelines were obtained using electronic hospital records. FINDINGS In total 787 hospital discharges to care homes were identified. Out of these 776 (99%) were ruled out for hospital discharge introduction. However, for 10 episodes the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission leading to 10 further positive cases in the care home. CONCLUSION Majority of hospital discharges were ruled out for introduction into Lothian care homes highlighting the importance of screening all new admissions when faced with a novel emerging virus and no vaccine available.
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Affiliation(s)
- S Cotton
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK; Infection Medicine, Edinburgh Medical School, University of Edinburgh, UK.
| | - M P McHugh
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK; School of Medicine, University of St Andrews, UK
| | - R Dewar
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK
| | - J G Haas
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK; Infection Medicine, Edinburgh Medical School, University of Edinburgh, UK
| | - K Templeton
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK; Infection Medicine, Edinburgh Medical School, University of Edinburgh, UK
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Zhao H, Xiao Z, Zhang L, Ford J, Zhong S, Ye W, Li J, Tockhorn-Heidenreich A, Cotton S, Chen C. Real-World Treatment Patterns and Outcomes Among Patients with Episodic Migraine in China: Results from the Adelphi Migraine Disease Specific Programme™. J Pain Res 2023; 16:357-371. [PMID: 36762367 PMCID: PMC9904300 DOI: 10.2147/jpr.s371887] [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: 04/22/2022] [Accepted: 12/22/2022] [Indexed: 02/05/2023] Open
Abstract
Objective This study assessed treatment patterns, disease burden, outcomes, and unmet needs among patients with episodic migraine (EM) in China using Adelphi Migraine Disease Specific Programme™ (DSP) real-world data. Background Migraine is a prevalent and debilitating neurological disorder which presents a major public health burden globally. Research on characteristics, disease burden, and treatment patterns in EM patients in China is limited. Methods Data were drawn from an existing data set Adelphi Migraine DSP, a point-in-time survey conducted in China (January-June 2014). Internists/neurologists completed patient record forms for the next 9 patients who consulted them in clinical practice; these same patients completed the 'patient self-completion questionnaires'. Descriptive analyses were used to assess key variables: patient demographics, treatment patterns (current acute and preventive medication [AM/PM]), effectiveness, issues with existing treatment, Migraine Disability Assessment (MIDAS) scores, and Work Productivity and Activity Impairment scores. Results Total of 125 internists/neurologists provided data on 1113 patients with EM (headache days/month <15). Mean (standard deviation [SD]) age was 43.8 (13.1) years; mean (SD) number of migraine days/month was 3.2 (1.7). AM was prescribed in 86.1% of patients (non-steroid anti-inflammatory drugs [NSAIDs]: 62.7%; triptans: 7.7%), PM in 38.5%, and both in 24.9% of patients. Approximately 55% of patients experienced ≥1 issue with their current AM or PM. Migraine-related symptoms (including nausea, photophobia, and phonophobia) were fully controlled in <50% of patients receiving NSAIDs (21.7-38.4%) or triptans (32.4-43.5%). Insufficient response to current AM (migraine headache fully resolved within 2 hours in ≤3/5 attacks) was reported by 42.5% of patients. Mild-to-severe disability was reported by 36.8% of patients with a mean (SD) MIDAS score of 5.8 (7.3). Overall, 58.0% of work time was impaired (including time missed and impairment while working). Conclusion This analysis suggests, despite existing treatment options, disease burden and unmet medical needs remain substantial in Chinese patients with EM.
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Affiliation(s)
- Hongru Zhao
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Zheman Xiao
- Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Lei Zhang
- Eli Lilly China, Shanghai, People’s Republic of China
| | - Janet Ford
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Shiying Zhong
- Eli Lilly China, Shanghai, People’s Republic of China
| | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Jinnan Li
- Eli Lilly China, Shanghai, People’s Republic of China
| | | | | | - Chunfu Chen
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University Jinan, Jinan, People’s Republic of China,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Correspondence: Chunfu Chen, Department of Neurology, Shandong Provincial Hospital, # 324 Jingwuweiqi, Road, Shandong, 250021, People’s Republic of China, Tel +86 13853153248, Email
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Watson M, Filia K, Stevens A, Cotton S, Nelson B, Ratheesh A. A systematic review and meta-analysis of global and social functioning among people at risk of bipolar disorder. J Affect Disord 2023; 321:290-303. [PMID: 36306929 DOI: 10.1016/j.jad.2022.10.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Functional status could predict development of bipolar disorder (BD) or have clinical significance. The relationship between BD risk and functioning is poorly understood. We undertook a systematic review examining the global and social functioning of those at risk for BD. METHODS We examined observational studies comparing a risk sample with healthy controls or full-threshold BD participants, using measures of global or social functioning. Risk status included family history of BD, meeting risk criteria, or having prodromal symptomatology, or premorbid functioning of persons with BD. Medline, PsycINFO, and Embase were searched. The Newcastle-Ottawa Scale for Cross-Sectional Studies was used to assess quality. Meta-analyses were performed where possible. RESULTS 7215 studies were screened and 40 studies were included (8474 participants). Risk samples had poorer functioning than controls, and superior functioning to participants with BD. Meta-analysis indicated poorer global functioning among persons with familial risk compared to healthy controls (mean global functional difference: 5.92; 95 % confidence interval: 7.90, 3.95; mean premorbid functioning difference: 2.31; 95 % confidence interval: 0.70, 3.92). Studies with higher proportions of female participants had slightly poorer global functioning. High heterogeneity was attributable functional measures and potentially functionally differential subgroups within the risk samples. LIMITATIONS Broader measures of functioning, such as neurocognition and behavioural measures, were excluded. Measures of global functioning are limited by conflating functioning and symptoms. CONCLUSIONS Functioning in the BD risk populations is intermediate to that of healthy controls and persons with BD, indicating their value in definitions of BD risk, in itself a likely heterogeneous state.
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Affiliation(s)
- M Watson
- The University of Melbourne, Centre for Youth Mental Health, Parkville 3052, Australia; The University of Melbourne, Melbourne Medical School, Parkville 3052, Australia
| | - K Filia
- Orygen, Parkville 3052, Australia
| | | | - S Cotton
- Orygen, Parkville 3052, Australia
| | - B Nelson
- Orygen, Parkville 3052, Australia
| | - A Ratheesh
- Orygen, Parkville 3052, Australia; The University of Melbourne, Centre for Youth Mental Health, Parkville 3052, Australia.
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Ford J, Nichols RM, Ye W, Tockhorn-Heidenreich A, Cotton S, Jackson J. Patient-Reported Outcomes for Migraine in the US and Europe: Burden Associated with Multiple Preventive Treatment Failures. Clinicoecon Outcomes Res 2021; 13:647-660. [PMID: 34285524 PMCID: PMC8286727 DOI: 10.2147/ceor.s304158] [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: 02/09/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate patient-reported outcomes (PROs) among patients with migraine, including those who were preventive-naïve and preventive-treated. Methods This was a point-in-time, real-world study of patients with migraine in the US and EU5 (France, Germany, Spain, Italy, and UK) and their physicians using data from the Adelphi Migraine Disease Specific Programme (DSP™). Physicians completed patient record forms (PRFs) for the next nine consulting patients with migraine plus a tenth patient, who did not need to be consecutive, for whom prior preventive migraine treatments had failed at least once, in order to achieve oversampling of such patients. Patients were given self-completion (PSC) forms that included the Migraine-Specific Quality of Life Questionnaire v2.1 (MSQ), Migraine Disability Assessment Scale (MIDAS), and Work Productivity and Activity Impairment (WPAI) questionnaire. Populations of interest included preventive-naïve and preventive-treated patients defined by the number of treatment lines (1–2 or 3+ preventive regimens). Continuous variables were compared using t-test or ANOVA if normally distributed and Mann–Whitney if not. Chi-squared was used for categorical variables. Results During August–December 2017, 615 physicians (359 PCPs, 256 neurologists) completed PRFs for 5785 patients (71% female; mean age 40 (±14) years; 65% in full- or part-time employment). Of these, 2798 completed a PSC (preventive-naïve/1–2/3+ preventive lines, n=1707/1034/57). Preventive-treated patients had a greater patient-reported burden across multiple measures versus preventive-naïve patients. Preventive-treated patients had lower MSQ scores indicating greater functional impairment, higher MIDAS scores indicating greater migraine-associated disability, and higher WPAI scores indicating greater overall work and activity impairment than preventive-naïve patients. The magnitude of difference was greatest for the 3+ preventive-treatments cohort. Patterns were similar in the US and EU5. Conclusion Among patients with migraine who are preventive-treated, including those with multiple lines of therapy, there remain considerable unmet needs in terms of restoring patient function.
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Affiliation(s)
- Janet Ford
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
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Hayashi E, Mitani H, Murayama H, Anzai T, Studer R, Cotton S, Jackson J, Bailey H, Kitagawa H, Oyama N. Characterizing the role of, and physical and emotional burden on caregivers of patients with heart failure: Results from a cross-sectional survey in Japan. Geriatr Nurs 2021; 42:379-385. [PMID: 33621781 DOI: 10.1016/j.gerinurse.2021.01.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022]
Abstract
The aim of this cross-sectional survey was to characterize the role of and burden on caregivers of heart failure (HF) patients in Japan, since such data are limited at present. Data from 126 caregivers whose average age was 63.5 years were analyzed. Helping to prepare meals/cooking was the most frequently reported activity (47% of caregivers); 24% found this the most burdensome. The most frequently reported physical consequence of caregiving was feeling physically tired (44%); emotionally worrying about the patient (62%) was the most frequent psychological consequence. Approximately half of the caregivers reported that caring for patients impacted their lifestyle. Although 40% of caregivers asked questions to physicians regarding diet or lifestyle modifications, 19% did not ask any. Caregivers play a crucial role in the management of HF patients in Japan but experience physical and emotional burden. Solutions are required to reduce the caregiver burden associated with HF.
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Affiliation(s)
- Erika Hayashi
- Medical Division, Novartis Pharma K.K., Tokyo, Japan
| | | | | | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Rachel Studer
- Real World Evidence, Cardio renal metabolic, Novartis Pharma AG, Basel, Switzerland
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Lahoz R, Proudfoot C, Fonseca AF, Loefroth E, Corda S, Jackson J, Cotton S, Studer R. Caregivers of Patients with Heart Failure: Burden and the Determinants of Health-Related Quality of Life. Patient Prefer Adherence 2021; 15:1153-1164. [PMID: 34079236 PMCID: PMC8165301 DOI: 10.2147/ppa.s297816] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/29/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To assess the burden among caregivers of patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤60%. The burden by New York Heart Association (NYHA) functional class was also characterized. PATIENTS AND METHODS A cross-sectional study was conducted in France, Germany, Italy, Spain, and UK from June to November 2019. Patient record forms were completed by 257 cardiologists and 158 general practitioners for consecutive HF patients. Caregivers who accompanied the patient to their consultation completed a caregiver self-completion survey voluntarily, which included the Family Caregiver Quality of Life Questionnaire (FAMQOL) and 5-level 5-dimension EuroQol questionnaire (EQ-5D-5L). RESULTS We analyzed 361 caregivers of patients with HF (NYHA class I, n=41; II, n=212; III IV, n=108). Mean age of caregivers was 58.8 years (NYHA I/II/III-IV: 59.1/60.8/54.6 years; p=0.0029), with majority being females (73.1%). Caregivers spent on average 19.8 hours/week caring for a HF patient, which increased with increase in NYHA class (I/II/III-IV: 11.8/18.1/25.9 hours/week; p=0.0094). Caregivers (24.1%) reported providing emotional support/encouragement to patients as the most troublesome/inconvenient caregiving activity (no significant difference across NYHA class). Nearly one-third of caregivers experienced stress (NYHA I/II/III-IV: 17.1%/28.8%/40.7%; p=0.0111) and anxiety (26.8%/24.1%/39.8%; p=0.0127) due to caregiving burden. The overall FAMQOL mean score decreased significantly (poorer QoL) with increase in NYHA class (I/II/III-IV: 58.1/56.3/52.2; p=0.0069). A trend of decreasing scores with increasing NYHA class was observed across physical, emotional, and social domains (each p≤0.012). CONCLUSION Caregivers of HF patients with LVEF ≤60% experienced a significant burden, which was higher among caregivers of patients with more severe and symptomatic disease.
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Affiliation(s)
- Raquel Lahoz
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
- Correspondence: Raquel Lahoz Real World Evidence and Data Science, Cardio-Renal-Metabolic Franchise, Novartis Pharma AG, Asklepios 8-4, Basel, CH-4002, SwitzerlandTel +41 79 535 99 30 Email
| | - Clare Proudfoot
- Health Economics and Outcomes Research, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Ana Filipa Fonseca
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Emil Loefroth
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Stefano Corda
- Global Medical Affairs, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - James Jackson
- Real World Research, Adelphi Real World, Bollington, UK
| | - Sarah Cotton
- Real World Research, Adelphi Real World, Bollington, UK
| | - Rachel Studer
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
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Fonseca AF, Lahoz R, Proudfoot C, Corda S, Loefroth E, Jackson J, Cotton S, Studer R. Burden and Quality of Life Among Female and Male Patients with Heart Failure in Europe: A Real-World Cross-Sectional Study. Patient Prefer Adherence 2021; 15:1693-1706. [PMID: 34354345 PMCID: PMC8331086 DOI: 10.2147/ppa.s312200] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To characterize symptoms, clinical burden, and health-related quality of life (HRQoL) among women and men with heart failure (HF) with a left ventricular ejection fraction (LVEF) of ≤60% in Europe. PATIENTS AND METHODS A real-world cross-sectional study was conducted in France, Germany, Italy, Spain, and United Kingdom from June to November 2019. Patient record forms were completed by 257 cardiologists and 158 general practitioners for consecutive patients with HF. The same patients were invited to complete a questionnaire comprising patient-reported outcomes: the Minnesota Living with Heart Failure Questionnaire (MLHFQ), five-level five-dimension EuroQol questionnaire (EQ-5D-5L), Visual Analogue Scale (VAS), and Work Productivity and Activity Impairment questionnaire. RESULTS The mean age of 804 patients (men, n=517; women, n=287) was 68.6 years (men, 67.8 years; women, 70.2 years; p=0.0022). The mean LVEF was 44.7% (men, 43.6%; women, 46.8%; p<0.0001). Patients reported dyspnoea when active (overall, 55.7%; men, 56.0%; women, 55.3%), fatigue/weakness/faintness (34.5%; men, 32.9%; women, 37.2%), and oedema (20.3%; men, 18.7%; women, 23.1%) as the most troublesome HF symptoms. Overall, 54.1% of patients reported low mood/depression (men, 50.8%; women, 60.1%). The overall MLHFQ mean score was higher (ie, poorer HRQoL) among women vs men (37.9 vs 34.6; p=0.0481). MLHFQ was consistently higher (ie, poorer HRQoL) for women vs men across the physical (18.6 vs 16.6; p=0.0041) and emotional (9.4 vs 7.9; p=0.0021) scoring domains. Mean EQ-5D utility (0.69 vs 0.75; p=0.0046) and VAS scores (55.4 vs 61.3; p<0.0001) were lower among women compared with men. Overall, 23.4% of patients were hospitalized owing to HF in the previous year (men, 22.7%; women, 24.6%). Patients reported 43.2% activity impairment due to HF (men, 41.6%; women, 46.4%; p=0.01). CONCLUSION HF causes a substantial burden on patients, with a greater burden among women vs men. This gender-related difference is consistent with other HF studies, warranting further research to understand the underlying reasons.
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Affiliation(s)
- Ana Filipa Fonseca
- Novartis Pharma AG, Basel, Switzerland
- Correspondence: Ana Filipa Fonseca Real World Evidence Group, Cardio-Renal-Metabolic Franchise, Novartis Pharma AG, Novartis Campus, Basel, CH-4002, Switzerland Tel: +41 (0) 793489979 Email
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Hirata K, Ueda K, Komori M, Ye W, Kim Y, Cotton S, Jackson J, Treuer T. Unmet Needs in Japanese Patients Who Report Insufficient Efficacy with Triptans for Acute Treatment of Migraine: Retrospective Analysis of Real-World Data. Pain Ther 2020; 10:415-432. [PMID: 33306190 PMCID: PMC8119538 DOI: 10.1007/s40122-020-00223-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Migraine attacks notably impact people's daily lives, health-related quality of life (HRQoL), and ability to work. Triptans are widely used as acute medication for a migraine attack but are ineffective, poorly tolerated, or contraindicated in some patients. HRQoL and work productivity are therefore likely to pose particular problems for patients whose migraine attacks do not respond sufficiently to triptan acute treatment. This real-world study aimed to determine whether migraine-related HRQoL, disability, and work productivity differed between triptan insufficient responders (TIRs) and sufficient responders (TSRs) receiving this acute treatment for migraine in Japan. METHODS This was a retrospective analysis of 2017 Adelphi Migraine Disease Specific Programme cross-sectional survey data collected from physicians and their consulting patients with migraine in Japan. Patients had to be receiving a triptan as their sole acute prescribed medication for migraine. TIRs were defined as patients who achieved headache pain freedom within 2 h of taking triptan acute treatment in no more than three of five migraine attacks. Differences in outcomes between TIRs and TSRs were examined in adjusted analyses using a multivariable general linear model. RESULTS Of 200 patients receiving a triptan as their sole prescribed acute treatment for migraine, 88 (44.0%) were classed as TIRs. Migraine-Specific Quality of Life Questionnaire scores were significantly lower-indicating poorer HRQoL-among TIRs than TSRs, as were mean EuroQol 5-dimension utility and visual analog scale scores (p < 0.05 for comparisons). TIRs also reported significantly (p ≤ 0.003) greater impairment than TSRs across all Work Productivity and Activity Impairment domains, with the exception of work time missed. Migraine disability was higher among TIRs than TSRs. CONCLUSION Migraine attacks had a negative impact on the HRQoL, disability, and work productivity of people with migraine in Japan reporting insufficient efficacy with acute triptan treatment, highlighting the need for more effective acute treatment options.
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Affiliation(s)
- Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | | | | | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Yongin Kim
- Eli Lilly and Company, Indianapolis, IN, USA
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Hayashi T, Morita Y, Mitani H, Murayama H, Anzai T, Studer R, Cotton S, Jackson J, Bailey H, Kitagawa H, Oyama N. Burden of Heart Failure on Patient Daily Life and Patient-Physician Discordance in Disease Management - Results From a Cross-Sectional Survey in Japan. Circ Rep 2020; 2:722-729. [PMID: 33693202 PMCID: PMC7937529 DOI: 10.1253/circrep.cr-20-0073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: We investigated the impact of heart failure (HF) on daily life and satisfaction with current HF medication from the patient perspective in a real-world study in Japan. Methods and Results: A cross-sectional survey of 154 HF patients treated by 58 cardiologists was conducted in Japan using patient self-completed questionnaires about their daily life and satisfaction with HF medication, as well as patient record forms completed by their physicians capturing corresponding data. The mean age of patients was 72.7 years. The proportion of patients within New York Heart Association Class I, II, III, and IV was 39%, 44%, 16%, and 1%, respectively. Symptoms reported by patients included dyspnea when active (46%), nocturia (43%), anxiety (18%), and depression (6%). There was a discordance between physician- and patient-reported symptoms, especially for nocturia and inability to sleep. The most frequent lifestyle recommendation from physicians was 'reduce salt/sodium intake', but only 51% of patients receiving this recommendation followed the advice. In all, 44% of patients reported dissatisfaction with their current medication; according to the patients, 27% reported no discussion with their physicians about their prescribed medication, while physicians reported the opposite. Conclusions: HF negatively impacts patient daily life. There is discordance between patients and physicians in symptom reporting, lifestyle modification advice and adherence, and reported medication decision making. Gaps in patient-physician communication exist.
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Affiliation(s)
| | - Yohei Morita
- Medical Division, Novartis Pharma K.K. Tokyo Japan
| | | | | | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine Hokkaido Japan
| | - Rachel Studer
- Real World Evidence, Cardio renal metabolic, Novartis Pharma AG Basel Switzerland
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Lahoz R, Corda S, Proudfoot C, Fonseca A, Cotton S, Jackson J, Studer R. Caregiver burden of patients with heart failure with a left-ventricular ejection fraction (LVEF) less than or equal to 60%: a cross-sectional survey in the EU. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and purpose
The majority of patients with heart failure (HF) have difficulties in independently carrying out activities of daily living and hence, require support from caregivers (CGs). This study assessed the quality of life (QoL) of CGs of HF patients with sub-normal LVEF (≤60%).
Methods
A cross-sectional survey of HF patients and their CGs was conducted in France, Germany, Italy, Spain and the UK. Cardiologists and primary care physicians completed patient record forms (PRF) between June and November 2019. Caregivers of the same patients were invited to complete a caregiver self-completion survey, which included the Family Caregiver QoL Scale (FAMQOL) and EQ-5D. Patient demographics were derived from PRFs.
Results
361 CGs (73.1% female, mean age: 58.8 yrs) and HF patients (39.9% female, mean age: 71.2 yrs) were included. 58.2% of the CGs were spouses, 23.4% a child of the patient. On average, CGs devoted 20 hrs/week in the care of HF patients; this CG time increased from 12 to 26 hrs/week with NYHA class I to III/IV of the HF patient. Further, anxiety/stress was experienced overall by 29/31% of CGs which increased from 27/17% for NYHA I to 40/41% for NYHA III/IV of the HF patient (Table 1).
Conclusions
Caregivers of patients with HF and LVEF ≤60% spend a significant amount of time to provide daily support to HF patients. Patients with progressive disease were older, more polymorbid and had a higher disease duration. These factors likely contributed towards increased caregiver burden of HF patients with increased NYHA class.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
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Affiliation(s)
- R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | - S Corda
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - S Cotton
- Adelphi Real World, Bollington, United Kingdom
| | - J Jackson
- Adelphi Real World, Bollington, United Kingdom
| | - R Studer
- Adelphi Real World, Bollington, United Kingdom
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Proudfoot C, Fonseca A, Lahoz R, Corda S, Cotton S, Jackson J, Studer R. Patients with heart failure and a LVEF less than 40% present an overall lower health related quality of life than those with LVEF between 40% and 60%: a multinational real-world survey in EU. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Heart Failure (HF) is associated with symptoms such as dyspnoea and fatigue which can impact patients' health related quality of life (HRQoL). This study aimed to characterize and assess the HRQoL of patients with HF and left-ventricular ejection fraction (LVEF) <40% versus those with ≥40%-60%.
Methods
A cross-sectional study of patients with HF was conducted in France, Germany, Italy, Spain and United Kingdom. Patient record forms (PRFs) were completed by 257 cardiologists and 158 general practitioners (GPs) for consecutively consulting patients. The same patients were invited to provide patient-reported outcomes including self-completion questionnaires, Minnesota Living with Heart Failure Questionnaire (MLHFQ) and EQ-5D-5L VAS.
Results
204 HF patients with LVEF <40% (mean age 67.7 years) and 600 patients with LVEF ≥40–60% (mean age 68.9 years) were included. Proportion of males was significantly higher in the lower LVEF group (73.5% vs. 61.2%, p=0.0017). Overall, the patients with lower LVEF more frequently presented with comorbidities than those with LVEF ≥40–60% (p<0.05, Figure 1). NYHA stage III/IV (35.8%/7.4% vs. 15.3%/0.8%) as well as self-reported HF symptoms were more frequently reported in the lower LVEF group (p<0.05, Figure 1). Similarly, patients with LVEF <40% reported statistically significantly worse HRQoL compared to those with LVEF ≥40–60% (Table 1).
Conclusions
The HRQoL of all HF patients with LVEF ≤60% appears impacted, while those with LVEF <40% had significantly worse HRQoL than those with LVEF ≥40–60%. These differences in HRQoL may not only be related to the LVEF but also to the overall characteristics of these patients. Addressing the HRQoL burden for patients should be a key aspect of HF management strategies for all HF patients.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
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Affiliation(s)
| | | | - R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | - S Corda
- Novartis Pharma AG, Basel, Switzerland
| | - S Cotton
- Adelphi Real World, Bollington, United Kingdom
| | - J Jackson
- Adelphi Real World, Bollington, United Kingdom
| | - R Studer
- Novartis Pharma AG, Basel, Switzerland
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Hirata K, Ueda K, Ye W, Kim Y, Komori M, Jackson J, Cotton S, Rajan N, Treuer T. Factors associated with insufficient response to acute treatment of migraine in Japan: analysis of real-world data from the Adelphi Migraine Disease Specific Programme. BMC Neurol 2020; 20:274. [PMID: 32641075 PMCID: PMC7341635 DOI: 10.1186/s12883-020-01848-4] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/29/2020] [Indexed: 12/11/2022] Open
Abstract
Background Real-world data on sufficient/insufficient response, and predictors of insufficient response, to acute treatments for migraine are limited in Japan. This study aimed to identify factors associated with insufficient response to acute treatment of migraine by exploring significant differences between people with migraine who sufficiently/insufficiently respond to prescribed acute treatment in Japan. Methods This was a retrospective analysis of 2014 Adelphi Migraine Disease Specific Programme cross-sectional survey data collected from physicians and their consulting adult patients with migraine in Japan. Insufficient responders to prescribed acute treatment were patients who achieved headache pain freedom within 2 h of acute treatment in no more than three of their last five migraine attacks. Factors associated with insufficient response to prescribed acute migraine treatment were identified using backward logistic regression. Results Overall, 227/538 (42.2%) patients were classified as insufficient responders to prescribed acute migraine treatment. Significantly more insufficient responders than sufficient responders had consulted a neurologist or a migraine/headache specialist, and had chronic migraine or medication-overuse or tension-type headaches (p < 0.05). More insufficient responders than sufficient responders reported taking acute treatment when/after the pain started (77.0 vs. 68.9%) than at first sign of migraine (p < 0.05). Compared with sufficient responders, insufficient responders reported a significantly higher mean ± standard deviation (SD) Migraine Disability Assessment total score (12.7 ± 23.3 vs. 5.8 ± 10.4, p < 0.001) and lower quality of life (EuroQol-5 Dimensions utility score 0.847 ± 0.19 vs. 0.883 ± 0.16, p = 0.024). Factors significantly associated with insufficient response to acute treatment included seeing a neurologist versus an internist (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.29–2.88; p = 0.002), taking acute medication when/after pain started versus at first sign of migraine (OR 1.65; 95% CI 1.05–2.60; p = 0.030), a higher MIDAS total score (OR 1.04; 95% CI 1.02–1.06; p < 0.001), and presence of comorbid cardiovascular disease (OR 0.53; 95% CI 0.28–0.98; p = 0.044). Conclusions Many people with migraine in Japan struggle to adequately treat migraine attacks with prescribed acute medication and exhibit high levels of unmet need for acute treatment. Optimized management strategies utilizing existing therapeutic options as well as additional effective therapeutic options for migraine are required to improve symptoms and quality of life.
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Affiliation(s)
- Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | | | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Yongin Kim
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Sarah Cotton
- Adelphi Real World, Adelphi Mill, Bollington, UK
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Ford JH, Foster SA, Nichols RM, Tockhorn-Heidenreich A, Ye W, Jackson J, Cotton S. A real-world analysis of patient-reported outcomes in patients with migraine by preventive treatment eligibility status in the US and Europe. J Patient Rep Outcomes 2020; 4:53. [PMID: 32632891 PMCID: PMC7338330 DOI: 10.1186/s41687-020-00221-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/19/2020] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Migraine has a severe impact on health-related quality of life (HRQoL) affecting physical, emotional, and social aspects of daily living of an individual. Preventive treatment has been demonstrated to improve HRQoL by reducing the frequency of migraine headache days. METHODS The study used data from 2017 Adelphi Migraine Disease Specific Program, which is a cross-sectional survey of physicians and their consulting patients with migraine in the United States (US) and five European countries (EU [Germany, France, UK, Italy and Spain]). Objectives were to evaluate patient-reported outcome (PRO) measures in the following two subgroups and by region (US and EU): (i) patients who are eligible for migraine preventive treatment (≥4 migraine headache days/month), and (ii) patients who are non-eligible for preventive treatment (< 4 migraine headache days/month). Patient-reported outcome measures that were assessed included the following: Migraine-Specific Quality-of-Life Questionnaire Version 2.1, Migraine Disability Assessment Scale (MIDAS), European Quality of Life-5 Dimensions-5 Levels version, and Work Productivity and Activity Impairment. RESULTS In total, 5462 patients (US = 1373; EU = 4089) were included in the study (preventive eligible: US = 584; EU = 1942; preventive non-eligible: US = 789; EU = 2147). In the US and EU, preventive eligible patients were significantly more likely to have worse disability as measured by MIDAS than non-eligible patients; preventive eligible patients also had significantly greater functional impairment, worse health utility, and overall greater work impairment (p < 0.0001). Among patients who were preventive eligible, a larger proportion of patients in the US reported that migraine forced them to reduce the number of hours worked as compared with the EU population (29.0% vs 24.7%). CONCLUSION Patients who were preventive eligible (≥4 migraine headache days/month) demonstrated greater burden of disease across multiple PRO measures; trends were similar across the US and the five EU countries.
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Affiliation(s)
- Janet H Ford
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA.
| | - Shonda A Foster
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Russell M Nichols
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | | | - Wenyu Ye
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
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Lombard L, Ye W, Nichols R, Jackson J, Cotton S, Joshi S. A Real-World Analysis of Patient Characteristics, Treatment Patterns, and Level of Impairment in Patients With Migraine Who are Insufficient Responders vs Responders to Acute Treatment. Headache 2020; 60:1325-1339. [PMID: 32510611 PMCID: PMC7497096 DOI: 10.1111/head.13835] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of this study was to examine if patients with migraine who responded sufficiently to acute treatment were significantly different from those who did not in terms of patient characteristics, treatment patterns, and patient level of impairment, and to identify characteristics associated with insufficient response. BACKGROUND Migraine is highly prevalent and impacts functional ability substantially. Current treatment approaches are not sufficiently meeting the needs of patients, and inadequate response to acute treatment is reported by at least 56% of patients with migraine in the United States. METHODS Data were obtained from the 2014 Adelphi Migraine Disease-Specific Program, a cross-sectional survey. Using logistic regression, we assessed the association between patient factors and insufficient response. Responders were defined as patients with migraine who achieved pain freedom within 2 hours of acute treatment in ≥4 of 5 attacks, while insufficient responders achieved it in ≤3 of 5 attacks. RESULTS Of 583 patients included, insufficient responders to acute treatment constituted 34.3% (200/583) of the study population. A statistically significantly larger proportion of insufficient responders vs responders had ≥4 migraine headache days/month (46.3% [88/190] vs 31% [114/368]), had ever been prescribed ≥3 unique preventive treatment regimens (11.7% [21/179] vs 6.3% [22/347]), and had chronic migraine, medication-overuse headaches, and comorbid depression (all P values ≤.05). Patient level of impairment was statistically significantly greater among insufficient responders vs responders. Factors associated with insufficient response after adjusting for covariates included Migraine Disability Assessment total score (odds ratio [OR] = 1.04, 95% CI [1.02, 1.05]), time of administration of acute treatment (OR = 1.83, 95% CI [1.15, 2.92]), depression (OR = 1.98, 95% CI [1.21, 3.23]), sensitivity to light not listed as current most troublesome symptom (OR = 2.30, 95% CI [1.21, 4.37]), and change in the average headache days per month before being prescribed an acute treatment vs now (OR = 1.75, 95% CI [1.05, 2.90]). CONCLUSIONS Clinical characteristics, treatment patterns, and health-related quality of life measures are statistically significantly different between insufficient responders and responders to acute treatment in patients with migraine.
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Affiliation(s)
| | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Sarah Cotton
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - Shivang Joshi
- DENT Neurologic Institute, Amherst, NY, USA.,University of Buffalo, School of Pharmacy, Buffalo, NY, USA
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Lombard L, Farrar M, Ye W, Kim Y, Cotton S, Buchanan AS, Jackson J, Joshi S. A global real-world assessment of the impact on health-related quality of life and work productivity of migraine in patients with insufficient versus good response to triptan medication. J Headache Pain 2020; 21:41. [PMID: 32349662 PMCID: PMC7189443 DOI: 10.1186/s10194-020-01110-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/15/2020] [Indexed: 01/03/2023] Open
Abstract
Background Migraine is a chronic, disabling neurological disease characterized by moderate-to-severe headache pain with other symptoms, including nausea, vomiting, and photophobia. Triptans, while generally effective, are insufficiently efficacious in 30–40% of patients and poorly tolerated by or contraindicated in others. We assessed the impact of insufficient response to triptans on health-related quality of life (HRQoL) and work productivity in patients currently receiving any prescribed triptan formulation as their only acute migraine medication. Methods Data were from the 2017 Adelphi Migraine Disease Specific Programme, a cross-sectional survey of primary care physicians, neurologists, and headache specialists and their consulting patients with migraine in the USA, France, Germany, Italy, Spain, and UK. Triptan insufficient responders (TIRs) achieved freedom from headache pain within 2 h of acute treatment in ≤3/5 migraine attacks; triptan responders (TRs) achieved pain freedom within 2 h in ≥4/5 attacks. Multivariable general linear model examined differences between TIRs and TRs in HRQoL and work productivity. Logistic regression identified factors associated with insufficient response to triptans. Results The study included 1413 triptan-treated patients (TIRs: n = 483, 34.2%; TRs: n = 930, 65.8%). TIRs were more likely to be female (76% vs. 70% for TIRs vs TRs, respectively; p = 0.011), older (mean age 42.6 vs. 40.5 years; p = 0.003), and had more headache days/month (7.0 vs. 4.4; p < 0.001). TIRs had significantly more disability, with higher Migraine Disability Scores (MIDAS; 13.2 vs. 7.7; p < 0.001), lower Migraine-specific Quality of Life scores, indicating greater impact (Role Function Restrictive: 62.4 vs. 74.5; Role Function Preventive: 70.0 vs. 82.2; Emotional Function: 67.7 vs. 82.1; all p < 0.001), and lower EQ5D utility scores (0.84 vs. 0.91; p = 0.001). Work productivity and activity were impaired (absenteeism, 8.6% vs. 5.1% for TIRs vs. TRs; presenteeism, 34.3% vs. 21.0%; work impairment, 37.1% vs. 23.3%; overall activity impairment, 39.8% vs. 25.3%; all p < 0.05). Conclusion HRQoL and work productivity were significantly impacted in TIRs versus TRs in this real-world analysis of patients with migraine acutely treated with triptans, highlighting the need for more effective treatments for patients with an insufficient triptan response. Further research is needed to establish causal relationships between insufficient response and these outcomes.
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Affiliation(s)
- Louise Lombard
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | - Wenyu Ye
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Yongin Kim
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | - Andrew S Buchanan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | | | - Shivang Joshi
- DENT Neurologic Institute, Amherst, and University of Buffalo School of Pharmacy, Buffalo, New York, USA
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Poitout-Belissent F, Culang D, Poulin D, Samadfan R, Cotton S, Bédard C. Monitoring Compound-Related Effects on Coagulability in Rats and Cynomolgus and Rhesus Monkeys by Thrombin Generation Kinetic Measurement. Int J Toxicol 2020; 39:207-217. [PMID: 32153221 DOI: 10.1177/1091581820907324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thrombin generation assay (TGA) is a sensitive method for the assessment of the global clotting potential of plasma. This kinetic assay can detect both hypocoagulable and hypercoagulable conditions: delayed or reduced thrombin generation leading to a prolonged clotting time, or induced thrombin activity, shifting the coagulation cascade toward thrombosis. The purpose of this study is to qualify the TGA in nonhuman primates (NHP) and rats for its use during nonclinical in vivo and in vitro studies. Blood was drawn from nonanesthetized animals, and platelet-poor plasma was obtained after double centrifugation; coefficients of variation were <10% for all derived parameters of thrombin generation assessed with 5 pM of tissue factor. Thrombin generation was evaluated in vitro in rat and NHP plasmas with ascending doses of unfractionated heparin (UFH), recombinant tissue factor, and anticoagulant compounds. Thrombin generation was decreased with UFH and anticoagulant compounds, but was increased in the presence of tissue factor, in a dose-dependent manner. In a rat model of inflammation, animals were administered a low dose of lipopolysaccharides. Thrombin generation measurements were decreased 3 hours post-LPS administration with a nadir at 24 hours, while thrombin-antithrombin complexes reached a peak at 8 hours, supporting an earlier production of thrombin. In conclusion, these data demonstrated that TGA can be performed in vitro for screening of compounds expected to have effects on coagulation cascade, and thrombin generation can be measured at interim time points during nonclinical in vivo studies in rats and NHP.
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Affiliation(s)
| | - D Culang
- Pathology and Microbiology Department, St.-Hyacinthe Veterinary School, University of Montreal, Canada
| | - D Poulin
- Charles River Laboratories, ULC, Senneville, Canada
| | - R Samadfan
- Charles River Laboratories, ULC, Senneville, Canada
| | - S Cotton
- Charles River Laboratories, ULC, Senneville, Canada
| | - C Bédard
- Pathology and Microbiology Department, St.-Hyacinthe Veterinary School, University of Montreal, Canada
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Booth J, Aucott L, Cotton S, Goodman C, Hagen S, Harari D, Lawrence M, Lowndes A, Macaulay L, MacLennan G, Mason H, McClurg D, Norrie J, Norton C, O’Dolan C, Skelton DA, Surr C, Treweek S. ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes: protocol for the ELECTRIC randomised trial. Trials 2019; 20:723. [PMID: 31843002 PMCID: PMC6915984 DOI: 10.1186/s13063-019-3723-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/13/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CHs) and profoundly impacts on residents' dignity and quality of life. CHs predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe and low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in CHs is not known. The ELECTRIC trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in CH residents and investigate the associated costs and consequences. METHODS This is a pragmatic, multicentre, placebo-controlled, randomised parallel-group trial comparing the effectiveness of TPTNS (target n = 250) with sham stimulation (target n = 250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff-reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-h Pad Weight Tests, post void residual urine (bladder scans), Patient Perception of Bladder Condition, Minnesota Toileting Skills Questionnaire and Dementia Quality of Life. Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors, and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers. DISCUSSION TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication. TRIAL REGISTRATION ClinicalTrials.gov, NCT03248362. Registered on 14 August 2017. ISRCTN, ISRCTN98415244. Registered on 25 April 2018. https://www.isrctn.com/.
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Affiliation(s)
- J. Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - L. Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - S. Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - C. Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - S. Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - D. Harari
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M. Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - A. Lowndes
- Playlist for Life, Unit 1/14, Govanhill Workspace, Glasgow,, UK
| | - L. Macaulay
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - G. MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - H. Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - D. McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - J. Norrie
- Usher Institute, Edinburgh University, Edinburgh, UK
| | | | - C. O’Dolan
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - D. A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - C. Surr
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - S. Treweek
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Jalloul RJ, Simpson I, Lin AS, Cotton S, Elshatanoufy S. 1954 Effect of Enhanced Recovery After Surgery (ERAS) Implementation on Surgical Outcomes and Opioid Prescription Patterns in Patients Undergoing Minimally Invasive Hysterectomy: A Safety-Net Teaching Hospital Experience. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Perera S, Hetrick S, Cotton S, Parker A, Rickwood D, Davenport T, Hickie IB, Herrman H, McGorry P. Awareness of headspace youth mental health service centres across Australian communities between 2008 and 2015. J Ment Health 2019; 29:410-417. [DOI: 10.1080/09638237.2019.1630718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. Perera
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S. Hetrick
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S. Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A. Parker
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - D. Rickwood
- Faculty of Health, University of Canberra, Canberra, Australia
- Headspace, National Youth Mental Health Foundation, Melbourne, Australia
| | - T. Davenport
- Brain and Mind Centre, University of Sydney, Australia
| | - I. B. Hickie
- Brain and Mind Centre, University of Sydney, Australia
| | - H. Herrman
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - P. McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Ueda K, Ye W, Lombard L, Kuga A, Kim Y, Cotton S, Jackson J, Treuer T. Real-world treatment patterns and patient-reported outcomes in episodic and chronic migraine in Japan: analysis of data from the Adelphi migraine disease specific programme. J Headache Pain 2019; 20:68. [PMID: 31174464 PMCID: PMC6734304 DOI: 10.1186/s10194-019-1012-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 02/14/2019] [Accepted: 05/05/2019] [Indexed: 02/08/2023] Open
Abstract
Background In Japan, detailed information on the characteristics, disease burden, and treatment patterns of people living with migraine is limited. The aim of this study was to compare clinical characteristics, disease burden, and treatment patterns in people with episodic migraine (EM) or chronic migraine (CM) using real-world data from clinical practice in Japan. Methods This was an analysis of data collected in 2014 by the Adelphi Migraine Disease Specific Programme, a cross-sectional survey of physicians and their consulting adult patients in Japan, using physician and patient questionnaires. We report patient demographics, prescribed treatment, work productivity, and quality-of-life data for people with CM (≥15 headache days/month) or EM (not fulfilling CM criteria). In descriptive analyses, continuous and categorical measures were assessed using t-tests and Chi-squared tests, respectively. Results Physicians provided data for 977 patients (mean age 44.5 years; 77.2% female; 94.5% with EM, 5.5% with CM). A total of 634/977 (64.9%) invited patients (600 with EM; 34 with CM) also provided data. Acute therapy was currently being prescribed in 93.7% and 100% of patients with EM and CM, respectively (p = 0.069); corresponding percentages for current preventive therapy prescriptions were 40.5% and 68.5% (p < 0.001). According to physicians who provided data, preventive therapy was used at least once by significantly fewer patients with EM than with CM (42.3% vs. 68.5%, respectively; p < 0.001). Among patients who provided physicians with information on issues with their current therapy (acute therapy: n = 668 with EM, n = 38 with CM; preventive therapy: n = 295 with EM, n = 21 with CM), lack of efficacy was the most frequently identified problem (acute therapy: EM 35.3%, CM 39.5% [p = 0.833]; preventive therapy: EM 35.3%, CM 52.4% [p = 0.131]). Moderate-to-severe headache-related disability (Migraine Disability Assessment total score ≥ 11) was reported by significantly fewer patients with EM than with CM (21.0% vs. 60.0%, respectively; p < 0.001) among patients who provided data. Conclusions Preventive treatment patterns in people with EM versus CM differ in Japan, with both types of migraine posing notable disease burdens. Our findings demonstrate that more effective migraine therapies are required to reduce the burden of the disease. Electronic supplementary material The online version of this article (10.1186/s10194-019-1012-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kaname Ueda
- , Eli Lilly Japan K.K., 5-1-28, Isogamidori, chuo-ku, Kobe-shi, 651-0086, Japan.
| | - Wenyu Ye
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Louise Lombard
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Atsushi Kuga
- , Eli Lilly Japan K.K., 5-1-28, Isogamidori, chuo-ku, Kobe-shi, 651-0086, Japan
| | - Yongin Kim
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Sarah Cotton
- Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK
| | - James Jackson
- Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK
| | - Tamas Treuer
- Lilly Hungária Kft, Madách Imre út 14, Budapest, 1075, Hungary
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Cotton S, Chen H, Wallace C, Jalloul R. 02: A county hospital experience with determining route of hysterectomy: can we safely increase the minimally invasive hysterectomy rate? Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wirta SB, Balas B, Proenca CC, Bailey H, Phillips Z, Jackson J, Cotton S. Perceptions of heart failure symptoms, disease severity, treatment decision-making, and side effects by patients and cardiologists: a multinational survey in a cardiology setting. Ther Clin Risk Manag 2018; 14:2265-2272. [PMID: 30532549 PMCID: PMC6247946 DOI: 10.2147/tcrm.s183200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Indexed: 01/14/2023] Open
Abstract
Purpose Explore the extent to which heart failure (HF) symptoms and side effects of HF treatment experienced by patients are recognized by cardiologists, and concordance between patient-cardiologist perceptions of HF severity and patients' contributions to treatment decision-making. Methods A multinational, cross-sectional survey of cardiologists and patients with HF was conducted. Patient-record forms (PRFs) were completed by cardiologists for consecutive consulting patients with HF, who completed a patient self-completion questionnaire (PSC). Responses from PRFs with an associated PSC were analyzed to compare patient- and cardiologist-reported occurrences of HF symptoms and treatment side effects, patient-perceived severity of HF and cardiologists' perceived risk of death within 12 months, and patient input into treatment decisions. Concordance was calculated as the number of response agreements between PSCs and PRFs for total number of matched pairs. Over- or underreporting of symptoms and side effects by cardiologists relative to patient-reported occurrences were calculated. Results Overall, 2,454 patient-cardiologist pairs were identified. High levels of concordance between matched pairs were observed for the occurrence of reported HF symptoms (93%), side effects (77%-98%) and degree of patient input into treatment decisions (74%); for perceived HF severity, concordance was 54%. Most symptoms (except dyspnea when active and fatigue/weakness, experienced by >50% of patients) were underreported by cardiologists. Of patients reporting to have been informed by their cardiologist that their HF was mild, 28% were perceived by their cardiologist to have a moderate-high/very high risk of death within 12 months. Treatment choice was not discussed with almost a third of patients. When discussed, 94% of patients (n=1,540) reported the cardiologist made the final decision. Cardiologists more often under- than overreported the occurrence of side effects reported by patients. Conclusion Improved patient-cardiologist dialogue and shared decision-making is required for optimizing patient care and outcomes in HF.
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Affiliation(s)
- Sara Bruce Wirta
- Real World Evidence, Cardio-Metabolic Franchise, Novartis Sweden, Stockholm, Sweden
| | - Bogdan Balas
- Real World Evidence, Cardio-Metabolic Franchise, Novartis Pharma, Basel, Switzerland
| | | | - Hollie Bailey
- Real World Research, Adelphi Real World, Bollington, UK,
| | - Zoe Phillips
- Real World Research, Adelphi Real World, Bollington, UK,
| | - James Jackson
- Real World Research, Adelphi Real World, Bollington, UK,
| | - Sarah Cotton
- Real World Research, Adelphi Real World, Bollington, UK,
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Faul A, D’Ambrosio J, Yankeelov P, Cotton S, Furman C, Hall-Faul M, Gordon B, Wright R. HUMAN FLOURISHING AS AN OUTCOME OF INTEGRATED PRIMARY CARE AND COMMUNITY BASED MODELS OF CARE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.439] [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)
- A Faul
- Institute for Sustainable Health & Optimal Aging, Louisville, KY
| | - J D’Ambrosio
- Institute for Sustainable Health & Optimal Aging, University of Louisville
| | - P Yankeelov
- Institute for Sustainable Health & Optimal Aging, University of Louisville
| | - S Cotton
- Institute for Sustainable Health & Optimal Aging, University of Louisville
| | - C Furman
- Institute for Sustainable Health & Optimal Aging, University of Louisville
| | - M Hall-Faul
- KIPDA Area Agency on Aging and Independent Living
| | - B Gordon
- KIPDA Area Agency on Aging and Independent Living
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Ford JH, Jackson J, Milligan G, Cotton S, Ahl J, Aurora SK. A Real-World Analysis of Migraine: A Cross-Sectional Study of Disease Burden and Treatment Patterns. Headache 2017; 57:1532-1544. [PMID: 28984356 DOI: 10.1111/head.13202] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this cross-sectional study was to assess the sociodemographics, disease burden, and treatment patterns of patients with episodic and chronic migraine in the United States. BACKGROUND Migraine is a disabling neurological disease that places an enormous burden on patients. METHODS Data were drawn from the Adelphi Migraine United States Disease Specific Programme (index period: January to March 2014). Physicians (N = 150) completed a patient report form on 10 consulting patients with migraine. Episodic migraineurs had ≤14 headache days per month (HDM) and those with chronic migraine had ≥15. Headache-related disability was assessed with the Migraine Disability Assessment (MIDAS) questionnaire. Disability was also compared across subgroups based on the number of HDM (≤3, 4-7, 8-14, and ≥15). RESULTS A total of 1487 patient report forms were completed. Over 70% of the patients were female, 90.8% (n = 1350) were episodic migraineurs, and 9.2% (n = 137) were chronic migraineurs. Acute treatment was prescribed for >90% of the patients, and >50% had a current prescription for preventive treatment. Despite taking acute and/or preventive treatment, 29.2% of episodic migraineurs (including some patients with ≤3 headache days/month) and 73.2% of chronic migraineurs had moderate-to-severe headache-related disability (MIDAS total score ≥11). Preventive treatment was discontinued/switched at least once by 26.4% of episodic migraineurs and by 53.3% of chronic migraineurs. Of those patients (n = 382) who gave collective reasons for discontinuation/switching preventive treatment, over 70% selected lack of efficacy and tolerability/safety. CONCLUSIONS This real-world analysis provides additional support for the unmet medical need for efficacious therapies that reduce migraine frequency and severity, headache-related disability, and have better tolerability for patients with migraine. In addition, further research is needed to better understand the burden of illness among patients with lower migraine frequency, and to implement treatment strategies to prevent progression of the disease.
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Affiliation(s)
| | | | | | - Sarah Cotton
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - Jonna Ahl
- Eli Lilly and Company, Indianapolis, IN, USA
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Munro A, Gillespie C, Cotton S, Busby-Earle C, Kavanagh K, Cuschieri K, Cubie H, Robertson C, Smart L, Pollock K, Moore C, Palmer T, Cruickshank ME. The impact of human papillomavirus type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme: a two-centre observational study. BJOG 2017; 124:1394-1401. [PMID: 28102931 DOI: 10.1111/1471-0528.14563] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether human papillomavirus (HPV) immunisation has affected the prevalence of HPV genotypes and colposcopic features of cervical intraepithelial neoplasia (CIN) in young women referred for colposcopy. DESIGN A two-centre observational study including vaccinated and unvaccinated women. SETTING Colposcopy clinics serving two health regions in Scotland, UK. POPULATION A total of 361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening. METHODS Cervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16, 18, 31, 33, and 45. Demographic data, cytology, and histology results and colposcopic features were recorded. Chi-square analysis was conducted to identify associations between vaccine status, HPV genotypes, and colposcopic features. MAIN OUTCOME MEASURES Colposcopic features, HPV genotypes, mRNA expression, and cervical histology. RESULTS The prevalence of HPV 16 was significantly lower in the vaccinated group (8.6%) compared with the unvaccinated group (46.7%) (P = 0.001). The number of cases of CIN2+ was significantly lower in women who had been vaccinated (P = 0.006). The HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features, but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+, from 74% (unvaccinated) to 66.7% (vaccinated). CONCLUSIONS In this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in women who have been vaccinated is at the lower acceptable level of the UK national cervical screening programme guidelines. TWEETABLE ABSTRACT Reduction of hrHPV positivity and CIN in immunised women consistent with lower PPV of colposcopy for CIN2+.
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Affiliation(s)
- A Munro
- University of Aberdeen, Aberdeen, UK
| | | | - S Cotton
- University of Aberdeen, Aberdeen, UK
| | | | | | - K Cuschieri
- Scottish Human Papillomavirus Reference Laboratory, Edinburgh, UK
| | - H Cubie
- Scottish Human Papillomavirus Reference Laboratory, Edinburgh, UK
| | | | | | - K Pollock
- Health Protection Scotland, Glasgow, UK
| | - C Moore
- Scottish Human Papillomavirus Reference Laboratory, Edinburgh, UK
| | - T Palmer
- University of Edinburgh, Edinburgh, UK
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Yates N, Stanger S, Wilding R, Cotton S. Approaches to assessing and minimizing blood wastage in the hospital and blood supply chain. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Yates
- Cranfield School of Management; Bedford UK
| | - S. Stanger
- Cranfield School of Management; Bedford UK
| | - R. Wilding
- Cranfield School of Management; Bedford UK
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Devereux G, Steele S, Griffiths K, Cotton S, Fraser-Pitt D, Devlin E, Chrystyn H, Norrie J, O'Neil D. 141 An open label investigation of the tolerability and pharmacokinetics of oral cysteamine in adults with cystic fibrosis. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30318-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, Macleod U, Mitchell ED, Pickett M, Rai T, Shaw K, Stuart N, Tørring ML, Wilkinson C, Williams B, Williams N, Emery J. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015; 112 Suppl 1:S92-107. [PMID: 25734382 PMCID: PMC4385982 DOI: 10.1038/bjc.2015.48] [Citation(s) in RCA: 614] [Impact Index Per Article: 68.2] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. METHODS Systematic review of the literature and narrative synthesis. RESULTS We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. CONCLUSIONS This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
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Affiliation(s)
- R D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - P Tharmanathan
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - B France
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - N U Din
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - S Cotton
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - J Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - W Hamilton
- University of Exeter Medical School, Exeter EX1 2LU, UK
| | - A Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - M Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - R Lewis
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - U Macleod
- Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - E D Mitchell
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - M Pickett
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - T Rai
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - K Shaw
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Stuart
- School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK
| | - M L Tørring
- Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark
| | - C Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - B Williams
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - J Emery
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia
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Cotton AJ, Cotton S, Small J, Pomiankowski A. Male mate preference for female eyespan and fecundity in the stalk-eyed fly, Teleopsis dalmanni. Behav Ecol 2014. [DOI: 10.1093/beheco/aru192] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cotton AJ, Földvári M, Cotton S, Pomiankowski A. Male eyespan size is associated with meiotic drive in wild stalk-eyed flies (Teleopsis dalmanni). Heredity (Edinb) 2014; 112:363-9. [PMID: 24398884 PMCID: PMC3966131 DOI: 10.1038/hdy.2013.131] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/15/2013] [Accepted: 10/24/2013] [Indexed: 11/30/2022] Open
Abstract
This study provides the first direct evidence from wild populations of stalk-eyed flies
to support the hypothesis that male eyespan is a signal of meiotic drive. Several
stalk-eyed fly species are known to exhibit X-linked meiotic drive. A recent quantitative
trait locus analysis in Teleopsis dalmanni found a potential link between
variation in male eyespan, a sexually selected ornamental trait, and the presence of
meiotic drive. This was based on laboratory populations subject to artificial selection
for male eyespan. In this study, we examined the association between microsatellite
markers and levels of sex ratio bias (meiotic drive) in 12 wild T. dalmanni
populations. We collected two data sets: (a) brood sex ratios of wild-caught males mated
to standard laboratory females and (b) variation in a range of phenotypic traits
associated with reproductive success of wild-caught males and females. In each case, we
typed individuals for eight X-linked microsatellite markers, including several that
previously were shown to be associated with male eyespan and meiotic drive. We found that
one microsatellite marker was very strongly associated with meiotic drive, whereas a
second showed a weaker association. We also found that, using both independent data sets,
meiotic drive was strongly associated with male eyespan, with smaller eyespan males being
associated with more female-biased broods. These results suggest that mate preference for
exaggerated male eyespan allows females to avoid mating with males carrying the meiotic
drive gene and is thus a potential mechanism for the maintenance and evolution of female
mate preference.
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Affiliation(s)
- A J Cotton
- 1] Department of Genetics, Evolution and Environment, University College London, London, UK [2] CoMPLEX, University College London, London, UK
| | - M Földvári
- 1] Department of Genetics, Evolution and Environment, University College London, London, UK [2] MTA-DE 'Lendület' Behavioural Ecology Research Group, Department of Evolutionary Zoology, University of Debrecen, 1, Egyetem tér, Debrecen, Hungary
| | - S Cotton
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | - A Pomiankowski
- 1] Department of Genetics, Evolution and Environment, University College London, London, UK [2] CoMPLEX, University College London, London, UK
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Schimmelmann B, Conus P, Cotton S, Kupferschmid S, McGorry P, Lambert M. Prevalence and impact of cannabis use disorders in adolescents with early onset first episode psychosis. Eur Psychiatry 2012; 27:463-9. [DOI: 10.1016/j.eurpsy.2011.03.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 02/08/2011] [Accepted: 03/06/2011] [Indexed: 11/28/2022] Open
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Luberto C, Cotton S, Yi M, Tsevat J. P04.01. Complementary and alternative medicine use and health outcomes among urban adolescents with asthma. BMC Complement Altern Med 2012. [PMCID: PMC3373669 DOI: 10.1186/1472-6882-12-s1-p271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
During 2009/2010 loss of platelets within NHS Blood and Transplant (NHSBT) due to time expiry was 9.3%. Hospitals remain reluctant to hold stocks of platelets due to the poor shelf life at issue. The purpose of this study was to identify areas for time compression in the apheresis platelet supply chain to extend the shelf life available for hospitals and reduce wastage in NHSBT. This was done within the context of NHSBT reconfiguring their supply chain and moving towards a consolidated and centralised approach. Time based process mapping was applied to identify value and non-value adding time in two manufacturing models. A large amount of the non-value adding time in the apheresis platelet supply chain is due to transportation and waiting for the next process in the manufacturing process to take place. Time based process mapping provides an effective 'lens' for supply chain professionals to identify opportunities for improvement in the platelet supply chain.
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Affiliation(s)
- R Wilding
- Cranfield School of Management, Centre for Logistics and Supply Chain Management, Cranfield, Bedford, UK.
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Sharp L, Cotton S, Thornton A, Gray N, Whynes D, Smart L, Waugh N, Duncan I, Cruickshank M, Little J. Which women default from follow-up cervical cytology tests? A cohort study within the TOMBOLA trial. Cytopathology 2011; 23:150-60. [PMID: 21366734 DOI: 10.1111/j.1365-2303.2011.00848.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify factors associated with default from follow-up cervical cytology tests. METHODS A cohort study was conducted involving 2166 women, aged 20-59, with recent low-grade cervical cytology taken within the NHS Cervical Screening Programmes in Scotland and England, and managed by 6-monthly cytology in primary care. For the first (6-month) and second (12-month) surveillance cytology tests separately, women were categorized as 'on-time attendees' (attended ≤6 months of test being due), 'late attendees' (attended greater than 6 months after test was due) or 'non-attendees' (failed to attend). Multivariate odds ratios (ORs) were computed for factors associated with late and non-attendance. RESULTS For the first surveillance test, risk of non-attendance was significantly higher in younger women, those without post-secondary education, and non-users of prescribed contraception. Factors significantly associated with late attendance for the first test were the same as for non-attendance, plus current smoking and having children. The most important predictor of non-attendance for the second surveillance test was late attendance for the first test (OR = 9.65; 95% CI, 6.60-16.62). Non-attendance for the second test was also significantly higher among women who were younger, smokers and had negative cytology on the first surveillance test. Late attendance for the second surveillance test was higher in women who were younger, smokers, had children and attended late for the first test. CONCLUSIONS Women at highest risk of default from follow-up cytology tend to be young, smoke, lack post-secondary education, and have defaulted from a previous surveillance appointment. Tackling default will require development of targeted strategies to encourage attendance and research to better understand the reasons underpinning default.
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Affiliation(s)
- L Sharp
- National Cancer Registry Ireland, Cork, Ireland.
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Schimmelmann B, Kupferschmid S, Conus P, Cotton S, McGorry P, Lambert M. Cannabis use disorders and age at onset of psychosis in 606 patients with first episode psychosis. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73204-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BackgroundAge at onset of psychosis (AAO) may be younger in patients with cannabis use disorders (CUD) compared to those without CUD (NCUD). Most previous studies did not control for potential confounders, did not report effect sizes and included mostly adult patients from non-representative samples.MethodsControlling for relevant confounders, differences in AAO between patients with and without lifetime CUD were analysed in a large epidemiologically based cohort of 606 first-episode psychosis (FEP) patients (age 14 to 29 years) admitted within three years to the Melbourne Early Psychosis Prevention and Intervention Centre. Data were collected from medical files using a standardized scale.ResultsOverall, AAO was not significantly different in CUD (n = 449; 74.1%) compared to NCUD, neither univariate nor when controlling for gender and premorbid functioning. However, AAO was younger in those with early CUD (starting before age 14) compared to NCUD (F(1) = 11.3; p = 0.001; partial η2 = 0.042). When considering the subgroups of early versus late onset psychosis, AAO was even later in early onset psychosis patients with CUD compared to those with NCUD (F(1) = 8.4; p = 0.004; partial η2 = 0.072). These findings were consistent for patients with non-affective psychoses, in those with CUD without other substance use disorders and in those with CUD explicitly starting in the pre-psychotic phase. Notably, 89.1% started cannabis before the onset of psychotic symptoms.ConclusionsCUD starting before age 14 was associated with an earlier AAO at a small effect size, but only in adult onset FEP patients.
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Schimmelmann B, Cotton S, Conus P, Kupferschmid S, McGorry P, Lambert M. P01-345-Prevalence and impact of cannabis use disorders in adolescents with early onset first episode psychosis. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72056-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
ObjectivePrevious studies on the impact of cannabis use disorders (CU) on outcome in psychosis were mostly based on non-representative samples, have often not controlled for confounders and rarely focused on adolescents. Thus, the aims of the present study were to assess;(i) prevalence of CU;(ii) pre-treatment and baseline differences between CU and those without CU (NCU); and(iii) the impact of baseline and course of CU on 18-month outcomes in a representative cohort of adolescents with early onset first episode psychosis (EOP).MethodThe sample comprised 99 adolescents (age 14 to 18) with EOP (onset age 14 to 17), admitted to the Early Psychosis Prevention and Intervention Centre in Australia. Data were collected from medical files using a standardized questionnaire.ResultsPrevalence of lifetime CU was 65.7%, baseline CU 53.5%, and persistent CU 26.3%. Baseline CU compared to NCU was associated with higher illness-severity, lower functioning, less insight, lower premorbid functioning and longer duration of untreated psychosis. Compared to both NCU and those who decreased or stopped CU during treatment, only persistent CU was linked to worse outcomes and more service disengagement. Effect sizes were medium controlling for relevant confounders. Medication non-adherence did not explain the link between persistent CU and worse outcome.ConclusionsThe prevalence of CU in adolescents with EOP is high, while only persistent CU use was associated with worse outcome with medium effect sizes. Specific needs of adolescent patients with respect to cannabis interventions within integrated care settings should be addressed in future studies.
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Devine DV, Sher GD, Reesink HW, Panzer S, Hetzel PAS, Wong JK, Horvath M, Leitner GC, Schennach H, Nussbaumer W, Genoe K, Cioffi JM, Givisiez FN, Rogerson M, Howe D, Delage G, Sarappa C, Fu Y, Sarlija D, Vuk T, Strauss Patko M, Balija M, Jukić I, Ali A, Auvinen MK, Jaakonsalo E, Cazenave JP, Waller C, Kientz D, David B, Walther-Wenke G, Heiden M, Lin CK, Tsoi WC, Lee CK, Barotine-Toth K, Sawant RB, Murphy W, Quirke B, Bowler P, Shinar E, Yahalom V, Aprili G, Piccoli P, Gandini G, Tadokaro K, Nadarajan VS, de Kort W, Jansen N, Flanagan P, Forsberg PO, Hervig T, Letowska M, Lachert E, Dudziak K, Antoniewicz-Papis J, de Olim G, Nascimento F, Hindawi S, Teo D, Reddy R, Scholtz J, Swanevelder R, Rovira LP, Sauleda S, Carasa MAV, Vaquero MP, Ania MA, Gulliksson H, Holdsworth S, Cotton S, Howell C, Baldwin C, Cusick RM, Geele GA, Paden C, McEvoy P, Gottschall JL, McLaughlin LS, Benjamin RJ, Eder A, Draper NL, AuBuchon JP, León de González G. Inventory management. Vox Sang 2010; 98:e295-363. [PMID: 20432515 DOI: 10.1111/j.1423-0410.2009.01252.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.
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Cotton S, Sharp L, Little J, Cruickshank M, Seth R, Smart L, Duncan I, Harrild K, Neal K, Waugh N. The role of human papillomavirus testing in the management of women with low-grade abnormalities: multicentre randomised controlled trial. BJOG 2010; 117:645-59. [PMID: 20374607 DOI: 10.1111/j.1471-0528.2010.02519.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the value of a single human papillomavirus (HPV) test in making decisions on management of women with cervical cytology showing borderline nuclear abnormality (BNA) or mild dyskaryosis. In particular, to determine whether information on high-risk (hr) HPV status would be valuable in the choice between (1) cytological surveillance versus immediate referral to colposcopy, and (2) at colposcopy, between biopsy and recall versus immediate large loop excision of the transformation zone (LLETZ). DESIGN Multicentre individually randomised controlled trial, nested within the NHS Cervical Screening Programmes, investigating the value of HPV testing by testing for interactions between HPV status and (1) cytological surveillance versus colposcopy, and (2) biopsy and recall versus immediate LLETZ. Setting Grampian, Tayside and Nottingham. Population Women (n = 4439), aged 20-59 years, with a cytology test showing borderline nuclear abnormalities or mild dyskaryosis during October 1999 to October 2002. METHODS High-risk HPV status was determined at recruitment using the polymerase chain reaction assay with the GP5+/6+ general primer system. The results of this HPV testing were not disclosed to either the participating women or to those involved in their management. Women were randomised to either (1) 6-monthly cytological screening in primary care or (2) referral for colposcopy. Human papillomavirus status was used to stratify both randomisations. All women were followed for 3 years, concluding with an invitation to an exit appointment at which colposcopic examination was undertaken. In addition, in women who were randomised to initial colposcopy and underwent colposcopy, the association between hrHPV status and presence of cervical intraepithelial neoplasia (CIN) grade 2 or more severe disease (henceforth CIN2 or worse) was examined. MAIN OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive values of the HPV test for predicting CIN2 or worse and the implications for the choice of management between cytological surveillance and immediate referral for colposcopy. RESULTS There were no significant interactions between management and HPV status. Hence, in women with mild dyskaryosis or BNA who are HPV positive, there is no advantage of (1) immediate colposcopy over cytological surveillance (P = 0.76) or (2) immediate LLETZ over biopsy and recall (P = 0.27). The sensitivity of HPV testing for detection of CIN2 or worse was 75.2% (95% CI 68.8-81.0%) among women with mild dyskaryosis and 69.9% (95% CI 61.7-77.3%) among those with BNA. Specificity was higher in those with BNA (71.3%; 95% CI 68.5-74.1%) than in those with mild dyskaryosis (46.9%; 95% CI 42.2-51.6%). Sensitivity decreased with increasing age whereas specificity increased. The negative predictive value was high, particularly among women with BNA (94.5%; 95% CI 92.9-96.0%). Across all ages, 22% of women who had CIN2 or worse were HPV negative. Conversely, 40% of those who were HPV positive did not have CIN. HPV was a much more reliable predictor in women aged over 40 years. CONCLUSIONS We conclude that in younger women with low-grade cytological abnormalities, a single HPV test would not be useful in determining who should be referred for colposcopy or the most effective management at colposcopy. In women over 40, a negative HPV test could be used to rule out further investigation.
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Affiliation(s)
- S Cotton
- Department of Public Health, University of Aberdeen, Aberdeen, UK
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Conus P, Cotton S, Benno S, Michael B, Rothanty D, McGorry P, Lambert M. PW01-07 - Correlates of past sexual and physical trauma in 118 bipolar I patients with a first episode of psychotic mania. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Conus P, Ward J, Cotton S, Yung A, Berk M, McGorry P. S05-04 - Conceptual aspects and recent data on the prodrome to first episode mania. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cotton S, Smart L. O-1 Results from TOMBOLA (trial of management of borderline and other low-grade abnormal smears). Cytopathology 2007. [DOI: 10.1111/j.1365-2303.2007.00500_1.x] [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: 11/27/2022]
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Cotton S, Hearnshaw K, Qureshi H, Prangnell D, Bailey C. P46 Sharing Information Via a Regional Web Site. Transfus Med 2006. [DOI: 10.1111/j.1365-3148.2006.00694_46.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Spectrophotometric intracutaneous analysis (SIAscopy) is a light-based imaging system capable of producing rapid images of melanin, blood and collagen of the skin. Although the SIAscope has been investigated for melanoma diagnosis, no formal study has been conducted to determine its use in the diagnosis of nonmelanoma skin cancer (NMSC). OBJECTIVES A prospective study was conducted to investigate the potential for the SIAscope to diagnose NMSC. METHODS In total, 302 consecutive patients were recruited into the study, 363 lesions being scanned. Logistic regression analysis was used to construct a predictive model for NMSC diagnosis and receiver-operator characteristic curves were used to assess overall accuracy of the model. RESULTS A sensitivity of 98.0%, specificity of 95.7% and overall accuracy of 98.2% was found for NMSC diagnosis by the SIAscope model. CONCLUSIONS Results suggest that the SIAscope may be a useful adjunct in the diagnosis of NMSC.
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Affiliation(s)
- H Tehrani
- Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
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Abstract
Stalk-eyed flies are exemplars of sexual selection leading to the evolution of exaggerated male ornaments (eyespan). In Sphyracephala beccarri, there is no evidence for female mate choice for exaggerated male eyespan and only minor sex differences in eyespan. We used S. beccarri to test whether heightened condition dependence only evolves when male eyespan becomes sexually exaggerated. Male eyespan showed heightened condition dependence under food stress compared with a control trait (wing length). However, female eyespan displayed a similar pattern and there was no sex difference in the degree of increased eyespan sensitivity. The finding that eyespan is a sensitive indicator of food stress, even in an unexaggerated state, suggests that this may have acted as a pre-adaptation to the role of eyespan in sexual signalling in other Diopsid species. These results are consistent with handicap theory and Fisher's view of how sexual selection is initiated.
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Affiliation(s)
- S Cotton
- The Galton Laboratory, Department of Biology, University College London, London, UK
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Ramsey D, Cotton S, Lawrence E, Semple M, Worth P, Petrie A, Stone T, Darlington L. Clotting Factors in Patients with Acute and Chronic Gout. J of Medical Sciences 2004. [DOI: 10.3923/jms.2005.47.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
STUDY OBJECTIVE Oral contraceptive pills (OCs) are a commonly prescribed method of birth control for sexually experienced adolescents. The purpose of the current study was to describe anticipated parental involvement and adolescent compliance with pill taking, and to describe experiences with a 20-mcg OC regarding satisfaction and side effects after six cycles. DESIGN Anticipated parental involvement and anticipated compliance, and experiences with an OC, were assessed at baseline, and after the first and sixth cycles during a clinical trial of oral contraceptives, which required parental consent. SETTING Three adolescent medicine clinics in New York, NY; Cincinnati, OH; and San Juan, Puerto Rico. PARTICIPANTS The sample consisted of 43 female adolescents with a mean age of 17 years. RESULTS The majority of adolescents living with a parent anticipated parental involvement, and few adolescents anticipated difficulties with consistent pill taking. For two side effects (weight and mood changes), more than 30% of the adolescents anticipated the occurrence or worsening of side effects. However, few adolescents actually experienced increases in any of the nine side effects assessed. Ninety-seven percent of adolescents in this trial reported being satisfied with a 20-mcg OC. CONCLUSIONS Health care providers can assess adolescents' anticipated difficulties with compliance with daily pill taking, and desire for help from their parents. This information can be incorporated into counseling to promote consistent and correct use.
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Affiliation(s)
- S L Rosenthal
- Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA.
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