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Ken-Dror G, Ajami I, Han TS, Aurelius T, Maheshwari A, Hail HA, Deleu D, Sharma SD, Amlani S, Gunathilagan G, Cohen DL, Rajkumar C, Maguire S, Ispoglou S, Balogun I, Parry A, Sekaran L, Syed H, Lawrence E, Singh R, Hassan A, Wharton C, Javaid K, Goorah N, Carr P, Abdus Sami E, Ali M, Hussein HA, Osman Abuzaid H, Sharif K, Ram Sharma S, Sylaja PN, Yousef Khan F, Prasad K, Sharma P. Diabetes mellitus and obesity among South Asians with ischemic stroke across three countries. Int J Stroke 2024; 19:235-243. [PMID: 37706299 PMCID: PMC10811966 DOI: 10.1177/17474930231203149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Diabetes mellitus and central obesity are more common among South Asian populations than among White British people. This study explores the differences in diabetes and obesity in South Asians with stroke living in the United Kingdom, India, and Qatar compared with White British stroke patients. METHODS The study included the UK, Indian, and Qatari arms of the ongoing large Bio-Repository of DNA in Stroke (BRAINS) international prospective hospital-based study for South Asian stroke. BRAINS includes 4580 South Asian and White British recruits from UK, Indian, and Qatar sites with first-ever ischemic stroke. RESULTS The study population comprises 1751 White British (WB) UK residents, 1165 British South Asians (BSA), 1096 South Asians in India (ISA), and 568 South Asians in Qatar (QSA). ISA, BSA, and QSA South Asians suffered from higher prevalence of diabetes compared with WB by 14.5% (ISA: 95% confidence interval (CI) = 18.6-33.0, p < 0.001), 31.7% (BSA: 95% CI = 35.1-50.2, p < 0.001), and 32.7% (QSA: 95% CI = 28.1-37.3, p < 0.001), respectively. Although WB had the highest prevalence of body mass index (BMI) above 27 kg/m2 compared with South Asian patients (37% vs 21%, p < 0.001), South Asian patients had a higher waist circumference than WB (94.8 cm vs 90.8 cm, p < 0.001). Adjusting for traditional stroke risk factors, ISA, BSA, and QSA continued to display an increased risk of diabetes compared with WB by 3.28 (95% CI: 2.53-4.25, p < 0.001), 3.61 (95% CI: 2.90-4.51, p < 0.001), and 5.24 (95% CI: 3.93-7.00, p < 0.001), respectively. CONCLUSION South Asian ischemic stroke patients living in Britain and Qatar have a near 3.5-fold risk of diabetes compared with White British stroke patients. Their body composition may partly help explain that increased risk. These findings have important implications for public health policymakers in nations with large South Asian populations.
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Affiliation(s)
- Gie Ken-Dror
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Intisar Ajami
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Thang S Han
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
- Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK
| | - Taylor Aurelius
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Ankita Maheshwari
- Departments of Neurology, All India Institute of Medical Sciences, New Delhi & Rajendra Institute of Medical Sciences, Ranchi, India
| | | | - Dirk Deleu
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sapna D Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Sageet Amlani
- BARTS and the London NHS Trust, Royal London Hospital, London, UK
| | | | | | - Chakravarthi Rajkumar
- Brighton and Sussex University Hospitals NHS Trust & Brighton and Sussex Medical School, University of Sussex, Sussex, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Peter Carr
- Birmingham Heartlands Hospital, West Midlands, UK
| | | | - Musab Ali
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Shri Ram Sharma
- North Eastern Indira Gandhi Regional Institute for Health and Medical Sciences, Shillong, Meghalaya, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Kameshwar Prasad
- Departments of Neurology, All India Institute of Medical Sciences, New Delhi & Rajendra Institute of Medical Sciences, Ranchi, India
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
- Ashford and St Peter's NHS Foundation Trust, Surrey, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
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O'Farrell R, Maguire S, Moore L, Murray K, Gorman A, Ball E, Riddell C, O'Neill M, Jordan N, O'Shea F, Veale D, Donnelly S, Murphy G, Fitzgerald G. Delivering Care for Pregnant Women with Rheumatic and Musculoskeletal Diseases. Ir Med J 2024; 117:894. [PMID: 38259237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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Bryant E, Koemel N, Martenstyn J, Marks P, Hickie I, Maguire S. Mortality and mental health funding-do the dollars add up? Eating disorder research funding in Australia from 2009 to 2021: a portfolio analysis. Lancet Reg Health West Pac 2023; 37:100786. [PMID: 37693868 PMCID: PMC10485676 DOI: 10.1016/j.lanwpc.2023.100786] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/01/2023] [Accepted: 04/25/2023] [Indexed: 09/12/2023]
Abstract
Background Eating Disorders (EDs) are among the deadliest of the mental disorders and carry a sizeable public health burden, however their research and treatment is consistently underfunded, contributing to protracted illness and ongoing paucity of treatment innovation. Methods We compare absolute levels and growth rates of Australian mental health research funding by illness group for the years 2009-2021, with a specific focus on eating disorders analysed at the portfolio level. Findings Actual and adjusted data obtained from Australia's three national medical research funding bodies (NHMRC, ARC and MRFF) shows eating disorders receive a disproportionately low allocation of mental health research funding despite having amongst the highest mortality rates. Forty-one category one research grants totalling $AUD28.1 million were funded for eating disorders over the period. When adjusted for inflation, this equates to $2.05 per affected individual, compared with $19.56 for depression, $32.11 for autism, and $176.19 for schizophrenia. Half of all research funded for eating disorders was 'basic' research (e.g., illness underpinning), with little investment in the development of innovative treatment models, novel therapeutics or translation, well reflected by recovery rates of less than 50% in individuals with Anorexia Nervosa. Interpretation Significant discrepancy remains between research funding dollars and disease burden associated with the mental health disorders. The extent to which eating disorders are underfunded may in part be attributable to inaccuracies in epidemiological and burden of disease data. Funding This work was in-part funded by the Australian Government Department of Health and the National Eating Disorder Research & Translation Strategy. The funder was not directly involved in informing the development of the current study.
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Affiliation(s)
- E. Bryant
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
| | - N. Koemel
- The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - J.A. Martenstyn
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
- School of Psychology, Faculty of Science, University of Sydney, Australia
| | - P. Marks
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
| | - I. Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - S. Maguire
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
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Davison J, Maguire S, McLaughlin M, Simms V, Bunting B. Exploring the psychometric properties of the Intellectual Disability versions of the Short Warwick-Edinburgh Mental Wellbeing Scale and Kidscreen10, self-reported by adolescents with intellectual disability. J Intellect Disabil Res 2023; 67:415-426. [PMID: 36785874 DOI: 10.1111/jir.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There are no validated self-report measures that can be used to assess health and wellbeing in adolescents with intellectual disability (ID). METHOD The aim of this study was to explore the psychometric properties of two newly adapted self-report health-related quality of life (HRQoL) and mental wellbeing measures: the Intellectual Disability versions of the Short Warwick-Edinburgh Mental Wellbeing Scale (ID-SWEMWBS) and Kidscreen10 (ID-Kidscreen10). For this, we used data from a sample of 427 adolescents (aged 11-19) with ID recruited from special school settings. RESULTS Confirmatory factor analysis (CFA) was conducted to validate the factor structure of both measures. Internal consistency was assessed using Cronbach's alpha and test-retest reliability was analysed using intra-class correlation coefficients. The internal consistency measured using Cronbach's alpha was found to be in the range of 0.70-0.78, test-retest reliabilities were expressed using intra-class correlation coefficients that were found to be high for both measures (ID-SWEMWBS, 0.758; ID-Kidscreen10, 0.723), and the CFA supported the unidimensional structure of both measures. CONCLUSIONS The results of this study indicate that the ID-SWEMWBS and ID-Kidscreen10 have very good psychometric properties and can be used as self-report measures to assess HRQoL and mental wellbeing in adolescents with ID.
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Affiliation(s)
- J Davison
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK
| | - S Maguire
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK
| | - M McLaughlin
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK
| | - V Simms
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK
| | - B Bunting
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK
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Bryant E, Touyz S, Maguire S. Public perceptions of people with eating disorders: Commentary on results from the 2022 Australian national survey of mental health-related stigma and discrimination. J Eat Disord 2023; 11:62. [PMID: 37062849 PMCID: PMC10108519 DOI: 10.1186/s40337-023-00786-z] [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: 11/22/2022] [Accepted: 04/12/2023] [Indexed: 04/18/2023] Open
Abstract
Mental illness is highly prevalent in the community. As such, significant attention has been paid in recent years to raising awareness of the mental health disorders (including eating disorders). This includes efforts to normalise help-seeking, campaigns to reduce stigma and discrimination, targeted research funding and advocacy for improved and accessible mental health service provision. But have these initiatives changed public attitude? The 2022 National Survey of Mental Health-Related Stigma and Discrimination is the first of four national surveys canvassing the general public's perceptions of people with mental health disorders (including stigmatising and discriminatory beliefs) conducted since 1995 to include eating disorders. It finds significant prejudice against those with mental health disorders still exists within the community, particularly among younger Australians. For eating disorders, this is primarily related to attributions of blame and personal weakness. Findings from the survey are discussed in this commentary.
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Affiliation(s)
- E Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.
| | - S Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - S Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
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Maguire S, Wilson F, Gallagher P, O'Shea FD. Worse scores but similar patterns of disease activity: interpreting outcomes in women with axial spondyloarthropathy. Scand J Rheumatol 2023; 52:142-149. [PMID: 35048786 DOI: 10.1080/03009742.2021.2007609] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of sex on disease activity in axial spondylitis (axSpA). METHOD Data were extracted from the Ankylosing Spondylitis Registry of Ireland (ASRI). In this cross-sectional study, patients were analysed on the basis of sex, with a series of comparison analyses performed. RESULTS Overall, 886 participants were enrolled in the ASRI [232 (26.2%) women, 644 (72.6%) men]. Females recorded significantly worse Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (4.57 vs 3.83, p < 0.01) and Ankylosing Spondylitis Quality of Life questionnaire (ASQoL) (7.51 vs 6.12, p < 0.01) scores than males. There was a stronger correlation in the Bath Ankylosing Spondylitis Functional and Metrology Indices (BASFI and BASMI) in females (rs = 0.619, p < 0.01) than in males (rs = 0.572, p < 0.01). Analysis of factors in BASDAI revealed that the higher total scores in females compared to males were due not to any single component, but to worse scores in all six components of the BASDAI combined. Ranking of components by severity between sexes revealed identical ranking in four of the six components of the BASDAI. CONCLUSIONS Women with axSpA reported significantly worse disease activity, quality of life, and functional ability than men. However, the BASDAI capturedsimilar patterns of disease activity. Limitation of spinal mobility in women with axSpA corresponded to greater impairment in functional ability. Further evaluation of disease monitoring tools is required to ensure that disease activity is accurately captured in men and women with axSpA.
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Affiliation(s)
- S Maguire
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - F Wilson
- Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - P Gallagher
- Department of Rheumatology, St Vincent's Hospital, Dublin, Ireland
| | - F D O'Shea
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
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Aurelius T, Ken-Dror G, Sharma SD, Amlani S, Gunathilagan G, Cohen DL, Rajkumar C, Maguire S, Ispoglou S, Balogun I, Parry A, Sekaran L, Syed H, Lawrence E, Singh R, Hassan A, Wharton C, Javaid K, Goorah N, Carr P, Abdus Sami E, Sharma P. Atrial fibrillation in UK South Asian hospitalized ischemic stroke patients: The BRAINS study. PLoS One 2023; 18:e0281014. [PMID: 36749768 PMCID: PMC9904493 DOI: 10.1371/journal.pone.0281014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION South Asian diaspora comprise one of the largest ethnic minority groups in the world yet data about atrial fibrillation (AF) in this demographic is understudied. Our aim is to identify differences in AF prevalence and treatment between South Asians and white British stroke patients. METHOD The UK arm of a prospective ongoing large international repository on stroke was analysed. Ethnic differences in AF prevalence and management in those with ischemic stroke were analysed. RESULTS Of the 3515 individuals recruited with ischemic stroke, 1482 (men: 972, women: 510) were South Asian and 2033 (men:1141, women:892) of white British ethnicity. AF was present in 462 white British and 193 South Asians stroke patients, with South Asians displaying a lower prevalence of AF (South Asians: 13.0% vs white British 22.7%, P<0.001). Despite adjustment for traditional AF risk factors, South Asians had a significantly lower OR of AF compared to white British stroke patients (OR: 0.40, 95%CI: 0.33:0.49, P<0.001). Among confirmed AF cases, 31.8% of South Asians and 41.4% of white British were untreated at admission (P = 0.02). Antiplatelet treatment was significantly higher among South Asians at both admission (South Asian: 47.4% vs. white British: 29.9%, P<0.001) and discharge (South Asian: 49.5% vs. white British: 34.7%, P = 0.001), although anticoagulation treatment was similar across both ethnic groups at admission (South Asian: 28.5% vs white British: 28.1%, P = 0.93), and discharge (South Asian: 45.1% vs white British: 43.1%, P = 0.64). CONCLUSION Stroke patients of South Asian descent are at significantly lower risk of AF but more likely to be on antiplatelet treatment compared to their white British counterparts.
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Affiliation(s)
- Taylor Aurelius
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, United Kingdom
| | - Gie Ken-Dror
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, United Kingdom
| | - Sapna D. Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, United Kingdom
| | - Sageet Amlani
- BARTS and the London NHS Trust/ Royal London Hospital, London, United Kingdom
| | | | | | - Chakravarthi Rajkumar
- Brighton and Sussex University Hospitals NHS Trust & Brighton and Sussex Medical School, University of Sussex, Sussex, United Kingdom
| | - Stuart Maguire
- Bradford Teaching Hospital, West Yorkshire, United Kingdom
| | | | | | | | | | - Hafiz Syed
- Newham University Hospital, London, United Kingdom
| | | | | | - Ahamad Hassan
- Leeds General Infirmary, West Yorkshire, United Kingdom
| | | | - Khalid Javaid
- Walsall Manor Hospital, West Midlands, United Kingdom
| | - Neetish Goorah
- Queen’s Park Hospital Royal Blackburn, Lancashire, United Kingdom
| | - Peter Carr
- Birmingham Heartlands Hospital, West Midlands, United Kingdom
| | | | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, United Kingdom
- Ashford & St Peter’s NHS Foundation Trust, Surrey, United Kingdom
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
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Aurelius T, Maheshwari A, Ken-Dror G, Sharma SD, Amlani S, Gunathilagan G, Cohen DL, Rajkumar C, Maguire S, Ispoglou S, Balogun I, Parry A, Sekaran L, Syed H, Lawrence E, Singh R, Hassan A, Wharton C, Javaid K, Goorah N, Carr P, Sami EA, Sharma SR, Sylaja PN, Prasad K, Sharma P. Ischaemic stroke in South Asians: The BRAINS study. Eur J Neurol 2023; 30:353-361. [PMID: 36260058 PMCID: PMC10098949 DOI: 10.1111/ene.15605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Studies on stroke in South Asian populations are sparse. The aim of this study was to compare differences in age of onset of ischaemic stroke in South Asian patients living in the United Kingdom and South Asian patients living in India versus White British stroke patients. METHODS We studied the UK and Indian arms of the ongoing BRAINS study, an international prospective hospital-based study of South Asian stroke patients. The BRAINS study includes 4038 South Asian and White British patients with first-ever ischaemic stroke, recruited from sites in the United Kingdom and India. RESULTS Of the included patients, 1126 were South Asians living in India (ISA), while 1176 were British South Asian (BSA) and 1736 were White British (WB) UK residents. Patients in the ISA and BSA groups experienced stroke 19.5 years and 7.2 years earlier than their WB counterparts, respectively (mean [interquartile range] age: BSA 64.3 [22] years vs. ISA 52.0 [18] years vs. WB 71.5 [19] years; p < 0.001). Patients in the BSA group had higher rates of hypertension, diabetes mellitus and hypercholesterolaemia than those in the ISA and WB groups. After adjustment for traditional stroke risk factors, an earlier age of stroke onset of 18.9 years (p < 0.001) and 8.9 years (p < 0.001) was still observed in the ISA and BSA groups, respectively. In multivariable stepwise linear regression analysis, ethnicity accounted for 24.7% of the variance in early age onset. CONCLUSION Patients in the BSA and ISA groups experienced ischaemic stroke approximately 9 and 19 years earlier, respectively, than their WB counterparts. Ethnicity is an independent predictor of early age of stroke onset. Our study has considerable implications for public health policymakers in countries with sizable South Asian populations.
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Affiliation(s)
- Taylor Aurelius
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Ankita Maheshwari
- Departments of Neurology, All India Institute of Medical Sciences, New Delhi & Rajendra Institute of Medical Sciences, Ranchi, India
| | - Gie Ken-Dror
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Sapna D Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Sageet Amlani
- BARTS and the London NHS Trust/ Royal London Hospital, London, UK
| | | | | | - Chakravarthi Rajkumar
- Brighton and Sussex University Hospitals NHS Trust & Brighton and Sussex Medical School, University of Sussex, Sussex, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Peter Carr
- Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Shri Ram Sharma
- North Eastern Indira Gandhi Regional Institute for Health and Medical Sciences, Shillong, India
| | - Padmavathy N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Kameshwar Prasad
- Departments of Neurology, All India Institute of Medical Sciences, New Delhi & Rajendra Institute of Medical Sciences, Ranchi, India
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
- Ashford & St Peter's NHS Foundation Trust, Surrey, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
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Davison J, Maguire S, McLaughlin M, Simms V. Involving adolescents with intellectual disability in the adaptation of self-reported subjective well-being measures: participatory research and methodological considerations. J Intellect Disabil Res 2022; 66:628-641. [PMID: 35521793 PMCID: PMC9321088 DOI: 10.1111/jir.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The measurement of subjective well-being is challenging with samples of adolescents with intellectual disability (ID) given the cognitive and linguistic difficulties they face in comprehending standardised measures, and as such is primarily based on proxy reports. The lack of appropriate tools needs to be addressed so that adolescents with ID can self-report on their own well-being. The current study reports on the use of participatory research methods to adapt and modify two standardised self-report measures of subjective well-being suitable for completion by adolescents with ID. METHOD Two special schools were recruited for this study. At each school, staff (n = 15) and pupils aged 11-17 years (n = 35) participated. A series of co-design workshops were conducted to adapt two standardised subjective well-being measures: Kidscreen-10 and short-form Warwick-Edinburgh Mental Well-being Scale. RESULTS Specific aspects for measure adaption were identified: simplifying the item wording and phrasing; inclusion of pictorial communication symbols and visual prompts to represent the meaning of items; changing of tense of questions from past to present; asking questions rather than statements; reducing 5-point Likert scales to 3-point or dichotomous; presenting one item at a time during administration; and developing alternate formats of the survey to ensure inclusivity. CONCLUSIONS This paper illustrates the value of using participatory research methods when working alongside adolescents with ID and offers methodological, as well as practical, guidance in the context of adapting subjective self-report measures for this target group, serving as a guide to fellow researchers and clinicians interested in modifying or developing self-report measures for adolescents with ID.
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Affiliation(s)
- J. Davison
- Psychology Research InstituteUlster UniversityColeraineUK
| | - S. Maguire
- Psychology Research InstituteUlster UniversityColeraineUK
| | - M. McLaughlin
- Psychology Research InstituteUlster UniversityColeraineUK
| | - V. Simms
- Psychology Research InstituteUlster UniversityColeraineUK
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Marsh K, Carty J, Gallagher P, Maguire S, O’shea FB, Fitzgerald G. POS1001 CURRENT SMOKING IS ASSOCIATED WITH LOWER RISK OF UVEITIS AND PERIPHERAL ARTHRITIS IN MALES WITH AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe associations between smoking and extra-axial manifestations of axial spondyloarthritis (axSpA) are inadequately described. Previous observational studies have demonstrated smoking as protective against some but not other manifestations. However, the impact of sex on these associations is unknown.ObjectivesUsing a large descriptive epidemiological dataset, we performed a sex-stratified analysis of the association between smoking status and extra-axial manifestations in axSpA.MethodsThis study was carried out within the framework of ASRI (Ankylosing Spondylitis Registry of Ireland), a descriptive epidemiological study of the axSpA population of Ireland. A standardised clinical assessment was performed on each patient, collecting demographic and clinical data. Smoking status was characterised as current, previous or never. The number of cigarettes per day, plus number of years smoking was also collected. Data on the following extra-axial manifestations was collected: arthritis, enthesitis, dactylitis, acute anterior uveitis (AAU), psoriasis (PsO), inflammatory bowel disease (IBD). Standardised measures of disease severity were also collected. Separate logistic regression models were used to define the association between extra-axial manifestations and smoking, controlling for potential confounders. SPSS was used for statistical analysis.ResultsSmoking data was available for 913 out of the 917 axSpA individuals with data in ASRI (mean age 46 (SD 13) years, disease duration 19 (SD 12) years, 72% male, 97% Caucasian). Twenty eight percent (n=259) were current smokers, 29% (n=268) were past smokers and 42% (n=386) were never smokers. Of the current smokers, the mean number of cigarettes per day was 12 (SD 7) and number of years smoking was 22 (SD 12). Thirty one percent had peripheral arthritis, 7% had dactylitis, 18% had enthesitis, 34% had AAU, 17% had psoriasis and 11% had IBD.Current smokers had a significantly lower prevalence of arthritis and uveitis than past or non-smokers (see Table 1). A sex-stratified analysis was performed. There was no association between smoking status and any extra-axial manifestation in females. However, current smoking was associated with lower prevalence of arthritis in males compared to past or non-smokers (22% v 36% v 42%, p=0.002). A similar pattern was seen for uveitis, where male current smokers had a lower prevalence than non-smokers (24% v 38%, p=0.01). In contrast, psoriasis was more prevalent in men who were current smokers compared to non-smokers (18% v 12%, p=0.01), with no difference seen in females. There was no association with number of cigarettes smoked or number of years smoking.Table 1.Association between smoking status and extra-axial manifestations in axSpA.AxSpA cohortCurrent smokerPast smokerNon-smokerArthritis30.9%22.4%a35.5%b33.3%bDactylitis6.7%5.5%a6.7% a7.4% aEnthesitis18.1%17.4% a16.2% a19.9% aUveitis34.3%27.4%a35.0%b38.6%bPsoriasis16.7%18.5% a19.3% a13.8% aInflammatory bowel disease10.7%9.9% a13.2% a9.5% aDifferent subscript letters denote significant (p<0.05) differences between groups. Significant values highlighted in bold.There was no association between smoking status and disease severity by subjective or objective measures, either for the cohort as a whole or by sex.When compared to non- or ex-smokers and controlled for potential confounders including sex, age, biologic use, the association remained only between current smokers and lower risk of uveitis (OR 0.68, 95% CI 0.49 to 0.96) and arthritis (OR 0.62, 95% CI 0.43 to 0.88), in separate logistic regression models. The association between current smoking and increased prevalence of psoriasis in males did not remain significant once controlled for confounders (OR 1.10, 96% CI 0.73 to 1.65).ConclusionWe demonstrated that current smoking is independently associated with a lower risk of uveitis and arthritis in males with axSpA, but not females. More research is needed to further investigate this paradoxical finding.Disclosure of InterestsNone declared
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Mahady B, Gilligan P, Maguire S, McCann H, Agnew A, Bissett J, McCoubrey B, Foley S, McKay C. Use of an MRI scan based 3D printed personalized phantom to assess lens dose reduction factors for lead glasses in interventional cardiology. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00063-1] [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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Oonan L, Gilligan P, Maguire S, McCann H, Mahon N, McKay C. A task based dosimetric assessment of interventional cardiologist behaviour using a real-time active dosimetry system. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00264-2] [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: 11/26/2022] Open
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Maguire S, Wilson F, Gallagher P, O'Shea F. The toll of unemployment in axial spondyloarthropathy: high prevalence and negative impact on outcomes captured in a national registry. Scand J Rheumatol 2021; 51:300-303. [PMID: 34788188 DOI: 10.1080/03009742.2021.1992861] [Citation(s) in RCA: 2] [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: 10/19/2022]
Abstract
OBJECTIVE Axial spondyloarthropathy (axSpA) is an inflammatory arthritis of the axial skeleton. Persistent disease activity can result in significant disability and affect the ability to maintain employment. This study aimed to determine the prevalence of unemployment in axSpA and the impact on patient outcomes. METHOD Data from the Ankylosing Spondylitis Registry of Ireland (ASRI) were cleaned, and information on employment, demographics, and disease characteristics was extracted. Patients were analysed on the basis of employment and categorized as employed or unemployed. RESULTS Of the 759 participants included in the analysis, 23.5% (178) were unemployed, higher than national averages of 6.2-13.1% during the study period. Unemployed participants reported significantly worse Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; 5.1 vs 3.6), Metrology Index (BASMI; 4.8 vs 3.4), Functional Index (BASFI; 5.2 vs 3.0), Health Assessment Questionnaire (HAQ; 0.82 vs 0.40), and Ankylosing Spondylitis Quality of Life (ASQoL; 9.4 vs 5.4) scores compared to employed (all p < 0.01). Male gender (odds ratio, 95% confidence interval: 2.65, 1.46-4.83), worse BASMI (1.16, 1.02-1.33), and worse HAQ scores (2.18, 1.13-4.19) were significantly associated with unemployment. CONCLUSION The prevalence of unemployment in axSpA patients is higher than in the general population, and is associated with worse quality of life, poorer levels of function, and higher levels of disease activity. Predictors of unemployment in axSpA were male gender, worse spinal mobility, and poorer level of function. Recognition of patients at risk of unemployment will improve opportunities for intervention and maintain participation in the workforce.
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Affiliation(s)
- S Maguire
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - F Wilson
- Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - P Gallagher
- Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland
| | - F O'Shea
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
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Fitzgerald G, Maguire S, O’shea FB, López-Medina C, Dougados M, Haroon N. POS0995 EFFECT OF SEX IN CO-EXISTENT FIBROMYALGIA AND ENTHESITIS IN SPONDYLOARTHRITIS: ANCILLARY ANALYSIS OF THE ASAS-PerSpA STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Enthesitis is a common feature of axial spondyloarthropathy (axSpA) and psoriatic arthritis (PsA). Up to 25% of individuals with axSpA and PsA have a co-existing diagnosis of fibromyalgia syndrome (FMS). The anatomic overlap between tender points in FMS and sites of entheses is a challenge when differentiating between active SpA and FMS. Literature investigating the co-existence of enthesitis and FMS in individuals with SpA is sparse, in particular the effect of sex. The ASAS Peripheral involvement in Spondyloarthritis (PerSpA) study aims to characterize peripheral musculoskeletal in individuals with SpA across the world.Objectives:(1)To characterise the co-existence of enthesitis and FMS in individuals with SpA.(2)To explore the effect of sex on the presence of FMS and enthesitis.Methods:All individuals from the cross-sectional multinational ASAS-PerSpA study with a diagnosis of axSpA, peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The Fibromyalgia Rapid Screening Tool (FiRST) was used to make the diagnosis of FMS. The baseline descriptive and clinical differences between sexes were performed using T-tests and crosstabs. Sex-stratified comparisons within the following categories were conducted using chi-square analysis and ANOVA as appropriate: (1) enthesitis & fibromyalgia; (2) enthesitis only; (3) fibromyalgia only; (4) neither.Results:Baseline characteristics of the 4465 included patients are outlined in Table 1, stratified by sex. Enthesitis occurred in 44% (n=1984) of the population and was more common in females than males (48% vs 42%, p<0.01). The majority affected had intermittent episodes of enthesitis (55%, n=1088), with the Achilles tendon and plantar fascia the two most common sites in both sexes. Enthesitis was more often confirmed on imaging in females than males (44% v 35%, p<0.01). The most common treatment for enthesitis was non-steroidal anti-inflammatories (97%, n=1318), with no difference when stratified by sex. FMS occurred in 19% (n=775) of patients and was more common in females than males (28% vs 13%, p<0.01).Table 1.Participant characteristics, stratified by sex. Values are mean (SD), median (25th, 75th) or n (%). P-values are independent T-tests or Mann-Whitney as appropriate.VariableTotalMaleFemaleP valueN446527241741Age, years45 (14)43 (14)46 (13)<0.01Disease duration, years11 (6, 20)12 (6, 21)11 (5, 19)0.01Delay to diagnosis, years3 (1, 9)3 (1, 9)3 (1, 10)0.11HLA-B27 positive2066 (66)1457 (73)609 (54)<0.01Radiographic sacroiliitis2517 (61)1788 (70)729 (46)<0.01Sacroiliitis on MRI1817 (65)1128 (68)689 (60)<0.01axSpA ASAS criteria2910 (65)1953 (72)957 (55)<0.01pSpA ASAS criteria555 (12)250 (9)305 (18)<0.01CASPAR criteria1043 (23)508 (19)535 (31)<0.01BMI, kg/m226 (23, 29)26 (23, 29)26 (23, 30)0.24Axial involvement3428 (76.8)2243 (82.3)1185 (68.1)<0.01Peripheral involvement2541 (56.9)1404 (51.5)1137 (65.3)<0.01Enthesitis1984 (44.4)1149 (42.2)835 (48.0)<0.01Uveitis738 (17)482 (18)256 (15)0.01Psoriasis1212 (27)615 (23)597 (34)<0.01Inflammatory bowel disease275 (6)150 (6)125 (7)0.02Enthesitis and FMS occurred together in 10% of the cohort, was more common in women than men (see Figure 1) and was associated with a significantly (p<0.01) longer delay to diagnosis of 1.8 years and a higher BMI of 2.1 kg/m2 than people with enthesitis only. Objective confirmation of enthesitis was similar in those with and without FMS (38% vs 38%, p=0.92).The presence of FMS added to the burden of disease in those with enthesitis as assessed by BASDAI (6.4 vs 3.6, p<0.01) and ASDAS-CRP (3.5 vs 2.5, p<0.01), with no difference between sexes (p>0.05).Conclusion:In this large cross-sectional multinational analysis, FMS affected 19% of individuals with SpA. The co-existence of enthesitis and FMS occurred in 16% of females compared to 6% of males. The presence of FMS increased the burden of disease in those with enthesitis, as assessed by BASDAI and ASDAS-CRP, with no difference between men and women.Disclosure of Interests:Gillian Fitzgerald: None declared, Sinead Maguire Grant/research support from: Recipient of Gilead Inflammation Fellowship, Finbar Barry O’Shea: None declared, Clementina López-Medina: None declared, Maxime Dougados: None declared, Nigil Haroon Speakers bureau: Received honorarium from AbbVie, Eli Lilly, Jannsen, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, Jannsen, Novartis, UCB, Grant/research support from: AbbVie, Eli Lilly, Jannsen, Novartis, UCB.
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Maguire S, Gallagher P, O’shea FB. OP0051 LOOKING BEYOND BASDAI TOTAL SCORES: ANALYSIS OF THE BASDAI ON THE BASIS OF SEX. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Females with axial spondyloarthropathy (axSpA) average scores on patient reported outcomes (PROs) than males. However, this does not necessarily correlate to worse clinical findings. The Ankylosing Spondylitis Registry of Ireland (ARSI) is a national registry on patients with axSpA in Ireland and a source of epidemiological data.Objectives:The purpose of this study was to compare the scores of each sex across the individual components of the BASDAI to understand why females report worse scores than males.Methods:Analysis of the ASRI was preformed using IBM SPSS version 26. Patients were analyzed on the basis of gender. Comparison of baseline characteristics and mean BASMI, BASFI, HAQ and ASQoL were tested for significance using an independent two tailed t-test and a Mann Whitney U test. Mean total BASDAI score and mean score for each component of the BASDAI were compared and tested for significance with the same statistical tests. A chi-squared test for independence was used to determine significance in variation of HLA-B27 status and radiographic findings.Results:A total of 857 patients were included in the analysis. Patient population was 24.9% (213) female and 75.1% (644) male with a mean age of 45.9 years and mean disease duration of 19.4 years (means: BASDAI 4.02, BASMI 4, BASFI 3.67, HAQ 0.53, ASQoL 6.48). Females had worse BASDAI(4.6 vs 3.83, p<0.01), HAQ(0.6 vs 0.51, p=0.03) and ASQoL scores (7.62 vs 6.12, p<0.01) than males. BASFI scores were worse in females which did not reach significance (3.89 vs 3.63, p=0.26). However, females had significantly better BASMI scores than males (3.51 vs 4.16, p<0.01). Within the BASDAI, females scored significantly worse than males across all components (Fatigue: 5.56 vs 4.51, p<0.01; Spinal pain: 5.51 vs 4.63, p<0.01; Other pain: 3.82 vs 3.19, p=0.01; Discomfort: 4.05 vs 3.29, p<0.01; EMS: 4.55 vs 3.94, p=0.01), however duration of EMS did not reach significance (3.54 vs 3.12, p=0.07)(graph 1). Within the BASDAI, females recorded highest mean scores for fatigue (5.56), while males recorded highest mean scores for spinal pain(4.63). Lowest mean scores for both genders was for EMS duration (3.54 vs 3.12). Ranking of the BASDAI components by mean scores show similarity in the ranking of discomfort, EMS, other pain and EMS duration(Table 1).Table 1.Ranking in order of severity by mean scoreFemalesMales1 -most severeFatigueSpinal pain2Spinal PainFatigue3EMSEMS4DiscomfortDiscomfort5Other painOther pain6 -least severeEMS durationEMS durationGraph 1.Breakdown of BASDAI scores in Females compared to MalesConclusion:AxSpA females have consistently worse PROs but have better spinal mobility than males. Despite females recording worse BASDAI scores than males, the pattern of active disease is similar in 4 of the 6 components of the BASDAI. However, fatigue is the most problematic symptom in females with active axSpA while spinal pain is the most problematic symptom for males. This variation by gender should be kept in consideration when evaluating a patient with suspected active axSpA.References:Disclosure of Interests:Sinead Maguire Grant/research support from: Recipient of the Gilead Inflammation Fellowship, Phil Gallagher: None declared, Finbar Barry O’Shea: None declared
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Maclean M, Maguire S, O’shea FB. POS0999 HIGH CORRELATIONS BETWEEN QUESTION 1 & 2 OF THE BASFI: AN OPPORTUNITY TO STREAMLINE THE BASFI. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The Bath Ankylosing Spondylitis Functional Index (BASFI) is a useful tool to quantitatively characterise functional ability in a patient with axial spondyloarthropathy (axSpA). Whether first presentation, decompensated, or routine follow-up, BASFI can help establish a more accurate understanding of disease progression, or response. As with any questionnaire, relevance and absence of redundancy is required. This analysis questions the redundancy of the first two questions of the BASFI:1) How difficult is it to put socks on your feet?2) How difficult is it to pick a pen up off the floor?Objectives:To compare variation in reporting of questions one and two of the BASFI, to establish redundancy or exclusivity of these questions.Methods:IBM SPSS version 26 was used for data analysis. Data from axSpA patients who attended the Rheumatology department during the study period were included in the analysis where BASFI scores were available. Both variables (pen scores and sock scores) were assessed with a Shapiro-Wilk’s test for normal distribution. The variables were also assessed for the presence of a monotonic relationship by visual inspection of a scatterplot of the variables. Once a monotonic relationship was established a Spearman’s rank order correlation between the sock score and pen scores for each participant was analysed.Results:In total data from 82 axSpA patients were included in this analysis. Population was made up of 28% (23) females, 72% (59) males with mean BASDAI score 4.33 and mean BASFI score 3.88(Table 1). Both variables were not normally distributed as assessed by Shapiro-Wilk’s test (p <0.05) necessitating a Spearman’s rank-order correlation for analysis. Preliminary analysis variables demonstrated the relationship between the variables to be monotonic as determined by visual inspection of the scatterplot (graph 1) with no outliers detected. There was a statistically significant, strong positive correlation between sock scores and pen scores in this axSpA population, rpartial(80) =0.809 significant at the p < 0.01 level.Table 1.Descriptive output of data% (n)n82Females28% (23)Males72% (59)Age45.03BASDAI4.33BASFI3.88Pen score3.93Sock score2.88Sock score greater7.3% (6)Pen score greater50% (41)Same scores42.7% (35)Conclusion:There is a strong positive correlation between sock (question 1) and pen scores (question 2) as captured by the BASFI. It appears that both questions are capturing a similar functional limitation in patients with axSpA. In order to minimise redundancy and improve the relevance of the BASFI our results support the removal of one of these questions to simplify the BASFI. From a practical perspective, putting on socks (question 1) would be a more commonly encountered daily activity than picking up apen from the floor(question 2). As such, we would suggest removal of question 2 from the BASFI.Table 1 & Figure 1Graph 1.Spread of Data points demonstrating a monotonic relationship with no outliersDisclosure of Interests:Michael MacLean: None declared, Sinead Maguire Grant/research support from: Recipient of the Gilead Inflammation Fellowship, Finbar Barry O’Shea: None declared.
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Maguire S, Gallagher P, Wilson F, O’shea FB. POS0949 HIGH PREVALENCE OF ABDOMINAL OBESITY IN FEMALES WITH AXIAL SPONDYLOARTHROPATHY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Worldwide prevalence of obesity has been steadily increasing, despite significant public health campaigns to raise health awareness. In axial spondyloarthropathy (axSpA) obesity has been shown to be associated with higher levels of disease activity and decreased response to treatment. The waist to hip ratio (WtHpR) is a tool to screen for abdominal obesity. Abdominal deposition of adipose tissue is associated with increased risk of cardiovascular disease, type II diabetes and premature death. Abdominal obesity is more commonly found in males, while females are more prone to gluteal-femoral fat deposition. The Ankylosing Spondylitis Registry of Ireland (ASRI) is a source of epidemiological data of axSpA patients in Ireland.Objectives:To capture the prevalence of abdominal obesity in a large cohort of axSpA patients and assess for variation in prevalence between sexes.Methods:Participants were analysed on the basis of sex and presence of obesity by BMI and WtHpR. Obesity was defined by body mass index (BMI) with a result of >30 categorised as obese as per CDC definitions. Abdominal obesity was assessed by WtHpR and defined as per WHO guidelines. Categorical variables were recorded as frequencies, with a chi2 test for independence used to test for statistical significance. Numerical variables were recorded as means within each group and an independent t-test or Mann Whitney U test was used to test for statistical significance between groups. A p-value of <0.05 was deemed significant. IBM SPSS version 26 was used for statistical analysis of the patient population captured within the ASRI.Results:At the time of analysis, physical measurements were available on 692 patients in the ASRI made up of 96.2% (666) Caucasians with 22.3% (154) females and 77.7% (538) males. The average age was 45.9 years with a mean disease duration of 18.8 years (mean scores: BASDAI 4.09, BASFI 3.71, BASMI 3.99, HAQ 0.54, ASQoL 6.72). 80.9% (560) of patients had radiographic sacroiliitis while 49.1% (340) had sacroiliitis on MRI.Overall 29.5% (215) patients were obese based on BMI results, while 37.5% (274) were centrally obese as per the WtHpR. Analysis on the basis of sex revealed no significant variation in mean BMI (28.1 vs 27.7, p=0.45) or prevalence of obesity as assessed by BMI (29.9% vs 28.6%, p=0.49) between males and females(table 1). As expected analysis of WtHpR revealed higher mean ratios in males compared to females (0.96 vs 0.89, p<0.01), however there was a significantly higher prevalence of abdominal obesity in females (29.9% vs 68.2%, p<0.01).Table 1.Assessment of Obesity by SexMalesFemalesp valuen77.7% (538)22.3% (154)Weight (kg)84.9872.76<0.01BMI28.0827.690.45Underweight0.9% (5)0.06% (1)0.49Normal Weight29.2% (157)36.4% (56)Overweight39.2% (211)34.4% (53)Obese29.9% (161)28.6% (44)Waist Circumference (cm)97.4390.03<0.01Hip Circumference (cm)102.11101.270.56Waist to Hip Ratio0.9560.8901<0.01Normal Weight23.8% (128)17.5% (27)<0.01Overweight46.3% (249)14.3% (22)Obese29.9% (161)68.2% (105)Conclusion:There is a high prevalence of abdominal obesity as assessed by WtHpR in axSpA, this is especially high in females with axSpA. Use of WtHpR should be considered when screening for obesity in this population.Disclosure of Interests:Sinead Maguire Grant/research support from: Recipient of the Gilead Inflammation fellowship grant, Phil Gallagher: None declared, Fiona Wilson: None declared, Finbar Barry O’Shea: None declared
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Quinn S, Maguire S, O’shea FB, O’neill L, Molloy E, Fearon U, Gallagher P, Veale D. POS0964 CHARACTERISTICS AND BURDEN OF DISEASE IN PATIENTS WITH RADIOGRAPHIC VERSUS NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS IN THE ANKYLOSING SPONDYLITIS REGISTRY OF IRELAND COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Axial spondyloarthritis (axSpA) is an umbrella term for types of inflammatory arthritis that primarily affect the spine and the sacroiliac joints. It is comprised of patients with both radiographic (r-axSpA) and non-radiographic features (nr-axSpA). R-axSpA was historically known as Ankylosing Spondylitis. Previous studies have shown the burden of disease to be largely similar in patients with radiographic versus non-radiographic axial spondyloarthritis in cohorts both in the US and Europe [1]. The Ankylosing Spondylitis Registry of Ireland (ASRI) was formed with the objective to measure the burden of axial spondyloarthritis in the population and identify early predictors of a poor outcome. All patients in the registry are 18 years or older and meet Assessment of Spondyloarthritis International Society (ASAS) criteria for a diagnosis of SpA.Objectives:To compare the characteristics and burden of disease in patients with radiographic versus non-radiographic axial spondyloarthritis in the ASRI cohort.Methods:Patients with radiographic axial spondyloarthritis (r-axSpA) were defined as those with x-ray evidence of sacroiliitis. Patients with non-radiographic axial spondyloarthritis (nr-axSpA) were defined as having MRI evidence of sacroiliitis but no x-ray evidence of sacroiliitis. A standardised clinical assessment was performed on each patient and structured interviews provided patient-reported data. For each patient the following scores were captured: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Health Assessment Questionnaire (HAQ) assesses the self-reported functional status for performing activities of daily living, and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Categorical variables were summarized as percentages with frequency counts, and continuous variables with a mean and standard deviation. Statistical comparisons between subgroups were evaluated using 2 sample t-tests for continuous variables and chi-square tests for categorical variables.Results:764 patients were available for analysis. Analysis of radiographic status showed 88.1% (n=673) of patients with r-axSpA and 11.9% (n=91) with nr-axSpA. Patients with nr-axSpA were younger (41.3 vs. 46.6 years, p<0.01), had shorter disease duration (14.8 vs. 20.2 years, p<0.01), lower proportion of males (66.6% vs. 78.4%, p=0.02) with lower rates of HLA-B27 positivity (73.6% vs. 90.5%, p<0.01). The nr-axSpA group had lower BASDAI (3.37 vs. 4.05, p=0.01), BASFI (2.46 vs. 3.88, p<0.01), BASMI (2.33 vs. 4.34, p<0.01), ASQoL (5.2 vs. 6.67, p=0.02), and HAQ scores (0.38 vs. 0.57, p<0.01). There were no significant differences in the prevalence of extra-articular manifestations.Conclusion:This study provides evidence that the burden of disease is less in patients with non-radiographic axial spondyloarthritis than radiographic axial spondyloarthritis, as demonstrated by better BASDAI, BASFI, BASMI, HAQ and ASQoL scores.References:[1]López-Medina C, et al. Characteristics and burden of disease in patients with radiographic and non-radiographic axial Spondyloarthritis: a comparison by systematic literature review and meta-analysis. RMD Open, 2019. 5(2) p1108.Table 1.r-axSpAnr-axSpAp valuen67391Age (years)46.6 (+/-12.4)41.3 (+/-12.4)<0.01Disease duration (years)20.2 (+/-12.4)14.8 (+/-11.7)<0.01Delay to diagnosis (years)8.41 (+/-8.6)6.34 (+/-7.2)0.03Males78.8% (528)65.9% (60)0.02Females21.5% (145)34.1% (31)0.02HLA-B27+90.50%(440 of 486 available results)73.60%(53 of 72 available results)<0.01BASDAI4.05 (+/-2.39)3.37 (+/-2.31)0.01BASFI3.88 (+/-3.00)2.46 (+/-2.39)<0.01BASMI4.34 (+/-2.08)2.33 (+/-1.42)<0.01ASQoL6.67 (+/-5.55)5.2 (+/-5.53)0.02HAQ0.57 (+/-0.54)0.38 (+/-0.44)<0.01Psoriasis17.8% (120)15.4% (14)0.31IBD11% (74)8.8% (8)0.58Uveitis33.9% (228)34.1% (31)0.54Disclosure of Interests:Sean Quinn: None declared, Sinead Maguire: None declared, Finbar Barry O’Shea: None declared, Lorraine O’Neill: None declared, Eamonn Molloy: None declared, Ursula Fearon Speakers bureau: Abbvie, Grant/research support from: Janssen, Abbvie, Pfizer, UCB, Phil Gallagher: None declared, Douglas Veale Speakers bureau: AbbVie, BMS, Celgene, Pfizer, MSD, Roche, Consultant of: AbbVie, Actelion, BMS, Novartis, Pfizer, MSD, Roche, Regeneron/Sanofi, Grant/research support from: AbbVie, Pfizer, MSD, Novartis, Roche, Janssen.
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Maguire S, O’shea FB. POS0942 THE NEGATIVE IMPACT OF UNDIAGNOSED DEPRESSION IN AXIAL SPONDYLOARTHROPARTHY: RESULTS OF A SCREENING STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Previous research in axial spondyloarthropathy(axSpA) has shown this population to have a high prevalence of depression. This co-morbidity has been previously shown to impact disease activity in patients with rheumatic disease.Objectives:The purpose of this study was to screen for early signs of depression using two validated tools, the Patient Health Questionaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale for depression (HADs-D) in patients with known axSpA.Methods:AxSpA patients attending the Rheumatology department in St James’ Hospital between February and October 2020 were invited to take a self-administered survey which included the PHQ-9 and the HADs-D. Scores from the HADs-D yielded a numerical result which was then categorised as normal, borderline or abnormal. PHQ-9 numerical results were categorised as normal, mild, moderate, moderate/severe or severe. Patients with a known diagnosis of depression were excluded. In addition to baseline demographics, patient reported outcomes from the clinic visit were also recorded.Data analysis was performed using IBM SPSS version 26. Continuous variables were recorded as means, categorical variables as frequencies with percentages. A one-way analysis of variance analysis (ANOVA) was used to determine significance of variation in outcomes between patient outcomes as determined by the HADs-D and PHQ-9. A p-value of <0.05 was deemed significant. Consent was obtained prior to participation. Approval was received from the St James’/Tallaght Hospital Joint Ethics Committee.Results:In total 71 axSpA patients took part in the survey. The population was 70.4%(50) males and 29.5%(21) female, with an average age 47.9 years and mean disease duration 19.7 years (mean outcomes: BASDAI 4.08, BASFI 3.62, BASMI 3.54, ASQoL 6.79). Overall, 7 (9.9%) participants recorded abnormal HADs-D scores, while 17 (23.9%) recorded moderate to severe PHQ-9 scores indicative of underlying depression. AxSpA females had higher mean HADs-D scores (7.5 vs 4.8, p=0.01) than males, with abnormal scores in 19%(4) of females and 6% (3) of males. No significant differences were found in PHQ-9 scores between genders.Analysis revealed significantly worse BASDAI (6.27 vs 3.42, p<0.01) and AQoL scores (12.57 vs 5.26, p<0.01) in axSpA patients with abnormal compared to normal HADs-D scores. No significant differences were noted in BASFI, BASMI or baseline demographics. A similar pattern was noted on analysis of PHQ-9 scores, with significantly worse BASDAI (7.9 vs 2.55, p<0.01), BASFI (8.05 vs 2.33, p<0.01) and ASQoL (19.5 vs 2.62, p<0.01) noted in those scoring as severe compared to normal. No significant differences were detected in BASMI scores or baseline demographics.Conclusion:A high percentage of axSpA patients recorded high HADs-D and PHQ-9 scores concerning for undiagnosed depression. These patients were noted to have significantly worse disease activity and quality of life as compared to patients with normal scores. Clinicians treating axSpA should consider screening for depression in this population.Disclosure of Interests:Sinead Maguire Speakers bureau: Speaker fee from Jassen, Grant/research support from: Recipient of the Gilead Inflammation Fellowship Grant, Finbar Barry O’Shea: None declared
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Baldelli P, Cardarelli P, Flanagan F, Maguire S, Phelan N, Tomasi S, Taibi A. Evaluation of microcalcification contrast in clinical images for digital mammography and synthetic mammography. Eur J Radiol 2021; 140:109751. [PMID: 34000600 DOI: 10.1016/j.ejrad.2021.109751] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/17/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this work was to compare, in a clinical study, digital mammography and synthetic mammography imaging by evaluating the contrast in microcalcifications of different sizes. METHODS A retrospective review of microcalcifications from 46 patients was undertaken. A Hologic 3-Dimensions mammography system and a HD Combo protocol was used for simultaneous acquisition of the digital and synthetic images. Microcalcifications were classified in accordance with their size, and patient breast images were classified in accordance with their density as adipose, moderately dense and dense. The contrast of the microcalcifications was measured and the contrast ratio between synthetic and digital images was compared. An additional qualitative assessment of the images was presented to correlate the conspicuity of the microcalcifications with the suppression of the structure noise. RESULTS Microcalcifications in adipose background always exhibit a comparable or better contrast on synthetic images, regardless their size. For moderately dense background, synthetic images show a better contrast in 91.2 % of cases for small microcalcifications and in 90.9 % of cases for large microcalcifications. For a dense background, better contrast is seen in 89.5 % of cases for small microcalcifications, and in 85.7 % of cases for large microcalcifications. The contrast ratio increases with increasing breast glandularity. The suppression of structure noise also contributes to the enhancement of microcalcifications in the synthetic images. CONCLUSIONS Synthetic mammography imaging is superior to digital mammography imaging in terms of microcalcification contrast, regardless their size and breast density.
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Affiliation(s)
- P Baldelli
- Breastcheck, National Breast Screening Program, 36 Eccles Street, Dublin 7, Ireland
| | - P Cardarelli
- National Institute for Nuclear Physics - Ferrara Division, via Saragat 1, 44122 Ferrara, Italy.
| | - F Flanagan
- Breastcheck, National Breast Screening Program, 36 Eccles Street, Dublin 7, Ireland; Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - S Maguire
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - N Phelan
- Breastcheck, National Breast Screening Program, 36 Eccles Street, Dublin 7, Ireland
| | - S Tomasi
- Dept of Physics and Earth Sciences, University of Ferrara, via Saragat 1, 44122 Ferrara, Italy
| | - A Taibi
- Dept of Physics and Earth Sciences, University of Ferrara, via Saragat 1, 44122 Ferrara, Italy
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Sipos O, Tovey H, Quist J, Haider S, Nowinski S, Gazinska P, Kernaghan S, Toms C, Maguire S, Orr N, Linn SC, Owen J, Gillett C, Pinder SE, Bliss JM, Tutt A, Cheang MCU, Grigoriadis A. Assessment of structural chromosomal instability phenotypes as biomarkers of carboplatin response in triple negative breast cancer: the TNT trial. Ann Oncol 2021; 32:58-65. [PMID: 33098992 PMCID: PMC7784666 DOI: 10.1016/j.annonc.2020.10.475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/05/2020] [Accepted: 10/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In the TNT trial of triple negative breast cancer (NCT00532727), germline BRCA1/2 mutations were present in 28% of carboplatin responders. We assessed quantitative measures of structural chromosomal instability (CIN) to identify a wider patient subgroup within TNT with preferential benefit from carboplatin over docetaxel. PATIENTS AND METHODS Copy number aberrations (CNAs) were established from 135 formalin-fixed paraffin-embedded primary carcinomas using Illumina OmniExpress SNP-arrays. Seven published [allelic imbalanced CNA (AiCNA); allelic balanced CNA (AbCNA); copy number neutral loss of heterozygosity (CnLOH); number of telomeric allelic imbalances (NtAI); BRCA1-like status; percentage of genome altered (PGA); homologous recombination deficiency (HRD) scores] and two novel [Shannon diversity index (SI); high-level amplifications (HLAMP)] CIN-measurements were derived. HLAMP was defined based on the presence of at least one of the top 5% amplified cytobands located on 1q, 8q and 10p. Continuous CIN-measurements were divided into tertiles. All nine CIN-measurements were used to analyse objective response rate (ORR) and progression-free survival (PFS). RESULTS Patients with tumours without HLAMP had a numerically higher ORR and significantly longer PFS in the carboplatin (C) than in the docetaxel (D) arm [56% (C) versus 29% (D), PHLAMP,quiet = 0.085; PFS 6.1 months (C) versus 4.1 months (D), Pinteraction/HLAMP = 0.047]. In the carboplatin arm, patients with tumours showing intermediate telomeric NtAI and AiCNA had higher ORR [54% (C) versus 20% (D), PNtAI,intermediate = 0.03; 62% (C) versus 33% (D), PAiCNA,intermediate = 0.076]. Patients with high AiCNA and PGA had shorter PFS in the carboplatin arm [3.4 months (high) versus 5.7 months (low/intermediate); and 3.8 months (high) versus 5.6 months (low/intermediate), respectively; Pinteraction/AiCNA = 0.027, Padj.interaction/AiCNA = 0.125 and Pinteraction/PGA = 0.053, Padj.interaction/PGA = 0.176], whilst no difference was observed in the docetaxel arm. CONCLUSIONS Patients with tumours lacking HLAMP and demonstrating intermediate CIN-measurements formed a subgroup benefitting from carboplatin relative to docetaxel treatment within the TNT trial. This suggests a complex and paradoxical relationship between the extent of genomic instability in primary tumours and treatment response in the metastatic setting.
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Affiliation(s)
- O Sipos
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - H Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - J Quist
- Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - S Haider
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Nowinski
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - P Gazinska
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Kernaghan
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - C Toms
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - S Maguire
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - N Orr
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - S C Linn
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - J Owen
- King's Health Partners Cancer Biobank, London, UK
| | - C Gillett
- King's Health Partners Cancer Biobank, London, UK
| | - S E Pinder
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - J M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - A Tutt
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK; Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - M C U Cheang
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - A Grigoriadis
- Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK.
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Hambleton A, Le Grange D, Miskovic-Wheatley J, Touyz S, Cunich M, Maguire S. Translating evidence-based treatment for digital health delivery: a protocol for family-based treatment for anorexia nervosa using telemedicine. J Eat Disord 2020; 8:50. [PMID: 33052259 PMCID: PMC7544521 DOI: 10.1186/s40337-020-00328-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT) is an efficacious outpatient intervention for young people diagnosed with Anorexia Nervosa (AN). To date, treatment to protocol has relied on standard face-to-face delivery. Face-to-face therapy is subject to geographic, temporal and human factors, rendering it particularly susceptible to inequities and disruption. This has resulted in poorer service provision for rural and regional families, and recently a significant challenge to providing face-to-face services during the COVID-19 global pandemic. The present study examines whether FBT for AN can be successfully translated to a digital delivery platform to address these access issues. METHOD Forty young people aged 12 to 18 years who meet DSM-5 diagnostic criteria for AN, and live in a rural or regional setting, will along with their family be recruited to the study. Trained therapists will provide 18 sessions of FBT over 9 months via telemedicine to the home of the young person and their family. The analysis will examine treatment effectiveness, feasibility, acceptability, and cost-effectiveness. DISCUSSION The study addresses the treatment needs of families not able to attend face-to-face clinical services for evidence-based treatment for eating disorders. This might be due to several barriers, including a lack of local services or long travel distances to services. There has been a recent and unprecedented demand for telemedicine to facilitate the continuity of care during COVID-19 despite geographical circumstances. If delivering treatment in this modality is clinically and economically effective and feasible, it will facilitate access to potentially lifesaving, evidence-based treatments for families formerly unable to access such care and provide evidence for the continuity of services when and where face-to-face treatment is not feasible.
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Affiliation(s)
- A. Hambleton
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - D. Le Grange
- UCSF Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, San Francisco, California USA
| | - J. Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - S. Touyz
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - M. Cunich
- The Boden Collaboration for Obesity, Nutrition & Eating Disorders, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW Australia
| | - S. Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, St Leonards, Australia
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Maguire S, Gallagher P, O’shea FB. SAT0382 THE SAME BUT DIFFERENT? ANALYSIS OF A COHORT OF PATIENTS WITH LATE ONSET ANKYLOSING SPONDYLITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Ankylosing spondylitis(AS) has long been described as presenting in the third decade of life with the onset rarely occurring over the age of 45 years old. Previous research has shown there are small numbers of patients being diagnosed with AS later in life. These studies have been limited to small numbers limiting the ability to detect patterns in disease. The Ankylosing Spondylitis Registry of Ireland (ASRI) is an epidemiological data source on patients with AS in Ireland. Large registries, such as this, are an opportunity to further study this subtype in large numbers with greater power to detect differences between late and typical onset.Objectives:The purpose of this study was to examine late onset AS in a large, well characterized cohort.Methods:Patient registered in ASRI were analysed on the basis of their age of symptom onset using IBM SPSS version 26. Patients were divided into two groups with an age over 45 years old at symptoms onset categorized at late onset. Mean BASMI, BASFI, BASDAI, HAQ, and ASQoL scores were compared between the two groups and tested for statistical significance using an independent two tailed t-test. Further analysis looking at differences in gender, HLA B27 status, sacroiliitis on MRI, medication use and extra-articular manifestations(EAMs) was also performed using a chi-squared test for independence.Results:A total of 851 patients with AS were included in the analysis. Of these patients 659(77.4%) were males, with 192(22.6%) females, mean age of 45.8 years and mean disease duration of 19.4 years (means: ASQoL 6.52, HAQ 0.54, BASDAI 4.03, BASFI 3.7, BASMI 4.03). Patient population was made up of 797 patients(93.7%) categorized as typical onset, 54 patients(6.3%) categorized as late onset(table 1). Males had a higher rate of late onset AS than females, but this did not reach significance (6.8% vs 4.7%, p=0.19). Patients with late onset AS were noted to have higher BASFI (5.53 vs 3.58, p<0.01), HAQ (0.75 vs 0.53, p<0.01) and ASQoL scores (7.68 vs 6.44, p<0.01). Late onset patients also had lower rates of HLA-B27 positivity (76.5% vs 91.2%, p<0.01). No significant difference was detected in BASDAI or BASMI scores. No difference was detected between groups regarding rates EAMs. The late onset AS patients were noted to have lower rates of biologic therapy use (50% vs 72%, p<0.01). No significant difference was detected in rates of NSAID use.Table 1.Onset < 45 years (n=797)Late Onset (n=54)pvalueMales (n=659)93.2% (614)6.8% (83.3)0.19Females (n=192)23% (183)16.6% (9)HLA B27+ (n=580)90.5% (554)76.5% (26)<0.01Enthesitis (n=146)16.9% (135)20.4% (11)0.45Dactylitis (n=54)6% (48)11.1% (6)0.21Arthritis (n=256)29.7% (237)35.2% (19)0.4MRI Sacroiliitis (n=384)45.3% (361)42.6% (23)0.69Bilateral sacroiliits (n=668)79% (628)74% (40)0.07BASDAI4.024.190.6BASFI3.585.53<0.01BASMI3.964.970.12HAQ0.530.75<0.01ASQoL6.447.68<0.01Uveitis28.5% (227)24.1% (13)0.07IBD9.9% (79)14.8% (8)0.32Psoriasis16.4% (131)18.5% (10)0.54Smokers (ever)57.3% (457)64.8% (35)0.01Alcohol consumption (ever)82% (654)75.9% (41)0.53Biologic tx69.1% (551)48.1% (26)<0.01NSAID tx54.2% (432)61.1% (33)0.2Figure 1.Conclusion:This analysis shows that late onset AS does occur in up to 6.3% of patients with AS. Patients with late onset disease were noted to have similar patterns of disease, EAMs and radiological findings consistent with current classification criteria for AS. Less patients with late onset disease were HLA-B27 positive, the reason for this is unknow. These patients had worse functional outcomes, which could reflect the older age of symptom onset. It is notable that patients with late onset AS are being treated with less biologic agents, and have a slightly higher rate of NSAID usage. Additional registry studies into this subgroup would help to understand these variations in medication usage and prescribing practices.Disclosure of Interests:Sinead Maguire Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB, Phil Gallagher: None declared, Finbar Barry O’Shea Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB
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Maguire S, Gallagher P, O’shea FB. SAT0381 UNDERSTANDING JOINT REPLACEMENT SURGERY IN AXIAL SPONDYLOARTHROPATHY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Axial spondyloarthropathy(axSpA) is a form of inflammatory arthritis that primarily affects the axial skeleton and sacroiliac joint, but can be associated with a peripheral arthritis. Rapid advances in the field of axSpA has led to faster detection, diagnosis and treatment of this disease. This improved management has led to improved level of function and quality of life for patients, despite this a proportion of patients are still requiring joint replacement surgery. The Ankylosing Spondylitis Registry of Ireland (ASRI) is a source of epidemiological data on patients with axSpA in Ireland. Given the large size of the ASRI to date, this is a prime opportunity to analyze patients with axSpA requiring joint replacement surgery.Objectives:Detailed analysis of a large cohort of patients with axSpA with a focus on those who underwent joint replacement to determine trends in disease and baseline demographics.Methods:The patient population registered in the ASRI was analysed using IBM SPSS version 26. Analysis was performed by comparing patients who underwent joint replacement surgery to the rest of the ASRI cohort. Mean age, disease duration, delay to diagnosis and scores of disease activity (BASDAI, BASFI, HAQ, ASQoL and BASMI) were compared between these two groups. Differences between the groups was tested for significance using an independent two tailed t-test. Further analysis on gender, HLA-B27 status, co-morbidities and medication exposure was done using a chi-squared test for independence. A p value of less than 0.05 was deemed significant.Results:At present 860 patients are currently enrolled in the ASRI with 76.6% (659) males and 23.4% (201) females. Average age of patients is 45.8 years, mean disease duration of 19.4 years with 95.5% (821) of patients listed as Caucasian. Mean scores were BASDAI 4.02, BASFI 3.7, BASMI4.02, HAQ 0.55, and ASQoL of 6.51. In total 33 (3.8%) of patients underwent joint replacement surgery. These patients were noted to be significantly older than the rest of the rest of the cohort (55.3 years old vs 45.1, p<0.01), with a longer disease duration (31.6 years vs 18.3, p<0.01) and higher rates of HLA-B27 positivity (94.7% vs 80.2%, p<0.01). No significant differences were noted between gender(table 1). No significant difference was found between medication exposure rates, although the joint replacement population did have higher rates of NSAID, sDMARD and biologic therapy usage than the rest of the population although this did not reach significance. These patients also scored worse in all measures of disease activity, although this only reached significance in the BASFI (5.67 vs 3.64, p<0.01), HAQ (0.9 vs 0.54, p<0.01) and the BASMI (6.07 vs 3.94, p<0.01).Table 1.Joint replacement (n=33)No Joint Replacement (n=827)p valueAge55.345.1<0.01Disease duration31.618.31<0.01Delay to dx6.977.970.51HLA-B27+94.7% (18)71.9% (491)<0.01Males78.8% (26)64.7% (535)0.76Females21.2% (7)19.3% (160)0.76Mean ScoresBASDAI4.914.060.06BASFI5.673.64<0.01HAQ0.90.54<0.01ASQoL7.426.670.45BASMI6.073.94<0.01MedicationsNSAIDs51.5% (17)47% (389)0.21Bio tx72.7% (24)57.2% (473)0.9DMARDs33.3% (11)15.7% (130)0.1Conclusion:Patients requiring joint replacement surgery, although few in number, represent a cohort with significantly impaired function and quality of life. This is likely due to the fact that these patients were older with more established disease. It is therefore not surprising that this cohort had significantly worse spinal mobility. As registries continues to develop, it will be interesting to see if rates of joint replacement surgery will decline with increased use of biologic therapy at an earlier stage of disease. This will help to differentiate patients requiring joint replacement surgery due to underlying inflammatory arthritis and those with osteoarthritis.Disclosure of Interests:Sinead Maguire Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB, Phil Gallagher: None declared, Finbar Barry O’Shea Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB
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Maguire S, Gallagher P, O’shea FB. AB0704 PRESCRIBING PRACTICES IN AXIAL SPONDYLOARTHROPATHY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Axial spondyloarthropathy(axSpA) treatment has undergone a number of significant developments over the past number of decades. Previously limited to non-steroidal anti-inflammatories (NSAIDs) and corticosteroids, treatment options now include synthetic disease modifying anti-rheumatic drugs(sDMARDs) and biologic agents. The development of national registries for inflammatory arthritis provides an opportunity to study medication usage in a large cohort of patients with axSpA. The Ankylosing Spondylitis Registry of Ireland (ASRI) is a source of epidemiological data on patients with axSpA in Ireland. The aim of this study was to examine medication exposure and outcomes.Objectives:To characterize a large cohort of patients with axSpA in terms of medications usage, burden of disease and patient reported outcomes.Methods:The patient population registered in the ASRI was analysed using IBM SPSS version 26. Patients were analyzed on the basis of medication exposure. The four treatment groups were classified as no treatment, NSAIDs only, biologics only, or biologics and NSAIDs. Mean age, duration of disease and delay to diagnosis was compared between groups. Burden of disease was assessed via mean BASDAI, BASFI, BASMI, HAQ and ASQoL between the four groups. Differences between groups was tested for statistical significance a one-way analysis of variance (ANOVA). A chi-squared test for independence was used to compare differences in rates of HLA-B27 positivity rates and gender. Results were deemed significant where p < 0.05.Results:At present 860 patients are currently enrolled in the ASRI with 76.6% (659) males and 23.4% (201) females. Average age of patients is 45.8 years, mean disease duration of 19.4 years with 95.5% (821) of patients listed as Caucasian. Mean scores were BASDAI 4.02, BASFI 3.7, BASMI 4.02, HAQ 0.55, and ASQoL of 6.51. Treatment groups were made up of 9.9%(85) on no treatment, 22.2%(191) NSAIDs treatment only, 34.8%(299) biologics treatment only and 32.1%(276) treated with both NSAIDs and biologics. Patients only on NSAIDs were noted to be older than patients on biologics, and those on both biologics and NSAIDs (p=0.02). Patients on NSAIDs were older at symptom onset than those on both biologic and NSAID treatment (p=0.02), however the effect size is small(0.012). No significant difference was noted between groups regarding disease duration, delay to diagnosis or distribution between genders (table 1). Difference in BASDAI scores between groups was significant between all groups, with patients on both biologics and NSAIDs having the highest scores and those on no treatment with the lowest scores(4.74 vs 3.37) possibly a reflection of disease severity(table 2).Table 1.ASRINo txNSAIDs txBiologic txBiologic & NSAIDsp valueNumber8609.9% (85)22.2% (191)37.8% (299)32.1% (276)Age45.849.746.245.345.10.02Symptom onset26.427.528.226.125.20.02Disease duration19.422.21819.119.80.06Delay to dx89.88.17.480.13Table 2.ASRINo txNSAIDs txBiologic txBiologic & NSAIDsp valueEffect SizeBASDAI4.023.374.213.44.740.063.374.210.043.374.74<0.014.213.4<0.013.44.74<0.01Conclusion:A large proportion of patients in the ASRI were treated with either biologics only or both biologics and NSAIDs. No treatment was the least common treatment within this cohort. Patients not on treatment tended to be older than those on any type of treatment. Overall patients on biologics alone tended to have better patient reported outcomes as compared to all other treatment groups. The development of longitudinal data for the ASRI will help to further understand the reason behind these differences.Disclosure of Interests:Sinead Maguire Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB, Phil Gallagher: None declared, Finbar Barry O’Shea Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB
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Dolan DR, Knight KA, Maguire S, Moug SJ. The relationship between sarcopenia and survival at 1 year in patients having elective colorectal cancer surgery. Tech Coloproctol 2019; 23:877-885. [PMID: 31486988 PMCID: PMC6791904 DOI: 10.1007/s10151-019-02072-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022]
Abstract
Background Colorectal cancer remains a common cause of cancer death in the UK, with surgery being the mainstay of treatment. An objective measurement of the suitability of each patient for surgery, and their risk–benefit calculation, would be of great utility. We postulate that sarcopenia (low muscle mass) could fulfil this role as a prognostic indicator. The aim of this study was to determine the relationship between sarcopenia and long-term outcomes in patients undergoing elective bowel resection for colorectal cancer. Methods One hundred and sixty-three consecutive patients who had elective curative colorectal resection for cancer were eligible for inclusion in the study. Psoas muscle mass was assessed on preoperative computed tomography scan at the level of the L3 vertebra and standardised for patient height (total psoas index, TPI). Sarcopenia (low muscle mass) was defined as < 524 mm2/m2 in males and 385 mm2/m2 in females. In addition to clinical–pathological parameters, postoperative complications were recorded and patients were followed up for mortality for 1 year after surgery. Results Sarcopenia was present in 19.6% of the study participants and was significantly related to body mass index (p = 0.007), 30-day mortality (p = 0.042) and 1-year mortality (p = 0.046). In univariate analysis, American Society of Anesthesiologists grade (p = 0.016), tumour stage (p = 0.018) and sarcopenia (p = 0.043) were found to be significant independent predictors of 1-year mortality. Conclusions This study has found sarcopenia to be prevalent in patients with colorectal cancer having elective surgery. Independent of age, sarcopenia was associated with poorer 30-day mortality and survival at 1 year. Measurement of muscle mass preoperatively could be used to stratify a patient’s risk, allowing targeted strategies such as prehabilitation, to be implemented to modify sarcopenia and improve long-term outcomes for patients.
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Affiliation(s)
- D R Dolan
- School of Medicine, University of Glasgow, Glasgow, UK
| | - K A Knight
- Department of Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK
| | - S Maguire
- School of Medicine, University of Glasgow, Glasgow, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK.
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Dennis M, Mead G, Forbes J, Graham C, Hackett M, Hankey GJ, House A, Lewis S, Lundström E, Sandercock P, Innes K, Williams C, Drever J, Mcgrath A, Deary A, Fraser R, Anderson R, Walker P, Perry D, Mcgill C, Buchanan D, Chun Y, Dinsmore L, Maschauer E, Barugh A, Mikhail S, Blair G, Hoeritzauer I, Scott M, Fraser G, Lawrence K, Shaw A, Williamson J, Burgess D, Macleod M, Morales D, Sullivan F, Brady M, French R, Van Wijck F, Watkins C, Proudfoot F, Skwarski J, Mcgowan D, Murphy R, Burgess S, Rutherford W, Mccormick K, Buchan R, Macraild A, Paulton R, Fazal A, Taylor P, Parakramawansha R, Hunter N, Perry J, Bamford J, Waugh D, Veraque E, Bedford C, Kambafwile M, Idrovo L, Makawa L, Smalley P, Randall M, Thirugnana-Chandran T, Hassan A, Vowden R, Jackson J, Bhalla A, Rudd A, Tam CK, Birns J, Gibbs C, Lee Carbon L, Cattermole E, Marks K, Cape A, Hurley L, Kullane S, Smyth N, Eglinton C, Wilson J, Giallombardo E, Frith A, Reidy P, Pitt M, Sykes L, Dellafera D, Croome V, Kerwood L, Hancevic M, Narh C, Merritt C, Duffy J, Cooke D, Willson J, Ali A, Naqvi A, Kamara C, Bowler H, Bell S, Jackson T, Harkness K, Stocks K, Duty S, Doyle C, Dunn G, Endean K, Claydon F, Richards E, Howe J, Lindert R, Majid A, Dakin K, Maatouk A, Barron L, Meegada M, Rana P, Nair A, Brighouse-Johnson C, Greig J, Kyu M, Prasad S, Robinson M, Alam I, Mclean B, Greenhalgh L, Ahmed Z, Roffe C, Brammer S, Beardmore C, Finney K, Barry A, Hollinshead P, Grocott J, Maguire H, Natarajan I, Chembala J, Sanyal R, Lijko S, Abano N, Remegoso A, Ferdinand P, Stevens S, Varquez R, Causley C, Butler A, Whitmore P, Stephen C, Carpio R, Hiden J, Muddegowda G, Denic H, Sword J, Curwen R, James M, Mudd P, Hall F, Cageao J, Keenan S, Roughan C, Kingwell H, Hemsley A, Lohan C, Davenport S, Bowring A, Chapter T, Hough M, Strain D, Gupwell K, Miller K, Goff A, Cusack E, Todd S, Partridge R, Jennings G, Thorpe K, Stephenson J, Littlewood K, Barber M, Brodie F, Marshall S, Esson D, Coburn I, Mcinnes C, Ross F, Bowie E, 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Selvarajah J, Kalladka D, Cheripelli B, Smith W, Moreton F, Welch A, Huang X, Douglas E, Lush A, Day N, El Tawil S, Montgomery K, Hamilton H, Ritchie D, Ramachandra S, Mcleish K, Thavanesan K, Loganathan S, Roberts J, Cox C, Orr S, Hogan A, Tiwari D, Hann G, Longland B, David O, Bell J, Ovington C, Rogers E, Bower R, Keltos M, Cohen D, Devine J, Alwis L, Southworth L, Burgess L, Lang M, Badiani B, Guo F, Oshodi A, Owoyele E, Epie N, David A, Mpelembue M, Bathula R, Abdul-Saheb M, Chamberlain A, Sudkeo V, Rashed K, Wood D, Williams-Yesson B, Board J, De Bruijn S, Buckley C, Board S, Allison J, Keeling E, Duckett T, Donaldson D, Vickers C, Barron C, Balian L, Wilson J, Edwards A, England T, Hedstrom A, Bedford E, Harper M, Melikyan E, Abbott W, Subramanian K, Goldsworthy M, Srinivasan M, Yeomans A, Donaldson D, Hurford F, Chapman R, Shahzad S, David O, Motherwell N, Tonks L, Young R, Ghani U, Mukherjee I, Dutta D, Obaid M, Brown P, Davis F, Ward D, Turfrey J, Cartwright B, Topia B, Spurway J, Collins K, Bakawala R, Hughes C, Oconnell S, Hill L, Chatterjee K, Webster T, Haider S, Rushworth P, Macleod F, Nallasivan A, Perkins C, Burns E, Leason S, Carter T, Seagrave S, Sami E, Armstrong L, Naqvi SN, Hassan M, Parkinson S, Mawer S, Darnbrook G, Booth C, Hairsine B, Smith M, Williamson S, Farquhar F, Esisi B, Cassidy T, Mankin G, Mcclelland B, Bokhari M, Sproates D, Epstein E, Hurdowar S, Blackburn R, Sukhdeep N, Razak S, Osman K, Hashmi A, Upton N, Harrington F, Courtauld G, Schofield C, Lucas L, Adie K, Bond K, Mate A, Skewes J, James A, Brodie C, Johnson M, Allsop L, Driver E, Harris K, Drake M, Ellis S, Maund B, Thomas E, Moore K, Burn M, Hamilton A, Mahalingam S, Misra A, Reid F, Benford A, Hilton D, Hazell L, Ofori K, Thomas AL, Mathew M, Dayal S, Burn I, Fotherby K, Jennings-Preece K, Willberry A, Morgan D, Butler D, Sahota G, Kauldhar K, Ahmad N, Stevens A, Das S, Bruce D, Pai Y, Nyo K, Stephenson L, Nendick R, Rogers G, Dhakal M, Dima S, Brown E, Clayton S, 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Weir N, Pressly V, Wood E, Sykes L, Howard G, Burton H, Crawford P, Egerton S, Evans S, Hakkak J, Andrews J, Lampard R, Allen C, Walters A, Said R, Marigold JR, Tsang SM, Creeden R, Cox C, Smith S, Gartrell I, Smith F, Jenkins C, Pryor J, Hedges A, Price F, Moseley L, Mercer L, Hughes C, Mcgowan D, Azim A, White J, Krasinska-Chavez M, Chaplin S, Curtis J, Singh D, Imam J, Nicolson A, Alam S, Whitworth S, Wood L, Warburton E, Kelly S, Mcgee J, Markus H, Chandrasena D, Hayden D, Sesay J, Hayhoe H, Bolton M, Macdonald J, Mitchell J, Farron C, Amis E, Day D, Culbert A, Espanol A, Hannon N, Handley D, Finlay S, Crisp S, Whitehead L, Francis J, Oconnell J, Osborne E, Beard R, Krishnamurthy R, Mokoena L, Sattar N, Myint M, Edwards M, Smith A, Corrigan P, Byrne A, Blackburn J, Mcghee C, Smart A, Macleod M, Donaldson F, Copeland C, Wilson J, Scott R, Fitzsimmons P, Lopez P, Wilkinson M, Manoj A, Cox P, Trainor L, Fletcher G, Denny L, Kavanagh K, Allsop H, Emsley H, Sultan S, Mcloughlin A, 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Sangaralingham S, Begum Y, Mutton S, Munuswamy Vaiyapuri E, Allen J, Lowe J, Hughes M, Wiggam I, Cuddy S, Tauro S, Wells B, Mohd Nor A, Eglinton C, Persad N, Kalita M, Weatherby S, Brown C, Pace A, Lashley D, Marner M, Weinling M, Wilmshurst N, Waugh D, Mucha A, Shah A, Baker J, Westcott J, Cowan R, Vasileiadis E, Mumani S, Parry A, Mason C, Holden M, Petrides K, Nishiyama T, Mehta H, Krishnan M, Lynne D, Thomas L, Lynda C, Hughes C, Clements C, Williams R, Anjum T, Sharon S, Tucker S, Jones P, Colwill D, Thompson Jones H, Chadha D, Fairweather M, Walstow D, Fong R, Johnston S, Almadenboyle C, Ross S, Carson S, Nair P, Tenbruck E, Stirling M, Pusalkar A, Beadle H, Chan K, Dangri P, Asokanathan A, Rana A, Gohil S, Massyn M, Aruldoss P, Cook A, Crabtree K, Dabbagh S, Black T, Clarke C, Mead D, Fennelly R, Anthony A, Nardone L, Dimartino V, Tribbeck M, Broughton D, Tryambake D, Dixon L, Skotnicka A, Thompson J, Whitehouse S, Sigsworth A, Wong J, Annamalai A, Pagan J, Affley B, Sunderland 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A, Rayessa R, Clarkson E, Rhian H, Fleming A, Mitchelson K, Lowthorpe V, Abdul-Hamid A, Jones P, Duggan C, Hynes A, Nurse E, Raza SA, Jones S, Pallikona U, Edwards B, Morgan G, Dennett K, Tench H, Loosley R, Trugeon-Smith T, Jones R, Williams R, Robson D, Mavinamane S, Meenakshisundaram S, Ranga L, Dealing S, Hill A, Hargreaves M, Smith T, Bate J, Harrison L, Kirthivasan R, Cannon E, Topliffe J, Keskeys R, Williams S, Mcneela F, Cairns F, James T, Lyle A, Shah S, Zachariah G, Fergey L, Smolen S, Cooper L, Bohannan E, Omer S, Amlani S, Hunter N, Hawkes-Blackburn M, Gulli G, Peacocke A, Amero J, Burova M, Speirs O, Levy S, Francis L, Holland S, Brotheridge S, Lyon H, Hare C, Jackson S, Stephenson L, Al Hussayni S, Featherstone J, Bwalya A, Singh A, Goorah MN, Walford J, Bell A, Kelly C, Rusk D, Sutton D, Patel F, Duberley S, Hayes K, Hunt L, El Nour A, Cottrell P, Westmoreland J, Honour S, Box C, Wood P, Haritakis M, Dyer S, Brown L, Elliott K, Temlett E, Paterson J, Furness R, Young S, Orugun E, Brewer C, Thornthwaite S, Crowther H, Glover R, Sein M, Haque K, Gibson E, Wong S, Rotchell K, Burton K, Brookes L, Bailey L, Leonard D, Lindley C, Murray A, Waltho K, Holland M, Kumar P, Harlekar P, Booth L, Culmsee C, Drew J, Khan M, Mackenzie N, Thomas C, Ritchie J, Barker J, Haley M, Cotterill D, Lane L, Little C, Simmons D, Saunders G, Dymond H, Kidd S, Warinton R, Neves-Silva Y, Nevajda B, Villaruel M, Umasankar U, Patel S, Man A, Christmas N, Rangasamy R, Ladner R, Butt G, Alvares W, Gadi N, Power M, Wroath B, Dynan K, Wilson D, Crothers S, Leonard C, Hagan S, Douris G, Vahidassr D, Thompson A, Gallen B, Mckenna S, Edwards C, Mcgoldrick C, Bhattad M, Kawafi K, Morse D, Jacob P, Turner L, Saravanan N, Johnson L, Humphrey S, Namushi R, Patel R, Mclaughlin J, Omahony P, Osikominu E, Orefo C, Mcdonald C, Jones V, Makanju E, Khan T, Appiatse G, Stone H, Augustin M, Wardale A, Salehin M, Bailey D, Garcia-Alen L, Kalathil L, Tinsley S, Jones T, Amor K, Ritchings A, Margerum E, Horton J, Miller R, Gautam N, Meir J, Jones A, Putteril J, Lepore M, Makanju E, Gallifent R, Arundell LL, Mcredmond C, Goulding A, Nadarajan V, Laurence J, Fung Lo S, Melander S, Nicholas P, Woodford E, Mckenzie G, Le V, Crause J, Luder R, Bhargava M, Shah R, Bhome G, Johnson VV, Chesser D, Bridger H, Murali E, Scott J, Morrison S, Burns A, Graham J, Duffy M, Ali K, Sargent T, Pitcher E, Gaylard J, Newman J, Punnoose S, Besley S, Purohit K, Rees A, Davy M, Chohan O, Khan MF, Walker R, Murray V, Bent C, Oakley S, Blight A, Peixoto C, Jones S, Livingstone G, Butler F, Bradfield S, Gordon L, Schmit J, Wijewardane A, Edmunds T, Wills R, Medcalf C, Argandona L, Cuenoud L, Hassan H, Erumere E, Ocallaghan A, Gompertz P, Redjep O, Auld G, Howaniec L, Song A, Tarkas T, Kabash H, Hungwe R. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet 2019; 393:265-274. [PMID: 30528472 PMCID: PMC6336936 DOI: 10.1016/s0140-6736(18)32823-x] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. METHODS FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. FINDINGS Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839-1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26-6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38-2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. INTERPRETATION Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. FUNDING UK Stroke Association and NIHR Health Technology Assessment Programme.
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Trefan L, Harris C, Evans S, Nuttall D, Maguire S, Kemp AM. A comparison of four different imaging modalities - Conventional, cross polarized, infra-red and ultra-violet in the assessment of childhood bruising. J Forensic Leg Med 2018; 59:30-35. [PMID: 30096460 PMCID: PMC6125673 DOI: 10.1016/j.jflm.2018.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 01/24/2023]
Abstract
Background It is standard practice to image concerning bruises in children. We aim to compare the clarity and measurements of bruises using cross polarized, infra-red (IR) and ultra-violet (UV) images to conventional images. Methods Children aged <11 years with incidental bruising were recruited. Demographics, skin and bruise details were recorded. Bruises were imaged by standard protocols in conventional, cross-polarized, IR and UV lights. Bruises were assessed in vivo for contrast, uniformity and diffuseness, and these characteristics were then compared across image modalities. Color images (conventional, cross polarized) were segmented and measured by ImageJ. Bruises of grey scale images (IR, UV) were measured by a ‘plug in’ of ImageJ. The maximum and minimum Feret's diameter, area and aspect ratio, were determined. Comparison of measurements across imaging modalities was conducted using Wilcoxon rank sum tests and modified Bland-Altman graphs. Significance was set at p < 0.05. Results Twenty five children had 39 bruises. Bruises that were of low contrast, i.e. difficult to distinguish from surrounding skin, were also more diffuse, and less uniformity in vivo. Low contrast bruises were best seen on conventional and cross-polarized images and less distinctive on IR and UV images. Of the 19 bruises visible in all modalities, the only significant difference was maximum and minimum Feret's diameters and area were smaller on IR compared to conventional images. Aspect ratios were not affected by the modality. Conclusions Conventional and cross-polarized imaging provides the most consistent bruise measurement, particularly in bruises that are not easily distinguished from surrounding skin visually. Diffuse bruises may be measured on conventional & cross polarized imaging. Infrared or ultraviolet imaging may not show bruises which are difficult to see in vivo. Measurements of bruises using infrared imaging may be smaller than other modalities.
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Affiliation(s)
- L Trefan
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
| | - C Harris
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
| | - S Evans
- Chief Clinical Photographer, Dental Photography, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK.
| | - D Nuttall
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
| | - S Maguire
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
| | - A M Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
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Baxter J, Dryden N, Fedele V, Johnson N, Maguire S, Orr N, Fletcher O. PO-054 Common genetic variants at the breast cancer risk region 2Q35 map to putative IGFbp5 enhancers. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Harris C, Alcock A, Trefan L, Nuttall D, Evans ST, Maguire S, Kemp AM. Optimising the measurement of bruises in children across conventional and cross polarized images using segmentation analysis techniques in Image J, Photoshop and circle diameter measurements. J Forensic Leg Med 2018; 54:114-120. [PMID: 29413952 DOI: 10.1016/j.jflm.2017.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/25/2017] [Accepted: 12/31/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bruising is a common abusive injury in children, and it is standard practice to image and measure them, yet there is no current standard for measuring bruise size consistently. We aim to identify the optimal method of measuring photographic images of bruises, including computerised measurement techniques. METHODS 24 children aged <11 years (mean age of 6.9, range 2.5-10 years) with a bruise were recruited from the community. Demographics and bruise details were recorded. Each bruise was measured in vivo using a paper measuring tape. Standardised conventional and cross polarized digital images were obtained. The diameter of bruise images were measured by three computer aided measurement techniques: Image J (segmentation with Simple Interactive Object Extraction (maximum Feret diameter), 'Circular Selection Tool' (Circle diameter), & the Photoshop 'ruler' software (Photoshop diameter)). Inter and intra-observer effects were determined by two individuals repeating 11 electronic measurements, and relevant Intraclass Correlation Coefficient's (ICC's) were used to establish reliability. Spearman's rank correlation was used to compare in vivo with computerised measurements; a comparison of measurement techniques across imaging modalities was conducted using Kolmogorov-Smirnov tests. Significance was set at p < 0.05 for all tests. RESULTS Images were available for 38 bruises in vivo, with 48 bruises visible on cross polarized imaging and 46 on conventional imaging (some bruises interpreted as being single in vivo appeared to be multiple in digital images). Correlation coefficients were >0.5 for all techniques, with maximum Feret diameter and maximum Photoshop diameter on conventional images having the strongest correlation with in vivo measurements. There were significant differences between in vivo and computer-aided measurements, but none between different computer-aided measurement techniques. Overall, computer aided measurements appeared larger than in vivo. Inter- and intra-observer agreement was high for all maximum diameter measurements (ICC's > 0.7). CONCLUSIONS Whilst there are minimal differences between measurements of images obtained, the most consistent results were obtained when conventional images, segmented by Image J Software, were measured with a Feret diameter. This is therefore proposed as a standard for future research, and forensic practice, with the proviso that all computer aided measurements appear larger than in vivo.
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Affiliation(s)
- C Harris
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
| | - A Alcock
- Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK.
| | - L Trefan
- School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Heath Park, Cardiff, UK.
| | - D Nuttall
- School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Heath Park, Cardiff, UK.
| | - S T Evans
- Dental Photography, School of Dentistry, College of Biomedical & Life Sciences, Cardiff University, Heath Park, Cardiff, UK.
| | - S Maguire
- School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Heath Park, Cardiff, UK; Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff CF14 4YS, UK.
| | - A M Kemp
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff CF14 4YS, UK.
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Ramadan H, Patterson C, Maguire S, Melvin I, Kain K, Teale E, Forster A. Incidence of first stroke and ethnic differences in stroke pattern in Bradford, UK: Bradford Stroke Study. Int J Stroke 2017; 13:374-378. [PMID: 29192873 DOI: 10.1177/1747493017743052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
Background Information on ethnic disparities in stroke between White and Pakistani population in Europe is scarce. Bradford District has the largest proportion of Pakistani people in England; this provides a unique opportunity to study the difference in stroke between the two major ethnic groups. Aim To determine the first-ever-stroke incidence and examine the disparities in stroke patterns between Whites and Pakistanis in Bradford. Methods Prospective 12 months study consisting of 273,327 adults (≥18 years) residents. Stroke cases were identified by multiple overlapping approaches. Results In the study period, 541 first-ever-strokes were recorded. The crude incidence rate was 198 per 100,000 person-years. Age adjusted-standardized rate to the World Health Organization world population of first-ever-stroke is 155 and 101 per 100,000 person-years in Pakistanis and Whites respectively. Four hundred and thirty-eight patients (81%) were Whites, 83 (15.3%) were Pakistanis, 11 (2%) were Indian and Bangladeshis, and 9 (1.7%) were of other ethnic origin. Pakistanis were significantly younger and had more obesity ( p = 0.049), and diabetes mellitus (DM) ( p = <0.001). They were less likely to suffer from atrial fibrillation ( p = <0.001), be ex- or current smokers ( p = <0.001), and drink alcohol above the recommended level ( p = 0.007) compared with Whites. In comparison with Whites, higher rates of age-adjusted stroke (1.5-fold), lacunar infarction (threefold), and ischemic infarction due to large artery disease (twofold) were found in the Pakistanis. Conclusions The incidence of first-ever-stroke is higher in the Pakistanis compared with the Whites in Bradford, UK. Etiology and vascular risk factors vary between the ethnic groups. This information should be considered when investigating stroke etiology, and when planning prevention and care provision to improve outcomes after stroke.
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Affiliation(s)
- Hawraman Ramadan
- 1 Neurology Department, 1906 Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK
| | - Chris Patterson
- 1 Neurology Department, 1906 Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK
| | - Stuart Maguire
- 1 Neurology Department, 1906 Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK
| | - Ian Melvin
- 1 Neurology Department, 1906 Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK
| | - Kirti Kain
- 2 Division of Cardiovascular & Diabetes Research, University of Leeds, Leeds, UK
| | - Elizabeth Teale
- 3 Academic Unit of Elderly Care and Rehabilitation, 70535 University of Leeds , Leeds, UK
| | - Anne Forster
- 3 Academic Unit of Elderly Care and Rehabilitation, 70535 University of Leeds , Leeds, UK
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Stewart R, Maguire S, Hanley K, Armstrong P. Donegal Going against the Flow: National Differences in Long-Term Urinary Catheterisation Rates in Men (> 65 Years) With Benign Prostatic Hypertrophy. Ir Med J 2017; 110:640. [PMID: 29372955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An analysis of Primary Care Reimbursement Service (PCRS, 2013) data demonstrated high rates of urinary catheter changes in Donegal compared to other regions of Ireland. There is a catheter change rate of 10.2% in Donegal men over 65 with medical cards (GMS) compared to rates of 2.7% and 0.17% in Waterford and South Dublin, respectively1. This 60-fold difference between an area with perceived good access to services (South Dublin) and Donegal an area that does not, prompted a survey of general practitioners in each of these areas to assess whether true male catheterisation rates were similarly disproportionate in Donegal. Based on this, data was collected from a population of 23,794 GMS patients in GP training practices in Donegal (Rural), Leinster (Urban) and Waterford (Suburban). The data sampled for Donegal demonstrated 19 long-term catheters (LTCs per 8603 GMS) compared to four LTCs (per 5,800 GMS) in Leinster and 3 LTCs (per 9,391 GMS) in Waterford (Table 1). This anomaly in LTC rates may be a proxy for lack of access to basic Urology services.
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Affiliation(s)
- R Stewart
- Donegal Specialist Training Scheme in General Practice, The Education Centre, St Conal's, Letterkenny, Donegal
| | - S Maguire
- Donegal Specialist Training Scheme in General Practice, The Education Centre, St Conal's, Letterkenny, Donegal
| | - K Hanley
- National Director of GP Training, ICGP, Donegal Specialist Training Scheme in General Practice
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Johnson E, Maguire S, Hollén L, Nuttall D, Rea D, Kemp A. Agents, mechanisms and clinical features of non-scald burns in children: A prospective UK study. Burns 2017. [DOI: 10.1016/j.burns.2017.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Betts T, Ahmed S, Maguire S, Watts P. Characteristics of non-vitreoretinal ocular injury in child maltreatment: a systematic review. Eye (Lond) 2017; 31:1146-1154. [PMID: 28338664 DOI: 10.1038/eye.2017.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/16/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo identify the spectrum of non-vitreoretinal ocular injury due to child maltreatment.MethodsAll language search of MEDLINE, PsychINFO, EMBASE, AMED, Web of Science, and CINAHL databases, 1950-2015, was conducted. INCLUSION CRITERIA explicit confirmation of injury aetiology, age <18 years, examination conducted by an ophthalmologist. Exclusion: post-mortem data, organic diseases, review articles. Standardised critical appraisal and narrative synthesis was conducted of included publications by two independent reviewers.ResultsOf 1492 studies identified, 153 full texts were assessed, 49 underwent full review, resulting in five included studies: three case series and two case reports. The 26 included cases describe a wide variety of ocular, facial and skeletal injuries occurring as a consequence of child maltreatment. Ocular signs included periorbital oedema, chemosis, injection, abrasion, hyphaema, and cataract. Of interest all children that had suffered physical abuse with ocular injury had subconjunctival haemorrhages. Children presenting with abusive ocular injuries had a mean age of 13.9 months (range 1-68), while those who suffered violent corporal punishment were considerably older (mean 96 months). All cases, apart from severe corporal punishment, underwent screening for occult fractures, but neuroimaging only apparent in 2/5 eligible cases.ConclusionAlthough, the face is the most common site of abusive injury, there is a paucity of high-quality data on non-vitreoretinal ocular abusive injury. Thus, while subconjunctival haemorrhages are a potential sentinel injury of maltreatment, and may warrant further evaluation, the lack of large-scale published data limits our ability to highlight further specific characteristics of non-vitreoretinal ocular injury indicative of child abuse.
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Affiliation(s)
- T Betts
- Ophthalmology Registrar, University Hospital of Wales, Cardiff, UK
| | - S Ahmed
- Cardiff University, Cardiff, UK
| | - S Maguire
- Senior Lecturer in Child Health, Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK
| | - P Watts
- Consultant Ophthalmologist, University Hospital of Wales, Cardiff, UK
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Mohd Noor A, Maguire S, Watkins J, Quist J, Mirza H, Tutt A, Gillett C, Natrajan R, Grigoriadis A. Abstract P1-05-14: Copy number aberration-induced gene breakage analysis identifies recurrent FOXP1 fusions in breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Genomic instability is a critical feature of breast cancers, which manifests in genome-wide copy number aberrations (CNA), often causing “gene breakage” and the generation of fusion genes. We aimed to identify aborted transcripts with underlying CNAs and to investigate the molecular landscape of breast cancers harbouring such events.
Methods: A walking student's t-test algorithm was applied to Affymetrix Exon 1.0ST array data of 123 breast cancers to identify regions of aborted transcription and overlaid with DNA breakpoints derived from matched Affymetrix SNP6 ASCAT-segmented copy number. Aborted transcripts were investigated as potential fusion gene partners through RNA-seq analysis of 151 breast cancer samples (TCGA) and 51 breast cancer cell lines (BCCL) using ChimeraScan. Clinical correlates were established for clinicopathological features, genomic instability measures, and gene expression-based molecular classifiers including PAM50, TNBCtype, IntClust subtypes and immune signatures.
Results: One hundred and six genes with recurrent CNA-induced aborted transcription were identified. Aborted transcription showed hormone receptor subtype-specificity for 7 genes (nTNBC=1, nNon-TNBC=6) and was less prevalent in samples of IntClust 2 and IntClust 4 subtypes (p: 0.0043, 0.0011). Aborted transcripts were more frequently observed in samples with greater copy-neutral loss of heterozygosity (p=0.012), while aborted transcription of 54/106 genes significantly affected enrichment of 27 tumor-infiltrating lymphocyte subpopulations.14 aborted transcripts were found as a fusion gene with one partner in RNA-seq of TCGA and BCCL, while 19 were involved in multiple fusion events (range=1-6, median=2). Nine of 106 genes displayed gene breakage and fusion events exclusively in samples with an enriched tandem duplication phenotype. Notably, FOXP1, localised to a tumour suppressor locus at 3p14.1, reported the highest number of fusion configurations (n=6) with concurrent aborted transcription across all RNA-seq datasets (nPRADA=9, nTCGA=38, nBCCL=6).
Conclusion: CNA-induced gene breakage affects the molecular landscape of breast cancers and is linked with many genomic configurations of interest including copy-neutral loss of heterozygosity and tandem duplications. In particular, the role of recurrent gene fusions of the tumour suppressor, FOXP1, in tumourigenesis warrants further investigation.
Citation Format: Mohd Noor A, Maguire S, Watkins J, Quist J, Mirza H, Tutt A, Gillett C, Natrajan R, Grigoriadis A. Copy number aberration-induced gene breakage analysis identifies recurrent FOXP1 fusions in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-14.
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Affiliation(s)
- A Mohd Noor
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - S Maguire
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - J Watkins
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - J Quist
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - H Mirza
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - A Tutt
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - C Gillett
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - R Natrajan
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - A Grigoriadis
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
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Henderson SJ, Konkar A, Hornigold DC, Trevaskis JL, Jackson R, Fritsch Fredin M, Jansson‐Löfmark R, Naylor J, Rossi A, Bednarek MA, Bhagroo N, Salari H, Will S, Oldham S, Hansen G, Feigh M, Klein T, Grimsby J, Maguire S, Jermutus L, Rondinone CM, Coghlan MP. Robust anti-obesity and metabolic effects of a dual GLP-1/glucagon receptor peptide agonist in rodents and non-human primates. Diabetes Obes Metab 2016; 18:1176-1190. [PMID: 27377054 PMCID: PMC5129521 DOI: 10.1111/dom.12735] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 06/20/2016] [Accepted: 06/29/2016] [Indexed: 01/11/2023]
Abstract
AIMS To characterize the pharmacology of MEDI0382, a peptide dual agonist of glucagon-like peptide-1 (GLP-1) and glucagon receptors. MATERIALS AND METHODS MEDI0382 was evaluated in vitro for its ability to stimulate cAMP accumulation in cell lines expressing transfected recombinant or endogenous GLP-1 or glucagon receptors, to potentiate glucose-stimulated insulin secretion (GSIS) in pancreatic β-cell lines and stimulate hepatic glucose output (HGO) by primary hepatocytes. The ability of MEDI0382 to reduce body weight and improve energy balance (i.e. food intake and energy expenditure), as well as control blood glucose, was evaluated in mouse models of obesity and healthy cynomolgus monkeys following single and repeated daily subcutaneous administration for up to 2 months. RESULTS MEDI0382 potently activated rodent, cynomolgus and human GLP-1 and glucagon receptors and exhibited a fivefold bias for activation of GLP-1 receptor versus the glucagon receptor. MEDI0382 produced superior weight loss and comparable glucose lowering to the GLP-1 peptide analogue liraglutide when administered daily at comparable doses in DIO mice. The additional fat mass reduction elicited by MEDI0382 probably results from a glucagon receptor-mediated increase in energy expenditure, whereas food intake suppression results from activation of the GLP-1 receptor. Notably, the significant weight loss elicited by MEDI0382 in DIO mice was recapitulated in cynomolgus monkeys. CONCLUSIONS Repeated administration of MEDI0382 elicits profound weight loss in DIO mice and non-human primates, produces robust glucose control and reduces hepatic fat content and fasting insulin and glucose levels. The balance of activities at the GLP-1 and glucagon receptors is considered to be optimal for achieving weight and glucose control in overweight or obese Type 2 diabetic patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - S. Will
- MedImmune LLCGaithersburgMDUSA
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Maguire S, Rea SM, Convery P. Electroconvulsive Therapy - What Do Patients Think Of Their Treatment? Ulster Med J 2016; 85:182-186. [PMID: 27698521 PMCID: PMC5031106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The Regulation and Quality Improvement Authority (RQIA) monitors the administration of electroconvulsive therapy (ECT) in Northern Ireland (NI). As part of their inspection methodology RQIA wished to include feedback from ECT patients. The aim of this report is to summarise the opinions of ECT patients over a 1-year period and to compare their feedback about treatment with the standards of best practice, as defined by the Electroconvulsive Therapy Accreditation Service (ECTAS). METHOD RQIA was granted permission to use the ECTAS patient questionnaire. The questionnaire was distributed to all the ECT clinics in NI and staff were requested to give them to patients who had received a course of ECT. RESULTS A total of 42 individuals returned questionnaires, 24 females (57.1%) and 18 (42.9%) males. The response rate was 26%. Almost half of respondents were detained under the Mental Health (Northern Ireland) Order 1986 (n=19, 45.2%), with one third receiving ECT as a day patient (n=14, 33.3%). Respondents reported having detailed information about ECT, with ECTAS standards 4.2 and 4.3 being affirmed in over 80% of cases. Eighty percent of respondents (n=34) believed they benefited from ECT. CONCLUSION The results are mainly favourable towards ECT. The majority felt they benefited from treatment.
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Abstract
This article provides a historical review of five long-term interventions which were undertaken within the NHS. The objective of the exercise was to examine how information systems (IS) were introduced into operational environments. The length of the interventions ranged from 9 months to almost 3 years. The five sites were all at different stages of system development and the research was carried out using a combination of participant observation and action research. The research question asks, `How can organizations think about and hence go about their information provision in such a way that successful IS are introduced?'
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Affiliation(s)
- Stuart Maguire
- Sheffield University 9 Mappin Street, Sheffield S1 4DT,
UK,
| | - Udechukwu Ojiako
- Division of Project Management Northumbria University
Newcastle upon Tyne NE18ST, UK,
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Noor AM, Maguire S, Watkins J, Quist J, Mirza H, Ougham K, Tutt A, Gillett C, Natrajan R, Grigoriadis A. The characterisation of potential fusion genes in breast cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61097-3] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rees P, Al-Hussaini A, Maguire S. Child abuse and fabricated or induced illness in the ENT setting: a systematic review. Clin Otolaryngol 2016; 42:783-804. [PMID: 27148702 DOI: 10.1111/coa.12668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Child maltreatment is persistently under-recognised. Given that a third of maltreated children may return with serious or fatal injuries, it is imperative that otolaryngologists who are in frequent contact with children are able to detect maltreatment at first presentation. OBJECTIVE OF REVIEW This review aims to identify ENT injuries, signs or symptoms that are indicative of physical abuse or fabricated or induced illness (child maltreatment). TYPE OF REVIEW Systematic review. SEARCH STRATEGY An all-language search, developed in Medline Ovid and consisting of 76 key words, was conducted of published and grey literature across 10 databases from inception to July 2015, for primary observational studies involving children aged <18 years. EVALUATION METHOD Each relevant article underwent two independent reviews with full critical appraisal, applying strict quality standards. RESULTS Of the 2448 studies identified and screened, 371 underwent full review, resulting in 38 included studies that detailed 122 maltreated children. Pharyngeal perforations (n = 20) were the most frequent abusive ENT injury, predominantly affecting neonates and infants, presenting with dysphagia, drooling, haemoptysis and surgical emphysema. At least 52% of children with abusive pharyngeal injuries had additional co-existent injuries. The majority of ear injuries were inflicted to the external ear (n = 11) and included auricular deformity, abrasions, petechiae, lacerations and burns. Fabricated or induced illness cases presented most commonly with recurrent, unexplained otorrhoea or ENT lesions that failed to heal despite appropriate therapy. CONCLUSIONS All clinicians should be familiar with the signs of child maltreatment. Pharyngeal injuries, or injuries to the external ear, presenting in young children without an explicit history of witnessed injury should prompt a child protection referral for full evaluation. Likewise, children who present with recurrent, or apparently intractable symptoms and signs despite appropriate treatment, should raise the possibility of fabricated or induced illness, and discussion with a child protection specialist is advised. Early recognition of possible child maltreatment and instigation of appropriate safeguarding measures are essential to prevent repetition and escalation of injury. This is of paramount importance to otolaryngologists, who have the potential to identify these children in their practice.
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Affiliation(s)
- P Rees
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - A Al-Hussaini
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Wales, Cardiff, UK
| | - S Maguire
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
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Stevenson CM, Dargan DP, Warnock J, Sloan S, Espey R, Maguire S, Eames N. Traumatic central cord syndrome: neurological and functional outcome at 3 years. Spinal Cord 2016; 54:1010-1015. [DOI: 10.1038/sc.2016.34] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/17/2016] [Accepted: 02/15/2016] [Indexed: 11/09/2022]
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Maguire S, Chotirmall SH, Parihar V, Cormican L, Ryan C, O'Keane C, Redmond K, Smyth C. Isolated anterior mediastinal tuberculosis in an immunocompetent patient. BMC Pulm Med 2016; 16:24. [PMID: 26842759 PMCID: PMC4739107 DOI: 10.1186/s12890-016-0175-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/11/2016] [Indexed: 01/15/2023] Open
Abstract
Background The differential diagnosis of a mediastinal mass is a common challenge in clinical practice, with a wide range of differential diagnosis to be considered. One of the rarer causes is tuberculosis. Atypical presentations of tuberculosis are well documented in immunocompromised patients, but should also be considered in the immunocompetent. Case presentation This case outlines a previously healthy 22 year-old immunocompetent male presenting with worsening chest pain, positional dyspnea, dry cough and dysphagia. Chest x-ray showed evidence of an isolated anterior mediastinal mass, which was confirmed on computed tomography. A mediastinoscopy was diagnostic as histology revealed necrotizing granulomatous inflammation and the presence of acid-fast bacilli, indicating mediastinal tuberculosis. Conclusion Typically the underlying presentation of mediastinal tuberculosis is mediastinal lymphadenitis. This case was unusual in that we detected an isolated large anterior mediastinal mass accompanied by a relatively small burden of mediastinal lymphadenitis. Cases similar to this have been documented in immunosuppressed patients however in our case no evidence of immunosuppression was found. This case report emphasizes the importance that a detailed and logical pathway of investigation is pursued when encountering a mediastinal mass. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0175-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Maguire
- Department of Gastroenterology, Connolly Hospital, Blanchardstown, Dublin, Dublin 15, Ireland.
| | - S H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - V Parihar
- Department of Gastroenterology, Connolly Hospital, Blanchardstown, Dublin, Dublin 15, Ireland.
| | - L Cormican
- Department of Respiratory Medicine, Connolly Hospital, Blanchardstown, Dublin, Dublin 15, Ireland.
| | - C Ryan
- Department of Histopathology, Mater Misericordiae Hospital, Dublin, Dublin 7, Ireland.
| | - C O'Keane
- Department of Histopathology, Mater Misericordiae Hospital, Dublin, Dublin 7, Ireland.
| | - K Redmond
- Department of Cardiothoracic Surgery, Mater Misericordiae Hospital, Dublin, Dublin 7, Ireland.
| | - C Smyth
- Department of Gastroenterology, Connolly Hospital, Blanchardstown, Dublin, Dublin 15, Ireland.
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Galvin M, Madden C, Maguire S, Heverin M, Vajda A, Staines A, Hardiman O. Patient journey to a specialist amyotrophic lateral sclerosis multidisciplinary clinic: an exploratory study. BMC Health Serv Res 2015; 15:571. [PMID: 26700026 PMCID: PMC4690216 DOI: 10.1186/s12913-015-1229-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/25/2015] [Indexed: 12/12/2022] Open
Abstract
Background The multidisciplinary approach in the management of Amyotrophic Lateral Sclerosis (ALS) has been shown to provide superior care to devolved care, with better survival, improved quality of care, and quality of life. Access to expert multidisciplinary management should be a standard for patients with ALS. This analysis explores the patient journey from symptom onset and first engagement with health services, to the initial visit to a specialist ALS Multidisciplinary Clinic (MDC) in Dublin, Ireland. Methods A retrospective exploratory multi-method study details the patient journey to the MDC. Data from medical interviews and systematic chart review identifies interactions with the health services and key timelines for thirty five new patients presenting with a diagnosis of ALS during a 6 month period in 2013. Results The time from first symptom to diagnosis was a mean of 16 months (median 13 months), with a mean interval of 19 months (median 14.6) from first symptoms to arrival at the MDC. The majority of patients were seen by a general practitioner, and subsequently by neurology services. There was an average of four contacts with health services and 4.8 investigations/tests, prior to their first Clinic visit. On the first visit to the MDC patients are linked into an integrated ‘system’ that can provide specialist care and link with voluntary, palliative and community services as required. Conclusions Engagement with a multidisciplinary team has implications for service utilization and quality of life of patients and their families. We have demonstrated that barriers exist that delay referral to specialist services. Comprehensive data recording and collection, using multiple data sources can reconstruct the timelines of the patient journey, which can in turn be used to identify pathways that can expedite early referral to specialist services.
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Affiliation(s)
- M Galvin
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - C Madden
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - S Maguire
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland. .,Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland.
| | - M Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - A Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - A Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland.
| | - O Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland. .,Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland.
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Affiliation(s)
- K Jones
- University Hospital of South Manchester, Manchester, UK
| | - A Dobson
- University Hospital of South Manchester, Manchester, UK.
| | - S Maguire
- University Hospital of South Manchester, Manchester, UK
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Gilligan P, Lynch J, Eder H, Maguire S, Fox E, Doyle B, Casserly I, McCann H, Foley D. Assessment of clinical occupational dose reduction effect of a new interventional cardiology shield for radial access combined with a scatter reducing drape. Catheter Cardiovasc Interv 2015; 86:935-40. [DOI: 10.1002/ccd.26009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/11/2015] [Accepted: 04/11/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Paddy Gilligan
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - J. Lynch
- School of Physics, Dublin Institute of Technology; Dublin 8 Ireland
| | - H. Eder
- Department for Radiation Protection; Bavarian Office for Occupational Health and Safety; München Germany
| | - S. Maguire
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - E. Fox
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - B. Doyle
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - I. Casserly
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - H. McCann
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - D. Foley
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
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Touyz S, Le Grange D, Lacey H, Hay P, Smith R, Maguire S, Bamford B, Pike K, Crosby R. Treating Severe and Enduring Anorexia Nervosa: a Randomized Control Trial. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30281-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Maguire S, Leonidou A, Wai P, Marchio C, Ng C, Weigelt B, Sapino A, Vincent-Salomon A, Reis-Filho J, Natrajan R. 575 SF3B1 mutations are associated with alternative splicing in ER-positive breast cancer. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70701-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Russell P, Wickenden J, Cadwallader K, Maguire S, Joel J, Stockdale M, Chicas A, Banka D, Darman R, Perino S, Fekkes P, Smith P, Zhu P, Buonamici S, Moore J. 527 Is CRAF required for the maintenance of KRAS mutant non-small cell lung cancer? Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70653-7] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ojiako U, Chipulu M, Gardiner P, Williams T, Mota C, Maguire S, Shou Y, Stamati T. Effect of project role, age and gender differences on the formation and revision of project decision judgements. International Journal of Project Management 2014. [DOI: 10.1016/j.ijproman.2013.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chipulu M, Ojiako U, Gardiner P, Williams T, Mota C, Maguire S, Shou Y, Stamati T, Marshall A. Exploring the impact of cultural values on project performance. International Journal of Operations & Production Management 2014. [DOI: 10.1108/ijopm-04-2012-0156] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– This study aims to explore the impact of cultural values on the importance individuals assign to project success/failure factors (PSFFs).
Design/methodology/approach
– Themes emerging from 40 interviews of project practitioners based in Brazil, China, Greece, Nigeria, Thailand, the UAE, the UK and the USA are integrated with literature evidence to design a survey instrument. One thousand three hundred and thirteen practitioner survey responses from the eight countries are analysed using multi-group, structural equation modelling.
Findings
– Ten project success/failure indicators (PSFIs) are found to reduce to two main PSFFs: project control and extra-organisational goals and project team management/development and intra-organisational goals. It is found that the levels of importance individuals assign to both factors are dependent, not only on age and gender, but also cultural values measured as constructs based on Hofstede's individualism, masculinity, power distance and uncertainty avoidance dimensions.
Research limitations/implications
– The snowballing method used to gather survey data and analysis of relationships at individual level reduces generalisability.
Practical implications
– The results reveal insights on how best to match the cultural values of project participants to project characteristics. They also increase knowledge on the likely perceptual differences among culturally diverse individuals within projects.
Originality/value
– This research contributes to the literature on culture in project environments by defining a factor structure of multiple-dependent PSFIs and increases insight on how specific cultural values may impact on the perception of the so-defined PSFFs.
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