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Jablonski RY, Malhotra T, Shaw D, Coward TJ, Shuweihdi F, Bojke C, Pavitt SH, Nattress BR, Keeling AJ. Comparison of trueness and repeatability of facial prosthesis design using a 3D morphable model approach, traditional computer-aided design methods, and conventional manual sculpting techniques. J Prosthet Dent 2024:S0022-3913(24)00191-4. [PMID: 38616155 DOI: 10.1016/j.prosdent.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 04/16/2024]
Abstract
STATEMENT OF PROBLEM Manually sculpting a wax pattern of a facial prosthesis is a time-, skill-, and resource-intensive process. Computer-aided design (CAD) methods have been proposed as a substitute for manual sculpting, but these techniques can still require high technical or artistic abilities. Three-dimensional morphable models (3DMMs) could semi-automate facial prosthesis CAD. Systematic comparisons of different design approaches are needed. PURPOSE The purpose of this study was to compare the trueness and repeatability of replacing facial features with 3 methods of facial prosthesis design involving 3DMM, traditional CAD, and conventional manual sculpting techniques. MATERIAL AND METHODS Fifteen participants without facial defects were scanned with a structured light scanner. The facial meshes were manipulated to generate artificial orbital, nasal, or combined defects. Three methods of facial prosthesis design were compared for the 15 participants and repeated to produce 5 of each design for 2 participants. For the 3DMM approach, the Leeds face model informed the designs in a statistically meaningful way. For the traditional CAD methods, designs were created by using mirroring techniques or from a nose model database. For the conventional manual sculpting techniques, wax patterns were manually created on 3D printed full face baseplates. For analysis, the unedited facial feature was the standard. The unsigned distance was calculated from each of the several thousand vertices on the unedited facial feature to the closest point on the external surface of the prosthesis prototype. The mean absolute error was calculated, and a Friedman test was performed (α=.05). RESULTS The median mean absolute error was 1.13 mm for the 3DMM group, 1.54 mm for the traditional CAD group, and 1.49 mm for the manual sculpting group, with no statistically significant differences among groups (P=.549). Boxplots showed substantial differences in the distribution of mean absolute error among groups, with the 3DMM group showing the greatest consistency. The 3DMM approach produced repeat designs with the lowest coefficient of variation. CONCLUSIONS The 3DMM approach shows potential as a semi-automated method of CAD. Further clinical research is planned to explore the 3DMM approach in a feasibility trial.
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Affiliation(s)
- Rachael Y Jablonski
- Specialty Registrar in Restorative Dentistry and NIHR Doctoral Fellow, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, England, UK.
| | - Taran Malhotra
- Lead Specialist Maxillofacial Prosthetist, Maxillofacial Prosthetics Laboratory, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Liverpool, England, UK
| | - Daniel Shaw
- Maxillofacial Laboratory Manager, Maxillofacial Department, Chesterfield Royal Hospital Calow, Chesterfield, England, UK
| | - Trevor J Coward
- Professor and Honorary Consultant in Maxillofacial and Craniofacial Rehabilitation, Academic Centre of Reconstructive Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, England, UK
| | - Farag Shuweihdi
- Lecturer in Medical Statistics and Health Data Science, Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, England, UK
| | - Chris Bojke
- Professor of Health Economics, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Sue H Pavitt
- Professor of Translational and Applied Health Research, Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, England, UK
| | - Brian R Nattress
- Emeritus Professor of Restorative Dentistry, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, England, UK
| | - Andrew J Keeling
- Professor of Prosthodontics and Digital Dentistry, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, England, UK
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Webb EJD, Meads D, Eskytė I, Ford HL, Bekker HL, Chataway J, Pepper G, Marti J, Okan Y, Pavitt SH, Schmierer K, Manzano A. Decision Making About Disease-Modifying Treatments for Relapsing-Remitting Multiple Sclerosis: Stated Preferences and Real-World Choices. Patient 2023; 16:457-471. [PMID: 37072663 DOI: 10.1007/s40271-023-00622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND People with relapsing-remitting multiple sclerosis can benefit from disease-modifying treatments (DMTs). Several DMTs are available that vary in their efficacy, side-effect profile and mode of administration. OBJECTIVE We aimed to measure the preferences of people with relapsing-remitting multiple sclerosis for DMTs using a discrete choice experiment and to assess which stated preference attributes correlate with the attributes of the DMTs they take in the real world. METHODS Discrete choice experiment attributes were developed from literature reviews, interviews and focus groups. In a discrete choice experiment, participants were shown two hypothetical DMTs, then chose whether they preferred one of the DMTs or no treatment. A mixed logit model was estimated from responses and individual-level estimates of participants' preferences conditional on their discrete choice experiment choices calculated. Logit models were estimated with stated preferences predicting current real-world on-treatment status, DMT mode of administration and current DMT. RESULTS A stated intrinsic preference for taking a DMT was correlated with currently taking a DMT, and stated preferences for mode of administration were correlated with the modes of administration of the DMTs participants were currently taking. Stated preferences for treatment effectiveness and adverse effects were not correlated with real-world behaviour. CONCLUSIONS There was variation in which discrete choice experiment attributes correlated with participants' real-world DMT choices. This may indicate patient preferences for treatment efficacy/risk are not adequately taken account of in prescribing. Treatment guidelines must ensure they take into consideration patients' preferences and improve communication around treatment efficacy/risk.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ieva Eskytė
- School of Law, University of Leeds, Leeds, UK
| | | | - Hilary L Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- The Research Centre for Patient Involvement, Central Denmark Region, Aarhus, Denmark
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK
- Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yasmina Okan
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Klaus Schmierer
- Blizard Institute (Neuroscience) Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Jablonski RY, Coward TJ, Bartlett P, Keeling AJ, Bojke C, Pavitt SH, Nattress BR. IMproving facial PRosthesis construction with contactlESs Scanning and Digital workflow (IMPRESSeD): study protocol for a feasibility crossover randomised controlled trial of digital versus conventional manufacture of facial prostheses in patients with orbital or nasal facial defects. Pilot Feasibility Stud 2023; 9:110. [PMID: 37400919 DOI: 10.1186/s40814-023-01351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Facial prostheses can have a profound impact on patients' appearance, function and quality of life. There has been increasing interest in the digital manufacturing of facial prostheses which may offer many benefits to patients and healthcare services compared with conventional manufacturing processes. Most facial prosthesis research has adopted observational study designs with very few randomised controlled trials (RCTs) documented. There is a clear need for a well-designed RCT to compare the clinical and cost-effectiveness of digitally manufactured facial prostheses versus conventionally manufactured facial prostheses. This study protocol describes the planned conduct of a feasibility RCT which aims to address this knowledge gap and determine whether it is feasible to conduct a future definitive RCT. METHODS The IMPRESSeD study is a multi-centre, 2-arm, crossover, feasibility RCT with early health technology assessment and qualitative research. Up to 30 participants with acquired orbital or nasal defects will be recruited from the Maxillofacial Prosthetic Departments of participating NHS hospitals. All trial participants will receive 2 new facial prostheses manufactured using digital and conventional manufacturing methods. The order of receiving the facial prostheses will be allocated centrally using minimisation. The 2 prostheses will be made in tandem and marked with a colour label to mask the manufacturing method to the participants. Participants will be reviewed 4 weeks following the delivery of the first prosthesis and 4 weeks following the delivery of the second prosthesis. Primary feasibility outcomes include eligibility, recruitment, conversion, and attrition rates. Data will also be collected on patient preference, quality of life and resource use from the healthcare perspective. A qualitative sub-study will evaluate patients' perception, lived experience and preference of the different manufacturing methods. DISCUSSION There is uncertainty regarding the best method of manufacturing facial prostheses in terms of clinical effectiveness, cost-effectiveness and patient acceptability. There is a need for a well-designed RCT to compare digital and conventional manufacturing of facial prostheses to better inform clinical practice. The feasibility study will evaluate key parameters needed to design a definitive trial and will incorporate early health technology assessment and a qualitative sub-study to identify the potential benefits of further research. TRIAL REGISTRATION ISRCTN ISRCTN10516986). Prospectively registered on 08 June 2021, https://www.isrctn.com/ISRCTN10516986 .
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Affiliation(s)
- Rachael Y Jablonski
- Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK.
| | - Trevor J Coward
- Academic Centre of Reconstructive Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Paul Bartlett
- Maxillofacial Laboratory, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew J Keeling
- Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - Chris Bojke
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Brian R Nattress
- Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
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Jablonski RY, Malhotra T, Coward TJ, Shaw D, Bojke C, Pavitt SH, Nattress BR, Keeling AJ. Digital database for nasal prosthesis design with a 3D morphable face model approach. J Prosthet Dent 2023:S0022-3913(23)00132-4. [PMID: 37019749 DOI: 10.1016/j.prosdent.2023.02.019] [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] [Received: 09/15/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 04/05/2023]
Abstract
Designing nasal prostheses can be challenging because of the unpaired nature of the facial feature, especially in patients lacking preoperative information. Various nose model databases have been developed as a helpful starting point for the computer-aided design of nasal prostheses, but these do not appear to be readily accessible. Therefore, an open-access digital database of nose models has been generated based on a 3-dimensional (3D) morphable face model approach. This article describes the generation of the database, highlights steps for designing a nasal prosthesis, and points readers to the database for future clinical application and research.
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Jablonski RY, Veale BJ, Coward TJ, Keeling AJ, Bojke C, Pavitt SH, Nattress BR. Outcome measures in facial prosthesis research: A systematic review. J Prosthet Dent 2021; 126:805-815. [PMID: 33581868 PMCID: PMC8664412 DOI: 10.1016/j.prosdent.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM Facial prosthesis research uses a wide variety of outcome measures, which results in challenges when comparing the effectiveness of interventions among studies. Consensus is lacking regarding the most appropriate and meaningful outcome measures to use in facial prosthesis research to capture important perspectives. PURPOSE The purpose of the systematic review was to identify and synthesize outcome measures used in facial prosthesis research. MATERIAL AND METHODS Electronic searches were performed in 11 databases (including nonpeer-reviewed literature). The citations were searched, and expert societies were contacted to identify additional studies. Inclusion criteria comprised studies of participants with facial defects who required or had received prosthetic rehabilitation with an external facial prosthesis. Exclusion criteria comprised participants with ocular prostheses, case reports, case series with fewer than 5 participants, laboratory-based studies, and studies published before 1980. Study selection was performed independently by 2 reviewers. Discrepancies were resolved through discussion or by a third reviewer. Outcome measures were synthesized with a categorization approach based on the perspective, theme, and subtheme of the outcome measures. Quality assessment was performed with an appraisal tool that enabled evaluation of studies with diverse designs. RESULTS Database searching identified 13 058 records, and 7406 remained after duplications were removed. After initial screening, 189 potentially relevant records remained, and 186 full texts were located (98% retrieval rate). After full-text screening, 124 records were excluded. Citation searches and contact with expert societies identified 4 further records. In total, 69 articles (grouped into 65 studies) were included. Studies were categorized as per the perspective of their outcome measures, with the following findings: patient-reported (74% of studies), clinical indicators (34%), clinician-reported (8%), multiple viewpoints (6%), and independent observer-reported (3%). Patient-reported outcome measures included tools to assess satisfaction, quality of life, and psychologic health. Variability in the choice of outcome measures was evident among the studies, with many self-designed, unvalidated, condition-specific questionnaires reported. A greater number of outcome measure themes emerged over time; themes such as service delivery and health state utility have recently been evaluated. CONCLUSIONS Over the past 40 years, facial prosthesis research has focused on patient-reported outcome measures. Outcome measures relating to other perspectives have been used less frequently, although new themes appear to be emerging in the literature. Future research should use outcome measures with appropriate measurement properties for use with facial prosthetics.
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Affiliation(s)
- Rachael Y Jablonski
- Specialty Registrar in Restorative Dentistry and NIHR Doctoral Fellow, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK.
| | - Benjamin J Veale
- Medical Student, Hull York Medical School, University of York, York, UK
| | - Trevor J Coward
- Reader and Honorary Consultant in Maxillofacial and Craniofacial Rehabilitation, Academic Centre of Reconstructive Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Andrew J Keeling
- Clinical Associate Professor, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - Chris Bojke
- Professor of Health Economics, Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- Professor of Translational and Applied Health Research, Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Brian R Nattress
- Clinical Professor and Honorary Consultant, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
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Bennett MI, Allsop MJ, Allen P, Allmark C, Bewick BM, Black K, Blenkinsopp A, Brown J, Closs SJ, Edwards Z, Flemming K, Fletcher M, Foy R, Godfrey M, Hackett J, Hall G, Hartley S, Howdon D, Hughes N, Hulme C, Jones R, Meads D, Mulvey MR, O’Dwyer J, Pavitt SH, Rainey P, Robinson D, Taylor S, Wray A, Wright-Hughes A, Ziegler L. Pain self-management interventions for community-based patients with advanced cancer: a research programme including the IMPACCT RCT. Programme Grants Appl Res 2021. [DOI: 10.3310/pgfar09150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background
Each year in England and Wales, 150,000 people die from cancer, of whom 110,000 will suffer from cancer pain. Research highlights that cancer pain remains common, severe and undertreated, and may lead to hospital admissions.
Objective
To develop and evaluate pain self-management interventions for community-based patients with advanced cancer.
Design
A programme of mixed-methods intervention development work leading to a pragmatic multicentre randomised controlled trial of a multicomponent intervention for pain management compared with usual care, including an assessment of cost-effectiveness.
Participants
Patients, including those with metastatic solid cancer (histological, cytological or radiological evidence) and/or those receiving anti-cancer therapy with palliative intent, and health professionals involved in the delivery of community-based palliative care.
Setting
For the randomised controlled trial, patients were recruited from oncology outpatient clinics and were randomly allocated to intervention or control and followed up at home.
Interventions
The Supported Self-Management intervention comprised an educational component called Tackling Cancer Pain, and an eHealth component for routine pain assessment and monitoring called PainCheck.
Main outcome measures
The primary outcome was pain severity (measured using the Brief Pain Inventory). The secondary outcomes included pain interference (measured using the Brief Pain Inventory), participants’ pain knowledge and experience, and cost-effectiveness. We estimated costs and health-related quality-of-life outcomes using decision modelling and a separate within-trial economic analysis. We calculated incremental cost-effectiveness ratios per quality-adjusted life-year for the trial period.
Results
Work package 1 – We found barriers to and variation in the co-ordination of advanced cancer care by oncology and primary care professionals. We identified that the median time between referral to palliative care services and death for 42,758 patients in the UK was 48 days. We identified key components for self-management and developed and tested our Tackling Cancer Pain resource for acceptability. Work package 2 – Patients with advanced cancer and their health professionals recognised the benefits of an electronic system to monitor pain, but had reservations about how such a system might work in practice. We developed and tested a prototype PainCheck system. Work package 3 – We found that strong opioids were prescribed for 48% of patients in the last year of life at a median of 9 weeks before death. We delivered Medicines Use Reviews to patients, in which many medicines-related problems were identified. Work package 4 – A total of 161 oncology outpatients were randomised in our clinical trial, receiving either supported self-management (n = 80) or usual care (n = 81); their median survival from randomisation was 53 weeks. Primary and sensitivity analyses found no significant treatment differences for the primary outcome or for other secondary outcomes of pain severity or health-related quality of life. The literature-based decision modelling indicated that information and feedback interventions similar to the supported self-management intervention could be cost-effective. This model was not used to extrapolate the outcomes of the trial over a longer time horizon because the statistical analysis of the trial data found no difference between the trial arms in terms of the primary outcome measure (pain severity). The within-trial economic evaluation base-case analysis found that supported self-management reduced costs by £587 and yielded marginally higher quality-adjusted life-years (0.0018) than usual care. However, the difference in quality-adjusted life-years between the two trial arms was negligible and this was not in line with the decision model that had been developed. Our process evaluation found low fidelity of the interventions delivered by clinical professionals.
Limitations
In the randomised controlled trial, the low fidelity of the interventions and the challenge of the study design, which forced the usual-care arm to have earlier access to palliative care services, might explain the lack of observed benefit. Overall, 71% of participants returned outcome data at 6 or 12 weeks and so we used administrative data to estimate costs. Our decision model did not include the negative trial results from our randomised controlled trial and, therefore, may overestimate the likelihood of cost-effectiveness.
Conclusions
Our programme of research has revealed new insights into how patients with advanced cancer manage their pain and the challenges faced by health professionals in identifying those who need more help. Our clinical trial failed to show an added benefit of our interventions to enhance existing community palliative care support, although both the decision model and the economic evaluation of the trial indicated that supported self-management could result in lower health-care costs.
Future work
There is a need for further research to (1) understand and facilitate triggers that prompt earlier integration of palliative care and pain management within oncology services; (2) determine the optimal timing of technologies for self-management; and (3) examine prescriber and patient behaviour to achieve the earlier initiation and use of strong opioid treatment.
Trial registration
Current Controlled Trials ISRCTN18281271.
Funding
This project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Bridgette M Bewick
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - S José Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Zoe Edwards
- School of Pharmacy, University of Bradford, Bradford, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Division of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mary Godfrey
- Academic Unit of Elderly Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Julia Hackett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Geoff Hall
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Jones
- Yorkshire Centre for Health Informatics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John O’Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | | | | | - Sally Taylor
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Angela Wray
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Wanat M, Anthierens S, Butler CC, Savic L, Savic S, Pavitt SH, Sandoe JAT, Tonkin-Crine S. Management of penicillin allergy in primary care: a qualitative study with patients and primary care physicians. BMC Fam Pract 2021; 22:112. [PMID: 34116641 PMCID: PMC8194168 DOI: 10.1186/s12875-021-01465-1] [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] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 05/20/2021] [Indexed: 12/02/2022]
Abstract
Background Six percent of patients are allergic to penicillin according to their medical records. While this designation protects a small number of truly allergic patients from serious reactions, those who are incorrectly labelled may be denied access to recommended first line treatment for many infections. Removal of incorrect penicillin allergy may have positive health consequences for the individual and the general population. We aimed to explore primary care physicians’ (PCPs) and patients’ views and understanding of penicillin allergy with a focus on clinical management of infections in the face of a penicillin allergy record. Methods We conducted an interview study with 31 patients with a penicillin allergy record, and 19 PCPs in the North of England. Data were analysed thematically. Results Patients made sense of their allergy status by considering the timing and severity of symptoms. Diagnosis of penicillin allergy was reported to be ‘imperfect’ with PCPs relying on patient reports and incomplete medical records. PCPs and patients often suspected that an allergy record was incorrect, but PCPs were reluctant to change records. PCPs had limited knowledge of allergy services. PCPs often prescribed alternative antibiotics which were easy to identify. Both patients and PCPs differed in the extent to which they were aware of the negative consequences of incorrect penicillin allergy records, their relevance and importance to their lives, and management of penicillin allergy. Conclusions PCPs and patients appear insufficiently aware of potential harms associated with incorrect penicillin allergy records. Some of the problems experienced by PCPs could be reduced by ensuring the details of newly diagnosed reactions to antibiotics are clearly documented. In order for PCPs to overturn more incorrect penicillin records through appropriate use of allergy services, more information and training about these services will be needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01465-1.
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Affiliation(s)
- Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK.
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK
| | - Louise Savic
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, Faculty of Medicine and Health, University of Leeds, Worsley Building, Clarendon Way, Leeds, UK
| | - Jonathan A T Sandoe
- Healthcare Associated Infection Group, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK.,NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
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Eskytė I, Gray-Burrows KA, Owen J, Sykes-Muskett B, Pavitt SH, West R, Marshman Z, Day PF. Organizational Barriers to Oral Health Conversations Between Health Visitors and Parents of Children Aged 9-12 Months Old. Front Public Health 2021; 9:578168. [PMID: 33708755 PMCID: PMC7940188 DOI: 10.3389/fpubh.2021.578168] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Dental caries is the most prevalent preventable childhood disease and a major public health priority. Local authorities in England have a statutory responsibility to improve child health, including oral health, through the “Healthy Child Programme.” The “Healthy Child Programme,” which includes the provision of oral health advice is delivered by health visitors to parents of young children. To date, research has mainly concentrated on individual interactions between health visitors and parents, with less attention given to the broader context in which these oral health conversations between health visitor and parents take place. Objective: Our study explored the organizational factors that obstruct health visitors from engaging in meaningful conversations with parents about young children's oral health. Methods: Qualitative interviews and focus groups were held with health visiting teams (n = 18) conducting home visits with parents of 9–12-month olds in a deprived, urban area in England. Results: The study revealed the wide variation in what and how oral health advice is delivered to parents at home visits. Several barriers were identified and grouped into four key themes: (1) Priority of topics discussed in the home visits; (2) Finance cuts and limited resources; (3) Oral health knowledge and skills; and (4) Collaborative working with other professionals. It was evident that organizational factors in current public health policy and service provision play an important role in shaping oral health practices and opportunities for behavior change. Conclusion: Organizational practices and procedures play an important role in creating interaction patterns between health visiting teams and parents of young children. They often limit effective engagement with and positive change in oral health. For future oral health interventions to be effective, awareness of these barriers is essential alongside them being founded on evidence-based advice and underpinned by appropriate theory.
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Affiliation(s)
- Ieva Eskytė
- School of Law, University of Leeds, Leeds, United Kingdom
| | | | - Jenny Owen
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Bianca Sykes-Muskett
- Occupational Health Department, University of Huddersfield, Huddersfield, United Kingdom
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Peter F Day
- School of Dentistry, University of Leeds, Leeds, United Kingdom.,Bradford Community Dental Service, Bradford District Care NHS Foundation Trust, Bradford, United Kingdom
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9
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Manzano A, Eskyté I, Ford HL, Pavitt SH, Potrata B, Schmierer K, Chataway J, Webb EJD, Meads D, Pepper G, Bekker HL. Patient perspective on decisions to switch disease-modifying treatments in relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2020; 46:102507. [PMID: 32979733 DOI: 10.1016/j.msard.2020.102507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/14/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are now large cohorts of people with relapsing-remitting multiple sclerosis (pwRRMS) who have taken several Disease-Modifying Treatments (DMTs). Studies about switching DMTs mostly focus on clinical outcomes rather than patients' decision-making. Neurologists are now required to support decisions at various times during the relapsing disease course and they do so with concerns about DMTs risks. This qualitative study investigates how pwRRMS weigh up the pros and cons of DMTs, focusing on perceptions of effectiveness and risks when new treatments are considered. OBJECTIVE To increase understanding of people's experiences of decision-making when switching DMTs. METHODS 30 semi-structured interviews were conducted with pwRRMS in England. 16 participants had switched DMT and their experiences were compared with those who had only taken one DMT. Interviews were analysed thematically to answer: what main factors influence people's decision-making to switch DMTs and why? RESULTS Of the 16 participants with experience of switching DMT, eight had taken two or more DMTs; eight had taken three or more. Two was the DMT median. This study demonstrated that despite the term "switching" implying that similar treatments are inter-changeable, for pwRRMS taking new treatments involves different emotions, routines, risks, prognosis and communication experiences. Two meta themes identified were: 1) A distinctive, rapid and emotional decision-making process where old emotions related to MS prognosis are revisited. 2) Switching has a different impact on communication for escalation or de-escalation processes. CONCLUSION Switching DMT involves different routines, risks, prognosis and communication experiences. These decisions are emotionally difficult because of the fear about transitioning to secondary progressive MS, and DMT effectiveness uncertainty. Patient centred decision aids should include information about first and consecutive treatment decisions.
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Affiliation(s)
- A Manzano
- School of Sociology & Social Policy, University of Leeds, Leeds, LS2 9JT, United Kingdom.
| | - I Eskyté
- Centre for Disability Studies, University of Leeds, Leeds, United Kingdom
| | - H L Ford
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - S H Pavitt
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - B Potrata
- Independent Consultant, Rotterdam, the Netherlands
| | - K Schmierer
- Blizard Institute (Neuroscience), Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - J Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom
| | - E J D Webb
- Leeds Institute for Health Science, University of Leeds, Leeds, United Kingdom
| | - D Meads
- Leeds Institute for Health Science, University of Leeds, Leeds, United Kingdom
| | | | - H L Bekker
- Leeds Institute for Health Science, University of Leeds, Leeds, United Kingdom
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10
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West RM, Smith CJ, Pavitt SH, Butler CC, Howard P, Bates C, Savic S, Wright JM, Hewison J, Sandoe JAT. 'Warning: allergic to penicillin': association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes. J Antimicrob Chemother 2020; 74:2075-2082. [PMID: 31225607 DOI: 10.1093/jac/dkz127] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prevalence of reported penicillin allergy (PenA) and the impact these records have on health outcomes in the UK general population are unknown. Without such data, justifying and planning enhanced allergy services is challenging. OBJECTIVES To determine: (i) prevalence of PenA records; (ii) patient characteristics associated with PenA records; and (iii) impact of PenA records on antibiotic prescribing/health outcomes in primary care. METHODS We carried out cross-sectional/retrospective cohort studies using patient-level data from electronic health records. Cohort study: exact matching across confounders identified as affecting PenA records. Setting: English NHS general practices between 1 April 2013 and 31 March 2014. Participants: 2.3 million adult patients. Outcome measures: prevalence of PenA, antibiotic prescribing, mortality, MRSA infection/colonization and Clostridioides difficile infection. RESULTS PenA prevalence was 5.9% (IQR = 3.8%-8.2%). PenA records were more common in older people, females and those with a comorbidity, and were affected by GP practice. Antibiotic prescribing varied significantly: penicillins were prescribed less frequently in those with a PenA record [relative risk (RR) = 0.15], and macrolides (RR = 4.03), tetracyclines (RR = 1.91) nitrofurantoin (RR = 1.09), trimethoprim (RR = 1.04), cephalosporins (RR = 2.05), quinolones (RR = 2.10), clindamycin (RR = 5.47) and total number of prescriptions were increased in patients with a PenA record. Risk of re-prescription of a new antibiotic class within 28 days (RR = 1.32), MRSA infection/colonization (RR = 1.90) and death during the year subsequent to 1 April 2013 (RR = 1.08) increased in those with PenA records. CONCLUSIONS PenA records are common in the general population and associated with increased/altered antibiotic prescribing and worse health outcomes. We estimate that incorrect PenA records affect 2.7 million people in England. Establishing true PenA status (e.g. oral challenge testing) would allow more people to be prescribed first-line antibiotics, potentially improving health outcomes.
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Affiliation(s)
- R M West
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - C J Smith
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - S H Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - C C Butler
- University of Oxford Primary Care Clinical Trials Unit, Oxford, UK
| | - P Howard
- Faculty of Medicine and Health, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - S Savic
- Faculty of Medicine and Health, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J M Wright
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - J Hewison
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - J A T Sandoe
- Faculty of Medicine and Health, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
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11
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Coats RO, Crossley KL, Conlin N, Wu J, Zakrzewska JM, Pavitt SH, Phillips N, Mon-Williams M. Cognitive and sensorimotor function in participants being treated for trigeminal neuralgia pain. J Headache Pain 2020; 21:91. [PMID: 32680462 PMCID: PMC7367337 DOI: 10.1186/s10194-020-01156-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/01/2020] [Indexed: 11/26/2022] Open
Abstract
Background Trigeminal neuralgia (TN) is an orofacial condition defined by reoccurring, spontaneous, short-lived but excruciating stabbing pain. Pharmacological interventions constitute the first-line treatment for TN, with antiepileptic drugs commonly prescribed. People treated for TN pain with antiepileptic drugs describe cognitive and motor difficulties affecting activities of daily living, and report poorer quality of life. We undertook the first comprehensive objective evaluation of sensorimotor and cognitive performance in participants being treated for TN pain with antiepileptic drugs relative to age-matched controls. Methods Participants (43 TN, 41 control) completed a battery of sensorimotor (steering, aiming and tracking) and cognitive (working memory, processing speed, inhibition) tasks. Results The TN group performed significantly worse than controls on the sensorimotor tracking and aiming tasks and across all cognitive measures. Conclusions The data explain why patients treated with antiepileptic drugs report impairment when conducting activities of daily living (given the need for cognitive and motor capability within most of these). The study is an important first step in: (i) ensuring there is adequate information on the impact of pharmacological treatment; (ii) identifying measures to determine optimal medication dosage and track change over time; (iii) creating an evidence base that could allow scientific justification of alternative pain treatment options for TN (e.g. the costs/benefits of surgery).
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Affiliation(s)
- Rachel O Coats
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
| | - Kirsty L Crossley
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Naomi Conlin
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
| | - Joanna M Zakrzewska
- Royal ENT and Eastman Dental Hospitals, University College London, London, UK
| | - Sue H Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Mark Mon-Williams
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
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12
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Manzano A, Eskytė I, Ford HL, Bekker HL, Potrata B, Chataway J, Schmierer K, Pepper G, Meads D, Webb EJ, Pavitt SH. Impact of communication on first treatment decisions in people with relapsing-remitting multiple sclerosis. Patient Educ Couns 2020; 103:S0738-3991(20)30280-9. [PMID: 32456983 DOI: 10.1016/j.pec.2020.05.014] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Disease-Modifying Treatments (DMTs) have contributed to a new clinical landscape for people with relapsing-remitting multiple sclerosis (pwRRMS). A challenge for services is how to support DMT decisions with changing clinical evidence, and differing treatment goals. This article investigates how pwRRMS weigh up the pros and cons of DMTs by examining how communication at the point of diagnosis is related to DMT decisions. METHODS 30 semi-structured interviews with pwRRMS in England were conducted using a theoretical purposive sampling strategy and analysed using the thematic approach to answer: How does communication about RRMS during diagnosis influence decisions about when and which DMT to choose? RESULTS Three meta-themes were identified: a) communication context; b) delayed communication and hope for people with "non-active" RRMS at diagnosis; c) people with "active" RRMS at diagnosis: Conflated, generic, selective and simplified information CONCLUSION: At the time of diagnosis, patient-physician interactions are characterised by emotions and information complexity. Clinical, social and psychological DMT filtering mechanisms are activated during first decisions. Personalised evidence is needed to make informed decisions. PRACTICE IMPLICATIONS Patient decision aids should consider first and consecutive decisions and should not encourage a false sense of large choices that could add to decision anxiety.
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Affiliation(s)
- Ana Manzano
- School of Sociology & Social Policy, Room 11.20 Social Sciences Building, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Ieva Eskytė
- School of Law, University of Leeds, Leeds, United Kingdom
| | - Helen L Ford
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Hilary L Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Jeremy Chataway
- Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Klaus Schmierer
- Blizard Institute (Neuroscience), Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Edward Jd Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sue H Pavitt
- School of Dentistry, University of Leeds, Leeds, United Kingdom
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13
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Thompson W, Tonkin-Crine S, Pavitt SH, McEachan RRC, Douglas GVA, Aggarwal VR, Sandoe JAT. Factors associated with antibiotic prescribing for adults with acute conditions: an umbrella review across primary care and a systematic review focusing on primary dental care. J Antimicrob Chemother 2019; 74:2139-2152. [PMID: 31002336 PMCID: PMC6640312 DOI: 10.1093/jac/dkz152] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION One way to slow the spread of resistant bacteria is by improved stewardship of antibiotics: using them more carefully and reducing the number of prescriptions. With an estimated 7%-10% of antibiotic prescriptions globally originating from dental practices and up to 80% prescribed unnecessarily, dentistry has an important role to play. To support the design of new stewardship interventions through knowledge transfer between contexts, this study aimed to identify factors associated with the decision to prescribe antibiotics to adults presenting with acute conditions across primary care (including dentistry). METHODS Two reviews were undertaken: an umbrella review across primary healthcare and a systematic review in dentistry. Two authors independently selected and quality assessed the included studies. Factors were identified using an inductive thematic approach and mapped to the Theoretical Domains Framework (TDF). Comparisons between dental and other settings were explored. Registration number: PROSPERO_CRD42016037174. RESULTS Searches identified 689 publications across primary care and 432 across dental care. Included studies (nine and seven, respectively) were assessed as of variable quality. They covered 46 countries, of which 12 were low and middle-income countries (LMICs). Across the two reviews, 30 factors were identified, with 'patient/condition characteristics', 'patient influence' and 'guidelines & information' the most frequent. Two factors were unique to dental studies: 'procedure possible' and 'treatment skills'. No factor related only to LMICs. CONCLUSIONS A comprehensive list of factors associated with antibiotic prescribing to adults with acute conditions in primary care settings around the world has been collated and should assist theory-informed design of new context-specific stewardship interventions.
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Affiliation(s)
- W Thompson
- University of Leeds, School of Dentistry, Leeds, UK
| | - S Tonkin-Crine
- University of Oxford, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK
| | - S H Pavitt
- University of Leeds, School of Dentistry, Leeds, UK
| | - R R C McEachan
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - V R Aggarwal
- University of Leeds, School of Dentistry, Leeds, UK
| | - J A T Sandoe
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK
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14
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Navarro-Coy NC, Hyrich K, Pavitt SH, West RM, Buch MH. 085 Mapping between the American College of Rheumatology 20/50/70 and (change in) Disease Activity Score-28 in rheumatoid arthritis. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez106.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nuria C Navarro-Coy
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UNITED KINGDOM
| | - Kimme Hyrich
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester, UNITED KINGDOM
| | - Sue H Pavitt
- School of Dentistry, University of Leeds, Leeds, UNITED KINGDOM
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UNITED KINGDOM
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UNITED KINGDOM
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UNITED KINGDOM
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15
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Wanat M, Anthierens S, Butler CC, Savic L, Savic S, Pavitt SH, Sandoe JAT, Tonkin-Crine S. Patient and Primary Care Physician Perceptions of Penicillin Allergy Testing and Subsequent Use of Penicillin-Containing Antibiotics: A Qualitative Study. J Allergy Clin Immunol Pract 2019; 7:1888-1893.e1. [PMID: 30877074 DOI: 10.1016/j.jaip.2019.02.036] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Removal of an inaccurate penicillin allergy record following testing allows patients to access first-line treatment for infections, and reduce the use of broad-spectrum antibiotics, which contribute to antibiotic resistance. However, it is seldom undertaken. OBJECTIVES To identify clinicians' working in primary care and patients' views on barriers and enablers for penicillin allergy testing and subsequent antibiotic use. METHODS Fifty interviews with patients and clinicians, including 31 patients with a record of penicillin allergy, 16 with experience of testing, and 19 clinicians. Interviews were analyzed thematically. RESULTS Patients were often unaware of the benefits of penicillin allergy testing and only those patients who had experienced negative consequences of having a penicillin allergy label were motivated to get tested. Clinicians were reluctant to change patient records on the basis of their clinical judgment alone but had limited experience of referring patients with suspected penicillin allergy and were often uncertain about referral criteria and what the testing involved. Clinicians felt that allergy testing could be beneficial and patients who had attended testing reported benefits of the test. Clinicians expressed uncertainty related to whose responsibility it was to make sure that the patient understood allergy test results. CONCLUSIONS Clinicians would benefit from information about penicillin allergy testing to be able to use these services appropriately, and to discuss referral with patients. Patients might be more motivated to seek testing if they were more informed regarding its benefits. Good communication between primary and secondary care would facilitate the updating of medical records, and promote better patient education.
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Affiliation(s)
- Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, United Kingdom.
| | - Sibyl Anthierens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, United Kingdom
| | - Louise Savic
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Jonathan A T Sandoe
- Healthcare Associated Infection Group, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
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16
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Webb EJD, Meads D, Eskyte I, King N, Dracup N, Chataway J, Ford HL, Marti J, Pavitt SH, Schmierer K, Manzano A. A Systematic Review of Discrete-Choice Experiments and Conjoint Analysis Studies in People with Multiple Sclerosis. Patient 2019; 11:391-402. [PMID: 29313265 DOI: 10.1007/s40271-017-0296-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disabling, inflammatory, and degenerative disease of the central nervous system that, in most cases, requires long-term disease-modifying treatment (DMT). The drugs used vary in efficacy and adverse effect profiles. Several studies have used attribute-based stated-preference methods, primarily to investigate patient preferences for initiating or escalating DMT. OBJECTIVES To conduct a systematic review of attribute-based stated-preference studies in people with MS to identify common methods employed and to assess study quality, with reference to the specific challenges of this disease area. METHODS We conducted a systematic search for studies related to attribute-based stated-preference and MS in multiple databases, including Cochrane and MEDLINE. Studies were included if they were published in a peer-reviewed journal, were on the topic of MS, and used a survey methodology that measured stated preferences for attributes of a whole. Analysis was conducted using narrative synthesis and summary statistics. Study quality was judged against the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) conjoint analysis checklist. RESULTS We identified 16 relevant articles reporting 17 separate studies, all but one focusing on DMTs. Most studies were discrete-choice experiments. Study quality was generally high, but we recommend the following: (1) that consideration of sample sizes be improved, (2) that survey design choices be justified and documented, (3) that qualitative approaches for attribute and level selection be incorporated to better involve patients, and (4) that reporting of experimental practice be improved. The effects of DMTs on reproduction and the impact of how risk and uncertainty are presented were identified as neglected research topics. The ISPOR conjoint analysis checklist was found to be unsuitable for the assessment of study quality. CONCLUSION Attribute-based stated preference is a useful method with which to examine the preferences of people with MS in their choice of DMT. However, further research embracing the methodological recommendations identified, particularly greater use of qualitative methods in attribute development, is needed.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK.
| | - David Meads
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Ieva Eskyte
- School of Dentistry, University of Leeds, Leeds, UK
| | - Natalie King
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Naila Dracup
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK
| | | | - Joachim Marti
- Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Klaus Schmierer
- Blizard Institute (Neuroscience) Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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17
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Connick P, De Angelis F, Parker RA, Plantone D, Doshi A, John N, Stutters J, MacManus D, Prados Carrasco F, Barkhof F, Ourselin S, Braisher M, Ross M, Cranswick G, Pavitt SH, Giovannoni G, Gandini Wheeler-Kingshott CA, Hawkins C, Sharrack B, Bastow R, Weir CJ, Stallard N, Chandran S, Chataway J. Multiple Sclerosis-Secondary Progressive Multi-Arm Randomisation Trial (MS-SMART): a multiarm phase IIb randomised, double-blind, placebo-controlled clinical trial comparing the efficacy of three neuroprotective drugs in secondary progressive multiple sclerosis. BMJ Open 2018; 8:e021944. [PMID: 30166303 PMCID: PMC6119433 DOI: 10.1136/bmjopen-2018-021944] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The major unmet need in multiple sclerosis (MS) is for neuroprotective therapies that can slow (or ideally stop) the rate of disease progression. The UK MS Society Clinical Trials Network (CTN) was initiated in 2007 with the purpose of developing a national, efficient, multiarm trial of repurposed drugs. Key underpinning work was commissioned by the CTN to inform the design, outcome selection and drug choice including animal models and a systematic review. This identified seven leading oral agents for repurposing as neuroprotective therapies in secondary progressive MS (SPMS). The purpose of the Multiple Sclerosis-Secondary Progressive Multi-Arm Randomisation Trial (MS-SMART) will be to evaluate the neuroprotective efficacy of three of these drugs, selected with distinct mechanistic actions and previous evidence of likely efficacy, against a common placebo arm. The interventions chosen were: amiloride (acid-sensing ion channel antagonist); fluoxetine (selective serotonin reuptake inhibitor) and riluzole (glutamate antagonist). METHODS AND ANALYSIS Patients with progressing SPMS will be randomised 1:1:1:1 to amiloride, fluoxetine, riluzole or matched placebo and followed for 96 weeks. The primary outcome will be the percentage brain volume change (PBVC) between baseline and 96 weeks, derived from structural MR brain imaging data using the Structural Image Evaluation, using Normalisation, of Atrophy method. With a sample size of 90 per arm, this will give 90% power to detect a 40% reduction in PBVC in any active arm compared with placebo and 80% power to detect a 35% reduction (analysing by analysis of covariance and with adjustment for multiple comparisons of three 1.67% two-sided tests), giving a 5% overall two-sided significance level. MS-SMART is not powered to detect differences between the three active treatment arms. Allowing for a 20% dropout rate, 110 patients per arm will be randomised. The study will take place at Neuroscience centres in England and Scotland. ETHICS AND DISSEMINATION MS-SMART was approved by the Scotland A Research Ethics Committee on 13 January 2013 (REC reference: 13/SS/0007). Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBERS NCT01910259; 2012-005394-31; ISRCTN28440672.
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Affiliation(s)
- Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Floriana De Angelis
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Richard A Parker
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Domenico Plantone
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Anisha Doshi
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Nevin John
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Jonathan Stutters
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - David MacManus
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Ferran Prados Carrasco
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
- Department of Medical Physics and Biomedical Engineering, Translational Imaging Group (TIG), Centre for Medical Image Computing (CMIC), UCL, London, UK
| | - Frederik Barkhof
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sebastien Ourselin
- Department of Medical Physics and Biomedical Engineering, Translational Imaging Group (TIG), Centre for Medical Image Computing (CMIC), UCL, London, UK
| | - Marie Braisher
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Moira Ross
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gina Cranswick
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit (part of the NIHR Leeds CRF), University of Leeds, Leeds, UK
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claudia Angela Gandini Wheeler-Kingshott
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
- Brain MRI 3T Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Clive Hawkins
- Keele Medical School and Institute for Science and Technology in Medicine, Keele University, Keele, UK
| | - Basil Sharrack
- Department of Neuroscience, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Nigel Stallard
- Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jeremy Chataway
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
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18
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Healy P, Galvin S, Williamson PR, Treweek S, Whiting C, Maeso B, Bray C, Brocklehurst P, Moloney MC, Douiri A, Gamble C, Gardner HR, Mitchell D, Stewart D, Jordan J, O'Donnell M, Clarke M, Pavitt SH, Guegan EW, Blatch-Jones A, Smith V, Reay H, Devane D. Identifying trial recruitment uncertainties using a James Lind Alliance Priority Setting Partnership - the PRioRiTy (Prioritising Recruitment in Randomised Trials) study. Trials 2018; 19:147. [PMID: 29490702 PMCID: PMC5831203 DOI: 10.1186/s13063-018-2544-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 02/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Despite the problem of inadequate recruitment to randomised trials, there is little evidence to guide researchers on decisions about how people are effectively recruited to take part in trials. The PRioRiTy study aimed to identify and prioritise important unanswered trial recruitment questions for research. The PRioRiTy study - Priority Setting Partnership (PSP) included members of the public approached to take part in a randomised trial or who have represented participants on randomised trial steering committees, health professionals and research staff with experience of recruiting to randomised trials, people who have designed, conducted, analysed or reported on randomised trials and people with experience of randomised trials methodology. Methods This partnership was aided by the James Lind Alliance and involved eight stages: (i) identifying a unique, relevant prioritisation area within trial methodology; (ii) establishing a steering group (iii) identifying and engaging with partners and stakeholders; (iv) formulating an initial list of uncertainties; (v) collating the uncertainties into research questions; (vi) confirming that the questions for research are a current recruitment challenge; (vii) shortlisting questions and (viii) final prioritisation through a face-to-face workshop. Results A total of 790 survey respondents yielded 1693 open-text answers to 6 questions, from which 1880 potential questions for research were identified. After merging duplicates, the number of questions was reduced to 496. Questions were combined further, and those that were submitted by fewer than 15 people and/or fewer than 6 of the 7 stakeholder groups were excluded from the next round of prioritisation resulting in 31 unique questions for research. All 31 questions were confirmed as being unanswered after checking relevant, up-to-date research evidence. The 10 highest priority questions were ranked at a face-to-face workshop. The number 1 ranked question was “How can randomised trials become part of routine care and best utilise current clinical care pathways?” The top 10 research questions can be viewed at www.priorityresearch.ie. Conclusion The prioritised questions call for a collective focus on normalising trials as part of clinical care, enhancing communication, addressing barriers, enablers and motivators around participation and exploring greater public involvement in the research process.
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Affiliation(s)
- Patricia Healy
- Health Research Board - Trials Methodology Research Network, Galway, Ireland. .,School of Nursing and Midwifery, NUI Galway, Galway, Ireland.
| | - Sandra Galvin
- Health Research Board - Trials Methodology Research Network, Galway, Ireland.,School of Nursing and Midwifery, NUI Galway, Galway, Ireland
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology, University of Liverpool, Liverpool, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Caroline Whiting
- James Lind Alliance, Wessex Institute, University of Southampton, Southampton, UK
| | - Beccy Maeso
- James Lind Alliance, Wessex Institute, University of Southampton, Southampton, UK
| | | | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Abdel Douiri
- Division of Health and Social Care Research, King's College London, London, UK
| | - Carrol Gamble
- MRC North West Hub for Trials Methodology, University of Liverpool, Liverpool, UK
| | - Heidi R Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Derick Mitchell
- Irish Platform for Patient Organisations, Science and Industry (IPPOSI), Dublin, Ireland
| | - Derek Stewart
- National Institute for Health Research, London, England, UK
| | - Joan Jordan
- Irish Platform for Patient Organisations, Science and Industry (IPPOSI), Dublin, Ireland
| | - Martin O'Donnell
- Health Research Board - Trials Methodology Research Network, Galway, Ireland.,HRB-Clinical Research Facility Galway, NUI Galway, Galway, Ireland
| | - Mike Clarke
- Health Research Board - Trials Methodology Research Network, Galway, Ireland.,Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit (DenTCRU), Leeds NIHR CRF, University of Leeds, Leeds, UK
| | - Eleanor Woodford Guegan
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), University of Southampton, Southampton, UK
| | - Amanda Blatch-Jones
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), University of Southampton, Southampton, UK
| | - Valerie Smith
- Health Research Board - Trials Methodology Research Network, Galway, Ireland.,School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Hannah Reay
- National Institute for Health Research-Clinical Research Network (NIHR CRN), Birmingham, England, UK
| | - Declan Devane
- Health Research Board - Trials Methodology Research Network, Galway, Ireland.,School of Nursing and Midwifery, NUI Galway, Galway, Ireland
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Muir D, Vat LE, Keller M, Bell T, Jørgensen CR, Eskildsen NB, Johnsen AT, Pandya-Wood R, Blackburn S, Day R, Ingram C, Hapeshi J, Khan S, Muir D, Baird W, Pavitt SH, Boards R, Briggs J, Loughhead E, Patel M, Khalil R, Cooper D, Day P, Boards J, Wu J, Zoltie T, Barber S, Thompson W, Kenny K, Owen J, Ramsdale M, Grey-Borrows K, Townsend N, Johnston J, Maddison K, Duff-Walker H, Mahon K, Craig L, Collins R, O’Grady A, Wadd S, Kelly A, Dutton M, McCann M, Jones R, Mathie E, Wythe H, Munday D, Millac P, Rhodes G, Roberts N, Simpson J, Barden N, Vicary P, Wellings A, Poland F, Jones J, Miah J, Bamforth H, Charalambous A, Dawes P, Edwards S, Leroi I, Manera V, Parsons S, Sayers R, Pinfold V, Dawson P, Gibbons B, Gibson J, Hobson-Merrett C, McCabe C, Rawcliffe T, Frith L, Gudgin B, Wellings A, Horobin A, Ewart C, Higton F, Vanhegan S, Pandya-Wood R, Stewart J, Wragg A, Wray P, Widdowson K, Brighton LJ, Pask S, Benalia H, Bailey S, Sumerfield M, Etkind S, Murtagh FEM, Koffman J, Evans CJ, Hrisos S, Marshall J, Yarde L, Riley B, Whitlock P, Jobson J, Ahmed S, Rankin J, Michie L, Scott J, Barker CR, Barlow-Pay M, Kekere-Ekun A, Mazumder A, Nishat A, Petley R, Brady LM, Templeton L, Walker E, Moore D, Shaw L, Nunns M, Thompson Coon J, Blomquist P, Cochrane S, Edelman N, Calliste J, Cassell J, Mader LB, Kläger S, Wilkinson IB, Hiemstra TF, Hughes M, Warren A, Atkins P, Eaton H, Keenan J, Poland F, Wythe H, Wellings A, Vicary P, Rhodes C, Skrybrant M, Blackburn S, Chatwin L, Darby MA, Entwistle A, Hull D, Quann N, Hickey G, Dziedzic K, Eltringham SA, Gordon J, Franklin S, Jackson J, Leggett N, Davies P, Nugawela M, Scott L, Leach V, Richards A, Blacker A, Abrams P, Sharma J, Donovan J, Whiting P, Stones SR, Wright C, Boddy K, Irvine J, Harris J, Joseph N, Kok M, Gibson A, Evans D, Grier S, MacGowan A, Matthews R, Papoulias C, Augustine C, Hoffman M, Doughty M, Surridge H, Tembo D, Roberts A, Chambers E, Beever D, Wildman M, Davies RL, Staniszewska S, Stephens R, Schroter S, Price A, Richards T, Demaine A, Harmston R, Elliot J, Flemyng E, Sproson L, Pryde L, Reed H, Squire G, Stanton A, Langley J, Briggs M, Brindle P, Sanders R, McDermott C, David C, Nicola H, Simon D, Martin W, Coldham T, Ballinger C, Kerridge L, Mullee M, Eyles C, Barlow-Pay M, Hickey G, Johns T, Paylor J, Turner K, Whiting L, Roberts S, Petty J, Meager G, Grinbergs-Saull A, Morgan N, Turner K, Collins F, Gibson S, Passmore S, Evans L, Green SA, Trite J, Matthews R, Hrisos S, Thomson R, Green D, Atkinson H, Mitchell A, Corner L, AM AMK, Nguyen R, Frank B, McNeil N, Harrison H. Abstracts from the NIHR INVOLVE Conference 2017. Res Involv Engagem 2017; 3:27. [PMCID: PMC5773864 DOI: 10.1186/s40900-017-0075-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Delia Muir
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lidewij Eva Vat
- Newfoundland and Labrador’s Support for People and Patient-Oriented Research and Trials Unit, Memorial University Newfoundland, St. Johns, Newfoundland and Labrador Canada
| | - Malori Keller
- Saskatchewan Centre for Patient-Oriented Research, Health Quality Council, Saskatoon, Saskatchewan Canada
| | - Tim Bell
- Canadian Institutes of Health Research, Ottawa, Ontario Canada
| | - Clara R. Jørgensen
- Department of Disability, Inclusion and Special Needs, School of Education, University of Birmingham, Birmingham, UK
| | - Nanna B. Eskildsen
- Department of Palliative Medicine, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Anna T. Johnsen
- Department of Palliative Medicine, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Raksha Pandya-Wood
- National Institute for Health Research, Research Design Service East Midlands, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Steven Blackburn
- National Institute for Health Research, Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Ruth Day
- National Institute for Health Research, Research Design Service East Midlands, Department of Health Sciences, University of Leicester, Leicester, UK
- Public contributor involved with the National Institute for Health Research, Research Design Service Public Involvement Community, Derby, UK
| | - Carol Ingram
- National Institute for Health Research, Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
- Public contributor involved with the National Institute for Health Research, Research Design Service Public Involvement Community, Derby, UK
| | - Julie Hapeshi
- National Institute for Health Research, Research Design Service South West, Gloucestershire Royal Hospital, Gloucester, UK
| | - Samaira Khan
- National Institute for Health Research, Research Design Service Yorkshire and Humber, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Delia Muir
- National Institute for Health Research, Research Design Service Yorkshire and Humber, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Wendy Baird
- National Institute for Health Research, Research Design Service Yorkshire and Humber, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sue H. Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Richard Boards
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Janet Briggs
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Ellen Loughhead
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
- Batley Girls High School, Batley, UK
| | - Mariya Patel
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
- Batley Girls High School, Batley, UK
| | - Rameesa Khalil
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
- Batley Girls High School, Batley, UK
| | | | - Peter Day
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jenny Boards
- School of Dentistry, University of Leeds, Leeds, UK
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Sophy Barber
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Kate Kenny
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jenny Owen
- School of Dentistry, University of Leeds, Leeds, UK
| | | | | | | | | | - Katie Maddison
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Harry Duff-Walker
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Katie Mahon
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Lily Craig
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Rebecca Collins
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Alice O’Grady
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Sarah Wadd
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Adrian Kelly
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Maureen Dutton
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Michelle McCann
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Rebecca Jones
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Elspeth Mathie
- CRIPACC, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Helena Wythe
- CRIPACC, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Diane Munday
- Public Involvement in Research Group, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Paul Millac
- Public Involvement in Research Group, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Graham Rhodes
- INsPIRE PPI Group, Cambridgeshire Community Services NHS Trust, Ely, Cambridgeshire, UK
| | - Nick Roberts
- INsPIRE PPI Group, Cambridgeshire Community Services NHS Trust, Ely, Cambridgeshire, UK
| | - Jean Simpson
- Cambridge University Hospital (CUH) Patient and Public Involvement Panel, Cambridgeshire, UK
| | - Nat Barden
- Service User and Research Group, Cambridge and Peterborough Foundation Trust, Cambridgeshire, UK
| | - Penny Vicary
- Public & Patient Involvement in Research (PPIRes), Norfolk and Suffolk, UK
| | - Amander Wellings
- Public & Patient Involvement in Research (PPIRes), Norfolk and Suffolk, UK
| | | | - Julia Jones
- CRIPACC, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Jahanara Miah
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- Public Programmes Team, Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Howard Bamforth
- SENSE-Cog Research User Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Anna Charalambous
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness (ManCAD), Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Steven Edwards
- Public Programmes Team, Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Valeria Manera
- CoBTeK COgnition Behaviour Technology, Universite de Nice Sophia Antipolis, Nice, France
| | - Suzanne Parsons
- Public Programmes Team, Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Paul Dawson
- Lancashire Care NHS Foundation Trust, Preston, UK
| | | | | | | | | | | | - Lucy Frith
- National Institute for Health Research (NIHR), Research Design Service North West, University of Liverpool, Liverpool, UK
| | | | | | - Adele Horobin
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | | | | | | | - Raksha Pandya-Wood
- National Institute for Health Research (NIHR) East Midlands Research Design Service, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jane Stewart
- National Institute for Health Research (NIHR) East Midlands Research Design Service, School of Medicine, University of Nottingham, Nottingham Health Science Partners, Queen’s Medical Centre, Nottingham, UK
| | - Andy Wragg
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham, UK
| | - Paula Wray
- INVOLVE Coordinating Centre, University of Southampton, Southampton, UK
| | - Kirsty Widdowson
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | - Lisa Jane Brighton
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Sophie Pask
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Hamid Benalia
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Sylvia Bailey
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Marion Sumerfield
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Simon Etkind
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Fliss E. M. Murtagh
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Catherine J. Evans
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
- Department of Palliative Medicine, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Susan Hrisos
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Bren Riley
- Riverside Project, Newcastle upon Tyne, UK
| | | | | | - Safia Ahmed
- Health and Race Equality Forum, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Lydia Michie
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jason Scott
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline R. Barker
- National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Megan Barlow-Pay
- National Institute for Health Research Design Service South Central, University of Southampton, Southampton, Hampshire, UK
| | - Aisha Kekere-Ekun
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Aniqa Mazumder
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Aniqa Nishat
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Rebecca Petley
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Louca-Mai Brady
- Kingston and St George’s Joint Faculty and Independent Research Consultant, London, UK
| | | | - Erin Walker
- Centre for Outcomes and Experiences Research in Child Health, Illness and Disease, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Darren Moore
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Liz Shaw
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Michael Nunns
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Jo Thompson Coon
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Paula Blomquist
- Public Health England, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
| | - Sarah Cochrane
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Natalie Edelman
- Brighton & Sussex Medical School, Brighton, UK
- University of Brighton, Brighton, UK
| | - Josina Calliste
- National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
| | - Jackie Cassell
- National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - Laura B. Mader
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sabine Kläger
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian B. Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Thomas F. Hiemstra
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mel Hughes
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Angela Warren
- PIER (Public Involvement in Education and Research) partnership, Bournemouth University, Bournemouth, UK
| | - Peter Atkins
- PIER (Public Involvement in Education and Research) partnership, Bournemouth University, Bournemouth, UK
| | - Hazel Eaton
- Research and Development, Dorset Healthcare University NHS Foundation Trust, Dorset, UK
| | | | | | - Helena Wythe
- University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Amander Wellings
- Members of the Patient and Public in Research Group (PPIRes), NHS South Norfolk Clinical Commissioning Group, Norwich, Norfolk, UK
| | - Penny Vicary
- Members of the Patient and Public in Research Group (PPIRes), NHS South Norfolk Clinical Commissioning Group, Norwich, Norfolk, UK
| | - Carol Rhodes
- NIHR Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Magdalena Skrybrant
- NIHR Collaboration for Leadership in Health Research and Care West Midlands, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Blackburn
- NIHR Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Lucy Chatwin
- Academic Health Science Network West Midlands, Institute of Translational Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Mary-Anne Darby
- NIHR Clinical Research Network West Midlands, Greyfriars Business Park, Stafford, UK
| | - Andrew Entwistle
- NIHR Clinical Research Network West Midlands, Greyfriars Business Park, Stafford, UK
| | - Diana Hull
- NIHR/Wellcome Trust Birmingham Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Naimh Quann
- NIHR/Wellcome Trust Birmingham Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gary Hickey
- INVOLVE, University of Southampton Science Park, Southampton, UK
| | - Krysia Dziedzic
- NIHR Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Sabrina A. Eltringham
- Directorate of Therapeutics and Palliative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim Gordon
- Directorate of Therapeutics and Palliative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sue Franklin
- Directorate of Therapeutics and Palliative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Joni Jackson
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nick Leggett
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Philippa Davies
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Manjula Nugawela
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lauren Scott
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Verity Leach
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Richards
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anthony Blacker
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Jitin Sharma
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Jenny Donovan
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Penny Whiting
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon R. Stones
- NIHR: CRN Children/Arthritis Research UK Paediatric Rheumatology Clinical Studies Group, Liverpool, UK
| | - Catherine Wright
- NIHR: CRN Children/Arthritis Research UK Paediatric Rheumatology Clinical Studies Group, Liverpool, UK
| | - Kate Boddy
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Jenny Irvine
- NIHR CLAHRC North West Coast (CLAHRC NWC), Based at Division of Health Research, Lancaster University, Lancaster, UK
| | - Jim Harris
- Peninsula Public Involvement Group (PenPIG), PenCLAHRC, South West Peninsula, Exeter, UK
| | - Neil Joseph
- Public Reference Panel (PRP), CLAHRC NWC, North West Coast area, Liverpool, UK
| | - Michele Kok
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Andy Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - David Evans
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Sally Grier
- Department of Medical Microbiology, North Bristol NHS Trust, Bristol, UK
| | - Alasdair MacGowan
- Department of Medical Microbiology, North Bristol NHS Trust, Bristol, UK
| | - Rachel Matthews
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Cherelle Augustine
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Maurice Hoffman
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Heidi Surridge
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), Southampton, UK
| | - Doreen Tembo
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), Southampton, UK
| | - Amanda Roberts
- Public member, NETSCC Public Involvement Virtual Network and Public member of a Trial Steering Committee, Southampton, UK
| | - Eleni Chambers
- Public member, NETSCC PPI Reference Group, Southampton, UK
| | - Daniel Beever
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire UK
| | - Martin Wildman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire UK
| | - Rosemary L. Davies
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Warwick, UK
| | | | | | - Amy Price
- The BMJ, London, UK
- Department of Continuing Education, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Lise Sproson
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Liz Pryde
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Heath Reed
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Gill Squire
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Andy Stanton
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Joe Langley
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Moya Briggs
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Philip Brindle
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Rod Sanders
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Coyle David
- NIHR Devices for Dignity Healthcare Technology Co-operative at Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
- Renal Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Heron Nicola
- NIHR Devices for Dignity Healthcare Technology Co-operative at Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Davies Simon
- Institute for Applied Clinical Sciences, Keele University, Keele, Staffordshire UK
- University Hospital of North Midlands, Newcastle Rd, Stoke-on-Trent, Staffordshire, ST46QG UK
| | - Wilkie Martin
- University Hospital of North Midlands, Newcastle Rd, Stoke-on-Trent, Staffordshire, ST46QG UK
| | | | | | | | - Mark Mullee
- Research Design Service South Central, Southampton General Hospital, Southampton, UK
| | - Caroline Eyles
- Research Design Service South Central, Southampton General Hospital, Southampton, UK
| | - Megan Barlow-Pay
- Research Design Service South Central, Southampton General Hospital, Southampton, UK
| | - Gary Hickey
- NIHR INVOLVE, University of Southampton, Southampton, UK
| | - Tracey Johns
- NIHR Research Design Service East of England, University of Essex, Essex, UK
| | - Jon Paylor
- NIHR Research Design Service London, Kings College London, London, UK
| | - Katie Turner
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Lisa Whiting
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | - Sheila Roberts
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | - Julia Petty
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | - Gary Meager
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | | | | | - Kati Turner
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Flavia Collins
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Sarah Gibson
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Siobhan Passmore
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Liz Evans
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Stuart A. Green
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Jenny Trite
- Central and Northwest London NHS Foundation Trust, London, UK
| | - Rachel Matthews
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Susan Hrisos
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Richard Thomson
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Dave Green
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Helen Atkinson
- Faculty of Medical Sciences Engage, Newcastle University, Newcastle, UK
| | - Alex Mitchell
- Faculty of Medical Sciences Engage, Newcastle University, Newcastle, UK
| | - Lynne Corner
- Faculty of Medical Sciences Engage, Newcastle University, Newcastle, UK
| | | | - Rebecca Nguyen
- Consumer and Community Health Research Network, Perth, Australia
- Telethon Kids Institute, Perth, Australia
| | - Belinda Frank
- Consumer and Community Health Research Network, Perth, Australia
| | - Ngaire McNeil
- Consumer and Community Health Research Network, Perth, Australia
| | - Hayley Harrison
- Consumer and Community Health Research Network, Perth, Australia
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Hulme C, Robinson PG, Saloniki EC, Vinall-Collier K, Baxter PD, Douglas G, Gibson B, Godson JH, Meads D, Pavitt SH. Shaping dental contract reform: a clinical and cost-effective analysis of incentive-driven commissioning for improved oral health in primary dental care. BMJ Open 2016; 6:e013549. [PMID: 27609858 PMCID: PMC5020665 DOI: 10.1136/bmjopen-2016-013549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the clinical and cost-effectiveness of a new blended dental contract incentivising improved oral health compared with a traditional dental contract based on units of dental activity (UDAs). DESIGN Non-randomised controlled study. SETTING Six UK primary care dental practices, three working under a new blended dental contract; three matched practices under a traditional contract. PARTICIPANTS 550 new adult patients. INTERVENTIONS A new blended/incentive-driven primary care dentistry contract and service delivery model versus the traditional contract based on UDAs. MAIN OUTCOME MEASURES Primary outcome was as follows: percentage of sites with gingival bleeding on probing. Secondary outcomes were as follows: extracted and filled teeth (%), caries (International Caries Detection and Assessment System (ICDAS)), oral health-related quality of life (Oral Health Impact Profile-14 (OHIP-14)). Incremental cost-effective ratios used OHIP-14 and quality adjusted life years (QALYs) derived from the EQ-5D-3L. RESULTS At 24 months, 291/550 (53%) patients returned for final assessment; those lost to follow-up attended 6.46 appointments on average (SD 4.80). The primary outcome favoured patients in the blended contract group. Extractions and fillings were more frequent in this group. Blended contracts were financially attractive for the dental provider but carried a higher cost for the service commissioner. Differences in generic health-related quality of life were negligible. Positive changes over time in oral health-related quality of life in both groups were statistically significant. CONCLUSIONS This is the first UK study to assess the clinical and cost-effectiveness of a blended contract in primary care dentistry. Although the primary outcome favoured the blended contract, the results are limited because 47% patients did not attend at 24 months. This is consistent with 39% of adults not being regular attenders and 27% only visiting their dentist when they have a problem. Promotion of appropriate attendance, especially among those with high need, necessitates being factored into recruitment strategies of future studies.
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Affiliation(s)
- C Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - P G Robinson
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - E C Saloniki
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - P D Baxter
- Division of Epidemiology & Biostatistics, Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - G Douglas
- School of Dentistry, University of Leeds, Leeds, UK
| | - B Gibson
- Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - J H Godson
- School of Dentistry, University of Leeds, Leeds, UK
| | - D Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - S H Pavitt
- Director of the Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
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21
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Pavitt SH, Baxter PD, Brunton PA, Douglas G, Edlin R, Gibson BJ, Godson J, Hall M, Porritt J, Robinson PG, Vinall K, Hulme C. The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients-innovation in the commissioning of primary dental care service delivery and organisation in the UK. BMJ Open 2014; 4:e005931. [PMID: 25231492 PMCID: PMC4166246 DOI: 10.1136/bmjopen-2014-005931] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards 'blended contracts' that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. METHODS AND ANALYSIS The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. ETHICS AND DISSEMINATION The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals.
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Affiliation(s)
- Sue H Pavitt
- Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul D Baxter
- Division of Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Gail Douglas
- School of Dentistry, University of Leeds, Leeds, UK
| | - Richard Edlin
- School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Jenny Godson
- School of Dentistry, University of Leeds, Leeds, UK
- Public Health England, Regional Office, Leeds, UK
| | | | - Jenny Porritt
- Department of Psychology, Sociology & Politics Collegiate Campus Sheffield Hallam University, Sheffield, UK
| | | | - Karen Vinall
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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22
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Hyde TP, Craddock HL, Gray JC, Pavitt SH, Hulme C, Godfrey M, Fernandez C, Navarro-Coy N, Dillon S, Wright J, Brown S, Dukanovic G, Brunton PA. A randomised controlled trial of complete denture impression materials. J Dent 2014; 42:895-901. [PMID: 24995473 PMCID: PMC4119301 DOI: 10.1016/j.jdent.2014.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 10/02/2013] [Revised: 02/07/2014] [Accepted: 02/11/2014] [Indexed: 11/15/2022] Open
Abstract
Objectives There is continuing demand for non-implant prosthodontic treatment and yet there is a paucity of high quality Randomised Controlled Trial (RCT) evidence for best practice. The aim of this research was to provide evidence for best practice in prosthodontic impressions by comparing two impression materials in a double-blind, randomised, crossover, controlled, clinical trial. Methods Eighty-five patients were recruited, using published eligibility criteria, to the trial at Leeds Dental Institute, UK. Each patient received two sets of dentures; made using either alginate or silicone impressions. Randomisations determined the order of assessment and order of impressions. The primary outcome was patient blinded preference for unadjusted dentures. Secondary outcomes were patient preference for the adjusted dentures, rating of comfort, stability and chewing efficiency, experience of each impression, and an OHIP-EDENT questionnaire. Results Seventy-eight (91.8%) patients completed the primary assessment. 53(67.9%) patients preferred dentures made from silicone impressions while 14(17.9%) preferred alginate impressions. 4(5.1%) patients found both dentures equally satisfactory and 7 (9.0%) found both equally unsatisfactory. There was a 50% difference in preference rates (in favour of silicone) (95%CI 32.7–67.3%, p < 0.0001). Conclusion There is significant evidence that dentures made from silicone impressions were preferred by patients. Clinical significance Given the strength of the clinical findings within this paper, dentists should consider choosing silicone rather than alginate as their material of choice for secondary impressions for complete dentures. Trial Registration: ISRCTN 01528038.
This article forms part of a project for which the author (TPH) won the Senior Clinical Unilever Hatton Award of the International Assocation for Dental Research, Capetown, South Africa, June 2014.
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Affiliation(s)
- T P Hyde
- Leeds Dental Institute, University of Leeds, Leeds LS2 9LU, UK.
| | - H L Craddock
- University of Aberdeen Dental School, Cornhill Road, Aberdeen AB25 2ZR, UK
| | - J C Gray
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - S H Pavitt
- Applied Health Research, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - C Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - M Godfrey
- Health and Social Care, Leeds Institute of Health Sciences, Leeds LS2 9LJ, UK
| | - C Fernandez
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - N Navarro-Coy
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - S Dillon
- Leeds Dental Institute, University of Leeds, Leeds LS2 9LU, UK
| | - J Wright
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - S Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - G Dukanovic
- Dental Translational Clinical Research Unit (DenTCRU), Leeds Dental institute, University of Leeds, Leeds LS2 9LU, UK
| | - P A Brunton
- Leeds Dental Institute, University of Leeds, Leeds LS2 9LU, UK; Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Barrie J, Jayne DG, Wright J, Murray CJC, Collinson FJ, Pavitt SH. Attaining surgical competency and its implications in surgical clinical trial design: a systematic review of the learning curve in laparoscopic and robot-assisted laparoscopic colorectal cancer surgery. Ann Surg Oncol 2013; 21:829-40. [PMID: 24217787 DOI: 10.1245/s10434-013-3348-0] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic surgery is increasingly used in the treatment of colorectal cancer and more recently robotic assistance has been advocated. However, the learning curve to achieve surgical proficiency in laparoscopic surgery is ill-defined and subject to many influences. The aim of this review was to comprehensively appraise the literature on the learning curve for laparoscopic and robotic colorectal cancer surgery, and to quantify attainment of surgical proficiency and its implications in surgical clinical trial design. METHODS A systematic review using a defined search strategy was performed. Included studies had to state an explicit numerical value of the learning curve evaluated by a single parameter or multiple parameters. RESULTS Thirty-four studies were included, 28 laparoscopic and 6 robot assisted. Of the laparoscopic studies, nine defined the learning curve on the basis of a single parameter. Nine studies used more than one parameter to define learning, and 11 used a cumulative sum (CUSUM) analysis. One study used both a multiparameter and CUSUM analysis. The definition of proficiency was subjective, and the number of operations to achieve it ranged from 5 to 310 cases for laparoscopic and 15-30 cases for robotic surgery. CONCLUSIONS The learning curve in laparoscopic colorectal surgery is multifaceted and often ill-defined, with poor descriptions of mentorship/supervision. Further, the quantification to attain proficiency is variable. The use of a single parameter to quantify this is simplistic. Multidimensional assessment is recommended; as part of this, the CUSUM model, which assesses trends in multiple surgical outcomes, is useful and appropriate when assessing the learning curve in a clinical setting.
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Affiliation(s)
- Jenifer Barrie
- Division of Clinical Sciences, Leeds Institute of Molecular Medicine, The University of Leeds, Leeds, UK
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24
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Gray JC, Navarro-Coy N, Pavitt SH, Hulme C, Godfrey M, Craddock HL, Brunton PA, Brown S, Dillon S, Dukanovic G, Fernandez C, Wright J, Collier H, Swithenbank S, Lee C, Hyde TP. IMPROVDENT: improving dentures for patient benefit. A crossover randomised clinical trial comparing impression materials for complete dentures. BMC Oral Health 2012; 12:37. [PMID: 22937901 PMCID: PMC3532377 DOI: 10.1186/1472-6831-12-37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/06/2012] [Indexed: 11/16/2022] Open
Abstract
Background According to the UK Adult Dental Health Survey (2009) 15% of adults aged 65–74, 30% aged 75–84 and 47% aged >85 years are edentulous and require complete dentures. Patients’ quality of life and nutrition status are affected by poor dentures. The quality of the dental impression is the most important issue for improving the fit and comfort of new dentures. There is paucity of RCT evidence for which impression material is best for complete dentures construction. This study aims to compare two impression materials for effectiveness and cost effectiveness. Methods/Design IMPROVDENT is a double-blind crossover trial comparing the use of alginate and silicone, two commonly used denture impression materials, in terms of patient preference and cost-effectiveness. Eighty five edentulous patients will be recruited and provided with two sets of dentures, similar in all aspects except for the impression material used (alginate or silicone). Patients will try both sets of dentures for a two-week period, unadjusted, to become accustomed to the feel of the new dentures (habituation period). Patients will then wear each set of dentures for a period of 8 weeks (in random order) during which time the dentures will be adjusted for optimum comfort. Finally, patients will be given both sets of dentures for a further two weeks to wear whichever denture they prefer (confirmation period). Patients will be asked about quality of life and to rate dentures on function and comfort at the end of each trial period and asked which set they prefer at the end of the habituation period (unadjusted denture preference) and confirmation period (adjusted denture preference). A health economic evaluation will estimate incremental cost-effectiveness ratios of producing dentures from the two materials. A qualitative study will investigate the impact of dentures on behaviour and quality of life. Funding: IMPROVDENT is funded by NIHR RfPB (PB-PG-0408-16300). Discussion This trial aims to provide evidence on the costs and quality of dentures cast from two different commonly used impression materials; the intention is to significantly impact on the quality of denture production within NHS dentistry. Trial Registration ISRCTN Register: ISRCTN01528038 UKCRN Portfolio ID: 8305
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Affiliation(s)
- Janine C Gray
- Clinical Trials Research Unit, University of Leeds, Leeds LS2 9JT, UK
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