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Lau TMM, Lowe J, Pickles T, Hood K, Kotecha S, Gillespie D. AZTEC-azithromycin therapy for prevention of chronic lung disease of prematurity: a statistical analysis plan for clinical outcomes. Trials 2022; 23:704. [PMID: 35999617 PMCID: PMC9396905 DOI: 10.1186/s13063-022-06604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background The AZTEC trial is a multi-centre, randomised, placebo-controlled trial of azithromycin to improve survival without development of chronic lung disease of prematurity (CLD) in preterm infants. The statistical analysis plan for the clinical outcomes of the AZTEC trial is described. Methods and design A double-blind, randomised, placebo-controlled trial of a 10-day course of intravenous azithromycin (20 mg/kg for 3 days; 10 mg/kg for 7 days) administered to preterm infants born at < 30 weeks’ gestational age across UK tertiary neonatal units. Following parental consent, infants are randomly allocated to azithromycin or placebo, with allocated treatment starting within 72 h of birth. The primary outcome is survival without moderate/severe CLD at 36 weeks’ postmenstrual age (PMA). Serial respiratory fluid and stool samples are being collected up to 21 days of life. The target sample size is 796 infants, which is based on detecting a 12% absolute difference in survival without moderate/severe CLD at 36 weeks’ PMA (90% power, two-sided alpha of 0.05) and includes 10% loss to follow-up. Results Baseline demographic and clinical characteristics will be summarised by treatment arm and in total. Categorical data will be summarised by numbers and percentages. Continuous data will be summarised by mean, standard deviation, if data are normal, or median, interquartile range, if data are skewed. Tests of statistical significance will not be undertaken for baseline characteristics. The primary analysis, on the intention to treat (ITT) population, will be analysed using multilevel logistic regression, within a multiple imputation framework. Adjusted odds ratios, 95% confidence intervals, and p-values will be presented. For all other analyses, the analysis population will be based on the complete case population, which is a modified ITT population. All analyses will be adjusted for gestational age and treatment arm and account for any clustering by centre and/or multiple births as a random effect. Conclusion We describe the statistical analysis plan for the AZTEC trial, including the analysis principles, definitions of the key clinical outcomes, methods for primary analysis, pre-specified subgroup analysis, sensitivity analysis, and secondary analysis. The plan has been finalised prior to the completion of recruitment. Trial registration ISRCTN registry ISRCTN11650227. Registered on 31 July 2018.
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Affiliation(s)
| | - John Lowe
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
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Abbott RA, Cordaro A, Lloyd B, Cannings-John R, Wootton M, Kirby N, Pickles T, McQueen A, Westmoreland M, Ziaj S, Martin-Clavijo A, Wernham A, Matin R, Thomas-Jones E. Observational study to estimate the proportion of surgical site infection following excision of ulcerated skin tumours (OASIS study). Clin Exp Dermatol 2022; 47:882-888. [PMID: 34855996 DOI: 10.1111/ced.15037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ulceration is a recognized risk factor for surgical site infection (SSI); however, the proportion of patients developing SSI after excision of an ulcerated skin cancer is unknown. AIM To determine the proportion of participants with SSI after surgical excision of an ulcerated skin cancer. A secondary aim was to assess feasibility outcomes to inform the design of a randomized controlled trial to investigate the benefits and harms of perioperative antibiotics following excision of ulcerated tumours. METHODS This was a multicentre, prospective, observational study of patients undergoing excision of an ulcerated skin cancer between March 2019 and March 2020. Prior to surgical excision, surface swabs of the ulcerated tumours of participants recruited from one centre were undertaken to determine organism growth. At 4 weeks after surgery, all participants were e-mailed or posted the Wound Healing Questionnaire (WHQ) to determine whether they had developed SSI. RESULTS In total, 148 participants were recruited 105 (70.9%) males; mean ± SD age 77.1 ± 12.3 years. Primary outcome data were available for 116 (78.4%) participants, of whom 35 (30.2%) were identified as having an SSI using the WHQ with a cutoff score of 8, and 47 (40.5%) were identified with a cutoff score of 6. Using the modified WHQ in participants with wounds left to heal by secondary intention, 33 (28.4%) and 43 (37.1%) were identified to have SSI respectively. CONCLUSION This prospective evaluation of SSI identified with the WHQ following excision of ulcerated skin cancers demonstrated a high proportion with SSI. The WHQ was acceptable to patients; however, further evaluation is required to ensure validity in assessing skin wounds.
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Affiliation(s)
- R A Abbott
- Department of Dermatology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - A Cordaro
- Department of Dermatology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - B Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - M Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, Cardiff, UK
| | - N Kirby
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - T Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - A McQueen
- Department of Dermatology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - M Westmoreland
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Ziaj
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Martin-Clavijo
- Department of Dermatology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Wernham
- Department of Dermatology, Manor Hospital, Walsall Healthcare NHS Trust, Wallsall, UK
- Department of Dermatology, Leicester Royal Infirmary, Leicester University Hospitals NHS Trust, Leicester, UK
| | - R Matin
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E Thomas-Jones
- Centre for Trials Research, Cardiff University, Cardiff, UK
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Holloway CL, Pickles T, Croteau NS, Wai ES. Treatment Outcomes of Low-grade Lymphoma of the Orbit. Clin Oncol (R Coll Radiol) 2022; 34:e298-e304. [PMID: 35210133 DOI: 10.1016/j.clon.2022.01.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 02/08/2023]
Abstract
AIMS Radiation therapy can be used with curative intent in patients with low-grade orbital non-Hodgkin's lymphoma (NHL) stages IE and IVE (limited to the bilateral orbits). This study evaluated local control and survival outcomes of patients with unilateral or bilateral orbital lymphoma treated in a provincial population. MATERIALS AND METHODS The study subjects were 176 patients with low-grade orbital or conjunctival lymphoma referred for management from 1980 to 2016. Demographic, tumour and treatment characteristics were abstracted by chart review. Recurrence-free survival (RFS) and overall survival were assessed with competing risks analysis and Gray's test. RESULTS The median follow-up was 8.5 years (range 0.4-29.5 years). The median age at diagnosis was 65 years (range 20-97 years). The most common histological subtype was mucosa-associated lymphoid tissue (MALT) (73%). Stage IVE accounted for 20.5% of the cohort. Orbital radiation therapy was used in 122 patients with stage IE (87%) and 12 patients with stage IVE (28%). The median dose was 25 Gy (range 2-35 Gy). Other treatments were antibiotics (seven patients), chemotherapy (10 patients), radioimmunotherapy (six patients), surgery (three patients) and observation (16 patients). Within the group treated with orbital external beam radiation therapy (EBRT) there were no local recurrences. Among those with stage IE NHL, EBRT was associated with improved local RFS (P ≤ 0.001) but did not have an impact on contralateral or distant RFS. In patients with stage IVE NHL limited to the bilateral orbit, bilateral EBRT was associated with improved RFS (P = 0.012) but did not affect distant recurrences or overall survival. CONCLUSION There were no local recurrences after EBRT for stage IE and IVE orbital low-grade NHL. The treatments offered over the study period varied, but only EBRT for stage IVE disease improved RFS. This supports EBRT as the preferred primary treatment for patients with localised orbital low-grade lymphoma, including those with bilateral disease.
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Affiliation(s)
- C L Holloway
- Radiation Oncology, University of British Columbia, BC Cancer, Victoria, British Columbia, Canada.
| | - T Pickles
- Radiation Oncology, University of British Columbia, BC Cancer, Vancouver, British Columbia, Canada
| | - N S Croteau
- Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia, Canada
| | - E S Wai
- Radiation Oncology, University of British Columbia, BC Cancer, Victoria, British Columbia, Canada
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Urban R, Chow R, Pickles T, Chan M, Livergant J, Gerrie A, Freeman C, Sehn L, Scott D, Villa D, Savage K, Slack G, Lo A. The Impact of Surveillance Imaging After Curative Intent Radiotherapy for Limited Stage Follicular Lymphoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pattinson RL, Trialonis-Suthakharan N, Gupta S, Henry AL, Lavallée JF, Otten M, Pickles T, Courtier N, Austin J, Janus C, Augustin M, Bundy C. Patient-Reported Outcome Measures in Dermatology: A Systematic Review. Acta Derm Venereol 2021; 101:adv00559. [PMID: 34263330 PMCID: PMC9425604 DOI: 10.2340/00015555-3884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
By relying on data from existing patient-reported outcome measures of quality of life, the true impact of skin conditions on patients’ lives may be underestimated. This study systematically reviewed all dermatology-specific (used across skin conditions) patient-reported outcome measures and makes evidence-based recommendations for their use. The study protocol is registered on PROSPERO (CRD42018108829). PubMed, PsycInfo and CINAHL were searched from inception to 25 June 2018. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria were used to assess the measurement properties and methodological quality of studies. A total of 12,925 abstracts were identified. Zero patient-reported outcome measures were assigned to category A (ready for use without further validation), 31 to category B (recommended for use, but only with further validation) and 5 to category C (not recommended for use). There is no gold-standard dermatology-specific patient-reported outcome measure that can be recommended or used without caution. A new measure that can comprehensively capture the impact of dermatological conditions on the patient’s life is needed.
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Affiliation(s)
- Rachael L Pattinson
- College of Biomedical and Life Sciences, School of Healthcare Sciences, Cardiff University, CF24 0AB Cardiff, United Kingdom. E-mail:
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6
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Chahal M, Jiang A, Hayden A, Savage K, Villa D, Scott D, Gerrie A, Lo A, Chan M, Pickles T, Connors J, Sehn L, Freeman C. OUTCOMES AFTER INITIAL REFUSAL OF CURATIVE TREATMENT IN PATIENTS WITH HODGKIN LYMPHOMA IN BRITISH COLUMBIA. Hematol Oncol 2021. [DOI: 10.1002/hon.112_2880] [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: 11/06/2022]
Affiliation(s)
- M. Chahal
- BC Cancer, Medical Oncology Vancouver Canada
| | - A. Jiang
- British Columbia Cancer Research Centre Biostatistics Vancouver Canada
| | - A. Hayden
- BC Cancer Medical Oncology Surrey Canada
| | - K. Savage
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - D. Villa
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - D. Scott
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - A. Gerrie
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - A. Lo
- BC Cancer Division of Radiation Oncology Vancouver Canada
| | - M. Chan
- BC Cancer Division of Radiation Oncology Vancouver Canada
| | - T. Pickles
- BC Cancer Division of Radiation Oncology Vancouver Canada
| | - J. Connors
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - L. Sehn
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - C. Freeman
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
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7
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McCarroll Z, Townson J, Pickles T, Gregory JW, Playle R, Robling M, Hughes DA. Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial. BMJ Open 2021; 11:e043523. [PMID: 34011587 PMCID: PMC8137197 DOI: 10.1136/bmjopen-2020-043523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this economic evaluation was to assess whether home management could represent a cost-effective strategy in the patient pathway of type 1 diabetes (T1D). This is based on the Delivering Early Care In Diabetes Evaluation trial (ISRCTN78114042), which compared home versus hospital management from diagnosis in childhood diabetes and found no statistically significant difference in glycaemic control at 24 months. DESIGN Cost-effectiveness analysis alongside a randomised controlled trial. SETTING Eight paediatric diabetes centres in England, Wales and Northern Ireland. PARTICIPANTS 203 clinically well children aged under 17 years, with newly diagnosed T1D and their carers. OUTCOME MEASURES The base-case analysis adopted n National Health Service (NHS) perspective. A scenario analysis assessed costs from a broader societal perspective. The incremental cost-effectiveness ratio (ICER), expressed as cost per mmol/mol reduction in glycated haemoglobin (HbA1c), was based on the mean difference in costs between the home and hospital groups, divided by mean differences in effectiveness (HbA1c). Uncertainty was considered in terms of the probability of cost-effectiveness. RESULTS At 24 months postintervention, the base-case analysis showed a difference in costs between home and hospital, in favour of home management (mean difference -£2,217; 95% CI -£2825 to -£1,609; p<0.001). Home care dominated, with an ICER of £7434 (saved) per mmol/mol reduction of HbA1c. The results of the scenario analysis also favoured home management. The greatest driver of cost differences was hospitalisation during the initiation period. CONCLUSIONS Home management from diagnosis of children with T1D who are medically stable represents a less costly approach for the NHS in the UK, without impacting clinical effectiveness. TRIAL REGISTRATION NUMBER ISRCTN78114042.
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Affiliation(s)
| | - Julia Townson
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Timothy Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Rebecca Playle
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Michael Robling
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
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8
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Bartlett R, Acton JH, Ryan B, Man R, Pickles T, Nollett C. Training results in increased practitioner confidence and identification of depression in people with low vision: a mixed methods study. Ophthalmic Physiol Opt 2021; 41:316-330. [PMID: 33590910 DOI: 10.1111/opo.12788] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE The prevalence of depression in people with low vision is high and often goes undiagnosed. There is the potential for those who provide low vision services to perform concurrent depression screening. However, prior training in depression identification and suitable referral pathways is required. The aims of this study were: (1) to assess the impact of a training programme on practitioners' confidence and behaviour in addressing depression in patients with low vision, and (2) to review the training programme and identify areas for further development. METHODS A convergent mixed methods approach was used. Questionnaires were completed by practitioners pre-, immediately post- and 6 months post- training (n = 40) to assess practitioner confidence in approaching depression in patients with low vision. Qualitative interviews were performed with a subset of practitioners 6 months post-training (n = 9). Additionally, routine data from the Low Vision Service Wales (LVSW) database was used to determine the change in the number of practitioners identifying depression in patients, and the change in the number of patients identified at risk of depression 6 months post-training. RESULTS Of the 148 practitioners who completed low vision assessments pre- and post-training, 28 (18.9%) documented risk of depression in their patients pre-training, which increased substantially to 65 (43.9%) post-training (p < 0.0001). Mixed methods analysis confirmed increased documentation of depressive symptoms by practitioners. Practitioner confidence increased following training, with 92.3% feeling more confident to approach emotional issues with patients and 92.2% intending to use the recommended screening tool to identify depression. Interviews provided insight into areas where confidence was still lacking. Quantitative questionnaires revealed that training content was considered appropriate by 91% of participants. Interviews confirmed these findings while expanding upon possibilities for programme improvement. CONCLUSIONS Training for depression screening was found to be time-efficient and acceptable for LVSW practitioners and shown to increase practitioner confidence in the identification of depression. Additionally, the programme changed behaviour, resulting in an increase in the identification of depression in patients with low vision. However, this is a complex topic and ongoing development is required to embed depression screening as an integral part of low vision services.
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Affiliation(s)
- Rebecca Bartlett
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jennifer H Acton
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Barbara Ryan
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ryan Man
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Claire Nollett
- Centre for Trials Research, Cardiff University, Cardiff, UK
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9
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Parimi S, Bondy S, Aparicio M, Sunderland K, Cho J, Bachand F, Nguyen Chi K, Pickles T, Tyldesley S. Presenting stage and risk group in men dying of prostate cancer. Curr Oncol 2020; 27:e547-e551. [PMID: 33380869 PMCID: PMC7755438 DOI: 10.3747/co.27.6385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction Prostate cancer remains the 3rd leading cause of cancer-related mortality in Canadian men, and yet screening for prostate cancer continues to be controversial because the majority of men diagnosed with prostate cancer do not die of the disease. It also remains uncertain whether treatment of cases that can be treated with curative intent alters the mortality rate. There are very few studies describing the presenting stage, risk groups, and survival after diagnosis for men dying of prostate cancer in the literature. In this study, we explored these characteristics for all men who died of prostate cancer in British Columbia between 2013 and 2015. Methods The population-based BC Cancer databases were used to identify all patients diagnosed between January 2013 and December 2015 who died of prostate cancer. Patient, tumour, and treatment characteristics were collected, and the risk grouping for each tumour was determined. The proportion of cases in each risk group at the time of diagnosis was determined. Survival time from diagnosis to death was calculated for all patients and for each risk group using the Kaplan-Meier method. Results A total of 1256 patients died of prostate cancer. Of patients who presented with metastatic disease, 57.2% presented with a Gleason score of 8 or more, compared with only 35.7% of patients who presented with nonmetastatic disease (p < 0.0001). The presenting stage and risk group of those dying of prostate cancer were as follows: 32% metastatic disease, 3% regional (defined as node-positive), 39% localized high risk, 9% localized intermediate risk, 4% localized low risk, 6% localized not otherwise specified, and 7% unknown. Therefore, 80.3% of those with a known risk group presented with either localized high-risk, regional, or metastatic disease at diagnosis. The median survival times from diagnosis to death were 12 years for localized low-risk, 10 years for localized intermediate-risk, 6.5 years for localized high-risk, 4 years for regional, and 1.7 years for metastatic disease at diagnosis. Conclusions This population-based analysis demonstrates that patients with localized high-risk, regional, or metastatic disease at diagnosis constitute the overwhelming majority of patients who die of prostate cancer in British Columbia. Unless these disease states can reliably be identified at an earlier low- or intermediate-risk localized state in the future, it is unlikely that treatment of localized low- and intermediate-risk cancer will have an impact on survival. Furthermore, patients with de novo metastatic disease had identifiable risk factors of a higher prostate-specific antigen and Gleason score. Further studies are required to confirm these results.
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Affiliation(s)
- S Parimi
- Medical Oncology, BC Cancer, Vancouver, BC
| | - S Bondy
- Genitourinary Cancer Outcomes Unit, BC Cancer, Vancouver, BC
| | - M Aparicio
- Genitourinary Cancer Outcomes Unit, BC Cancer, Vancouver, BC
| | - K Sunderland
- Genitourinary Cancer Outcomes Unit, BC Cancer, Vancouver, BC
| | - J Cho
- Radiation Oncology, BC Cancer, Vancouver, BC
| | - F Bachand
- Radiation Oncology, BC Cancer, Vancouver, BC
| | | | - T Pickles
- Radiation Oncology, BC Cancer, Vancouver, BC
| | - S Tyldesley
- Radiation Oncology, BC Cancer, Vancouver, BC
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Lowe J, Gillespie D, Hubbard M, Zhang L, Kirby N, Pickles T, Thomas-Jones E, Turner MA, Klein N, Marchesi JR, Hood K, Berrington J, Kotecha S. Study protocol: azithromycin therapy for chronic lung disease of prematurity (AZTEC) - a randomised, placebo-controlled trial of azithromycin for the prevention of chronic lung disease of prematurity in preterm infants. BMJ Open 2020; 10:e041528. [PMID: 33028566 PMCID: PMC7539578 DOI: 10.1136/bmjopen-2020-041528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/01/2023] Open
Abstract
INTRODUCTION Chronic lung disease of prematurity (CLD), also known as bronchopulmonary dysplasia (BPD), is a cause of significant respiratory morbidity in childhood and beyond. Coupled with lung immaturity, infections (especially by Ureaplasma spp) are implicated in the pathogenesis of CLD through promotion of pulmonary inflammation. Azithromycin, which is a highly effective against Ureaplasma spp also has potent anti-inflammatory properties. Thus, azithromycin therapy may improve respiratory outcomes by targeting infective and inflammatory pathways. Previous trials using macrolides have not been sufficiently powered to definitively assess CLD rates. To address this, the azithromycin therapy for chronic lung disease of prematurity (AZTEC) trial aims to determine if a 10-day early course of intravenous azithromycin improves rates of survival without CLD when compared with placebo with an appropriately powered study. METHODS AND ANALYSIS 796 infants born at less than 30 weeks' gestational age who require at least 2 hours of continuous respiratory support within the first 72 hours following birth are being enrolled by neonatal units in the UK. They are being randomised to receive a double-blind, once daily dose of intravenous azithromycin (20 mg/kg for 3 days, followed by 10 mg/kg for a further 7 days), or placebo. CLD is being assessed at 36 weeks' PMA. Whether colonisation with Ureaplasma spp prior to randomisation modifies the treatment effect of azithromycin compared with placebo will also be investigated. Secondary outcomes include necrotising enterocolitis, intraventricular/cerebral haemorrhage, retinopathy of prematurity and nosocomial infections, development of antibiotic resistance and adverse reactions will be monitored. ETHICS AND DISSEMINATION Ethics permission has been granted by Wales Research Ethics Committee 2 (Ref 18/WA/0199), and regulatory permission by the Medicines and Healthcare Products Regulatory Agency (Clinical Trials Authorisation reference 21323/0050/001-0001). The study is registered on ISRCTN (ISRCTN11650227). The study is overseen by an independent Data Monitoring Committee and an independent Trial Steering Committee. We shall disseminate our findings via national and international peer-reviewed journals, and conferences. A summary of the findings will also be posted on the trial website.
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Affiliation(s)
- John Lowe
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - David Gillespie
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Marie Hubbard
- Neonatal Intensive Care Unit, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Lei Zhang
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Nigel Kirby
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Timothy Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Nigel Klein
- GOS Institute of Child Health, University College London, London, London, UK
| | | | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Janet Berrington
- Neonatal Intensive Care Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Nollett C, Bartlett R, Man R, Pickles T, Ryan B, Acton JH. Barriers to integrating routine depression screening into community low vision rehabilitation services: a mixed methods study. BMC Psychiatry 2020; 20:419. [PMID: 32842989 PMCID: PMC7448511 DOI: 10.1186/s12888-020-02805-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Undetected depression is common in people with low vision and depression screening has been recommended. However, depression screening is a complex procedure for which low vision practitioners need training. This study examined the integration of routine depression screening, using two questions, and referral pathways into a national low vision service in Wales at 6 months following practitioner training, and identified key barriers to implementation. METHODS This pre-post single group study employed a convergent mixed methods design to collect quantitative questionnaire and qualitative interview data on low vision practitioners' clinical practice and perceived barriers to implementing depression screening. Forty practitioners completed questionnaires pre-, immediately post- and 6 months post-training and nine engaged in interviews 6 months post-training. Ordinal questionnaire scores were Rasch-transformed into interval-level data before linear regression analyses were performed to determine the change in scores over time and the association between perceived barriers and clinical practice. Thematic Analysis was applied to the interviews and the narrative results merged with the questionnaire findings. RESULTS Before training, only one third of practitioners (n = 15) identified depression in low vision patients, increasing to over 90% (n = 37) at 6 months post-training, with a corresponding increase in those using validated depression screening questions from 10% (n = 4) to 80% (n = 32). Six months post-training, practitioners reported taking significantly more action in response to suspected depression (difference in means = 2.77, 95% CI 1.93 to 3.61, p < 0.001) and perceived less barriers to addressing depression (difference in means = - 0.95, 95% CI - 1.32 to - 0.59, p < 0.001). However, the screening questions were not used consistently. Some barriers to implementation remained, including perceived patient reluctance to discuss depression, time constraints and lack of confidence in addressing depression. CONCLUSIONS The introduction of depression screening service guidelines and training successfully increased the number of low vision practitioners identifying and addressing depression. However, standardized screening of all low vision attendees has not yet been achieved and several barriers remain. Healthcare services need to address these barriers when considering mental health screening, and further research could focus on the process from the patients' perspective, to determine the desire for and acceptability of screening.
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Affiliation(s)
- Claire Nollett
- Centre for Trials Research, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Rebecca Bartlett
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
| | - Ryan Man
- Singapore Eye Research Institute, 20 College Road, Ngee Ann KongSi The Academia, Discovery Tower Level 6, Singapore, 169856 Singapore
| | - Timothy Pickles
- Centre for Trials Research, Cardiff University, 5th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Barbara Ryan
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
| | - Jennifer H. Acton
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
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Bisson JI, van Deursen R, Hannigan B, Kitchiner N, Barawi K, Jones K, Pickles T, Skipper J, Young C, Abbott LR, van Gelderen M, Nijdam MJ, Vermetten E. Randomized controlled trial of multi-modular motion-assisted memory desensitization and reconsolidation (3MDR) for male military veterans with treatment-resistant post-traumatic stress disorder. Acta Psychiatr Scand 2020; 142:141-151. [PMID: 32495381 DOI: 10.1111/acps.13200] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the potential efficacy of multi-modular motion-assisted memory desensitization and reprocessing (3MDR) in British military veterans with treatment-resistant service-related PTSD. METHODS Exploratory single-blind, randomized, parallel arm, cross-over controlled trial with nested process evaluation to assess fidelity, adherence and factors that influence outcome. RESULTS A total of 42 participants (all male) were randomized with 83% retention at 12 weeks and 86% at 26 weeks. The difference in mean Clinician-Administered PTSD Scale for DSM-5 scores between the immediate and delayed 3MDR arms was -9.38 (95% CI -17.33 to -1.44, P = 0.021) at 12 weeks and -3.59 (-14.39 to 7.20, P = 0.513) at 26 weeks when both groups had received 3MDR. The likely effect size of 3MDR was found to be 0.65. Improvements were maintained at 26-week follow-up. 3MDR was found to be acceptable to most, but not all, participants. Several factors that may impact efficacy and acceptability of 3MDR were identified. CONCLUSION 3MDR is a promising new intervention for treatment-resistant PTSD with emerging evidence of effect.
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Affiliation(s)
- J I Bisson
- School of Medicine, Cardiff University, Cardiff, UK
| | - R van Deursen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - B Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - N Kitchiner
- Veterans' NHS Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - K Barawi
- School of Medicine, Cardiff University, Cardiff, UK
| | - K Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - T Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - J Skipper
- School of Medicine, Cardiff University, Cardiff, UK
| | - C Young
- Cardiff and Vale University Health Board, Cardiff, UK
| | - L R Abbott
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - M van Gelderen
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Nijdam
- ARQ Centrum'45, ARQ National Psychotrauma Centre, Diemen, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - E Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CC. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2020; 56:173-181. [PMID: 32557921 DOI: 10.1002/uog.22125] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - T Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | | | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - G H A Visser
- Department of Obstetrics, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - C C Lees
- Imperial College School of Medicine, Imperial College London and Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust, London, UK
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Nollett C, Bartlett R, Man R, Pickles T, Ryan B, Acton JH. How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study. BMC Psychiatry 2019; 19:426. [PMID: 31888603 PMCID: PMC6937690 DOI: 10.1186/s12888-019-2387-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clinically significant depressive symptoms are prevalent in people attending low vision clinics and often go undetected. The Low Vision Service Wales (LVSW) plans to introduce depression screening and management pathways. Prior to implementation there is an unmet need to understand how eye care practitioners providing the service currently address depression with patients, and the characteristics and beliefs that influence their practice. METHODS A mixed methods convergent design was employed. Twelve low vision practitioners were purposively selected to engage in individual semi-structured interviews which were analysed using thematic analysis. A further 167 practitioners were invited to complete a questionnaire assessing professional background, current practice, confidence and perceived barriers in working with people with low vision and suspected depression. Multiple regression analyses were performed to determine the characteristics related to the Rasch-transformed questionnaire scores. RESULTS Of the 122 practitioners that responded to the questionnaire, 33% aimed to identify depression in patients, and those who were more confident were more likely to do so. Those who scored higher on the perceived barriers scale and lower on confidence were less likely to report acting in response to suspected depression (all p < 0.05). Three qualitative themes were identified; depression is an understandable response to low vision, patients themselves are a barrier to addressing depression and practitioners lacked confidence in their knowledge and skills to address depression. The qualitative data largely expanded the quantitative findings. CONCLUSIONS Practitioners viewed their own lack of knowledge and confidence as a barrier to the identification and management of depression and expressed a need for training prior to the implementation of service changes. The study findings will help to inform the development of a training programme to support low vision practitioners and those working with other chronic illness in Wales, and internationally, in the identification and management of people with depression.
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Affiliation(s)
- Claire Nollett
- Centre for Trials Research, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Rebecca Bartlett
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
| | - Ryan Man
- Singapore Eye Research Institute, 20 College Road, The Academia, Discovery Tower Level 6, Singapore, 169856 Singapore
| | - Timothy Pickles
- Centre for Trials Research, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Barbara Ryan
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
| | - Jennifer H. Acton
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
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15
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Gregory JW, Townson J, Channon S, Cohen D, Longo M, Davies J, Harman N, Hood K, Pickles T, Playle R, Randell T, Robling M, Touray M, Trevelyan N, Warner J, Lowes L. Effectiveness of home or hospital initiation of treatment at diagnosis for children with type 1 diabetes (DECIDE trial): a multicentre individually randomised controlled trial. BMJ Open 2019; 9:e032317. [PMID: 31796486 PMCID: PMC6924753 DOI: 10.1136/bmjopen-2019-032317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether, in children with newly diagnosed type 1 diabetes who were not acutely unwell, management at home for initiation of insulin treatment and education of the child and family, would result in improved clinical and psychological outcomes at 2 years postdiagnosis. DESIGN A multicentre randomised controlled trial (January 2008/October 2013). SETTING Eight paediatric diabetes centres in England, Wales and Northern Ireland. PARTICIPANTS 203 clinically well children aged under 17 years, with newly diagnosed type 1 diabetes and their carers. INTERVENTION Management of the initiation period from diagnosis at home, for a minimum of 3 days, to include at least six supervised injections and delivery of pragmatic educational care. MAIN OUTCOME MEASURES Primary outcome was glycosylated haemoglobin (HbA1c) concentration at 24 months postdiagnosis. Secondary outcomes included coping, anxiety, quality of life and use of NHS resources. RESULTS 203 children, newly diagnosed, were randomised to commence management at home (n=101) or in hospital (n=102). At the 24 month primary end point, there was one withdrawal and a follow-up rate of 194/202 (96%). Mean HbA1c in the home treatment arm was 72.1 mmol/mol and in the hospital treated arm 72.6 mmol/mol. There was a negligible difference between the mean HbA1c levels in the two arms adjusted for baseline (1.01, 95% CI 0.93 to 1.09). There were mostly no differences in secondary outcomes at 24 months, apart from better child self-esteem in the home-arm. No home-arm children were admitted to hospital during initiation and there were no adverse events at that time. The number of investigations was higher in hospital patients during the follow-up period. There were no differences in insulin regimens between the two arms. CONCLUSIONS There is no evidence of a difference between home-based and hospital-based initiation of care in children newly diagnosed with type 1 diabetes across relevant outcomes. TRIAL REGISTRATION NUMBER ISRCTN78114042.
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Affiliation(s)
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - David Cohen
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK
| | - Mirella Longo
- Marie Curie Palliative Care Research Centre, Cardiff University, School of Medicine, Cardiff, UK
| | - Justin Davies
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola Harman
- University of Liverpool, Institute of Translational Medicine, Liverpool, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tabitha Randell
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Morro Touray
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Nicola Trevelyan
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Justin Warner
- Department of Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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16
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Ambler GK, Bosanquet DC, Waldron CA, Thomas-Jones E, Brookes-Howell L, Pickles T, Kelson MJ, Harris D, Fitzsimmons D, Saxena N, Twine CP. The Perineural Local Anaesthetic Catheter After Major Lower Limb Amputation Trial (Placement): A Randomised Controlled Feasibility Study. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Bosanquet DC, Ambler GK, Waldron CA, Thomas-Jones E, Brookes-Howell L, Kelson M, Pickles T, Harris D, Milosevic S, Fitzsimmons D, Saxena N, Twine CP. Perineural local anaesthetic catheter after major lower limb amputation trial (PLACEMENT): results from a randomised controlled feasibility trial. BMJ Open 2019; 9:e029233. [PMID: 31719071 PMCID: PMC6858124 DOI: 10.1136/bmjopen-2019-029233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To determine the feasibility of undertaking a randomised controlled effectiveness trial evaluating the use of a perineural catheter (PNC) after major lower limb amputation with postoperative pain as the primary outcome. DESIGN Randomised controlled feasibility trial. SETTING Two vascular Centres in South Wales, UK. PARTICIPANTS 50 patients scheduled for major lower limb amputation (below or above knee) for complications of peripheral vascular disease. INTERVENTIONS The treatment arm received a PNC placed adjacent to the sciatic or tibial nerve at the time of surgery, with continuous infusion of levobupivacaine hydrochloride 0.125% for up to 5 days. The control arm received neither local anaesthetic nor PNC. Both arms received usual perioperative anaesthesia and postoperative analgesia. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were the proportion of eligible patients who were randomised and the proportion of recruited patients who provided primary effectiveness outcome data. Secondary outcomes were: the proportion of recruited patients reaching 2 and 6 month follow-up and supplying pain data; identification of key cost drivers; development of an economic analysis framework for a future effectiveness trial; identification of barriers to recruitment and site set-up; and identification of the best way to measure postoperative pain. RESULTS Seventy-six of 103 screened patients were deemed eligible over a 10 month period. Fifty (64.5%) of these patients were randomised, with one excluded in the perioperative period. Forty-five (91.3%) of 49 recruited patients provided enough pain scores on a 4-point verbal rating scale to allow primary effectiveness outcome evaluation. Attrition rates were high; 18 patients supplied data at 6 month follow-up. Costs were dominated by length of hospital stay. Patients and healthcare professionals reported that trial processes were acceptable. CONCLUSIONS Recruitment of patients into a trial comparing PNC use to usual care after major lower limb amputation with postoperative pain measured on a 4-point verbal rating scale is feasible. Evaluation of longer-term symptoms is difficult. TRIAL REGISTRATION NUMBER ISRCTN: 85 710 690. EudraCT: 2016-003544-37.
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Affiliation(s)
- David C Bosanquet
- Department of Vascular Surgery, Aneurin Bevan University Health Board, Newport, UK
| | - Graeme K Ambler
- Department of Vascular Surgery, Aneurin Bevan University Health Board, Newport, UK
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Mark Kelson
- Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Deborah Fitzsimmons
- Swansea Centre for Health Economics, College of Human Health Sciences, Swansea University, Swansea, UK
| | - Neeraj Saxena
- Department of Anaesthetics, Royal Glamorgan Hospital, Cwm Taf University Health Board, Abercynon, UK
- CUBRIC, School of Psychology, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Department of Vascular Surgery, Aneurin Bevan University Health Board, Newport, UK
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Hayden A, Tonseth P, Villa D, Gerrie A, Scott D, Freeman C, Slack G, Parsons C, Pickles T, Wilson D, Connors J, Sehn L, Savage K. OUTCOME OF PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA IN THE RITUXIMAB ERA: IMPACT OF A PET-GUIDED APPROACH. Hematol Oncol 2019. [DOI: 10.1002/hon.113_2629] [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: 11/05/2022]
Affiliation(s)
- A. Hayden
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - P. Tonseth
- Division of Radiology; BC Cancer; Vancouver Canada
| | - D. Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - A.S. Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - D.W. Scott
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - C.L. Freeman
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - G.W. Slack
- Centre for Lymphoid Cancer and Division of Pathology; BC Cancer; Vancouver Canada
| | - C. Parsons
- Division of Radiation Oncology; BC Cancer; Vancouver Canada
| | - T. Pickles
- Division of Radiation Oncology; BC Cancer; Vancouver Canada
| | - D. Wilson
- Division of Radiology; BC Cancer; Vancouver Canada
| | - J.M. Connors
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - L.H. Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - K.J. Savage
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
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Joshi H, Pickles T, Pietropaolo A, Matenhelia M, Somani B, Phillip J, Biyani S. Health related quality of life impact of renal and ureteric stones - do these differ? ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31453-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Griffiths C, Guest E, Pickles T, Hollén L, Grzeda M, White P, Tollow P, Harcourt D. The Development and Validation of the CARe Burn Scale—Adult Form: A Patient-Reported Outcome Measure (PROM) to Assess Quality of Life for Adults Living with a Burn Injury. J Burn Care Res 2019; 40:312-326. [PMID: 30820556 DOI: 10.1093/jbcr/irz021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Catrin Griffiths
- Centre for Appearance Research (CAR), University of the West of England, Bristol, UK
| | - Ella Guest
- Centre for Appearance Research (CAR), University of the West of England, Bristol, UK
| | | | - Linda Hollén
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - Mariusz Grzeda
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - Paul White
- Department of Engineering, Design and Mathematics, University of the West of England, Bristol, UK
| | - Philippa Tollow
- Centre for Appearance Research (CAR), University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research (CAR), University of the West of England, Bristol, UK
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Morgan-Trimmer S, Chadwick BL, Hutchings S, Scoble C, Lisles C, Drew CJ, Murphy S, Pickles T, Hood K, Chestnutt IG. The acceptability of fluoride varnish and fissure sealant treatments in children aged 6-9 delivered in a school setting. Community Dent Health 2019; 36:33-38. [PMID: 30667189 DOI: 10.1922/cdh_4263morgan-trimmer06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the acceptability of fluoride varnish and fissure sealant treatments for children. To investigate the acceptability of delivering this treatment in a school setting for children, parents, clinicians and school staff. BASIC RESEARCH DESIGN Semi-structured interviews (with children, parents, clinicians and school staff) and a questionnaire (for school staff) as part of a two-arm, randomised clinical trial. PARTICIPANTS Children aged 6-9, their parents, clinical staff and school staff. INTERVENTIONS Fluoride varnish or fissure sealant was delivered to children from the ages of 6 to 9 years for 36 months, by a community dental service in a school setting. Fluoride varnish was re-applied every 6 months; fissure sealant was applied once to first permanent molars and re-applied as required. RESULTS Interviews with children a few days after treatment indicated little difference in preference; acceptability at this point was driven by factors such as finding it fun to visit 'the van' (i.e. mobile dental unit) and receiving a "sticker" rather than specific treatment received. Interviews with parents, clinicians and school staff indicated high acceptability of delivering this type of intervention in a school setting; this may have been partly due to the service being delivered by a well-established, child-oriented community dental service which delivered the clinical trial. CONCLUSIONS Preventive fluoride varnish and fissure sealant treatments in a school setting has high overall acceptability.
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Affiliation(s)
- S Morgan-Trimmer
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU
| | - B L Chadwick
- Applied Clinical Research and Public Health, Cardiff University School of Dentistry, Heath Park, Cardiff. CF14 4XY, UK
| | - S Hutchings
- Simbec-Orion Group Ltd, Simbec House, Merthyr Tydfil Industrial Park, Pentrebach, Merthyr Tydfil, Mid Glamorgan,CF48 4DR
| | - C Scoble
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - C Lisles
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - C J Drew
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - S Murphy
- DECIPHer, School of Social Sciences, Cardiff University, 1 - 3 Museum Place, Cardiff. CF10 3BD
| | - T Pickles
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - K Hood
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - I G Chestnutt
- Applied Clinical Research and Public Health, Cardiff University School of Dentistry, Heath Park, Cardiff. CF14 4XY, UK
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22
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Wong J, Pickles T, Connors J, Aquino-Parsons C, Sehn L, Freeman C, Lo A. Efficacy of Palliative Radiation Therapy (RT) for Diffuse Large B-Cell Lymphoma: A Population-Based Retrospective Review. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Bosanquet DC, Ambler GK, Waldron CA, Thomas-Jones E, Brookes-Howell L, Kelson M, Harris D, Pickles T, Milosevic S, Fitzsimmons D, Saxena N, Twine CP. Major lower limb amputation audit - introduction and implementation of a multimodal perioperative pain management guideline. Br J Pain 2018; 12:257-258. [PMID: 30349700 PMCID: PMC6194973 DOI: 10.1177/2049463718800736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- David C Bosanquet
- Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Graeme K Ambler
- Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Mark Kelson
- Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Deborah Fitzsimmons
- Swansea Centre for Health Economics, College of Human Health Sciences, Swansea University, Swansea, UK
| | - Neeraj Saxena
- Department of Anaesthetics, Royal Glamorgan Hospital, Cwm Taf Local Health Board, Llantrisant, UK
- School of Psychology, Cardiff University, Cardiff, UK
- Psychology and Therapeutic Studies, University of South Wales, Pontypridd, UK
| | - Christopher P Twine
- Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Loblaw D, Bassett J, D'Este C, Pond G, Cheung P, Frydenberg M, King M, Lukka H, Malone S, Millar J, Milne R, Pickles T, Smith R, Stockler M, Turner S, Tai K, Woo H, Duchesne G. Timing of Androgen Deprivation Therapy for Prostate Cancer Patients after Radiation: Planned Combined Analysis of Two Randomized Phase 3 Trials. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nollett C, Lewis C, Kitchiner N, Roberts N, Addison K, Brookes-Howell L, Cosgrove S, Cullen K, Ehlers A, Heke S, Kelson M, Lovell K, Madden K, McEwan K, McNamara R, Phillips C, Pickles T, Simon N, Bisson J. Pragmatic RAndomised controlled trial of a trauma-focused guided self-help Programme versus InDividual trauma-focused cognitive Behavioural therapy for post-traumatic stress disorder (RAPID): trial protocol. BMC Psychiatry 2018; 18:77. [PMID: 29580220 PMCID: PMC5870753 DOI: 10.1186/s12888-018-1665-3] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is good evidence that trauma-focused therapies for Post-Traumatic Stress Disorder are effective. However, they are not always feasible to deliver due a shortage of trained therapists and demands on the patient. An online trauma-focused Guided Self-Help (GSH) programme which could overcome these barriers has shown promise in a pilot study. This study will be the first to evaluate GSH against standard face-to-face therapy to assess its suitability for use in the NHS. METHODS The study is a large-scale multi-centre pragmatic randomised controlled non-inferiority trial, with assessors masked to treatment allocation. One hundred and ninety-two participants will be randomly allocated to receive either face-to-face trauma-focused cognitive behaviour therapy (TFCBT) or trauma-focused online guided self-help (GSH). The primary outcome will be the severity of symptoms of PTSD over the previous week as measured by the Clinician Administered PTSD Scale for DSM5 (CAPS-5) at 16 weeks post-randomisation. Secondary outcome measures include PTSD symptoms over the previous month as measured by the CAPS-5 at 52 weeks plus the Impact of Event Scale - revised (IES-R), Work and Social Adjustment Scale (WSAS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Alcohol Use Disorders Test (AUDIT-O), Multidimensional Scale for Perceived Social Support (MSPSS), short Post-Traumatic Cognitions Inventory (PTCI), Insomnia Severity Index (ISI) and General Self Efficacy Scale (GSES) measured at 16 and 52 weeks post-randomisation. Changes in health-related quality of life will be measured by the EQ-5D and the level of healthcare resource utilisation for health economic analysis will be determined by an amended version of the Client Socio-Demographic and Service Receipt Inventory European Version. The Client Satisfaction Questionnaire (CSQ) will be collected at 16 weeks post-randomisation to evaluate treatment satisfaction. DISCUSSION This study will be the first to compare online GSH with usual face-to-face therapy for PTSD. The strengths are that it will test a rigorously developed intervention in a real world setting to inform NHS commissioning. The potential challenges of delivering such a pragmatic study may include participant recruitment, retention and adherence, therapist retention, and fidelity of intervention delivery. TRIAL REGISTRATION ISRCTN13697710 registered on 20/12/2016.
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Affiliation(s)
- Claire Nollett
- Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Catrin Lewis
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Neil Kitchiner
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK ,0000 0001 0807 5670grid.5600.3Cardiff & Vale University Health Board, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Neil Roberts
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK ,0000 0001 0807 5670grid.5600.3Cardiff & Vale University Health Board, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Katy Addison
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Lucy Brookes-Howell
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Sarah Cosgrove
- Independent Public and Patient Involvement (PPI) representative, Cardiff, UK
| | - Katherine Cullen
- 0000 0001 0658 8800grid.4827.9Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Anke Ehlers
- grid.470387.fDepartment of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, Paradise Square, Oxford, OX1 1TW UK
| | - Sarah Heke
- grid.439501.aGrenfell Emotional Health and Wellbeing service, Central and Northwest London (CNWL) NHS Trust, St Charles Hospital, Exmoor Street, London, UK ,0000 0004 0581 2008grid.451052.7Formerly at Institute of Psychotrauma, East London Foundation NHS Trust, 86 Old Montague Street, London, E1 8NN UK
| | - Mark Kelson
- 0000 0004 1936 8024grid.8391.3Department of Mathematics, Laver Building, University of Exeter, Exeter, EX4 4QRE UK
| | - Karina Lovell
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Room 6.322a, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Kim Madden
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Kirsten McEwan
- 0000 0001 2232 4004grid.57686.3aDepartment of Psychology, University of Derby, Kedleston Road, Derby, DE22 1GB UK
| | - Rachel McNamara
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Ceri Phillips
- 0000 0001 0658 8800grid.4827.9Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Timothy Pickles
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Natalie Simon
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK.
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Chestnutt IG, Hutchings S, Playle R, Morgan-Trimmer S, Fitzsimmons D, Aawar N, Angel L, Derrick S, Drew C, Hoddell C, Hood K, Humphreys I, Kirby N, Lau TMM, Lisles C, Morgan MZ, Murphy S, Nuttall J, Onishchenko K, Phillips C, Pickles T, Scoble C, Townson J, Withers B, Chadwick BL. Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay. Health Technol Assess 2018; 21:1-256. [PMID: 28613154 DOI: 10.3310/hta21210] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Fissure sealant (FS) and fluoride varnish (FV) have been shown to be effective in preventing dental caries when tested against a no-treatment control. However, the relative clinical effectiveness and cost-effectiveness of these interventions is unknown. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- and 7-year-olds and to determine their acceptability. DESIGN A randomised controlled allocation-blinded clinical trial with two parallel arms. SETTING A targeted population programme using mobile dental clinics (MDCs) in schools located in areas of high social and economic deprivation in South Wales. PARTICIPANTS In total, 1016 children were randomised, but one parent subsequently withdrew permission and so the analysis was based on 1015 children. The randomisation of participants was stratified by school and balanced for sex and primary dentition baseline caries levels using minimisation in a 1 : 1 ratio for treatments. A random component was added to the minimisation algorithm, such that it was not completely deterministic. Of the participants, 514 were randomised to receive FS and 502 were randomised to receive FV. INTERVENTIONS Resin-based FS was applied to caries-free FPMs and maintained at 6-monthly intervals. FV was applied at baseline and at 6-month intervals over the course of 3 years. MAIN OUTCOME MEASURES The proportion of children developing caries into dentine (decayed, missing, filled teeth in permanent dentition, i.e. D4-6MFT) on any one of up to four treated FPMs after 36 months. The assessors were blinded to treatment allocation; however, the presence or absence of FS at assessment would obviously indicate the probable treatment received. Economic measures established the costs and budget impact of FS and FV and the relative cost-effectiveness of these technologies. Qualitative interviews determined the acceptability of the interventions. RESULTS At 36 months, 835 (82%) children remained in the trial: 417 in the FS arm and 418 in the FV arm. The proportion of children who developed caries into dentine on a least one FPM was lower in the FV arm (73; 17.5%) than in the FS arm (82, 19.6%) [odds ratio (OR) 0.84, 95% confidence interval (CI) 0.59 to 1.21; p = 0.35] but the difference was not statistically significant. The results were similar when the numbers of newly decayed teeth (OR 0.86, 95% CI 0.60 to 1.22) and tooth surfaces (OR 0.85, 95% CI 0.59 to 1.21) were examined. Trial fidelity was high: 95% of participants received five or six of the six scheduled treatments. Between 74% and 93% of sealants (upper and lower teeth) were intact at 36 months. The costs of the two technologies showed a small but statistically significant difference; the mean cost to the NHS (including intervention costs) per child was £500 for FS, compared with £432 for FV, a difference of £68.13 (95% CI £5.63 to £130.63; p = 0.033) in favour of FV. The budget impact analysis suggests that there is a cost saving of £68.13 (95% CI £5.63 to £130.63; p = 0.033) per child treated if using FV compared with the application of FS over this time period. An acceptability score completed by the children immediately after treatment and subsequent interviews demonstrated that both interventions were acceptable to the children. No adverse effects were reported. LIMITATIONS There are no important limitations to this study. CONCLUSIONS In a community oral health programme utilising MDCs and targeted at children with high caries risk, the twice-yearly application of FV resulted in caries prevention that is not significantly different from that obtained by applying and maintaining FSs after 36 months. FV proved less expensive. FUTURE WORK The clinical effectiveness and cost-effectiveness of FS and FV following the cessation of active intervention merits investigation. TRIAL REGISTRATION EudraCT number 2010-023476-23, Current Controlled Trials ISRCTN17029222 and UKCRN reference 9273. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ivor Gordon Chestnutt
- Applied Clinical Research and Public Health, Cardiff University School of Dentistry, Cardiff, UK
| | - Simon Hutchings
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Rebecca Playle
- Applied Clinical Research and Public Health, Cardiff University School of Dentistry, Cardiff, UK.,South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Deborah Fitzsimmons
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Nadine Aawar
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Lianna Angel
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sharron Derrick
- Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - Cheney Drew
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ceri Hoddell
- Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - Kerenza Hood
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ioan Humphreys
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Nigel Kirby
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tin Man Mandy Lau
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Catherine Lisles
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Maria Zeta Morgan
- Applied Clinical Research and Public Health, Cardiff University School of Dentistry, Cardiff, UK
| | - Simon Murphy
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Jacqueline Nuttall
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kateryna Onishchenko
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Ceri Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Timothy Pickles
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Charlotte Scoble
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Townson
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Beverley Withers
- Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - Barbara Lesley Chadwick
- Applied Clinical Research and Public Health, Cardiff University School of Dentistry, Cardiff, UK
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Hay AD, Birnie K, Busby J, Delaney B, Downing H, Dudley J, Durbaba S, Fletcher M, Harman K, Hollingworth W, Hood K, Howe R, Lawton M, Lisles C, Little P, MacGowan A, O'Brien K, Pickles T, Rumsby K, Sterne JA, Thomas-Jones E, van der Voort J, Waldron CA, Whiting P, Wootton M, Butler CC. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness. Health Technol Assess 2018; 20:1-294. [PMID: 27401902 DOI: 10.3310/hta20510] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment. OBJECTIVES To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness. DESIGN Multicentre, prospective diagnostic cohort study. SETTING AND PARTICIPANTS Children < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms. METHODS One hundred and seven clinical characteristics (index tests) were recorded from the child's past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood ('clinical diagnosis') and urine sampling and treatment intentions ('clinical judgement') were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 10(5) colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the 'clinician diagnosis' AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with 'clinical judgement'. RESULTS A total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, 'clinical diagnosis' correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. 'Clinical diagnosis' correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut. CONCLUSIONS Clinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Alastair D Hay
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Birnie
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Busby
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Brendan Delaney
- Department of Primary Care and Public Health Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Harriet Downing
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jan Dudley
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stevo Durbaba
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK
| | - Margaret Fletcher
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK.,South West Medicines for Children Local Research Network, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kim Harman
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Robin Howe
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Cardiff, UK
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Catherine Lisles
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | | | - Kathryn O'Brien
- Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Timothy Pickles
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Kate Rumsby
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Jonathan Ac Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Judith van der Voort
- Department of Paediatrics and Child Health, University Hospital of Wales, Cardiff, UK
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Penny Whiting
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Cardiff, UK
| | - Christopher C Butler
- Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Ingram JR, Cawley S, Coulman E, Gregory C, Thomas‐Jones E, Pickles T, Cannings‐John R, Francis NA, Harding K, Hood K, Piguet V. Levels of wound calprotectin and other inflammatory biomarkers aid in deciding which patients with a diabetic foot ulcer need antibiotic therapy (INDUCE study). Diabet Med 2018; 35:255-261. [PMID: 28734103 PMCID: PMC5811820 DOI: 10.1111/dme.13431] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Four inflammatory biomarkers were investigated to develop a composite algorithm for mildly infected diabetic foot ulcers: venous white cell count, C-reactive protein (CRP) and procalcitonin, and a novel wound exudate calprotectin assay. Calprotectin is a marker of neutrophilic inflammation. METHODS In a prospective study, people with uninfected or mildly infected diabetic foot ulcers who had not received oral antibiotics in the preceding 2 weeks were recruited from community podiatry clinics for measurement of inflammatory biomarkers. Antibiotic prescribing decisions were based on clinicians' baseline assessments and participants were reviewed 1 week later; ulcer infection was defined by clinicians' overall impression from their two assessments. RESULTS Some 363 potential participants were screened, of whom 67 were recruited, 29 with mildly infected diabetic foot ulcers and 38 with no infection. One participant withdrew early in each group. Ulcer area was 1.32 cm2 [interquartile range (IQR) 0.32-3.61 cm2 ] in infected ulcers and 0.22 cm2 (IQR 0.09-1.46 cm2 ) in uninfected ulcers. Baseline CRP for mild infection was 9.00 mg/ml and 6.00 mg/ml for uninfected ulcers; most procalcitonin levels were undetectable. Median calprotectin level in infected diabetic foot ulcers was 1437 ng/ml and 879 ng/ml in uninfected diabetic foot ulcers. Area under the receiver operating characteristic curve for a composite algorithm incorporating calprotectin, CRP, white cell count and ulcer area was 0.68 (95% confidence intervals 0.52-0.82), sensitivity 0.64, specificity 0.81. CONCLUSIONS A composite algorithm including CRP, calprotectin, white cell count and ulcer area may help to distinguish uninfected from mildly infected diabetic foot ulcers. Venous procalcitonin is unhelpful for mild diabetic foot ulcer infection.
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Affiliation(s)
- J. R. Ingram
- Division of Infection and ImmunityCardiff UniversityCardiffUK
| | - S. Cawley
- Podiatry DepartmentCardiff and Vale University Health BoardCardiffUK
| | - E. Coulman
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - C. Gregory
- Division of Population MedicineCardiff UniversityCardiffUK
| | - E. Thomas‐Jones
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - T. Pickles
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - R. Cannings‐John
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - N. A. Francis
- Division of Population MedicineCardiff UniversityCardiffUK
| | - K. Harding
- Division of Population MedicineCardiff UniversityCardiffUK
| | - K. Hood
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - V. Piguet
- Division of Infection and ImmunityCardiff UniversityCardiffUK
- Division of DermatologyWomen's College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
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White J, Hawkins J, Madden K, Grant A, Er V, Angel L, Pickles T, Kelson M, Fletcher A, Murphy S, Midgley L, Eccles G, Cox G, Hollingworth W, Campbell R, Hickman M, Bonell C, Moore L. Adapting the ASSIST model of informal peer-led intervention delivery to the Talk to FRANK drug prevention programme in UK secondary schools (ASSIST + FRANK): intervention development, refinement and a pilot cluster randomised controlled trial. Public Health Res 2017. [DOI: 10.3310/phr05070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIllicit drug use increases the risk of poor physical and mental health. There are few effective drug prevention interventions.ObjectiveTo assess the acceptability of implementing and trialling two school-based peer-led drug prevention interventions.DesignStage 1 – adapt ASSIST, an effective peer-led smoking prevention intervention to deliver information from the UK national drug education website [see www.talktofrank.com (accessed 29 August 2017)]. Stage 2 – deliver the two interventions, ASSIST + FRANK (+FRANK) and FRANK friends, examine implementation and refine content. Stage 3 – four-arm pilot cluster randomised control trial (cRCT) of +FRANK, FRANK friends, ASSIST and usual practice, including a process evaluation and an economic assessment.SettingFourteen secondary schools (two in stage 2) in South Wales, UK.ParticipantsUK Year 8 students aged 12–13 years at baseline.Interventions+FRANK is a UK informal peer-led smoking prevention intervention provided in Year 8 followed by a drug prevention adjunct provided in Year 9. FRANK friends is a standalone informal peer-led drug prevention intervention provided in Year 9. These interventions are designed to prevent illicit drug use through training influential students to disseminate information on the risks associated with drugs and minimising harms using content from www.talktofrank.com. Training is provided off site and follow-up visits are made in school.OutcomesStage 1 – +FRANK and FRANK friends intervention manuals and resources. Stage 2 – information on the acceptability and fidelity of delivery of the interventions for refining manuals and resources. Stage 3 – (a) acceptability of the interventions according to prespecified criteria; (b) qualitative data from students, staff, parents and intervention teams on implementation and receipt of the interventions; (c) comparison of the interventions; and (d) recruitment and retention rates, completeness of primary, secondary and intermediate outcome measures and estimation of costs.Results+FRANK and FRANK friends were developed with stakeholders [young people, teachers (school management team and other roles), parents, ASSIST trainers, drug agency staff and a public health commissioner] over an 18-month period. In the stage 2 delivery of +FRANK, 12 out of the 14 peer supporters attended the in-person follow-ups but only one completed the electronic follow-ups. In the pilot cRCT, 12 schools were recruited, randomised and retained. The student response rate at the 18-month follow-up was 93% (1460/1567 students). Over 80% of peer supporters invited were trained and reported conversations on drug use and contact with trainers. +FRANK was perceived less positively than FRANK friends. The prevalence of lifetime illicit drug use was 4.1% at baseline and 11.6% at follow-up, with low numbers of missing data for all outcomes. The estimated cost per school was £1942 for +FRANK and £3041 for FRANK friends. All progression criteria were met.ConclusionsBoth interventions were acceptable to students, teachers and parents, but FRANK friends was preferred to +FRANK. A limitation of the study was that qualitative data were collected on a self-selecting sample. Future work recommendations include progression to a Phase III effectiveness trial of FRANK friends.Trial registrationCurrent Controlled Trials ISRCTN14415936.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 7. See the NIHR Journals Library website for further project information. The work was undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer). Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK CRC, is gratefully acknowledged.
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Affiliation(s)
- James White
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jemma Hawkins
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Kim Madden
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Aimee Grant
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Vanessa Er
- DECIPHer, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Lianna Angel
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Timothy Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Mark Kelson
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Adam Fletcher
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Simon Murphy
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Luke Midgley
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Gemma Eccles
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | | | - William Hollingworth
- DECIPHer, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rona Campbell
- DECIPHer, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Matthew Hickman
- DECIPHer, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Bonell
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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30
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Hullegie S, Wootton M, Verheij TJM, Thomas-Jones E, Bates J, Hood K, Gal M, Francis NA, Little P, Moore M, Llor C, Pickles T, Gillespie D, Kirby N, Brugman C, Butler CC. Clinicians' interpretations of point of care urine culture versus laboratory culture results: analysis from the four-country POETIC trial of diagnosis of uncomplicated urinary tract infection in primary care. Fam Pract 2017; 34:392-399. [PMID: 28334777 DOI: 10.1093/fampra/cmx009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Urine culture at the point of care minimises delay between obtaining the sample and agar inoculation in a microbiology laboratory, and quantification and sensitivity results can be available more rapidly in primary care. OBJECTIVE To identify the degree to which clinicians' interpretations of a point-of-care-test (POCT) urine culture (Flexicult™ SSI-Urinary Kit) agrees with laboratory culture in women presenting to primary care with symptoms of uncomplicated urinary tract infections (UTI). METHODS Primary care clinicians used the Flexicult™-POCT, recorded their findings and took a photograph of the result, which was interpreted by microbiology laboratory technicians. Urine samples were additionally processed in routine care laboratories. Cross tabulations were used to identify important differences in organism identification, quantification and antibiotic susceptibility between these three sources of data. The influence of various laboratory definitions for UTI on culture were assessed. RESULTS Primary care clinicians identified 202/289 urine samples (69.9%) as positive for UTI using the Flexicult™-POCT, whereas laboratory culture identified 94-190 (32.5-65.7%) as positive, depending on definition thresholds. 82.9% of samples identified positive for E. coli on laboratory culture were also considered positive for E. coli using the Flexicult™ -POCT, and susceptibilities were reasonably concordant. There were major discrepancies between laboratory staff interpretation of Flexicult™ photographs, clinicians' interpretation of the Flexicult™ test, and laboratory culture results. CONCLUSION Flexicult™-POCT overestimated the positivity rate of urine samples for UTI when laboratory culture was used as the reference standard. However, it is unclear whether point-of-care or laboratory based urine culture provides the most valid diagnostic information.
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Affiliation(s)
- Saskia Hullegie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff, UK
| | - Theo J M Verheij
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, the Netherlands
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Janine Bates
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Micaela Gal
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Nick A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Michael Moore
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Carl Llor
- Primary Health Centre Via Roma, University Institute in Primary Care Research Jordi Gol, Barcelona, Spain
| | - Timothy Pickles
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - David Gillespie
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Nigel Kirby
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Curt Brugman
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, the Netherlands
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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31
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Chestnutt IG, Playle R, Hutchings S, Morgan-Trimmer S, Fitzsimmons D, Aawar N, Angel L, Derrick S, Drew C, Hoddell C, Hood K, Humphreys I, Kirby N, Lau TMM, Lisles C, Morgan MZ, Murphy S, Nuttall J, Onishchenko K, Phillips C, Pickles T, Scoble C, Townson J, Withers B, Chadwick BL. Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness. J Dent Res 2017; 96:754-761. [PMID: 28394709 DOI: 10.1177/0022034517702094] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).
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Affiliation(s)
- I G Chestnutt
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - R Playle
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK.,2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Hutchings
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Morgan-Trimmer
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - D Fitzsimmons
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Aawar
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - L Angel
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Derrick
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - C Drew
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Hoddell
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - K Hood
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - I Humphreys
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Kirby
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - T M M Lau
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Lisles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - M Z Morgan
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - S Murphy
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - J Nuttall
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - K Onishchenko
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - C Phillips
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - T Pickles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Scoble
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - J Townson
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - B Withers
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - B L Chadwick
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
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Loblaw A, Pickles T, Crook J, Martin AG, Vigneault E, Souhami L, Cury F, Morris J, Catton C, Lukka H, Cheung P, Sethukavalan P, Warner A, Yang Y, Rodrigues G. Stereotactic Ablative Radiotherapy Versus Low Dose Rate Brachytherapy or External Beam Radiotherapy: Propensity Score Matched Analyses of Canadian Data. Clin Oncol (R Coll Radiol) 2017; 29:161-170. [DOI: 10.1016/j.clon.2016.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/25/2016] [Accepted: 09/22/2016] [Indexed: 02/05/2023]
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Clarke N, De Santis M, Costello A, Chang YH, Pickles T, Pompeo A, Bazarbashi S, Haas G, Cooperberg M. Global treatment patterns for late-stage prostate cancer: Updated results from ASPIRE-PCa. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Atwan A, Ingram JR, Abbott R, Kelson MJ, Pickles T, Bauer A, Piguet V. Oral fumaric acid esters for psoriasis: abridged Cochrane systematic review including GRADE assessments. Br J Dermatol 2016; 175:873-881. [PMID: 27087044 PMCID: PMC5095877 DOI: 10.1111/bjd.14676] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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] [Accepted: 04/12/2016] [Indexed: 01/09/2023]
Abstract
Fumaric acid esters (FAEs) are licensed for the treatment of moderate‐to‐severe psoriasis in Germany but are also used off‐label in many other countries. We conducted this systematic review to synthesize the highest‐quality evidence for the benefits and risks of FAEs for psoriasis. Our primary outcomes were change in Psoriasis Area and Severity Index score and dropout rates due to adverse effects. Randomized controlled trials (RCTs) of FAEs or dimethylfumarate were included, with no restriction on age or psoriasis subtype. We searched the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library, Medline, Embase, LILACS and five trials registers, and hand searched six conference proceedings. Six RCTs with a total of 544 participants were included, four of which were published only as abstracts or brief reports, limiting study reporting. Five RCTs compared FAEs with placebo, and all demonstrated benefit in favour of FAEs. However, meta‐analysis was possible only for PASI 50 response after 12–16 weeks, which was achieved by 64% of participants on FAEs compared with 14% on placebo: risk ratio (RR) 4·55, 95% confidence interval (CI) 2·80–7·40; two studies; 247 participants; low‐quality evidence). There was no difference in dropout rates due to adverse effects (RR 5·36, 95% CI 0·28–102·12; one study; 27 participants; very low‐quality evidence and wide CI). More participants experienced nuisance adverse effects with FAEs (76%) than with placebo (16%) (RR 4·72, 95% CI 2·45–9·08; one study; 99 participants; moderate‐quality evidence), mainly abdominal pain, diarrhoea and flushing. One head‐to‐head study of very low‐quality evidence comparing FAEs with methotrexate reported comparable efficacy and dropout rates, although FAEs caused more flushing. The evidence in this review was limited and must be interpreted with caution; studies with better design and outcome reporting are needed. What's already known about this topic? Fumaric acid esters (FAEs) are licensed for the treatment of moderate‐to‐severe psoriasis in Germany, and are used off‐label in many other countries. Non‐Cochrane systematic reviews previously examined the effect of FAEs in psoriasis, but have not rigorously assessed the quality of the evidence.
What does this study add? Six randomized controlled trials with 544 participants were included, four of which were published only as abstracts or brief reports, resulting in low‐ or very low‐quality evidence. Results suggest that FAEs are superior to placebo, but their efficacy in comparison with methotrexate is uncertain due to very low‐quality evidence. The relative risk of nuisance adverse effects with FAEs is about five times greater than with placebo; however, there is insufficient evidence available to give an accurate figure for dropout rates due to adverse effects.
Linked Comment:Egeberg. Br J Dermatol 2016; 175:857. Audio Commentary
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Affiliation(s)
- A Atwan
- Department of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity, Cardiff University, 3rd Floor Glamorgan House, Heath Park, Cardiff, CF14 4XN, U.K
| | - J R Ingram
- Department of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity, Cardiff University, 3rd Floor Glamorgan House, Heath Park, Cardiff, CF14 4XN, U.K..
| | - R Abbott
- Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, U.K
| | - M J Kelson
- South East Wales Trials Unit, Institute of Translation, Innovation, Methodology and Engagement, Cardiff University, Cardiff, U.K
| | - T Pickles
- South East Wales Trials Unit, Institute of Translation, Innovation, Methodology and Engagement, Cardiff University, Cardiff, U.K
| | - A Bauer
- Department of Dermatology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - V Piguet
- Department of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity, Cardiff University, 3rd Floor Glamorgan House, Heath Park, Cardiff, CF14 4XN, U.K
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35
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Hay AD, Sterne JAC, Hood K, Little P, Delaney B, Hollingworth W, Wootton M, Howe R, MacGowan A, Lawton M, Busby J, Pickles T, Birnie K, O'Brien K, Waldron CA, Dudley J, Van Der Voort J, Downing H, Thomas-Jones E, Harman K, Lisles C, Rumsby K, Durbaba S, Whiting P, Butler CC. Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study. Ann Fam Med 2016; 14:325-36. [PMID: 27401420 PMCID: PMC4940462 DOI: 10.1370/afm.1954] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/07/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment. METHODS We recruited acutely unwell children aged under 5 years from 233 primary care sites across England and Wales. Index tests were parent-reported symptoms, clinician-reported signs, urine dipstick results, and clinician opinion of UTI likelihood (clinical diagnosis before dipstick and culture). The reference standard was microbiologically confirmed UTI cultured from a clean-catch urine sample. We calculated sensitivity, specificity, and area under the receiver operator characteristic (AUROC) curve of coefficient-based (graded severity) and points-based (dichotomized) symptom/sign logistic regression models, and we then internally validated the AUROC using bootstrapping. RESULTS Three thousand thirty-six children provided urine samples, and culture results were available for 2,740 (90%). Of these results, 60 (2.2%) were positive: the clinical diagnosis was 46.6% sensitive, with an AUROC of 0.77. Previous UTI, increasing pain/crying on passing urine, increasingly smelly urine, absence of severe cough, increasing clinician impression of severe illness, abdominal tenderness on examination, and normal findings on ear examination were associated with UTI. The validated coefficient- and points-based model AUROCs were 0.87 and 0.86, respectively, increasing to 0.90 and 0.90, respectively, by adding dipstick nitrites, leukocytes, and blood. CONCLUSIONS A clinical rule based on symptoms and signs is superior to clinician diagnosis and performs well for identifying young children for noninvasive urine sampling. Dipstick results add further diagnostic value for empiric antibiotic treatment.
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Affiliation(s)
- Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Paul Little
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, United Kingdom
| | - Brendan Delaney
- Guys' and St Thomas' Charity Chair in Primary Care Research, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Department of Primary Care and Public Health Sciences, London, United Kingdom
| | - William Hollingworth
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff, United Kingdom
| | - Robin Howe
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff, United Kingdom
| | - Alasdair MacGowan
- North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - John Busby
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Timothy Pickles
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kate Birnie
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Kathryn O'Brien
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Jan Dudley
- Bristol Royal Hospital for Children, University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | - Judith Van Der Voort
- Department of Paediatrics and Child Health, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Harriet Downing
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kim Harman
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, United Kingdom
| | - Catherine Lisles
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kate Rumsby
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, United Kingdom
| | - Stevo Durbaba
- King's College London, Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, London, United Kingdom
| | - Penny Whiting
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, United Kingdom, and General Practitioner, Cwm Taf University Health Board, Wales, United Kingdom
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Butler CC, O'Brien K, Wootton M, Pickles T, Hood K, Howe R, Waldron CA, Thomas-Jones E, Dudley J, Van Der Voort J, Rumsby K, Little P, Downing H, Harman K, Hay AD. Empiric antibiotic treatment for urinary tract infection in preschool children: susceptibilities of urine sample isolates. Fam Pract 2016; 33:127-32. [PMID: 26984993 DOI: 10.1093/fampra/cmv104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Antibiotic treatment recommendations based on susceptibility data from routinely submitted urine samples may be biased because of variation in sampling, laboratory procedures and inclusion of repeat samples, leading to uncertainty about empirical treatment. OBJECTIVE To describe and compare susceptibilities of Escherichia coli cultured from routinely submitted samples, with E. coli causing urinary tract infection (UTI) from a cohort of systematically sampled, acutely unwell children. METHODS Susceptibilities of 1458 E. coli isolates submitted during the course of routine primary care for children <5 years (routine care samples), compared to susceptibilities of 79 E. coli isolates causing UTI from 5107 children <5 years presenting to primary care with an acute illness [systematic sampling: the Diagnosis of Urinary Tract infection in Young children (DUTY) cohort]. RESULTS The percentage of E. coli sensitive to antibiotics cultured from routinely submitted samples were as follows: amoxicillin 45.1% (95% confidence interval: 42.5-47.7%); co-amoxiclav using the lower systemic break point (BP) 86.6% (84.7-88.3%); cephalexin 95.1% (93.9-96.1%); trimethoprim 74.0% (71.7-76.2%) and nitrofurantoin 98.2% (97.4-98.8%). The percentage of E. coli sensitive to antibiotics cultured from systematically sampled DUTY urines considered to be positive for UTI were as follows: amoxicillin 50.6% (39.8-61.4%); co-amoxiclav using the systemic BP 83.5% (73.9-90.1%); co-amoxiclav using the urinary BP 94.9% (87.7-98.4%); cephalexin 98.7% (93.2-99.8%); trimethoprim 70.9% (60.1-80.0%); nitrofurantoin 100% (95.3-100.0%) and ciprofloxacin 96.2% (89.4-98.7%). CONCLUSION Escherichia coli susceptibilities from routine and systematically obtained samples were similar. Most UTIs in preschool children remain susceptible to nitrofurantoin, co-amoxiclav and cephalexin.
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Affiliation(s)
- Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Cwm Taf University Health Board, Abercynon,
| | - Kathryn O'Brien
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff
| | - Timothy Pickles
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff
| | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - Robin Howe
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - Jan Dudley
- Bristol Royal Hospital for Children, University Hospitals Bristol, NHS Foundation Trust, Bristol
| | - Judith Van Der Voort
- Department of Paediatrics and Child Health, University Hospital of Wales, Cardiff
| | - Kate Rumsby
- Primary Care and Population Sciences Division, University of Southampton, Southampton and
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton and
| | - Harriet Downing
- Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kim Harman
- Primary Care and Population Sciences Division, University of Southampton, Southampton and
| | - Alastair D Hay
- Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Rodrigues G, Wang T, Warner A, Pickles T, Crook J, Martin A, Vigneault E, Cury F, Souhami L, Morris W, Catton C, Lukka H. Post–Biochemical Failure Risk Stratification to Predict Survival in Prostate Cancer: A Recursive Partitioning Analysis. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Conway J, Connors J, Pickles T. A Population-Based Analysis of Secondary Breast Cancer Risk According to Radiation Volume in Women With Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Randell E, Pickles T, Simpson SA, Spanou C, McCambridge J, Hood K, Butler CC. Eligibility for interventions, co-occurrence and risk factors for unhealthy behaviours in patients consulting for routine primary care: results from the Pre-Empt study. BMC Fam Pract 2015; 16:133. [PMID: 26453044 PMCID: PMC4600219 DOI: 10.1186/s12875-015-0359-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/06/2015] [Indexed: 11/11/2022]
Abstract
Background Smoking, excessive drinking, lack of exercise and a poor diet remain key causes of premature morbidity and mortality globally, yet it is not clear what proportion of patients attending for routine primary care are eligible for interventions about these behaviours, the extent to which they co-occur within individuals, and which individuals are at greatest risk for multiple unhealthy behaviours. The aim of the trial was to examine ‘intervention eligibility’ and co-occurrence of the ‘big four’ risky health behaviours – lack of exercise, smoking, an unhealthy diet and excessive drinking – in a primary care population. Methods Data were collected from adult patients consulting routinely in general practice across South Wales as part of the Pre-Empt study; a cluster randomised controlled trial. After giving consent, participants completed screening instruments, which included the following to assess eligibility for an intervention based on set thresholds: AUDIT-C (for alcohol), HSI (for smoking), IPAQ (for exercise) and a subset of DINE (for diet). The intervention following screening was based on which combination of risky behaviours the patient had. Descriptive statistics, χ2 tests for association and ordinal regressions were undertaken. Results Two thousand sixty seven patients were screened: mean age of 48.6 years, 61.9 % female and 42.8 % in a managerial or professional occupation. In terms of numbers of risky behaviours screened eligible for, two was the most common (43.6 %), with diet and exercise (27.2 %) being the most common combination. Insufficient exercise was the most common single risky behaviour (12.0 %). 21.8 % of patients would have been eligible for an intervention for three behaviours and 5.9 % for all four behaviours. Just 4.5 % of patients did not identify any risky behaviours. Women, older age groups and those in managerial or professional occupations were more likely to exhibit all four risky behaviours. Conclusion Very few patients consulting for routine primary care screen ineligible for interventions about common unhealthy behaviours, and most engage in more than one of the major common unhealthy behaviours. Clinicians should be particularly alert to opportunities to engaging younger, non professional men and those with multi-morbidity about risky health behaviour. Trial registration ISRCTN22495456
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Affiliation(s)
- Elizabeth Randell
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Timothy Pickles
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | | | - Clio Spanou
- School of Psychology, Faculty of Health & Social Sciences, University of Bedfordshire, Park Square, Luton, LU1 3JU, UK.
| | - Jim McCambridge
- Department of Health Sciences, Seebohm Rowntree Building University of York, Heslington, York, YO10 5DD, UK.
| | - Kerenza Hood
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6NW, UK.
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Al Ali A, Richmond S, Popat H, Playle R, Pickles T, Zhurov AI, Marshall D, Rosin PL, Henderson J, Bonuck K. The influence of snoring, mouth breathing and apnoea on facial morphology in late childhood: a three-dimensional study. BMJ Open 2015; 5:e009027. [PMID: 26351193 PMCID: PMC4563226 DOI: 10.1136/bmjopen-2015-009027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 06/10/2015] [Accepted: 06/17/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To explore the relationship between the prevalence of sleep disordered breathing (SDB) and face shape morphology in a large cohort of 15-year-old children. DESIGN Observational longitudinal cohort study SETTING Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England. PARTICIPANTS Three-dimensional surface laser scans were taken for 4784 white British children from the ALSPAC during a follow-up clinic. A total of 1724 children with sleep disordered breathing (SDB) and 1862 healthy children were identified via parents' report of sleep disordered symptoms for their children. We excluded from the original cohort all children identified as having congenital abnormalities, diagnoses associated with poor growth and children with adenoidectomy and/or tonsillectomy. MAIN OUTCOME MEASURES Parents in the ALSPAC reported sleep disordered symptoms (snoring, mouth breathing and apnoea) for their children at 6, 18, 30, 42, 57, 69 and 81 months. Average facial shells were created for children with and without SDB in order to explore surface differences. RESULTS Differences in facial measurements were found between the children with and without SDB throughout early childhood. The mean differences included an increase in face height in SDB children of 0.3 mm (95% CI -0.52 to -0.05); a decrease in mandibular prominence of 0.9° (95% CI -1.30 to -0.42) in SDB children; and a decrease in nose prominence and width of 0.12 mm (95% CI 0.00 to 0.24) and 0.72 mm (95% CI -0.10 to -0.25), respectively, in SDB children. The odds of children exhibiting symptoms of SDB increased significantly with respect to increased face height and mandible angle, but reduced with increased nose width and prominence. CONCLUSIONS The combination of a long face, reduced nose prominence and width, and a retrognathic mandible may be diagnostic facial features of SBD that may warrant a referral to specialists for the evaluation of other clinical symptoms of SDB.
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Affiliation(s)
- Ala Al Ali
- Applied Clinical Research & Public Health, Dental School, Wales, UK
| | - Stephen Richmond
- Applied Clinical Research & Public Health, Dental School, Wales, UK
| | - Hashmat Popat
- Applied Clinical Research & Public Health, Dental School, Wales, UK
| | - Rebecca Playle
- Applied Clinical Research & Public Health, Dental School, Wales, UK
| | - Timothy Pickles
- Applied Clinical Research & Public Health, Dental School, Wales, UK
| | - Alexei I Zhurov
- Applied Clinical Research & Public Health, Dental School, Wales, UK
| | - David Marshall
- School of Computer Science & Informatics, Cardiff University, Wales, UK
| | - Paul L Rosin
- School of Computer Science & Informatics, Cardiff University, Wales, UK
| | - John Henderson
- Avon Longitudinal Study of Parents and Children, University of Bristol, Bristol, UK
| | - Karen Bonuck
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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De Santis M, Costello A, Chang Y, Clarke N, Pickles T, Bellm L, Haas G, Pompeo A, Bazarbashi S, Cooperberg M. 2525 ASPIRE-PCa: Initial findings from a prospective, global observational study of men with late-stage prostate cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin condition that can markedly reduce life quality. Several systemic therapies exist for moderate to severe psoriasis, including oral fumaric acid esters (FAE). These contain dimethyl fumarate (DMF), the main active ingredient, and monoethyl fumarate. FAE are licensed for psoriasis in Germany but used off-licence in many countries. OBJECTIVES To assess the effects and safety of oral fumaric acid esters for psoriasis. SEARCH METHODS We searched the following databases up to 7 May 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (Issue 4, 2015), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials. We handsearched six conference proceedings that were not already included in the Cochrane Skin Group Specialised Register. SELECTION CRITERIA Randomised controlled trials (RCTs) of FAE, including DMF monotherapy, in individuals of any age and sex with a clinical diagnosis of psoriasis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. Primary outcomes were improvement in Psoriasis Area and Severity Index (PASI) score and the proportion of participants discontinuing treatment due to adverse effects. MAIN RESULTS We included 6 studies (2 full reports, 2 abstracts, 1 brief communication, and 1 letter), with a total of 544 participants. Risk of bias was unclear in several studies because of insufficient reporting. Five studies compared FAE with placebo, and one study compared FAE with methotrexate. All studies reported data at 12 to 16 weeks, and we identified no longer-term studies. When FAE were compared with placebo, we could not perform meta-analysis for the primary outcome of PASI score because the three studies that assessed this outcome reported the data differently, although all studies reported a significant reduction in PASI scores with FAE. Only 1 small study designed for psoriatic arthritis reported on the other primary outcome of participants discontinuing treatment due to adverse effects (2 of 13 participants on FAE compared with none of the 14 participants on placebo; risk ratio (RR) 5.36, 95% confidence interval (CI) 0.28 to 102.1; 27 participants; very low-quality evidence). However, these findings are uncertain due to indirectness and a very wide confidence interval. Two studies, containing 247 participants and both only reported as abstracts, allowed meta-analysis for PASI 50, which showed superiority of FAE over placebo (RR 4.55, 95% CI 2.80 to 7.40; low-quality evidence), with a combined PASI 50 of 64% in those given FAE compared with a PASI 50 of 14% for those on placebo, representing a number needed to treat to benefit of 2. The same studies reported more participants achieving PASI 75 with FAE, but we did not pool the data because of significant heterogeneity; none of the studies measured PASI 90. One study reported significant improvement in participants' quality of life (QoL) with FAE, measured with Skindex-29. However, we could not compute the mean difference because of insufficient reporting in the abstract. More participants experienced adverse effects, mainly gastrointestinal disturbance and flushing, on FAE (RR 4.72, 95% CI 2.45 to 9.08; 1 study, 99 participants; moderate-quality evidence), affecting 76% of participants given FAE and 16% of the placebo group (representing a number needed to treat to harm of 2). The other studies reported similar findings or did not report adverse effects fully.One study of 54 participants compared methotrexate (MTX) with FAE. PASI score at follow-up showed superiority of MTX (mean Difference (MD) 3.80, 95% CI 0.68 to 6.92; 51 participants; very low-quality evidence), but the difference was not significant after adjustment for baseline disease severity. The difference between groups for the proportion of participants who discontinued treatment due to adverse effects was uncertain because of imprecision (RR 0.19, 95% CI 0.02 to 1.53; 1 study, 51 participants; very low-quality evidence). Overall, the number of participants experiencing common nuisance adverse effects was not significantly different between the 2 groups, with 89% of the FAE group affected compared with 100% of the MTX group (RR 0.89, 95% CI 0.77 to 1.03; 54 participants; very low-quality evidence). Flushing was more frequent in those on FAE, with 13 out of 27 participants affected compared with 2 out of 27 given MTX. There was no significant difference in the number of participants who attained PASI 50, 75, and 90 in the 2 groups (very low-quality evidence) whereas this study did not measure the effect of treatments on QoL. The included studies reported no serious adverse effects of FAE and were too small and of limited duration to provide evidence about rare or delayed effects. AUTHORS' CONCLUSIONS Evidence suggests that FAE are superior to placebo and possibly similar in efficacy to MTX for psoriasis; however, the evidence provided in this review was limited, and it must be noted that four out of six included studies were abstracts or brief reports, restricting study reporting. FAE are associated with nuisance adverse effects, including flushing and gastrointestinal disturbance, but short-term studies reported no serious adverse effects.
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Affiliation(s)
- Ausama Atwan
- Cardiff UniversityDepartment of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity3rd Floor, Glamorgan HouseHeath ParkCardiffUKCF14 4XN
| | - John R Ingram
- Cardiff UniversityDepartment of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity3rd Floor, Glamorgan HouseHeath ParkCardiffUKCF14 4XN
| | - Rachel Abbott
- University Hospital of WalesWelsh Institute of DermatologyHeath ParkCardiffUKCF14 4XW
| | - Mark J Kelson
- Cardiff UniversitySouth East Wales Trials Unit, Institute of Translation, Innovation, Methodology and EngagementNeuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Timothy Pickles
- Cardiff UniversitySouth East Wales Trials Unit, Institute of Translation, Innovation, Methodology and EngagementNeuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Andrea Bauer
- Universitätsklinikum Carl Gustav CarusDepartment of DermatologyFetscherstr. 74DresdenGermany01307
| | - Vincent Piguet
- Cardiff UniversityDepartment of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity3rd Floor, Glamorgan HouseHeath ParkCardiffUKCF14 4XN
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Weber B, Paton K, Ma R, Pickles T. PO-0812: Long-term outcomes and toxicity after proton beam radiotherapy of large non-peripapillary choroidal melanoma. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Al Ali A, Richmond S, Popat H, Toma AM, Playle R, Pickles T, Zhurov AI, Marshall D, Rosin PL, Henderson J. A three-dimensional analysis of the effect of atopy on face shape. Eur J Orthod 2014; 36:506-11. [PMID: 25257926 PMCID: PMC4174908 DOI: 10.1093/ejo/cjs107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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] [Indexed: 11/24/2022]
Abstract
Three-dimensional (3D) imaging technology has been widely used to analyse facial morphology and has revealed an influence of some medical conditions on craniofacial growth and morphology. The aim of the study is to investigate whether craniofacial morphology is different in atopic Caucasian children compared with controls. Study design included observational longitudinal cohort study. Atopy was diagnosed via skin-prick tests performed at 7.5 years of age. The cohort was followed to 15 years of age as part of the Avon Longitudinal Study of Parents and Children (ALSPAC). A total of 734 atopic and 2829 controls were identified. 3D laser surface facial scans were obtained at 15 years of age. Twenty-one reproducible facial landmarks (x, y, z co-ordinates) were identified on each facial scan. Inter-landmark distances and average facial shells for atopic and non-atopic children were compared with explore differences in face shape between the groups. Both total anterior face height (pg-g, pg-men) and mid-face height (Is-men, sn-men, n-sn) were longer (0.6 and 0.4mm respectively) in atopic children when compared with non-atopic children. No facial differences were detected in the transverse and antero-posterior relationships. Small but statistically significant differences were detected in the total and mid-face height between atopic and non-atopic children. No differences were detected in the transverse and antero-posterior relationships.
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Affiliation(s)
- Ala Al Ali
- *Applied Clinical Research & Public Health, Dental School,
| | | | - Hashmat Popat
- *Applied Clinical Research & Public Health, Dental School
| | - Arshed M Toma
- *Applied Clinical Research & Public Health, Dental School
| | - Rebecca Playle
- *Applied Clinical Research & Public Health, Dental School
| | | | | | - David Marshall
- **School of Computer Science & Informatics, Cardiff University, Wales and
| | - Paul L Rosin
- **School of Computer Science & Informatics, Cardiff University, Wales and
| | - John Henderson
- ***Avon Longitudinal Study of Parents and Children, University of Bristol, UK
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Hamilton S, Tyldesley S, Hamm J, Keyes M, Pickles T, Lapointe V, Kahnamelli A, McKenzie M, Miller S, Morris W. The Incidence of Second Malignancies Following Low-Dose-Rate Brachytherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Loblaw D, Pickles T, Crook J, Martin A, Vigneault E, Catton C, Lukka H, Cheung P, Sethukavalan P, Warner A, Yang Y, Rodrigues G. Stereotactic Ablative Radiation Therapy Versus Low-Dose-Rate Brachytherapy: A Propensity Matched Analysis of Canadian Data. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De Santis M, Cooperberg M, Chang Y, Clarke N, Costello A, Pickles T, Curiel R, Pompeo A. A Prospective, Multinational Observational Study of Men with Later-Stage Prostate Cancer, a New Global Study to Examine Patterns of Care and Outcomes. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Haddad NS, Istepanian R, Philip N, Khazaal FAK, Hamdan TA, Pickles T, Amso N, Gregory JW. A feasibility study of mobile phone text messaging to support education and management of type 2 diabetes in Iraq. Diabetes Technol Ther 2014; 16:454-9. [PMID: 24502284 DOI: 10.1089/dia.2013.0272] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND We undertook a feasibility study to evaluate feasibility and utility of short message services (SMSs) to support Iraqi adults with newly diagnosed type 2 diabetes. SUBJECTS AND METHODS Fifty patients from a teaching hospital clinic in Basrah in the first year after diagnosis were recruited to receive weekly SMSs relating to diabetes self-management over 29 weeks. Numbers of messages received, acceptability, cost, effect on glycated hemoglobin (HbA1c), and diabetes knowledge were documented. RESULTS Forty-two patients completed the study, receiving an average 22 of 28 messages. Mean knowledge score rose from 8.6 (SD 1.5) at baseline to 9.9 (SD 1.4) 6 months after receipt of SMSs (P=0.002). Baseline and 6-month knowledge scores correlated (r=0.297, P=0.049). Mean baseline HbA1c was 79 mmol/mol (SD 14 mmol/mol) (9.3% [SD 1.3%]) and decreased to 70 mmol/mol (SD 13 mmol/mol) (8.6% [SD 1.2%]) (P=0.001) 6 months after the SMS intervention. Baseline and 6-month values were correlated (r=0.898, P=0.001). Age, gender, and educational level showed no association with changes in HbA1c or knowledge score. Changes in knowledge score were correlated with postintervention HbA1c (r=-0.341, P=0.027). All patients were satisfied with text messages and wished the service to be continued after the study. The cost of SMSs was €0.065 per message. CONCLUSIONS This study demonstrates SMSs are acceptable, cost-effective, and feasible in supporting diabetes care in the challenging, resource-poor environment of modern-day Iraq. This study is the first in Iraq to demonstrate similar benefits of this technology on diabetes education and management to those seen from its use in better-resourced parts of the world. A randomized controlled trial is needed to assess precise benefits on self-care and knowledge.
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Affiliation(s)
- Nazar S Haddad
- 1 Department of Biochemistry, Al-Bradheia , Basrah, Iraq
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Marrin K, Wood F, Firth J, Kinsey K, Edwards A, Brain KE, Newcombe RG, Nye A, Pickles T, Hawthorne K, Elwyn G. Option Grids to facilitate shared decision making for patients with Osteoarthritis of the knee: protocol for a single site, efficacy trial. BMC Health Serv Res 2014; 14:160. [PMID: 24708747 PMCID: PMC3986464 DOI: 10.1186/1472-6963-14-160] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 03/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite policy interest, an ethical imperative, and evidence of the benefits of patient decision support tools, the adoption of shared decision making (SDM) in day-to-day clinical practice remains slow and is inhibited by barriers that include culture and attitudes; resources and time pressures. Patient decision support tools often require high levels of health and computer literacy. Option Grids are one-page evidence-based summaries of the available condition-specific treatment options, listing patients' frequently asked questions. They are designed to be sufficiently brief and accessible enough to support a better dialogue between patients and clinicians during routine consultations. This paper describes a study to assess whether an Option Grid for osteoarthritis of the knee (OA of the knee) facilitates SDM, and explores the use of Option Grids by patients disadvantaged by language or poor health literacy. METHODS/DESIGN This will be a stepped wedge exploratory trial involving 72 patients with OA of the knee referred from primary medical care to a specialist musculoskeletal service in Oldham. Six physiotherapists will sequentially join the trial and consult with six patients using usual care procedures. After a period of brief training in using the Option Grid, the same six physiotherapists will consult with six further patients using an Option Grid in the consultation. The primary outcome will be efficacy of the Option Grid in facilitating SDM as measured by observational scores using the OPTION scale. Comparisons will be made between patients who have received the Option Grid and those who received usual care. A Decision Quality Measure (DQM) will assess quality of decision making. The health literacy of patients will be measured using the REALM-R instrument. Consultations will be observed and audio-recorded. Interviews will be conducted with the physiotherapists, patients and any interpreters present to explore their views of using the Option Grid. DISCUSSION Option Grids offer a potential solution to the barriers to implementing traditional decision aids into routine clinical practice. The study will assess whether Option Grids can facilitate SDM in day-to-day clinical practice and explore their use with patients disadvantaged by language or poor health literacy. TRIAL REGISTRATION Current Controlled Trials ISRCTN94871417.
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Affiliation(s)
- Katy Marrin
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Fiona Wood
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Jill Firth
- Pennine MSK Partnership Ltd, Integrated Care Centre, New Radcliffe Street, Oldham OL1 1NL, UK
| | - Katharine Kinsey
- Pennine MSK Partnership Ltd, Integrated Care Centre, New Radcliffe Street, Oldham OL1 1NL, UK
| | - Adrian Edwards
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Kate E Brain
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Robert G Newcombe
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Alan Nye
- Pennine MSK Partnership Ltd, Integrated Care Centre, New Radcliffe Street, Oldham OL1 1NL, UK
| | - Timothy Pickles
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Kamila Hawthorne
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dewey Field Road, Hanover, NH 03755, USA
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Pickles T, Morris W, Tyldesley S. PO-0725: Neoadjuvant PSA kinetics in prostate cancer with LHRH agonists: The importance of full testosterone suppression. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30843-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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