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Hwai SWC, Wardlaw JM, Williams A, Doubal FN. What matters to people and families affected by cerebral small vessel disease (SVD)? A qualitative grounded theory investigation. Cereb Circ Cogn Behav 2024; 6:100202. [PMID: 38379937 PMCID: PMC10877198 DOI: 10.1016/j.cccb.2024.100202] [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] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/22/2024]
Abstract
Background Cerebral small vessel disease (SVD) is a common neurological disorder contributing to stroke, dementia, and disability. No treatment options exist although clinical trials are ongoing. We aimed to understand what matters to people and families affected by SVD to inform future research. Methods We thematically analysed unsolicited correspondences from members of the public addressed to members of the Edinburgh SVD Research Group on a variety of subjects related to SVD. We used inductive thematic codes, categorised under concerns, requests, emotions, and contributions, to form a grounded theory that categorised and ranked concerns raised. Results 101 correspondents expressed 346 concerns between August 2015 and February 2021, mostly via email. 60 correspondents (59.4 %) disclosed a SVD diagnosis, 39 (38.6 %) disclosed a previous stroke or TIA, and 40 (39.6 %) were family of people living with SVD. Primary concerns related to cognitive problems (number of correspondents (n)=43 (42.6 %)), lack of support or information from healthcare services (n = 41 (40.6 %)), prognosis (n = 37 (36.6 %)), sensory disturbances (n = 27 (26.7 %)), functional problems (n = 24, (23.8 %)), impact on daily life (n = 24 (23.8 %)), and causes of SVD (n = 19 (18.8 %)). 57 correspondents (56.4 %) expressed support for research, 43 (42.6 %) expressed an eagerness to understand SVD, 35 (34.7 %) expressed helplessness, and 19 (18.8 %) expressed frustration. Conclusions Cognitive decline was the main concern for people and families living with SVD who corresponded with the Edinburgh SVD research group. These findings also indicate a need for more accessible services and better information about SVD for patients and families.
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Affiliation(s)
| | - Joanna M. Wardlaw
- The University of Edinburgh, Scotland, United Kingdom
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, University of Edinburgh, United Kingdom
| | - Anna Williams
- The University of Edinburgh, Scotland, United Kingdom
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, University of Edinburgh, United Kingdom
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, United Kingdom
| | - Fergus N. Doubal
- The University of Edinburgh, Scotland, United Kingdom
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, University of Edinburgh, United Kingdom
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Nascimento GG, Raittio E, Machado V, Leite FRM, Botelho J. Advancing Universal Oral Health Coverage via Person-Centred Outcomes. Int Dent J 2023; 73:793-799. [PMID: 37684172 PMCID: PMC10658430 DOI: 10.1016/j.identj.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 09/10/2023] Open
Abstract
The World Health Organization member states proposed a comprehensive "Global Strategy on Oral Health," which includes achieving universal oral health coverage by 2030. Challenges and barriers, including persistent inequalities, will hamper the achievement of universal oral health coverage. In low- and middle-income countries, the oral health of a large proportion of the population has been neglected, increasing oral health inequalities. In high-income countries, some receive excessive dental treatment, whilst particularly those with higher needs receive too little dental care. Therefore, an analysis of individual countries' needs, encompassing the training of oral health professionals in a new philosophy of care and attention and the optimisation of the existing resources, is necessary. Distancing from a person-centred focus has prompted individual and societal issues, including under-/overdiagnosis and under-/overtreatment. The person-centred approach considers the perceptions, needs, preferences, and circumstances of individuals and populations. Patient-reported outcome measures, such as self-rated and -reported health, reflect an individual's overall perception of health and are designed to mediate human biology (ie, the disease) and psychology. The usage of patient-reported outcome measures in dentistry to place the individual at the centre of treatment is delayed compared to other areas. This paper discusses some challenges and potential solutions of patient-reported outcome measures in dentistry for achieving universal oral health coverage.
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Affiliation(s)
- Gustavo G Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore; Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Eero Raittio
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.
| | - Vanessa Machado
- Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Caparica, Portugal
| | - Fábio R M Leite
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore; Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - João Botelho
- Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Caparica, Portugal
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Marella P, Laupland KB, Shekar K, Tabah A, Edwards F, Ramanan M. Institution-free days after critical illness: A multicenter retrospective study. J Crit Care 2023; 74:154253. [PMID: 36640478 DOI: 10.1016/j.jcrc.2023.154253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patient-centered outcomes beyond mortality such as institution-free days (IFD) are becoming increasingly relevant in critical care trials. METHODS We calculated IFD using three definitions which differed in the way death and censoring of after-hospital deaths were handled analysing data from adult patient databases admitted to four ICUs of North Brisbane, Australia. Differences in distribution of IFD using different definitions were explored with descriptive statistics and histograms. Six pre-specified variables (age, illness severity, comorbidities index, elective status, surgical/medical admission and treatment limitations) were assessed and reported as determinants of IFDs for the proposed definitions. RESULTS Data from 25,371 ICU admissions was analysed. The density distribution of IFD was bimodal with a peak at 0 days and a variable right-sided peak depending on the definition used. The mean IFD varied from 253 (standard deviation(SD) 151.3) to 295 (SD 116.2) depending on definition used. Multivariable zero-inflated negative binomial regression modelling showed that the six pre-specified variables had significant associations with IFD and their magnitude of effect varied with the definition used. CONCLUSIONS IFD is a simple, easily measurable patient-centered outcome that varies depending on the definition used. Patient input should be sought to define the optimum definition and clinical use of IFD.
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Affiliation(s)
- Prashanti Marella
- Intensive Care Unit, Caboolture Hospital, Metro North Hospital and Health Services, Queensland, Australia; Mater Clinical Unit, University of Queensland, Brisbane, Australia
| | - Kevin B Laupland
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Department of Intensive Care Services, Royal Brisbane and Womens hospital, Brisbane, Queensland, Australia
| | - Kiran Shekar
- The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Alexis Tabah
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services, Queensland, Australia
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Mahesh Ramanan
- Intensive Care Unit, Caboolture Hospital, Metro North Hospital and Health Services, Queensland, Australia; The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
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Hocaoglu MB, Murtagh FEM, Walshe C, Chambers RL, Maddocks M, Sleeman KE, Oluyase AO, Dunleavy L, Bradshaw A, Bajwah S, Fraser LK, Preston N, Higginson IJ. Adaptation and multicentre validation of a patient-centred outcome scale for people severely ill with COVID (IPOS-COV). Health Qual Life Outcomes 2023; 21:29. [PMID: 36964550 PMCID: PMC10036974 DOI: 10.1186/s12955-023-02102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/20/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Patient-centred measures to capture symptoms and concerns have rarely been reported in severe COVID. We adapted and tested the measurement properties of the proxy version of the Integrated Palliative care Outcome Scale-IPOS-COV for severe COVID using psychometric approach. METHODS We consulted experts and followed consensus-based standards for the selection of health status measurement instruments and United States Food and Drug Administration guidance for adaptation and analysis. Exploratory Factor Analysis and clinical perspective informed subscales. We tested the internal consistency reliability, calculated item total correlations, examined re-test reliability in stable patients, and also evaluated inter-rater reproducibility. We examined convergent and divergent validity of IPOS-COV with the Australia-modified Karnofsky Performance Scale and evaluated known-groups validity. Ability to detect change was examined. RESULTS In the adaptation phase, 6 new items were added, 7 items were removed from the original measure. The recall period was revised to be the last 12-24 h to capture fast deterioration in COVID. General format and response options of the original Integrated Palliative care Outcome Scale were preserved. Data from 572 patients with COVID from across England and Wales seen by palliative care services were included. Four subscales were supported by the 4-factor solution explaining 53.5% of total variance. Breathlessness-Agitation and Gastro-intestinal subscales demonstrated good reliability with high to moderate (a = 0.70 and a = 0.67) internal consistency, and item-total correlations (0.62-0.21). All except the Flu subscale discriminated well between patients with differing disease severity. Inter-rater reliability was fair with ICC of 0.40 (0.3-0.5, 95% CI, n = 324). Correlations between the subscales and AKPS as predicted were weak (r = 0.13-0.26) but significant (p < 0.01). Breathlessness-Agitation and Drowsiness-Delirium subscales demonstrated good divergent validity. Patients with low oxygen saturation had higher mean Breathlessness-Agitation scores (M = 5.3) than those with normal levels (M = 3.4), t = 6.4 (186), p < 0.001. Change in Drowsiness-Delirium subscale correctly classified patients who died. CONCLUSIONS IPOS-COV is the first patient-centred measure adapted for severe COVID to support timely management. Future studies could further evaluate its responsiveness and clinical utility with clinimetric approaches.
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Affiliation(s)
- Mevhibe B Hocaoglu
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
- Global Health and Social Medicine, Harvard Medical School, Boston, USA.
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Catherine Walshe
- International Observatory on End-of-Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Rachel L Chambers
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Matthew Maddocks
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Katherine E Sleeman
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Adejoke O Oluyase
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Lesley Dunleavy
- International Observatory on End-of-Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sabrina Bajwah
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Lorna K Fraser
- Health Sciences, University of York, York, North Yorkshire, UK
| | - Nancy Preston
- International Observatory on End-of-Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Irene J Higginson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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Roth S, M'Pembele R, Stroda A, Voit J, Lurati Buse G, Sixt SU, Westenfeld R, Polzin A, Rellecke P, Tudorache I, Hollmann MW, Boeken U, Akhyari P, Lichtenberg A, Huhn R, Aubin H. Days alive and out of hospital after left ventricular assist device implantation. ESC Heart Fail 2022; 9:2455-2463. [PMID: 35513994 PMCID: PMC9288752 DOI: 10.1002/ehf2.13942] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
Aims Implantation of left ventricular assist devices (LVADs) as a bridge to transplant or as destination therapy is increasing. The selection of suitable patients and outcome assessment belong to the key challenges. Mortality has traditionally been a focus of research in this field, but literature on quality of life is very limited. This study aimed to identify perioperative factors influencing patients' life as measured by days alive and out of hospital (DAOH) in the first year after LVAD implantation. Methods and results This retrospective single‐centre cohort study screened 227 patients who underwent LVAD implantation at the University Hospital Duesseldorf, Germany, between 2010 and 2020. First, the influence of 10 prespecified variables on DAOH was investigated by univariate analysis. Second, multivariate quantile regression was conducted including all factors with significant influence on DAOH in the univariate model. Additionally, the impact of all variables on 1 year mortality was investigated using Kaplan–Meier curves to oppose DAOH and mortality. In total, 221 patients were included into analysis. As pre‐operative factors, chronic kidney disease (CKD), pre‐operative mechanical circulatory support (pMCS), and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) stadium < 3 were associated with lower DAOH at 1 year [CKD: 280 (155–322) vs. 230 (0–219), P = 0.0286; pMCS: 294 (155–325) vs. 243 (0–293), P = 0.0004; INTERMACS 1: 218 (0–293) vs. INTERMACS 2: 264 (6–320) vs. INTERMACS 3: 299 (228–325) vs. INTERMACS 4: 313 (247–332), P ≤ 0.0001]. Intra‐operative additional implantation of a right ventricular assist device (RVAD) was also associated with lower DAOH [RVAD: 290 (160–325) vs. 174 (0–277), P ≤ 0.0001]. As post‐operative values that were associated with lower DAOH, dialysis and tracheotomy could be identified [dialysis: 300 (252–326) vs. 186 (0–300), P ≤ 0.0001; tracheotomy: 292 (139–325) vs. 168 (0–269), P ≤ 0.0001]. Multivariate analysis revealed that all of these factors besides pMCS were independently associated with DAOH. According to Kaplan–Meier analysis, only post‐operative dialysis was significantly associated with increased mortality at 1 year (survival: no dialysis 89.4% vs. dialysis 70.1%, hazard ratio: 0.56, 95% confidence interval: 0.33–0.94; P = 0.031). Conclusions The results of this study indicate that there can be a clear discrepancy between hard endpoints such as mortality and more patient‐centred outcomes reflecting life impact. DAOH may relevantly contribute to a more comprehensive selection process and outcome assessment in LVAD patients.
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Affiliation(s)
- Sebastian Roth
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - René M'Pembele
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Alexandra Stroda
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Josephine Voit
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Giovanna Lurati Buse
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan U Sixt
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center (AUMC), Location AMC, Amsterdam, The Netherlands
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Ragnar Huhn
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.,Department of Anesthesiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
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Kirsty CW, Mary H, Sumner J. Identify the report as a systematic review. Nutr Health 2022; 28:527-542. [PMID: 35254171 DOI: 10.1177/02601060221080240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: To examine the relationship of vitamin B12 and folate concentrations to cognitive function, fatigue measures, physical function, quality of life (patient-centred outcomes) and homocysteine plasma concentrations (intermediate marker of cobalamin and folate deficiency) for patients with Multiple Sclerosis (MS). Methods: Systematic searches for eligible articles of MEDLINE, CINAHL, EMBASE, Scopus, Web of Science and OpenGray databases were conducted from 1983 in March 2021. Heterogeneity, Weighted Mean Difference (WMD) and Confidence Intervals (CI) calculated using Random Effects Model. Results: Sixteen studies were included involving; 616 MS patients and 655 healthy controls. 14 of these had acceptable or better quality but there was high heterogeneity. No difference was found between MS, healthy controls for folate and cobalamin concentrations; WMD 0.00ug/L (95% CI: -0.01, 0.01) and WMD 7.01pmol/L (95% CI: -25.54, 39.55) respectively. MS group showed mild-to-moderate disability WMD was 2.78 (95% CI: 2.00, 3.56). MS may be associated with elevated plasma homocysteine concentrations on average 2.47µmol/L more than healthy controls. Discussion: Physical ability of MS group was worse than healthy controls, but there was no difference in folate and cobalamin concentrations. This suggests folate and cobalamin are not influential factors in worsening physical function. There may be an association between worse cognitive function, and increased homocysteine concentrations. Results were inconclusive due to high heterogeneity and limited number of studies. A core outcome set would enable easier synthesis of future results.
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Affiliation(s)
- Cummins-Williams Kirsty
- 62641University of Plymouth Faculty of Health and Human Sciences Ringgold standard institution, Peninsula Allied Health Centre Derriford Road, Plymouth PL4 8AA, UK of Great Britain and Northern Ireland
| | - Hickson Mary
- 62641University of Plymouth Faculty of Health and Human Sciences Ringgold standard institution, Peninsula Allied Health Centre Derriford Road, Plymouth PL4 8AA, UK of Great Britain and Northern Ireland
| | - Jonathan Sumner
- 62641University of Plymouth Faculty of Health and Human Sciences Ringgold standard institution, Peninsula Allied Health Centre Derriford Road, Plymouth PL4 8AA, UK of Great Britain and Northern Ireland
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M'Pembele R, Roth S, Stroda A, Buse GL, Sixt SU, Westenfeld R, Polzin A, Rellecke P, Tudorache I, Hollmann MW, Aubin H, Akhyari P, Lichtenberg A, Huhn R, Boeken U. Life impact of VA-ECMO due to primary graft dysfunction in patients after orthotopic heart transplantation. ESC Heart Fail 2021; 9:695-703. [PMID: 34734490 PMCID: PMC8788039 DOI: 10.1002/ehf2.13686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/01/2021] [Accepted: 10/09/2021] [Indexed: 12/04/2022] Open
Abstract
Aims Primary graft dysfunction (PGD) is a feared complication after heart transplantation (HTX). HTX patients frequently receive veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) until graft recovery. Long‐term mortality of patients weaned from VA‐ECMO after HTX is comparable with non‐ECMO patients. However, impact on quality of life is unknown. This study investigated days alive and out of hospital (DAOH) as patient‐centred outcome in HTX patients at 1 year after surgery. Methods and results This retrospective single‐centre cohort study included patients who underwent HTX at the University Hospital Düsseldorf, Germany, from 2010 to 2020. Main exposure was VA‐ECMO due to PGD. VA‐ECMO and non‐VA‐ECMO patients were compared regarding the primary endpoint DAOH at 1 year after HTX. Subgroup analysis for patients weaned from VA‐ECMO was performed. In total, 144 patients were included into analysis; 1 year mortality was significantly lower in non‐ECMO patients [non‐ECMO 14.3% (14/98) vs. VA‐ECMO 34.8% (16/46), adjusted hazard ratio: 0.32, 95% confidence interval: 0.15–0.74; P = 0.002]. Mortality did not differ significantly between patients weaned from VA‐ECMO and non‐ECMO patients [non‐ECMO 14.3% (14/98) vs. VA‐ECMO (weaned) 18.9% (7/37), adjusted hazard ratio: 0.72, 95% confidence interval: 0.27–1.90; P = 0.48]. DAOH were significantly higher in non‐ECMO patients compared with VA‐ECMO patients and patients weaned from VA‐ECMO [non‐ECMO vs. VA‐ECMO: median 310 (inter‐quartile range 277–327) days vs. 243 (0–288) days; P < 0.0001; non‐ECMO vs. VA‐ECMO (weaned): 310 (277–327) days vs. 253 (208–299) days; P < 0.0001]. These results were still significant after multivariable adjustment with forced entry of predefined covariables. Conclusions Despite similar survival rates, VA‐ECMO due to PGD has a relevant life impact as defined by DAOH in the first year after HTX. As a more patient‐centred endpoint, DAOH may contribute to a more comprehensive assessment of outcome in HTX patients.
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Affiliation(s)
- René M'Pembele
- Department of Anesthesiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sebastian Roth
- Department of Anesthesiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexandra Stroda
- Department of Anesthesiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Giovanna Lurati Buse
- Department of Anesthesiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stephan U Sixt
- Department of Anesthesiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center (AUMC), Location AMC, Amsterdam, The Netherlands
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ragnar Huhn
- Department of Anesthesiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Evangelidis N, Sautenet B, Madero M, Tong A, Ashuntantang G, Sanabria LC, de Boer IH, Fung S, Gallego D, Levey AS, Levin A, Lorca E, Okpechi IG, Rossignol P, Sola L, Usherwood T, Wheeler DC, Cho Y, Howell M, Guha C, Scholes-Robertson N, Widders K, Gonzalez AM, Teixeira-Pinto A, Viecelli AK, Bernier-Jean A, Anumudu S, Dunn L, Wilkie M, Craig JC. Standardised Outcomes in Nephrology - Chronic Kidney Disease (SONG-CKD): a protocol for establishing a core outcome set for adults with chronic kidney disease who do not require kidney replacement therapy. Trials 2021; 22:612. [PMID: 34503563 PMCID: PMC8427149 DOI: 10.1186/s13063-021-05574-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 03/17/2021] [Accepted: 08/27/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Globally, over 1.2 million people die from chronic kidney disease (CKD) every year. Patients with CKD are up to 10 times more likely to die prematurely than progress to kidney failure requiring kidney replacement therapy. The burden of symptoms and impaired quality of life in CKD may be compounded by comorbidities and treatment side effects. However, patient-important outcomes remain inconsistently and infrequently reported in trials in patients with CKD, which can limit evidence-informed decision-making. The Standardised Outcomes in Nephrology - Chronic Kidney Disease (SONG-CKD) aims to establish a consensus-based core outcome set for trials in patients with CKD not yet requiring kidney replacement therapy to ensure outcomes of relevance to patients, caregivers and health professionals are consistently reported in trials. METHODS SONG-CKD involves four phases: a systematic review to identify outcomes (domains and measures) that have been reported in randomised controlled trials involving adults with CKD who do not require kidney replacement therapy; stakeholder key informant interviews with health professionals involved in the care of adults with CKD to ascertain their views on establishing core outcomes in CKD; an international two-round online Delphi survey with patients, caregivers, clinicians, researchers, policy makers and industry representatives to obtain consensus on critically important outcome domains; and stakeholder consensus workshops to review and finalise the set of core outcome domains for trials in CKD. DISCUSSION Establishing a core outcome set to be reported in trials in patients with CKD will enhance the relevance, transparency and impact of research to improve the lives of people with CKD. TRIAL REGISTRATION Not applicable. This study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database: http://www.comet-initiative.org/Studies/Details/1653 .
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Affiliation(s)
- Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia.
| | - Benedicte Sautenet
- Department of Nephrology, CHU Tours, INSERM SPHERE U1246, University of Tours, University of Nantes, Tours, France
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Gloria Ashuntantang
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Laura Cortes Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Ian H de Boer
- Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Samuel Fung
- Division of Nephrology, Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Daniel Gallego
- Federacion Nacional ALCER (Spanish Kidney Patient's Federation), Madrid, Spain
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Eduardo Lorca
- Department of Nephrology, Hospital Salvador, Santiago, Chile
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Clinique 1433 and Inserm U1116; CHRU Nancy; F-CRIN INI-CRCT, Nancy, France
| | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Tim Usherwood
- The University of Sydney, Westmead Clinical School, Westmead, NSW, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Katherine Widders
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Amelie Bernier-Jean
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Samaya Anumudu
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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9
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Clarkson JE, Ramsay CR, Ricketts D, Banerjee A, Deery C, Lamont T, Boyers D, Marshman Z, Goulao B, Banister K, Conway D, Dawett B, Baker S, Sherriff A, Young L, van der Pol M, MacLennan G, Floate R, Braid H, Fee P, Forrest M, Gouick J, Mitchell F, Gupta E, Dakri R, Kettle J, McGuff T, Dunn K. Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care. BMC Oral Health 2021; 21:336. [PMID: 34243733 PMCID: PMC8267238 DOI: 10.1186/s12903-021-01637-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/18/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth. METHOD This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes. DISCUSSION SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN. TRIAL REGISTRATION NUMBER ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search .
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Affiliation(s)
- Jan E Clarkson
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK.,NHS Education for Scotland, Edinburgh, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Ricketts
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Avijit Banerjee
- Faculty of Dentistry, Oral and Craniofacial Services, Kings College London, London, UK
| | - Chris Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Thomas Lamont
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK.
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Bhupinder Dawett
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.,Hafren House Dental Practice, Alfreton, Derbyshire, UK
| | - Sarah Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Andrea Sherriff
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | | | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ruth Floate
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Hazel Braid
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Patrick Fee
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jill Gouick
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Fiona Mitchell
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Ekta Gupta
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Riz Dakri
- Faculty of Dentistry, Oral and Craniofacial Services, Kings College London, London, UK
| | - Jennifer Kettle
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Tina McGuff
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Katharine Dunn
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
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10
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Long VJE, Cheung YB, Qu D, Lim K, Lee G, Yee ACP, Guo P, Harding R, Yang GM. Validity and reliability of the English and translated Chinese versions of the Integrated Palliative care Outcome Scale (IPOS) in Singapore. BMC Palliat Care 2021; 20:40. [PMID: 33750367 PMCID: PMC7944591 DOI: 10.1186/s12904-021-00737-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
CONTEXT Measurement of patient-centred outcomes enables clinicians to focus on patient and family priorities and enables quality of palliative care to be assessed. OBJECTIVES This study aimed to evaluate the validity and reliability of the English and translated Chinese versions of the Integrated Palliative care Outcome Scale (IPOS) among advanced cancer patients in Singapore. METHODS IPOS was forward and backward translated from English into Chinese. Structural validity was assessed by confirmatory factor analysis; known-group validity by comparing inpatients and community patients; construct validity by correlating IPOS with Edmonton Symptom Assessment System-revised (ESAS-r) and Functional Assessment of Cancer Therapy-General (FACT-G); internal consistency by Cronbach's alpha; inter-rater reliability between patient and staff responses; test-retest reliability of patient responses between two timepoints. RESULTS One hundred eleven English-responding and 109 Chinese-responding patients participated. The three-factor structure (Physical Symptoms, Emotional Symptoms and Communication and Practical Issues) was confirmed with Comparative Fit Index and Tucker-Lewis-Index > 0.9 and Root Mean Square Error of Approximation < 0.08. Inpatients scored higher than outpatients as hypothesised. Construct validity (Pearson's correlation coefficient, r ≥ |0.608|) was shown between the related subscales of IPOS and FACT-G and ESAS-r. Internal consistency was confirmed for total and subscale scores (Cronbach's alpha≥0.84), except for the Communication and Practical Issues subscale (Cronbach's alpha = 0.29-0.65). Inter-rater reliability (Intra-class correlation coefficient [ICC] ≤ 0.43) between patient and staff responses was insufficient. Test-retest reliability was confirmed with Intra-class correlation coefficient ICC = 0.80 (English) and 0.88 (Chinese) for IPOS Total. CONCLUSION IPOS in English and Chinese showed good validity, good internal consistency, and good test-retest reliability, except for the Communication and Practical Issues subscale. There was poor inter-rater reliability between patients and staff.
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Affiliation(s)
| | - Yin Bun Cheung
- Duke-NUS Medical School, Singapore, Singapore
- Tampere University, Tampere, Finland
| | - Debra Qu
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Guozhang Lee
- Singapore General Hospital, Singapore, Singapore
| | - Alethea C P Yee
- National Cancer Centre Singapore, Singapore, Singapore
- Assisi Hospice, Singapore, Singapore
| | - Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Grace Meijuan Yang
- Duke-NUS Medical School, Singapore, Singapore.
- National Cancer Centre Singapore, Singapore, Singapore.
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11
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Depla AL, Crombag NM, Franx A, Bekker MN. Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives. BMC Health Serv Res 2021; 21:113. [PMID: 33530989 PMCID: PMC7852077 DOI: 10.1186/s12913-021-06121-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve their quality, healthcare systems are increasingly focused on value delivered to patients. For perinatal care, the International Consortium for Health Outcomes Measurement (ICHOM) proposed a patient-centred outcome set with both clinical and patient-reported measures for pregnancy and childbirth (PCB set). This study aimed to identify factors that affect the implementation of the PCB set at the pre-implementation stage, using the consolidated framework for implementation research (CFIR). METHODS In this qualitative study, we conducted semi-structured interviews amongst a purposive sample of key stakeholders within an obstetric care network (OCN): 1) patients, 2) perinatal care professionals involved in the full cycle of perinatal care, and 3) policy makers, including hospital managers, administrative staff and health care insurers. While the CFIR guided data capture and structuring, thematic analysis revealed overarching themes that best reflected the barriers and facilitators from different stakeholder perspectives. Within these overarching themes, the CFIR constructs were maintained. RESULTS Interviews were conducted with 6 patients, 16 professionals and 5 policy makers. Thematic analysis supported by the CFIR framework identified four main themes: the instrument and its implementation process, use in individual patient care, use in quality improvement, and the context of the OCN. Important barriers included professional workload, data reliability, and interprofessional and interorganizational collaboration. Potential facilitators were the PCB set's direct value in individual care, interprofessional feedback and education, and aligning with existing systems. Prominent variations between stakeholder groups included the expected patient burden, the level of use, transparency of outcomes and the degree of integrated care. CONCLUSIONS This study clarified critical factors that affect successful implementation of the PCB set in perinatal care. Practice recommendations, suggested at multiple levels, can enable structural patient-centred care improvement and may unite stakeholders towards integrated birth care.
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Affiliation(s)
- Anne L Depla
- Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Neeltje M Crombag
- Department of Development and Regeneration, KU Leuven University, Leuven, Belgium
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584, EA, Utrecht, The Netherlands.
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12
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Wyld L, Reed MWR, Morgan J, Collins K, Ward S, Holmes GR, Bradburn M, Walters S, Burton M, Herbert E, Lifford K, Edwards A, Ring A, Robinson T, Martin C, Chater T, Pemberton K, Shrestha A, Brennan A, Cheung KL, Todd A, Audisio R, Wright J, Simcock R, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Patnick J, Gosney M, Hatton M, Thomson AM. Bridging the age gap in breast cancer. Impacts of omission of breast cancer surgery in older women with oestrogen receptor positive early breast cancer. A risk stratified analysis of survival outcomes and quality of life. Eur J Cancer 2020; 142:48-62. [PMID: 33220653 PMCID: PMC7789991 DOI: 10.1016/j.ejca.2020.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/14/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
Background Age-related breast cancer treatment variance is widespread with many older women having primary endocrine therapy (PET), which may contribute to inferior survival and local control. This propensity-matched study determined if a subgroup of older women may safely be offered PET. Methods Multicentre, prospective, UK, observational cohort study with propensity-matched analysis to determine optimal allocation of surgery plus ET (S+ET) or PET in women aged ≥70 with breast cancer. Data on fitness, frailty, cancer stage, grade, biotype, treatment and quality of life were collected. Propensity-matching (based on age, health status and cancer stage) adjusted for allocation bias when comparing S+ET with PET. Findings A total of 3416 women (median age 77, range 69–102) were recruited from 56 breast units—2854 (88%) had ER+ breast cancer: 2354 had S+ET and 500 PET. Median follow-up was 52 months. Patients treated with PET were older and frailer than patients treated with S+ET. Unmatched overall survival was inferior in the PET group (hazard ratio, (HR) 0.27, 95% confidence interval (CI) 0.23–0.33, P < 0.001). Unmatched breast cancer–specific survival (BCSS) was also inferior in patients treated with PET (HR: 0.41, CI: 0.29–0.58, P < 0.001 for BCSS). In the matched analysis, PET was still associated with an inferior overall survival (HR = 0.72, 95% CI: 0.53–0.98, P = 0.04) but not BCSS (HR = 0.74, 95% CI: 0.40–1.37, P = 0.34) although at 4–5 years subtle divergence of the curves commenced in favor of surgery. Global health status diverged at certain time points between groups but over 24 months was similar when adjusted for baseline variance. Interpretation For the majority of older women with early ER+ breast cancer, surgery is oncologically superior to PET. In less fit, older women, with characteristics similar to the matched cohort of this study (median age 81 with higher comorbidity and functional impairment burdens, the BCSS survival differential disappears at least out to 4–5 year follow-up, suggesting that for those with less than 5-year predicted life-expectancy (>90 years or >85 with comorbidities or frailty) individualised decision making regarding PET versus S+ET may be appropriate and safe to offer. The Age Gap online decision tool may support this decision-making process (https://agegap.shef.ac.uk/). Trial registration number ISRCTN: 46099296. Propensity matched study of women >70 with breast cancer comparing surgery or PET Unmatched analysis found surgery improves overall & disease-specific survival. Matched analysis (stage, age, health, frailty) found similar disease-specific survival Surgery led to adverse events in 19% & negative impacts on QoL and physical function Less fit women >85 may be offered PET to reduce morbidity, without survival detriment
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Affiliation(s)
- Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | | | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Karen Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Cresent Campus, Sheffield, UK
| | - Sue Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Geoffrey R Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Maria Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Cresent Campus, Sheffield, UK
| | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kate Lifford
- Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Alistair Ring
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, The Glenfield General Hospital, Leicester, LE3 9QP, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Alan Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Kwok L Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Riccardo Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, 41345 Göteborg, Sweden
| | - Juliet Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, UK
| | | | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, UK
| | - Kieran Horgan
- Dept of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Prescott Street, Liverpool L7 8 XP, UK
| | - Matt Winter
- Weston Park Hospital, Whitham Rd, Sheffield S10 2SJ, UK
| | - Jay Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Aberford Rd, Wakefield, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary Ashton Road, Lancaster, Lancashire, LA1 4RP, UK
| | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Margot Gosney
- Royal Berkshire NHS Foundation Trust, Reading, RG1 5AN, UK
| | | | - Alastair M Thomson
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
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13
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Staibano P, Perelman I, Lombardi J, Davis A, Tinmouth A, Carrier M, Stevenson C, Saidenberg E. Patient-Centred Outcomes in Anaemia and Renal Disease: A Systematic Review. Kidney Dis (Basel) 2020; 6:74-84. [PMID: 32309289 DOI: 10.1159/000502208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/17/2019] [Indexed: 12/17/2022]
Abstract
Background Anaemia is a nearly universal complication of chronic kidney disease (CKD). Erythropoiesis-stimulating agents (ESAs) have been demonstrated to improve clinical outcomes and quality of life (QOL) in renal patients with anaemia. Patient-reported outcome measures (PROMs) are increasingly being used to evaluate the patient-centred impact of medical therapy. Here, we describe a systematic review of studies that evaluated patient-centred outcomes (PCOs) in renal patients undergoing anaemia treatment. Methods We conducted a search of Medline (Ovid), EMBASE (Ovid), PsychINFO, and CINAHL databases for studies published until March 2018 that investigated an intervention to treat anaemia in renal patients and used at least one PROM. We also performed a quality assessment for all included studies. Statistical analyses characterized each study, PROMs used, the quality of PCO reporting, and the association between haematological outcomes and PCOs. Results Of the 3,533 studies identified in the database search, 21 met all eligibility criteria. Fourteen (67%) of the studies were randomized-controlled trials. Most studies (81%) investigated CKD patients, 14% investigated post-renal transplant patients and 5% assessed patients with heart disease on haemodialysis. The most common anaemia intervention, used in 95% of studies, was ESAs. Forty-three percent of studies utilized one PROM, most commonly the SF-36, a measure of QOL not specifically created for use in nephrology patients. About a third of studies selectively reported PROM subscales, rather than reporting all subscales. Notable biases among included studies included lack of blinding, selective outcome reporting, and lack of power estimates for PCOs. We did not find a statistically significant association between improvements in haemoglobin and QOL. Conclusions Future studies employing anaemia and nephrology-specific PROMs and conducted with greater rigour, standardization in the research methods, and reporting of PCOs in renal populations will improve understanding of PCOs in this patient group and hopefully improve patient outcomes and experiences.
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Affiliation(s)
- Phillip Staibano
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Iris Perelman
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Julia Lombardi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Alan Tinmouth
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marc Carrier
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Elianna Saidenberg
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
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Bayer O, Adrion C, Al Tawil A, Mansmann U, Strupp M. Results and lessons learnt from a randomized controlled trial: prophylactic treatment of vestibular migraine with metoprolol (PROVEMIG). Trials 2019; 20:813. [PMID: 31888723 PMCID: PMC6937687 DOI: 10.1186/s13063-019-3903-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022] Open
Abstract
Background Vestibular migraine (VM) is the most frequent cause of recurrent spontaneous attacks of vertigo causally related to migraine. The objective of the Prophylactic treatment of vestibular migraine with metoprolol (PROVEMIG) trial was to demonstrate that metoprolol succinate is superior to placebo in the prevention of episodic vertigo- and migraine-related symptoms in patients with VM. Methods This phase III, two-arm, parallel-group, double-blind, randomized placebo-controlled trial was designed to be conducted at tertiary referral centres at neurology and ear, nose and throat departments of eight German university hospitals. The planned sample size was a total of 266 patients to be allocated. Adults aged 18 years or above diagnosed with probable or definitive VM according to the Neuhauser criteria 2001 were randomly assigned 1:1 to 6 months blinded metoprolol (maintenance dosage of 95 mg daily) or placebo. The primary efficacy outcome was the self-reported number of vertiginous attacks per 30 days documented by means of a paper-based daily symptom diary. The pre-specified time period of primary interest was defined as months 4 to 6. Secondary outcomes included the patient-reported number of migraine days and vertigo days, the Dizziness Handicap Inventory, and clinical assessments. Adverse events were reported throughout the whole 9-month study period. Results At the time of trial termination, no evidence for a difference in the incidence of vertiginous attacks between groups was detected. For the full analysis set, the incidence rate ratio was 0.983 (95% confidence interval (CI) 0.902–1.071) for metoprolol versus placebo. In both groups, there was a significant decline over time in the overall monthly vertigo attacks by a factor of 0.830 (95% CI 0.776–0.887). Results were consistent for all subjective and objective key measures of efficacy. The treatment was well tolerated with no unexpected safety findings. Conclusions After randomizing 130 patients PROVEMIG had to be discontinued because of poor participant accrual not related to the tolerability of the study medication or safety concerns; no treatment benefit of metoprolol over placebo could be established. Additional preparatory work is much needed in the development, psychometric evaluation and interpretation of clinically meaningful end points in trials on episodic syndromes like VM taking into consideration the complexity of this disease entity comprising two domains (vertigo- and headache-related disability). Trial registration EudraCT, 2009-013701-34. Prospectively registered on 8 April 2011.
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Affiliation(s)
- Otmar Bayer
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig Maximilians University, Campus Grosshadern, Munich, Germany.,ReliaTec GmbH, Garching, Germany
| | - Christine Adrion
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Amani Al Tawil
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig Maximilians University, Campus Grosshadern, Munich, Germany.,Department of Neurology, Ludwig Maximilians University, University Hospital Munich, Campus Grosshadern, Munich, Germany
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15
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Fenwick EK, Man RE, Aung T, Ramulu P, Lamoureux EL. Beyond intraocular pressure: Optimizing patient-reported outcomes in glaucoma. Prog Retin Eye Res 2020; 76:100801. [PMID: 31676347 DOI: 10.1016/j.preteyeres.2019.100801] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/02/2023]
Abstract
Glaucoma, an irreversible blinding condition affecting 3-4% adults aged above 40 years worldwide, is set to increase with a rapidly aging global population. Raised intraocular pressure (IOP) is a major risk factor for glaucoma where the treatment paradigm is focused on managing IOP using medications, laser, or surgery regimens. However, notwithstanding IOP and other clinical parameters, patient-reported outcomes, including daily functioning, emotional well-being, symptoms, mobility, and social life, remain the foremost concerns for people being treated for glaucoma. These outcomes are measured using objective patient-centered outcome measures (PCOMs) and subjective patient-reported outcome measures (PROMs). Studies using PCOMs have shown that people with glaucoma have several mobility, navigational and coordination challenges; reading and face recognition deficits; and are slower in adapting to multiple real-world situations when compared to healthy controls. Similarly, studies have consistently demonstrated, using PROMs, that glaucoma substantially and negatively impacts on peoples' self-reported visual functioning, mobility, independence, emotional well-being, self-image, and confidence in healthcare, compared to healthy individuals, particularly in those with late-stage disease undergoing a heavy treatment regimen. The patient-centred effectiveness of current glaucoma treatment paradigms is equivocal due to a lack of well-designed randomized controlled trials; short post-treatment follow-up periods; an inappropriate selection or availability of PROMs; and/or an insensitivity of currently available PROMs to monitor changes especially in patients with newly diagnosed early-stage glaucoma. We provide a comprehensive, albeit non-systematic, critique of the psychometric properties, limitations, and recent advances of currently available glaucoma-specific PCOMs and PROMs. Finally, we propose that item banking and computerized adaptive testing methods can address the multiple limitations of paper-pencil PROMs; customize their administration; and have the potential to improve healthcare outcomes for people with glaucoma.
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16
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Rosenblat JD, Simon GE, Sachs GS, Deetz I, Doederlein A, DePeralta D, Dean MM, McIntyre RS. Treatment effectiveness and tolerability outcomes that are most important to individuals with bipolar and unipolar depression. J Affect Disord 2019; 243:116-20. [PMID: 30241026 DOI: 10.1016/j.jad.2018.09.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate patient-reported determinants of treatment effectiveness and tolerability amongst persons with major depressive or bipolar disorders. METHODS The Depression and Bipolar Support Alliance (DBSA) conducted an online survey February 2016-April 2016 asking participants about which outcomes are most important in determining subjective treatment effectiveness and tolerability. RESULTS In total, 896 participants completed the survey [49.9% unipolar depression (n = 447) and 50.1% bipolar depression (n = 449)]. Survey respondents reported several previous medication trials with the minority (25% of depression and 29% of bipolar group) of respondents reporting that their current treatment plan was completely effective. When asked how they know that the treatment is working, for both groups, the highest rated response was, "I don't feel overly anxious, agitated or irritable." Weight gain was the adverse effect that most commonly led respondents to discontinue a medication. Lethargy, emotional blunting, shaking/trembling and anxiety were also identified as common treatment-emergent experiences leading to medication discontinuation in greater than one-third of respondents. The bipolar group more frequently identified several signs that suggested treatment was working (e.g., improved neurocognitive function, improved sleep), as well as more frequently reported several reasons to discontinue medications (e.g., weight gain, trembling). CONCLUSION Numerous factors emerged as important to patients when evaluating treatment effectiveness and tolerability. Some of these factors are inadequately assessed by current standard clinical trial outcome measures. Considering these important patient-centred outcomes in future clinical trials, treatment guidelines and direct patient care may serve to improve patient satisfaction, quality of life and the therapeutic alliance.
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17
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Prasad R, Gelder K, Wiles R. The patient's experience of defaecating proctography: Comparing magnetic resonance with conventional fluoroscopy techniques. Radiography (Lond) 2019; 25:24-27. [PMID: 30599825 DOI: 10.1016/j.radi.2018.07.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/10/2018] [Accepted: 07/14/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Fluoroscopy and MRI are currently used to investigate defaecation and pelvic floor dysfunction, with advantages and disadvantages to both modalities. Anecdotally it is suspected that MRI, allowing more privacy, may be better tolerated by patients but that symptoms may be more easily replicated with fluoroscopic technique due to the physiological position. The aim of this study was to evaluate the patient experience of both techniques to potentially help guide the choice of defaecating proctography modality in the future. METHODS This prospective study was conducted June 2015-March 2017 in a large teaching hospital. Patients undergoing fluoroscopy (FDP) or MR defaecating proctography (MRDP) completed a post-procedure questionnaire rating their satisfaction (1-5, 5 being most satisfied) of different aspects of the test. RESULTS 24 patients underwent FDP and 17 MRDP. Both procedures were scored highly in general for all questions with mean >4.1 and median 5, out of 5. Though not statistically significant, the mean scores for all aspects of the test were slightly higher for fluoroscopy than MR. As well as scoring higher for comfort (4.8 vs 4.4) and dignity maintained (4.6 vs 4.1), the patients who underwent fluoroscopy thought it was easier to replicate symptoms than the patient who underwent MR defaecating proctography (4.6 vs 4.2). CONCLUSION This study shows that both FDP and MRDP are well tolerated in the investigation of defaecation and pelvic floor dysfunction. FDP was scored consistently higher than MRDP, but this was not statistically significant. Thus, this study suggests that patient tolerance of the test is unlikely to be any worse for FDP than for MRDP. Clinicians and radiologists should take into account risks of radiation exposure as well as potential for surgical management when making their decision as to which test is appropriate. The authors recommend that if the patient is unable to replicate their symptoms in MRDP, fluoroscopy should be performed to ensure significant pathology is not being missed.
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Affiliation(s)
- R Prasad
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
| | - K Gelder
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
| | - R Wiles
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
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18
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Nijagal MA, Wissig S, Stowell C, Olson E, Amer-Wahlin I, Bonsel G, Brooks A, Coleman M, Devi Karalasingam S, Duffy JMN, Flanagan T, Gebhardt S, Greene ME, Groenendaal F, R Jeganathan JR, Kowaliw T, Lamain-de-Ruiter M, Main E, Owens M, Petersen R, Reiss I, Sakala C, Speciale AM, Thompson R, Okunade O, Franx A. Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal. BMC Health Serv Res 2018; 18:953. [PMID: 30537958 PMCID: PMC6290550 DOI: 10.1186/s12913-018-3732-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families. METHODS An interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi process, were held to reach consensus on the proposed Standard Set. RESULTS The Working Group selected 24 outcome measures to evaluate care during pregnancy and up to 6 months postpartum. These include clinical outcomes such as maternal and neonatal mortality and morbidity, stillbirth, preterm birth, birth injury and patient-reported outcome measures (PROMs) that assess health-related quality of life (HRQoL), mental health, mother-infant bonding, confidence and success with breastfeeding, incontinence, and satisfaction with care and birth experience. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were also defined. CONCLUSIONS We propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.
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Affiliation(s)
- Malini Anand Nijagal
- University of California, Zuckerberg San Francisco General Hospital, San Francisco, CA USA
| | - Stephanie Wissig
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Caleb Stowell
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Elizabeth Olson
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
- University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | | | | | - Allyson Brooks
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA USA
| | | | | | - James M N Duffy
- Balliol College, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Stefan Gebhardt
- Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | | | | | - Tessa Kowaliw
- South Australian Maternity Reform Association (SAMRA) Inc, Adelaide, Australia
| | | | - Elliott Main
- California Maternal Quality Care Collaborative, Stanford, CA USA
| | - Michelle Owens
- University of Mississippi Medical Center, Jackson, MS USA
| | - Rod Petersen
- Women and Children’s Health Network, North Adelaide, South Australia
| | - Irwin Reiss
- University Hospital Southampton, Hampshire, UK
| | - Carol Sakala
- National Partnership for Women & Families, Washington, D.C., USA
| | | | - Rachel Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH USA
| | - Oluwakemi Okunade
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Arie Franx
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, 3508 AB The Netherlands
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19
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Kelly A, Tong A, Tymms K, March L, Craig JC, De Vera M, Evans V, Hassett G, Toupin-April K, van den Bemt B, Teixeira-Pinto A, Alten R, Bartlett SJ, Campbell W, Dawson T, Gill M, Hebing R, Meara A, Nieuwlaat R, Shaw Y, Singh JA, Suarez-Almazor M, Sumpton D, Wong P, Christensen R, Beaton D, de Wit M, Tugwell P. Outcome Measures in Rheumatology - Interventions for medication Adherence (OMERACT-Adherence) Core Domain Set for Trials of Interventions for Medication Adherence in Rheumatology: 5 Phase Study Protocol. Trials 2018; 19:204. [PMID: 29587864 PMCID: PMC5870260 DOI: 10.1186/s13063-018-2565-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Over the last 20 years, there have been marked improvements in the availability of effective medications for rheumatic conditions such as gout, osteoporosis and rheumatoid arthritis (RA), which have led to a reduction in disease flares and the risk of re-fracture in osteoporosis, and the slowing of disease progression in RA. However, medication adherence remains suboptimal, as treatment regimens can be complex and difficult to continue long term. Many trials have been conducted to improve adherence to medication. Core domains, which are the outcomes of most relevance to patients and clinicians, are a pivotal component of any trial. These core domains should be measured consistently, so that all relevant trials can be combined in systematic reviews and meta-analyses to reach conclusions that are more valid. Failure to do this severely limits the potential for trial-based evidence to inform decisions on how to support medication adherence. The Outcome Measures in Rheumatology (OMERACT) - Interventions for Medication Adherence study by the OMERACT-Adherence Group aims to develop a core domain set for interventions that aim to support medication adherence in rheumatology. METHODS/DESIGN This OMERACT-Adherence study has five phases: (1) a systematic review to identify outcome domains that have been reported in interventions focused on supporting medication adherence in rheumatology; (2) semi-structured stakeholder interviews with patients and caregivers to determine their views on the core domains; (3) focus groups using the nominal group technique with patients and caregivers to identify and rank domains that are relevant to them, including the reasons for their choices; (4) an international three-round modified Delphi survey involving patients with diverse rheumatic conditions, caregivers, health professionals, researchers and other stakeholders to develop a preliminary core domain set; and (5) a stakeholder workshop with OMERACT members to review, vote on and reach a consensus on the core domain set for interventions to support medication adherence in rheumatology. DISCUSSION Establishing a core domain set to be reported in all intervention studies undertaken to support patients with medication adherence will enhance the relevance and the impact of these results and improve the lives of people with rheumatic conditions.
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Affiliation(s)
- Ayano Kelly
- Canberra Rheumatology, Level 9, 40 Marcus Clarke St, Canberra City, ACT, 2606, Australia. .,Department of Rheumatology, Canberra Hospital, Canberra, ACT, Australia. .,College of Health and Medicine, Australian National University, Canberra, ACT, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kathleen Tymms
- Canberra Rheumatology, Level 9, 40 Marcus Clarke St, Canberra City, ACT, 2606, Australia.,Department of Rheumatology, Canberra Hospital, Canberra, ACT, Australia.,College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.,Institute of Bone and Joint Research, Kolling Institute of Medical Research, Sydney, NSW, Australia.,Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Mary De Vera
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Vicki Evans
- Patient Research Partner, Clear Vision Consulting, Canberra, ACT, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Karine Toupin-April
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Netherlands.,Radboud University Medical Centre, Nijmegen, Netherlands
| | - Armando Teixeira-Pinto
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rieke Alten
- Department of Rheumatology, Clinical Immunology, Osteology, Physical therapy and Sports Medicine, Schlosspark Klinik, Charité University Medicine, Berlin, Germany
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada.,Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Willemina Campbell
- Patient Research Partner, Toronto Western Hospital, Toronto, Ottawa, Canada
| | - Therese Dawson
- Lord Street Specialist Centre, Port Macquarie, NSW, Australia.,Mayo Hospital Specialist Centre, Taree, NSW, Australia
| | - Michael Gill
- Patient Research Partner, Dragon Claw, Sydney, NSW, Australia
| | - Renske Hebing
- Amsterdam Rheumatology and Immunology Centre, Amsterdam, Netherlands
| | - Alexa Meara
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Robby Nieuwlaat
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Yomei Shaw
- National Data Bank for Rheumatic Diseases, Wichita, KS, USA
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA.,Department of Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA.,Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL, USA
| | - Maria Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Sumpton
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Concord Hospital, Sydney, NSW, Australia
| | - Peter Wong
- Mid-North Coast Arthritis Clinic, Coffs Harbour, NSW, Australia.,University of New South Wales Rural Clinical School, Coffs Harbour, NSW, Australia
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Dorcas Beaton
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute for Work & Health, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy and the Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maarten de Wit
- Metamedica, VU Medical Centre, Amsterdam, The Netherlands
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Kerr C, Bottomley C, Shingler S, Giangregorio L, de Freitas HM, Patel C, Randall S, Gold DT. The importance of physical function to people with osteoporosis. Osteoporos Int 2017; 28:1597-1607. [PMID: 28265717 PMCID: PMC5391375 DOI: 10.1007/s00198-017-3911-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022]
Abstract
There is increasing need to understand patient outcomes in osteoporosis. This article discusses that fracture in osteoporosis can lead to a cycle of impairment, driven by complex psychosocial factors, having a profound impact on physical function/activity which accumulates over time. More information is required on how treatments impact physical function. INTRODUCTION There is increasing need to understand patient-centred outcomes in osteoporosis (OP) clinical research and management. This multi-method paper provides insight on the effect of OP on patients' physical function and everyday activity. METHODS Data were collected from three sources: (1) targeted literature review on OP and physical function, conducted in MEDLINE, Embase and PsycINFO; (2) secondary thematic analysis of transcripts from patient interviews, conducted to develop a patient-reported outcome instrument. Transcripts were re-coded to focus on OP impact on daily activities and physical function for those with and without fracture history; and (3) discussions of the literature review and secondary qualitative analysis results with three clinical experts to review and interpret the importance and implications of the findings. RESULTS Results suggest that OP, particularly with fracture, can have profound impacts on physical function/activity. These impacts accumulate over time through a cycle of impairment, as fracture leads to longer term detriments in physical function, including loss of muscle, activity avoidance and reduced physical capacity, which in turn leads to greater risk of fracture and potential for further physical restrictions. The cycle of impairment is complex, as other physical, psychosocial and treatment-related factors, such as comorbidities, fears and beliefs about physical activity and fracture risk influence physical function and everyday activity. CONCLUSION More information on how treatments impact physical function would benefit healthcare professionals and persons with OP in making treatment decisions and improving treatment compliance/persistence, as these impacts may be more salient to patients than fracture incidence.
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Affiliation(s)
- C Kerr
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - C Bottomley
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - S Shingler
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - L Giangregorio
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
| | - H M de Freitas
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA.
- Mapi, Translation and Innovation Hub Building, 80 Wood Lane, White City, London, W12 0BZ, UK.
| | - C Patel
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - S Randall
- National Osteoporosis Foundation, 251 18th Street South, Suite 630, Arlington, VA, 22202, USA
| | - D T Gold
- Duke University Medical Center, Durham, NC, 27710, USA
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21
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Tong A, Samuel S, Zappitelli M, Dart A, Furth S, Eddy A, Groothoff J, Webb NJA, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Hanson CS, Evangelidis N, Crowe S, Harris T, Hemmelgarn BR, Manns B, Gill J, Tugwell P, Van Biesen W, Wheeler DC, Winkelmayer WC, Craig JC. Standardised Outcomes in Nephrology-Children and Adolescents (SONG-Kids): a protocol for establishing a core outcome set for children with chronic kidney disease. Trials 2016; 17:401. [PMID: 27519274 PMCID: PMC4982996 DOI: 10.1186/s13063-016-1528-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/26/2016] [Indexed: 01/03/2023] Open
Abstract
Background Children with chronic kidney disease (CKD), requiring dialysis or kidney transplantation, have a mortality rate of up to 30-fold higher than the general aged-matched population, and severely impaired quality of life. Symptoms such as fatigue and pain are prevalent and debilitating. Children with CKD are at risk of cognitive impairment, and poorer educational, vocational, and psychosocial outcomes compared with their well peers, which have consequences through to adulthood. Treatment regimens for children with CKD are long-term, complex, and highly intrusive. While many trials have been conducted to improve outcomes in children with CKD, the outcomes measured and reported are often not relevant to patients and clinicians, and are highly variable. These problems can diminish the value of trials as a means to improve the lives of children with CKD. The Standardised Outcomes in Nephrology—Children and Adolescents (SONG-Kids) study aims to develop a core outcome set for trials in children and adolescents with any stage of CKD that is based on the shared priorities of all stakeholders. Methods/Design SONG-Kids involves five phases: a systematic review to identify outcomes (both domains and measures) that have been reported in randomised controlled trials involving children aged up to 21 years with CKD; focus groups (using nominal group technique) with adolescent patients and caregivers of paediatric patients (all ages) to identify outcomes that are relevant and important to patients and their family and the reasons for their choices; semistructured key informant interviews with health professionals involved in the care of children with CKD to ascertain their views on establishing core outcomes in paediatric nephrology; an international three-round online Delphi survey with patients, caregivers, clinicians, researchers, policy-makers, and members from industry to develop consensus on important outcome domains; and a stakeholder workshop to review and finalise the set of core outcome domains for trials in children with CKD (including nondialysis-dependent, dialysis, and kidney transplantation). Discussion Establishing a core outcome set to be reported in all trials conducted in children with any stage of CKD will enhance the relevance, transparency, and impact of research to improve the lives of children and adolescents with CKD.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia.
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Furth
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine and Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison Eddy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC Academic Medical Center, Amsterdam, The Netherlands
| | - Nicholas J A Webb
- Department of Paediatric Nephrology and NIHR/Wellcome Trust Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, UK
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Detlef Bockenhauer
- UCL Centre for Nephrology and Great Ormond Street Hospital for Children NHS Foundation Trus, London, UK
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Debbie S Gipson
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | | | | | - Brenda R Hemmelgarn
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - John Gill
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - David C Wheeler
- Centre for Nephrology, University College London, London, UK
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
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Ter Louw RP, Patel KM, Sosin M, Weissler JM, Nahabedian MY. Patient-centred decision making in breast reconstruction utilising the delayed-immediate algorithm. J Plast Reconstr Aesthet Surg 2014; 67:477-82. [PMID: 24486151 DOI: 10.1016/j.bjps.2013.12.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 12/26/2013] [Indexed: 11/30/2022]
Abstract
Delayed-immediate reconstruction is an increasingly valuable algorithm for patients anticipating post-mastectomy radiation therapy. Despite the cosmetic and long-term advantages of autologous tissue repair, a subset of patients choose implant-based reconstruction after their initial preference for autologous reconstruction. A critical evaluation of patients who initially planned to undergo delayed-immediate reconstruction but later chose to continue with implant-based reconstruction has not been previously reported. A retrospective analysis of the senior author's (M.Y.N.) patients who initially intended to undergo delayed-immediate autologous breast reconstruction following mastectomy and chose to abandon autologous reconstruction in favour of prosthetic reconstruction was completed from 2005 to 2011. Seven patients (10 breasts) met inclusion criteria. The mean patient age and body mass index were 50.2 years and 32.1 kg m(-2), respectively. Expansion required an average of 4.4 office visits to achieve adequate expansion volume, mean 483 ml (240-600 ml). The mean time from expander placement to definitive reconstruction was 14.6 months. Mean follow-up time was 20.4 months. Complications included infection (1/7), incisional dehiscence (1/7) and capsular contracture (2/7), and late revision surgery was performed in two patients. Successful reconstruction was achieved in 100% of patients (7/7) with a patient-reported satisfaction of 100%. Patient motivations for changing the reconstructive algorithm included a faster post-operative recovery in four patients (4/7) and potential donor-site morbidity in three patients (3/7). Depression or cancer-related fatigue symptoms were self-reported in 4/7. Avoiding donor-site morbidity and a simpler recovery are the main factors that influence patients to change their desire for autologous reconstruction to an implant-based reconstruction. Cancer-related fatigue and depression are prevalent in this population and may be implicated in a patient's desire to undergo less extensive reconstructive surgery. Allowing for the choice of definitive implant-based reconstruction in select patients is safe and is likely to result in high patient satisfaction with satisfactory aesthetic outcomes.
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Affiliation(s)
- Ryan P Ter Louw
- Georgetown University Hospital, Department of Plastic Surgery, Washington, DC, USA
| | - Ketan M Patel
- Georgetown University Hospital, Department of Plastic Surgery, Washington, DC, USA
| | - Michael Sosin
- Georgetown University Hospital, Department of Surgery, Washington, DC, USA
| | - Jason M Weissler
- George Washington University School of Medicine, Washington, DC, USA
| | - Maurice Y Nahabedian
- Georgetown University Hospital, Department of Plastic Surgery, Washington, DC, USA.
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