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Boyd A, Mealand K, Briggs Early K, Oestreich E. Perceived Stress, Grit, and Self-Care Behaviors in First-Year Medical Students. Am J Lifestyle Med 2023; 17:803-812. [PMID: 38511119 PMCID: PMC10948928 DOI: 10.1177/15598276221124576] [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: 03/22/2024] Open
Abstract
Medical students experience more stress than the general population, which over time can cause mental and physical disease, including burnout. Identifying factors impacting stress during early medical training could inform strategies to minimize its impacts throughout training and in clinical practice. This study surveyed 238 first-year osteopathic medical students to assess stress (Perceived Stress Scale; PSS), grit, sleep quality (Pittsburgh Sleep Quality Index; PSQI), physical activity (Godin-Shephard Leisure-Time Physical Activity Score; LTPA), and nutrition habits (Rapid Eating Assessment for Participants; REAP) within the first 2 weeks of starting medical school and again 10 weeks later. Incomplete responses were removed, leaving 204 study participants. We observed statistically significant decreases in grittiness (∆grit = -2.230%, P = .002) and physical activity (∆LTPA = -22.147%, P < .0001), while perceived stress (∆PSS = 34.548%, P < .0001) and poor sleep quality (∆PSQI% = 19.853, P < .0001) increased. Correlation analyses identified the strongest relationships were between ∆PSS vs ∆PSQI (r = .47, P < .0001) and ∆PSS vs ∆LTPA (r = -.20, P < .01). Multivariable linear regression analysis isolated ∆PSQI (P < .0001) and ∆LTPA (P = .012) as statistically significant predictors of ∆PSS. These results suggest early, repeated curricular interventions focused on physical activity and sleep hygiene may help students better manage stress during medical education.
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Affiliation(s)
- Alan Boyd
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA (AB, KM, KBE, EO)
| | - Kyle Mealand
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA (AB, KM, KBE, EO)
| | - Kathaleen Briggs Early
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA (AB, KM, KBE, EO)
| | - Emily Oestreich
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA (AB, KM, KBE, EO)
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McMullan C, Retzer A, Hughes SE, Aiyegbusi OL, Bathurst C, Boyd A, Coleman J, Davies EH, Denniston AK, Dunster H, Frost C, Harding R, Hunn A, Kyte D, Malpass R, McNamara G, Mitchell S, Mittal S, Newsome PN, Price G, Rowe A, van Reil W, Walker A, Wilson R, Calvert M. Development and usability testing of an electronic patient-reported outcome (ePRO) solution for patients with inflammatory diseases in an Advanced Therapy Medicinal Product (ATMP) basket trial. J Patient Rep Outcomes 2023; 7:98. [PMID: 37812323 PMCID: PMC10562321 DOI: 10.1186/s41687-023-00634-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/10/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Electronic patient-reported outcome (ePRO) systems are increasingly used in clinical trials to provide evidence of efficacy and tolerability of treatment from the patient perspective. The aim of this study is twofold: (1) to describe how we developed an electronic platform for patients to report their symptoms, and (2) to develop and undertake usability testing of an ePRO solution for use in a study of cell therapy seeking to provide early evidence of efficacy and tolerability of treatment and test the feasibility of the system for use in later phase studies. METHODS An ePRO system was designed to be used in a single arm, multi-centre, phase II basket trial investigating the safety and activity of the use of ORBCEL-C™ in the treatment of patients with inflammatory conditions. ORBCEL-C™ is an enriched Mesenchymal Stromal Cells product isolated from human umbilical cord tissue using CD362+ cell selection. Usability testing sessions were conducted using cognitive interviews and the 'Think Aloud' method with patient advisory group members and Research Nurses to assess the usability of the system. RESULTS Nine patient partners and seven research nurses took part in one usability testing session. Measures of fatigue and health-related quality of life, the PRO-CTCAE™ and FACT-GP5 global tolerability question were included in the ePRO system. Alert notifications to the clinical team were triggered by PRO-CTCAE™ and FACT-GP5 scores. Patient participants liked the simplicity and responsiveness of the patient-facing app. Two patients were unable to complete the testing session, due to technical issues. Research Nurses suggested minor modifications to improve functionality and the layout of the clinician dashboard and the training materials. CONCLUSION By testing the effectiveness, efficiency, and satisfaction of our novel ePRO system (PROmicsR), we learnt that most people with an inflammatory condition found it easy to report their symptoms using an app on their own device. Their experiences using the PROmicsR ePRO system within a trial environment will be further explored in our upcoming feasibility testing. Research nurses were also positive and found the clinical dashboard easy-to-use. Using ePROs in early phase trials is important in order to provide evidence of therapeutic responses and tolerability, increase the evidence based, and inform methodology development. TRIAL REGISTRATION ISRCTN, ISRCTN80103507. Registered 01 April 2022, https://www.isrctn.com/ISRCTN80103507.
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Affiliation(s)
- Christel McMullan
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK.
| | - Ameeta Retzer
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Camilla Bathurst
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Jamie Coleman
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Alastair K Denniston
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute of Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, UK
| | | | | | - Rosie Harding
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | | | - Derek Kyte
- School of Allied Health & Community, University of Worcester, Worcester, UK
| | - Rebecca Malpass
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Philip N Newsome
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Anna Rowe
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Wilma van Reil
- Research Governance, University Hospital Birmingham, Birmingham, UK
| | - Anita Walker
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- National Cancer Research Institute (NCRI) Consumer Forum, London, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, UK
- Midlands Health Data Research UK, Birmingham, UK
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Lochmaier PG, Boyd A, Irelan DW, Fiedler E, Lee J, Fouty B, Saleh LA, Richter W. PDE4 inhibition induces an acute and transient reduction in serum potassium in mice. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Bredesen DE, Toups K, Hathaway A, Gordon D, Chung H, Raji C, Boyd A, Hill BD, Hausman-Cohen S, Attarha M, Chwa WJ, Kurakin A, Jarrett M. Precision Medicine Approach to Alzheimer's Disease: Rationale and Implications. J Alzheimers Dis 2023; 96:429-437. [PMID: 37807782 PMCID: PMC10741308 DOI: 10.3233/jad-230467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/10/2023]
Abstract
The neurodegenerative disease field has enjoyed extremely limited success in the development of effective therapeutics. One potential reason is the lack of disease models that yield accurate predictions and optimal therapeutic targets. Standard clinical trials have pre-determined a single treatment modality, which may be unrelated to the primary drivers of neurodegeneration. Recent proof-of-concept clinical trials using a precision medicine approach suggest a new model of Alzheimer's disease (AD) as a chronic innate encephalitis that creates a network insufficiency. Identifying and addressing the multiple potential contributors to cognitive decline for each patient may represent a more effective strategy. Here we review the rationale for a precision medicine approach in prevention and treatment of cognitive decline associated with AD. Results and implications from recent proof-of-concept clinical trials are presented. Randomized controlled trials, with much larger patient numbers, are likely to be significant to establishing precision medicine protocols as a standard of care for prevention and treatment of cognitive decline. Furthermore, combining this approach with the pharmaceutical approach offers the potential for enhanced outcomes. However, incorporating precision medicine approaches into everyday evaluation and care, as well as future clinical trials, would require fundamental changes in trial design, IRB considerations, funding considerations, laboratory evaluation, personalized treatment plans, treatment teams, and ultimately in reimbursement guidelines. Nonetheless, precision medicine approaches to AD, based on a novel model of AD pathophysiology, offer promise that has not been realized to date with monotherapeutic approaches.
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Affiliation(s)
- Dale E. Bredesen
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Kat Toups
- Bay Area Wellness, Walnut Creek, CA, USA
| | | | | | | | - Cyrus Raji
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alan Boyd
- CNS Vital Signs, Morrisville, NC, USA
| | - Benjamin D. Hill
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | | | | | - Won Jong Chwa
- Department of Radiology, St. Louis University, St. Louis, MO, USA
| | - Alexei Kurakin
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Chwa WJ, Raji CA, Toups K, Hathaway A, Gordon D, Chung H, Boyd A, Hill BD, Hausman-Cohen S, Attarha M, Jarrett M, Bredesen DE. Longitudinal White and Gray Matter Response to Precision Medicine-Guided Intervention for Alzheimer's Disease. J Alzheimers Dis 2023; 96:1051-1058. [PMID: 38007669 DOI: 10.3233/jad-230481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is a debilitating condition that is widely known to adversely affect gray matter (GM) and white matter (WM) tracts within the brain. Recently, precision medicine has shown promise in alleviating the clinical and gross morphological trajectories of patients with AD. However, regional morphological changes have not yet been adequately characterized. OBJECTIVE Investigate regional morphological responses to a precision medicine-guided intervention with regards to white and gray matter in AD and mild cognitive impairment (MCI). METHODS Clinical and neuroimaging data were compiled over a 9-month period from 25 individuals who were diagnosed with AD or MCI receiving individualized treatment plans. Structural T1-weighted MRI scans underwent segmentation and volumetric quantifications via Neuroreader. Longitudinal changes were calculated via annualized percent change of WM or GM ratios. RESULTS Montreal Cognitive Assessment scores (p < 0.001) and various domains of the Computerized Neurocognitive Screening Vital Signs significantly improved from baseline to 9-month follow-up. There was regional variability in WM and GM atrophy or hypertrophy, but none of these observed changes were statistically significant after correction for multiple comparisons.
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Affiliation(s)
- Won Jong Chwa
- Saint Louis University School of Medicine, Saint Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Cyrus A Raji
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kat Toups
- Bay Area Wellness, Walnut Creek, CA, USA
| | | | | | | | - Alan Boyd
- CNS Vital Signs, Morrisville, NC, USA
| | - Benjamin D Hill
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | | | | | | | - Dale E Bredesen
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Geenty P, Sivapathan S, Stefani LD, Zada M, Boyd A, Kwok F, Thomas L. A novel echocardiographic risk score predicts prognosis in AL-amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Prognosis in light chain (AL) amyloidosis is largely determined by the severity of cardiac involvement. Conventional (Mayo) staging includes 1) hs troponin 2) N-terminal pro-beta natriuretic peptide (NT-pro BNP) and 3)free light chain difference.
Methods
In a retrospective study of 75 AL amyloidosis patients referred to a quaternary amyloid clinic, all patients underwent comprehensive echocardiographic assessment. Echocardiographic parameters included left ventricular (LV) ejection fraction, LV mass, diastolic function, global longitudinal strain (GLS) and indexed left atrial volume (LAVI). Mortality was assessed through review of clinical records.
Results
Over a median follow up of 51 months, 29/75 (39%) of patients died. LAVI, E/e', e', LVGLS, were univariate predictors of mortality (p<0.1). LAVI was the only independent echocardiographic predictor in a multivariable model. Kaplan Meir analysis evaluated LAVI, LVGLS and E/e' using clinical cutoffs as a predictor of survival; only LAVI and LVGLS were significant. A novel “Echo score” comprising of LAVI (>42 ml/m2) and LVGLS (<−12%) was a predictor of mortality with similar prognostic performance as Mayo stage. (Echo score AUC 0.745, 95% CI 0.64–0.85 vs Mayo score AUC 0.752 95% CI 0.66–0.86, p=0.9).
Conclusion
LAVI, a simple, echocardiographic parameter was as an independent predictor of mortality in AL amyloidosis. A composite echocardiographic score combining LAVI and LVGLS stratified AL-amyloidosis patients into 3 distinct groups with similar prognostic power as Mayo stage for all-cause mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Geenty
- Westmead Hospital , Sydney , Australia
| | | | | | - M Zada
- Westmead Hospital , Sydney , Australia
| | - A Boyd
- Westmead Private Cardiology , Sydney , Australia
| | - F Kwok
- Westmead Hospital , Sydney , Australia
| | - L Thomas
- Westmead Hospital , Sydney , Australia
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7
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Toups K, Hathaway A, Gordon D, Chung H, Raji C, Boyd A, Hill BD, Hausman-Cohen S, Attarha M, Chwa WJ, Jarrett M, Bredesen DE. Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project. J Alzheimers Dis 2022; 88:1411-1421. [PMID: 35811518 PMCID: PMC9484109 DOI: 10.3233/jad-215707] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Effective therapeutics for Alzheimer’s disease are needed. However, previous clinical trials have pre-determined a single treatment modality, such as a drug candidate or therapeutic procedure, which may be unrelated to the primary drivers of the neurodegenerative process. Therefore, increasing data set size to include the potential contributors to cognitive decline for each patient, and addressing the identified potential contributors, may represent a more effective strategy. Objective: To determine whether a precision medicine approach to Alzheimer’s disease and mild cognitive impairment is effective enough in a proof-of-concept trial to warrant a larger, randomized, controlled clinical trial. Methods: Twenty-five patients with dementia or mild cognitive impairment, with Montreal Cognitive Assessment (MoCA) scores of 19 or higher, were evaluated for markers of inflammation, chronic infection, dysbiosis, insulin resistance, protein glycation, vascular disease, nocturnal hypoxemia, hormone insufficiency or dysregulation, nutrient deficiency, toxin or toxicant exposure, and other biochemical parameters associated with cognitive decline. Brain magnetic resonance imaging with volumetrics was performed at baseline and study conclusion. Patients were treated for nine months with a personalized, precision medicine protocol, and cognition was assessed at t = 0, 3, 6, and 9 months. Results: All outcome measures revealed improvement: statistically significant improvement in MoCA scores, CNS Vital Signs Neurocognitive Index, and Alzheimer’s Questionnaire Change score were documented. No serious adverse events were recorded. MRI volumetrics also improved. Conclusion: Based on the cognitive improvements observed in this study, a larger, randomized, controlled trial of the precision medicine therapeutic approach described herein is warranted.
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Affiliation(s)
- Kat Toups
- Bay Area Wellness, Walnut Creek, CA, USA
| | | | | | | | - Cyrus Raji
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alan Boyd
- CNS Vital Signs, Morrisville, NC, USA
| | - Benjamin D. Hill
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | | | | | - Won Jong Chwa
- Department of Radiology, St. Louis University, St. Louis, MO, USA
| | | | - Dale E. Bredesen
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Mitra AP, Narayan VM, Mokkapati S, Miest T, Boorjian SA, Alemozaffar M, Konety BR, Shore ND, Gomella LG, Kamat AM, Bivalacqua TJ, Montgomery JS, Lerner SP, Busby JE, Poch M, Crispen PL, Steinberg GD, Schuckman AK, Downs TM, Svatek RS, Mashni J, Lane BR, Guzzo TJ, Bratslavsky G, Karsh LI, Woods ME, Brown GA, Canter D, Luchey A, Lotan Y, Krupski T, Inman BA, Williams MB, Cookson MS, Keegan KA, Andriole GL, Sankin AI, Boyd A, O’Donnell MA, Philipson R, Ylä-Herttuala S, Sawutz D, Parker NR, McConkey DJ, Dinney CP. Antiadenovirus Antibodies Predict Response Durability to Nadofaragene Firadenovec Therapy in BCG-unresponsive Non-muscle-invasive Bladder Cancer: Secondary Analysis of a Phase 3 Clinical Trial. Eur Urol 2022; 81:223-228. [PMID: 34933753 PMCID: PMC8891058 DOI: 10.1016/j.eururo.2021.12.009] [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: 06/09/2021] [Revised: 11/04/2021] [Accepted: 12/02/2021] [Indexed: 01/09/2023]
Abstract
A recent phase 3 trial of intravesical nadofaragene firadenovec reported a promising complete response rate for patients with bacillus Calmette-Guérin-unresponsive non-muscle-invasive bladder cancer. This study examined the ability of antiadenovirus antibody levels to predict the durability of therapeutic response to nadofaragene firadenovec. A standardized and validated quantitative assay was used to prospectively assess baseline and post-treatment serum antibody levels among 91 patients from the phase 3 trial, of whom 47 (52%) were high-grade recurrence free at 12 mo (responders). While baseline titers did not predict treatment response, 3-mo titer >800 was associated with a higher likelihood of durable response (p = 0.026). Peak post-treatment titers >800 were noted in 42 (89%) responders versus 26 (59%) nonresponders (p = 0.001; assay sensitivity, 89%; negative predictive value, 78%). Moreover, 22 (47%) responders compared with eight (18%) nonresponders had a combination of peak post-treatment titers >800 and peak antibody fold change >8 (p = 0.004; assay specificity, 82%; positive predictive value, 73%). A majority of responders continued to have post-treatment antibody titers >800 after the first 6 mo of therapy. In conclusion, serum antiadenovirus antibody quantification may serve as a novel predictive marker for nadofaragene firadenovec response durability. Future studies will focus on large-scale validation and clinical utility of the assay. PATIENT SUMMARY: This study reports on a planned secondary analysis of a phase 3 multicenter clinical trial that established the benefit of nadofaragene firadenovec, a novel intravesical gene therapeutic, for the treatment of patients with bacillus Calmette-Guérin (BCG)-unresponsive high-risk non-muscle-invasive bladder cancer. Prospective assessment of serum anti-human adenovirus type-5 antibody levels of patients in this trial indicated that a combination of post-treatment titers and fold change from baseline can predict treatment efficacy. While this merits additional validation, our findings suggest that serum antiadenovirus antibody levels can serve as an important predictive marker for the durability of therapeutic response to nadofaragene firadenovec.
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Affiliation(s)
- Anirban P. Mitra
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vikram M. Narayan
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharada Mokkapati
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tanner Miest
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Neal D. Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Leonard G. Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashish M. Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Trinity J. Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | | | - Seth P. Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - J. Erik Busby
- Department of Surgery, Prisma Health, University of South Carolina School of Medicine at Greenville, Greenville, SC, USA
| | - Michael Poch
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Paul L. Crispen
- Department of Urology, University of Florida, Gainesville, FL, USA
| | - Gary D. Steinberg
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Anne K. Schuckman
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Tracy M. Downs
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Robert S. Svatek
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Joseph Mashni
- Department of Surgical Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Brian R. Lane
- Division of Urology, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Thomas J. Guzzo
- Division of Urology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Adam Luchey
- Department of Urology, West Virginia University Cancer Institute, Morgantown, WV, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracey Krupski
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Brant A. Inman
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA
| | | | - Michael S. Cookson
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kirk A. Keegan
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerald L. Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Alexander I. Sankin
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Seppo Ylä-Herttuala
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Nigel R. Parker
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - David J. McConkey
- Department of Urology, Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Colin P.N. Dinney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,Corresponding author. Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030, USA. Tel. +1-713-792-3250; Fax: +1-713-794-4824, (C.P.N. Dinney)
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Ferkh A, Tjahjadi C, Geenty P, Stefani L, Boyd A, Richards D, Mollee P, Korczyk D, Taylor M, Kwok F, Kizana E, Ng A, Thomas L. Echocardiographic Deep Phenotyping of Hypertrophic Cardiomyopathies: Amyloid, Anderson-Fabry and Hypertensive Heart Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Stefani L, Boyd A, Ferkh A, Zada M, Devine K, Trivedi S, Tchan M, Thomas L. Basal Segmental Strain as a Marker of Cardiac Involvement in Anderson-Fabry Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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11
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MacDonald-Ottevanger MS, Boyd A, Prins M, van der Helm JJ, Zijlmans CWR, Hindori-Mohangoo AD, Harkisoen S, Hermelijn SM, Brinkman K, Codrington J, Roosblad J, Kort SAR, Dams ETM, van de Laar TJW, Vreden SGS. Differences in prevalence of hepatitis B virus infection and genotypes between ethnic populations in Suriname, South America. Virology 2021; 564:53-61. [PMID: 34656809 DOI: 10.1016/j.virol.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/24/2022]
Abstract
Epidemiological data on hepatitis B virus (HBV) are needed to benchmark HBV elimination goals. We recently assessed prevalence of HBV infection and determinants in participants attending the Emergency Department in Paramaribo, Suriname, South America. Overall, 24.5% (95%CI = 22.7-26.4%) of participants had anti-Hepatitis B core antibodies, which was associated with older age (per year, adjusted Odds Ratio [aOR] = 1.03, 95%CI = 1.02-1.04), Afro-Surinamese (aOR = 1.84, 95%CI = 1.52-2.19) and Javanese ethnicity (aOR = 1.63, 95%CI = 1.28-2.07, compared to the grand mean). 3.2% of participants were Hepatitis B surface Ag-positive, which was also associated with older age (per year, aOR = 1.02, 95%CI = 1.00-1.04), Javanese (aOR = 4.3, 95%CI = 2.66-6.95) and Afro-Surinamese ethnicity (aOR = 2.36, 95%CI = 1.51-3.71). Sex, nosocomial or culturally-related HBV transmission risk-factors were not associated with infection. Phylogenetic analysis revealed strong ethnic clustering: Indonesian subgenotype HBV/B3 among Javanese and African subgenotypes HBV/A1, HBV/QS-A3 and HBV/E among Afro-Surinamese. Testing for HBV during adulthood should be considered for individuals living in Suriname, specifically with Javanese and Afro-Surinamese ancestry.
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Affiliation(s)
- M S MacDonald-Ottevanger
- Scientific Research Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname; Department of Medical Microbiology, Academic Medical Center, Amsterdam, the Netherlands.
| | - A Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - M Prins
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands
| | - J J van der Helm
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands
| | - C W R Zijlmans
- Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname; Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA; Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname
| | - A D Hindori-Mohangoo
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA; Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname
| | - S Harkisoen
- Department of Infectious Diseases, Academic Hospital Paramaribo, Suriname
| | - S M Hermelijn
- Department of Medical Microbiology, Academic Hospital Paramaribo, Suriname
| | - K Brinkman
- Department of Infectious Diseases, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - J Codrington
- Department of Clinical Chemistry, Academic Hospital Paramaribo, Suriname
| | - J Roosblad
- Department of Clinical Chemistry, Academic Hospital Paramaribo, Suriname
| | | | - E Th M Dams
- Department of Internal Medicine, Diakonessenhuis, Paramaribo, Suriname
| | - T J W van de Laar
- Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; Sanquin Research, Department of Donor Medicine Research, Amsterdam, the Netherlands
| | - S G S Vreden
- Department of Infectious Diseases, Academic Hospital Paramaribo, Suriname; Foundation for Scientific Research Suriname, Paramaribo, Suriname
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Meador KJ, Leeman-Markowski B, Medina AE, Illamola SM, Seliger J, Novak G, Lin C, Ivanisevic M, Razavi B, Marino S, Boyd A, Loring DW. Vinpocetine, cognition, and epilepsy. Epilepsy Behav 2021; 119:107988. [PMID: 33957389 DOI: 10.1016/j.yebeh.2021.107988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Vinpocetine has been shown to enhance memory in animal models, with possible cognitive benefit in humans. The present study sought to demonstrate if vinpocetine can enhance cognition in healthy volunteers or patients with epilepsy. In addition, we compare blood levels of vinpocetine and its active metabolite (apovincaminic acid; AVA) in humans and animals to further characterize factors related to possible therapeutic benefit. METHODS The cognitive effects of vinpocetine were assessed in healthy adult volunteers (n = 8) using a double-blind, randomized, crossover design at single doses (placebo, 10, 20, and 60 mg oral). Cognitive effects of vinpocetine in patients with focal epilepsy (n = 8) were tested using a double-blind, randomized, crossover design at single doses (placebo, 20 mg oral) followed by one-month open label at 20 mg oral three times a day. The neuropsychological battery included both computerized and non-computerized tests. Levels of vinpocetine and AVA in the human studies were compared to levels in 45 mice across time dosed at 5-20 mg/kg intraperitoneal of vinpocetine. RESULTS No significant cognitive benefits were seen in healthy volunteers or patients with epilepsy. No appreciable side effects occurred. Vinpocetine and AVA levels were lower in humans than animals. CONCLUSIONS Vinpocetine was well tolerated, but was not associated with positive cognitive effects. However, blood levels obtained in humans were substantially less than levels in animals obtained from dosages known to be effective in one model. This suggests that higher dosages are needed in humans to assess vinpocetine's cognitive efficacy.
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Affiliation(s)
- Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Beth Leeman-Markowski
- Department of Neurology, New York University and VA New York Harbor Healthcare System, NY, NY USA.
| | | | - Sílvia M Illamola
- Department of Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA.
| | - Jordan Seliger
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Gloria Novak
- Department of Neurology, Emory University, Atlanta, GA, USA.
| | - Christine Lin
- School of Medicine, University of California, San Diego, CA, USA.
| | | | - Babak Razavi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Susan Marino
- Department of Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA.
| | | | - David W Loring
- Department of Neurology, Emory University, Atlanta, GA, USA.
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13
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Mansour W, Boyd A, Walshe K. National accreditation programmes for hospitals in the Eastern Mediterranean Region: Case studies from Egypt, Jordan, and Lebanon. Int J Health Plann Manage 2021; 36:1500-1520. [PMID: 33949699 DOI: 10.1002/hpm.3178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/21/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Many countries use external evaluation programmes such as accreditation in order to improve quality and safety in their healthcare settings. Hospital accreditation has developed in many low-and-middle-income countries (LMICs); however, the implementation and sustainability of these programmes vary in each country. This study addresses design and implementation issues of national hospital accreditation programmes. It identifies factors which may explain why programmes can be implemented successfully in one country but not in another and derives lessons for the design and implementation of national accreditation programmes in poor-resource settings. METHODS A multiple case study design was used, comprising three countries in the Eastern Mediterranean Region: Egypt, Lebanon and Jordan. In-depth semi-structured interviews were conducted with 27 key stakeholders in the three countries and experts from international organisations concerned with accreditation activities in LMICs. RESULTS The hospital accreditation programme was successful and sustainable in Jordan but experienced some difficulties in Egypt and Lebanon. The premature end of external funding and devastating political instability after the Arab Spring were problematic for the programmes in Egypt and Lebanon, but continuous funding and strong political will supported the implementation and sustainability of the programme in Jordan. CONCLUSIONS LMICs striving to improve their hospitals' performance through accreditation programmes should consider their vulnerability to a scarcity of financial resources and political instability. An important factor underpinning sustainability is recognising that the accreditation programme is an ongoing and developing quality improvement process that needs continuing and careful attention from funders and political systems if it is to survive and thrive.
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Affiliation(s)
- Wesam Mansour
- Department of Management and Policy, Alliance Manchester Business School, Manchester, UK
| | - Alan Boyd
- Department of Management and Policy, Alliance Manchester Business School, Manchester, UK
| | - Kieran Walshe
- Department of Management and Policy, Alliance Manchester Business School, Manchester, UK
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14
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Boyd A. Commentary on "Regulatory Science and Innovation Programme for Europe (ReScIPE): A proposed model". Br J Clin Pharmacol 2021; 87:3647-3648. [PMID: 33742699 DOI: 10.1111/bcp.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/18/2019] [Accepted: 01/01/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Alan Boyd
- Boyd Consultants Ltd, Electra House, Crewe Business Park, Crewe, Cheshire, UK.,Faculty of Pharmaceutical Medicine, Royal Colleges of Physicians UK, London, UK
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Mansour W, Boyd A, Walshe K. The development of hospital accreditation in low- and middle-income countries: a literature review. Health Policy Plan 2021; 35:684-700. [PMID: 32268354 PMCID: PMC7294243 DOI: 10.1093/heapol/czaa011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Accepted: 01/19/2020] [Indexed: 11/14/2022] Open
Abstract
Hospital accreditation has been transferred from high-income countries (HICs) to many low- and middle-income countries (LMICs), supported by a variety of advocates and donor agencies. This review uses a policy transfer theoretical framework to present a structured analysis of the development of hospital accreditation in LMICs. The framework is used to identify how governments in LMICs adopted accreditation from other settings and what mechanisms facilitated and hindered the transfer of accreditation. The review examines the interaction between national and international actors, and how international organizations influenced accreditation policy transfer. Relevant literature was found by searching databases and selected websites; 78 articles were included in the analysis process. The review concludes that accreditation is increasingly used as a tool to improve the quality of healthcare in LMICs. Many countries have established national hospital accreditation programmes and adapted them to fit their national contexts. However, the implementation and sustainability of these programmes are major challenges if resources are scarce. International actors have a substantial influence on the development of accreditation in LMICs, as sources of expertise and pump-priming funding. There is a need to provide a roadmap for the successful development and implementation of accreditation programmes in low-resource settings. Analysing accreditation policy processes could provide contextually sensitive lessons for LMICs seeking to develop and sustain their national accreditation programmes and for international organizations to exploit their role in supporting the development of accreditation in LMICs.
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Affiliation(s)
- Wesam Mansour
- Liverpool School of Tropical Medicine, Department of International Public Health, Pembroke Place, Liverpool L3 5QA, UK
| | - Alan Boyd
- Alliance Manchester Business School, Innovation, Policy and Management Department, University of Manchester, Booth Street West, Manchester M15 6PB, UK
| | - Kieran Walshe
- Alliance Manchester Business School, Innovation, Policy and Management Department, University of Manchester, Booth Street West, Manchester M15 6PB, UK
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Zada M, Lo Q, Trivedi S, Harapoz M, Boyd A, Devine K, Sadick N, Tchan M, Thomas L. Electrocardiographic Characteristics in Fabry Disease Patients: Impact of Impaired Longitudinal Strain and Left Ventricular Hypertrophy. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Emerson P, Stefani L, Terluk A, Boyd A, Hui R, Thomas L. Left Atrial Strain Analysis in Breast Cancer Patients Post Anthracycline (AC). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Balachandran V, Huang L, Garnham C, Singh T, Boyd A, Grant A. P45 Cardiopulmonary Bypass for Renal and IVC Tumour Resection–Our Experiences. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Boorjian SA, Alemozaffar M, Konety BR, Shore ND, Gomella LG, Kamat AM, Bivalacqua TJ, Montgomery JS, Lerner SP, Busby JE, Poch M, Crispen PL, Steinberg GD, Schuckman AK, Downs TM, Svatek RS, Mashni J, Lane BR, Guzzo TJ, Bratslavsky G, Karsh LI, Woods ME, Brown G, Canter D, Luchey A, Lotan Y, Krupski T, Inman BA, Williams MB, Cookson MS, Keegan KA, Andriole GL, Sankin AI, Boyd A, O'Donnell MA, Sawutz D, Philipson R, Coll R, Narayan VM, Treasure FP, Yla-Herttuala S, Parker NR, Dinney CPN. Intravesical nadofaragene firadenovec gene therapy for BCG-unresponsive non-muscle-invasive bladder cancer: a single-arm, open-label, repeat-dose clinical trial. Lancet Oncol 2021; 22:107-117. [PMID: 33253641 PMCID: PMC7988888 DOI: 10.1016/s1470-2045(20)30540-4] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND BCG is the most effective therapy for high-risk non-muscle-invasive bladder cancer. Nadofaragene firadenovec (also known as rAd-IFNa/Syn3) is a replication-deficient recombinant adenovirus that delivers human interferon alfa-2b cDNA into the bladder epithelium, and a novel intravesical therapy for BCG-unresponsive non-muscle-invasive bladder cancer. We aimed to evaluate its efficacy in patients with BCG-unresponsive non-muscle-invasive bladder cancer. METHODS In this phase 3, multicentre, open-label, repeat-dose study done in 33 centres (hospitals and clinics) in the USA, we recruited patients aged 18 years or older, with BCG-unresponsive non-muscle-invasive bladder cancer and an Eastern Cooperative Oncology Group status of 2 or less. Patients were excluded if they had upper urinary tract disease, urothelial carcinoma within the prostatic urethra, lymphovascular invasion, micropapillary disease, or hydronephrosis. Eligible patients received a single intravesical 75 mL dose of nadofaragene firadenovec (3 × 1011 viral particles per mL). Repeat dosing at months 3, 6, and 9 was done in the absence of high-grade recurrence. The primary endpoint was complete response at any time in patients with carcinoma in situ (with or without a high-grade Ta or T1 tumour). The null hypothesis specified a complete response rate of less than 27% in this cohort. Efficacy analyses were done on the per-protocol population, to include only patients strictly meeting the BCG-unresponsive definition. Safety analyses were done in all patients who received at least one dose of treatment. The study is ongoing, with a planned 4-year treatment and monitoring phase. This study is registered with ClinicalTrials.gov, NCT02773849. FINDINGS Between Sept 19, 2016, and May 24, 2019, 198 patients were assessed for eligibility. 41 patients were excluded, and 157 were enrolled and received at least one dose of the study drug. Six patients did not meet the definition of BCG-unresponsive non-muscle-invasive bladder cancer and were therefore excluded from efficacy analyses; the remaining 151 patients were included in the per-protocol efficacy analyses. 55 (53·4%) of 103 patients with carcinoma in situ (with or without a high-grade Ta or T1 tumour) had a complete response within 3 months of the first dose and this response was maintained in 25 (45·5%) of 55 patients at 12 months. Micturition urgency was the most common grade 3-4 study drug-related adverse event (two [1%] of 157 patients, both grade 3), and there were no treatment-related deaths. INTERPRETATION Intravesical nadofaragene firadenovec was efficacious, with a favourable benefit:risk ratio, in patients with BCG-unresponsive non-muscle-invasive bladder cancer. This represents a novel treatment option in a therapeutically challenging disease state. FUNDING FKD Therapies Oy.
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Affiliation(s)
| | | | | | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Leonard G Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Trinity J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Seth P Lerner
- Scott Department of Urology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Joseph E Busby
- Cancer Centers of the Carolinas, Greenville Hospital System, Greenville, SC, USA
| | - Michael Poch
- Department of GU Oncology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Paul L Crispen
- Department of Urology, University of Florida, Gainesville, FL, USA
| | - Gary D Steinberg
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Anne K Schuckman
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Tracy M Downs
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Brian R Lane
- Division of Urology, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Thomas J Guzzo
- Division of Urology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Michael E Woods
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Adam Luchey
- West Virginia University Cancer Institute, Morgantown, WV, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracey Krupski
- Department of Urology, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Brant A Inman
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Michael S Cookson
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kirk A Keegan
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerald L Andriole
- Washington University School of Medicine in St Louis, St Louis, MO, USA
| | | | | | | | | | | | | | - Vikram M Narayan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Seppo Yla-Herttuala
- AI Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Nigel R Parker
- AI Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Colin P N Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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20
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Ferguson J, Tazzyman A, Walshe K, Bryce M, Boyd A, Archer J, Price T, Tredinnick-Rowe J. 'You're just a locum': professional identity and temporary workers in the medical profession. Sociol Health Illn 2021; 43:149-166. [PMID: 33112436 DOI: 10.1111/1467-9566.13210] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
Internationally, there has been substantial growth in temporary working, including in the medical profession where temporary doctors are known as locums. There is little research into the implications of temporary work in health care. In this paper, we draw upon theories concerning the sociology of the medical profession to examine the implications of locum working for the medical profession, healthcare organisations and patient safety. We focus particularly on the role of organisations in professional governance and the positioning of locums as peripheral to or outside the organisation, and the influence of intergroup relationships (in this case between permanent and locum doctors) on professional identity. Qualitative semi-structured interviews were conducted between 2015 and 2017 in England with 79 participants including locum doctors, locum agency staff, and representatives of healthcare organisations who use locums. An abductive approach to analysis combined inductive coding with deductive, theory-driven interpretation. Our findings suggest that locums were perceived to be inferior to permanently employed doctors in terms of quality, competency and safety and were often stigmatised, marginalised and excluded. The treatment of locums may have negative implications for collegiality, professional identity, group relations, team functioning and the way organisations deploy and treat locums may have important consequences for patient safety.
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Affiliation(s)
- Jane Ferguson
- Alliance Manchester Business School, Institute for Health Policy and Organisation, Manchester, UK
| | - Abigail Tazzyman
- Sheffield Methods Institute, University of Sheffield, Sheffield, UK
| | - Kieran Walshe
- Alliance Manchester Business School, Institute for Health Policy and Organisation, Manchester, UK
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Peninsula Medical School, University of Plymouth Faculty of Health, Plymouth, UK
| | - Alan Boyd
- Alliance Manchester Business School, Institute for Health Policy and Organisation, Manchester, UK
| | - Julian Archer
- Faculty of Medicine, Nursing and Healthcare, Monash University, Melbourne, Australia
| | - Tristan Price
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - John Tredinnick-Rowe
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
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Baird K, Carrasco A, Gillespie K, Boyd A. Qualitative analysis of domestic violence detection and response in a tertiary hospital. J Prim Health Care 2020; 11:178-184. [PMID: 32171361 DOI: 10.1071/hc18058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 06/08/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Domestic and family violence is a public health problem of epidemic proportions and a significant issue facing the Australian community. It knows no boundaries, is indiscriminate to geographical location, social class, age, religious or cultural background. AIM This study aimed to analyse the processes currently used to identify and respond to domestic and family violence in a large tertiary hospital in Australia, and to classify the benefits and weaknesses of these existing systems. METHODS A qualitative method used semistructured, face-to-face and telephone interviews with key informants in 16 key areas across the hospital. Thematic analysis of the interviews was used to define the key issues and areas of interest identified by participants. RESULTS There was a dearth of existing guidelines or pathways of care for patients experiencing domestic violence. Several strengths and weaknesses were identified in relation to the protocols and systems used by the hospital, including limited training for staff and a lack of standardisation of processes, workplace instructions and clinical guidelines. With the exception of maternity services, no clinical service area used a guideline or work instruction. Most interviewees highlighted the need for the safety and protection of staff and victims as a priority. DISCUSSION Domestic and family violence is an enormous burden on the health system. However, many staff have little or no guidance on dealing with it or are unaware of existing protocols or guidelines for detection or response. Participants recommended further education and training for staff, consistent guidelines, specialist liaison and more educational and information resources for staff and patients. Further investigation and discussions with patients affected by violence is warranted to provide robust recommendations for policy change.
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Affiliation(s)
- K Baird
- Gold Coast University Hospital, 1 Hospital Blvd, Southport, Gold Coast, Qld 4215, Australia; and School of Nursing & Midwifery, Griffith University, Logan Campus University Drive, Meadowbrook, Qld 4131, Australia; and Corresponding author.
| | - A Carrasco
- Gold Coast University Hospital, 1 Hospital Blvd, Southport, Gold Coast, Qld 4215, Australia
| | - K Gillespie
- Gold Coast University Hospital, 1 Hospital Blvd, Southport, Gold Coast, Qld 4215, Australia; and School of Nursing & Midwifery, Griffith University, Logan Campus University Drive, Meadowbrook, Qld 4131, Australia
| | - A Boyd
- Gold Coast University Hospital, 1 Hospital Blvd, Southport, Gold Coast, Qld 4215, Australia
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Surgers L, Boyd A, Rougier H, Chiarabini T, Valin N, Decré D, Royer G, Decousser J, Girard P, Lacombe K. Entérobactéries productrices de BLSE : une nouvelle infection sexuellement transmissible ? Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Achterbergh R, Hoornenborg E, Boyd A, Coyer L, Meuzelaar S, Hogewoning A, Davidovich U, van Rooijen M, Schim van der Loeff M, Prins M, de Vries H. Changes in mental health and drug use among men who have sex with men using daily and event-driven pre-exposure prophylaxis: Results from a prospective demonstration project in Amsterdam, the Netherlands. EClinicalMedicine 2020; 26:100505. [PMID: 33089120 PMCID: PMC7564518 DOI: 10.1016/j.eclinm.2020.100505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 07/03/2020] [Accepted: 07/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gay, bisexual and other men who have sex with men (GBMSM) are at increased risk of mental health disorders and drug use. In GBMSM taking pre-exposure prophylaxis (PrEP) for HIV, the proportion engaging in risk behaviors could increase due to decreased perception in HIV risk. In turn, this could leave them further susceptible to mental health disorders. METHODS The AMsterdam PrEP study (AMPrEP) is a demonstration project offering a choice of daily PrEP or event-driven PrEP regimen at the STI clinic of the Public Health Service of Amsterdam. Eligible participants were HIV-negative GBMSM and transgender people at risk of HIV, aged ≥18 years. We assessed anxiety and depressive mood disorders (Mental Health Inventory 5), sexual compulsivity (Sexual Compulsivity Scale), alcohol use disorder (Alcohol Use Disorder Identification Test), and drug use disorder (Drug Use Disorder Identification Test) using yearly self-administered assessments (August 2015-September 2018). The proportion of mental health problems were analyzed and changes over time and between regimen were assessed using a logistic regression model. Variables associated with the development or recovery of disorders were assessed using a multistate Markov model. OUTCOMES Of 376 enrolled, we analyzed 341 participants with data at baseline and at least one follow-up visit. During a median follow-up of 2.5 years (IQR=2.3-2.7), the proportion assessed with sexual compulsivity decreased from 23% at baseline to 10% at the last visit (p<0.001) and drug use disorder decreased from 38% at baseline to 31% at the last visit (p = 0.004). No changes occurred in proportion assessed with anxiety/depressive mood disorders (20% at baseline, 18% at last visit, p = 0.358) or alcohol use disorder (28% at baseline, 22% at the last visit, p = 0.106). During follow-up, participants reported significant less use of alcohol (p<0.001), nitrites (p<0.001) and ecstasy (p<0.001). We found no differences between daily and event-driven PrEP users. The development and recovery of disorders during follow-up were highly interrelated. INTERPRETATION Mental health disorders are prevalent among those initiating PrEP. We did not find increases in mental health disorders during PrEP use, but rather a decrease in sexual compulsivity and drug use disorders. The initial prevalence of mental health disorders in our study point at the continuous need to address mental health disorders within PrEP programs. FUNDING ZonMw, H-TEAM, Internal GGD research funds, Aidsfonds, Stichting AmsterdamDiner Foundation, Gilead Sciences, Janssen Pharmaceutica, M A C AIDS Fund, and ViiV Healthcare.
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Affiliation(s)
- R.C.A. Achterbergh
- STI outpatient clinic, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - E. Hoornenborg
- STI outpatient clinic, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Research and Prevention, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - A. Boyd
- Research and Prevention, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - L. Coyer
- Research and Prevention, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - S.J.A. Meuzelaar
- STI outpatient clinic, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - A.A. Hogewoning
- STI outpatient clinic, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - U. Davidovich
- Research and Prevention, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - M.S. van Rooijen
- STI outpatient clinic, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - M.F. Schim van der Loeff
- Research and Prevention, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - M. Prins
- Research and Prevention, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Meibergdreef 9, AII, the Netherlands
| | - H.J.C. de Vries
- STI outpatient clinic, Department of infectious diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), Meibergdreef 9, AII, the Netherlands
- Corresponding author at: STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, the Netherlands.
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van Dulm E, Klok S, Boyd A, Joore IK, Prins M, van Dam AP, Tramper-Stranders GA, van Duijnhoven YTHP. Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among undocumented migrants and uninsured legal residents in Amsterdam, the Netherlands: a cross-sectional study. Antimicrob Resist Infect Control 2020; 9:118. [PMID: 32727560 PMCID: PMC7391596 DOI: 10.1186/s13756-020-00785-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/21/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increased risk of infection. Colonization with MRSA is observed in < 1% of the general Dutch population. Increased risk for MRSA carriage is known to occur in several key groups, one of which is asylum seekers. However, little is known about MRSA carriage among undocumented migrants and uninsured legal residents. This study aimed to determine the prevalence of nasal MRSA carriage among these groups in Amsterdam, the Netherlands. METHODS In this cross-sectional study, between October 2018 and October 2019, undocumented migrants and uninsured legal residents aged 18 years or older who were able to understand one of the study languages were recruited at an NGO health care facility in Amsterdam, the Netherlands, for general practitioner (GP) consultations. Participants were asked questions on demographics, migration history, antibiotic use and other possible risk factors for MRSA carriage and were screened for nasal MRSA carriage by selective culturing e-swabs. Characteristics of MRSA-negative and MRSA-positive participants were compared using univariable logistic regression analysis with Firth's correction. RESULTS Of the 3822 eligible patients, 760 were screened for nasal MRSA carriage (19.9%). Of the 760 participants, over half were male (58%; 442/760) and originated mainly from Africa (35%; 267/760), Asia (30%; 229/760) and North or South America (30%; 227/760). In total, 705/760 participants (93%) were undocumented migrants and 55/760 (7%) were uninsured legal residents of Amsterdam. The overall prevalence of nasal MRSA carriage was 2.0% (15/760) (95%CI 1.1 to 3.2%), with no difference between undocumented migrants (14/705) (2.0, 95%CI 1.1 to 3.3%) and uninsured legal residents (1/55) (1.8, 95%CI 0.1 to 9.7%). Genotyping showed no clustering of the 15 isolates. MRSA carriage was not associated with sociodemographic, migration history or other possible risk factors. Nevertheless, this study had limited power to detect significant determinants. Three participants (3/15; 20%) harbored Panton-Valentine leukocidin (PVL)-positive isolates. CONCLUSION Even though our study population of undocumented migrants and uninsured legal residents had a higher prevalence of nasal MRSA carriage compared to the general Dutch population, the prevalence was relatively low compared to acknowledged other high-risk groups.
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Affiliation(s)
- E van Dulm
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.
| | - S Klok
- NGO health care clinic Kruispost, Amsterdam, the Netherlands
| | - A Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.,HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - I K Joore
- Department of Infectious Diseases, Public Health Service Flevoland, Lelystad, the Netherlands
| | - M Prins
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.,Division of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Amsterdam, the Netherlands
| | - A P van Dam
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.,Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Y T H P van Duijnhoven
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands
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25
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Wiig S, Rutz S, Boyd A, Churruca K, Kleefstra S, Haraldseid-Driftland C, Braithwaite J, O'Hara J, van de Bovenkamp H. What methods are used to promote patient and family involvement in healthcare regulation? A multiple case study across four countries. BMC Health Serv Res 2020; 20:616. [PMID: 32631343 PMCID: PMC7336629 DOI: 10.1186/s12913-020-05471-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/25/2020] [Indexed: 11/24/2022] Open
Abstract
Background In the regulation of healthcare, the subject of patient and family involvement figures increasingly prominently on the agenda. However, the literature on involving patients and families in regulation is still in its infancy. A systematic analysis of how patient and family involvement in regulation is accomplished across different health systems is lacking. We provide such an overview by mapping and classifying methods of patient and family involvement in regulatory practice in four countries; Norway, England, the Netherlands, and Australia. We thus provide a knowledge base that enables discussions about possible types of involvement, and advantages and difficulties of involvement encountered in practice. Methods The research design was a multiple case study of patient and family involvement in regulation in four countries. The authors collected 1) academic literature if available and 2) documents of regulators that describe user involvement. Based on the data collected, the authors from each country completed a pre-agreed template to describe the involvement methods. The following information was extracted and included where available: 1) Method of involvement, 2) Type of regulatory activity, 3) Purpose of involvement, 4) Who is involved and 5) Lessons learnt. Results Our mapping of involvement strategies showed a range of methods being used in regulation, which we classified into four categories: individual proactive, individual reactive, collective proactive, and collective reactive methods. Reported advantages included: increased quality of regulation, increased legitimacy, perceived justice for those affected, and empowerment. Difficulties were also reported concerning: how to incorporate the input of users in decisions, the fact that not all users want to be involved, time and costs required, organizational procedures standing in the way of involvement, and dealing with emotions. Conclusions Our mapping of user involvement strategies establishes a broad variety of ways to involve patients and families. The four categories can serve as inspiration to regulators in healthcare. The paper shows that stimulating involvement in regulation is a challenging and complex task. The fact that regulators are experimenting with different methods can be viewed positively in this regard.
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Affiliation(s)
- Siri Wiig
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Suzanne Rutz
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.,Dutch Health and Youth Care Inspectorate, Utrecht, the Netherlands
| | - Alan Boyd
- Alliance Manchester Business, University of Manchester, Manchester, England
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sophia Kleefstra
- Dutch Health and Youth Care Inspectorate, Utrecht, the Netherlands
| | - Cecilie Haraldseid-Driftland
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jane O'Hara
- School of Healthcare, University of Leeds, Leeds, England
| | - Hester van de Bovenkamp
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
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26
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Stonier PD, Silva H, Boyd A, Criscuolo D, Gabbay FJ, Imamura K, Kesselring G, Kerpel-Fronius S, Klech H, Klingmann I. Evolution of the Development of Core Competencies in Pharmaceutical Medicine and Their Potential Use in Education and Training. Front Pharmacol 2020; 11:282. [PMID: 32265699 PMCID: PMC7096542 DOI: 10.3389/fphar.2020.00282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
The evolution of postgraduate vocational education and training in pharmaceutical medicine is described alongside the growth of this scientific-medical discipline and profession for the development of new medicines. Over the past 50 years, whilst the training of competent professionals for their work has been paramount, this has paralleled the need to engage with the rapid and complex changes in R&D technologies, patient and healthcare system needs, and the ethical and regulatory obligations applied to the development of medicines throughout their lifecycle. The move from unstructured training to formal programs with syllabus, curricula and assessments for certification, has been accompanied by educational changes to outcomes-based, learner-centered, competency-based programs. The evolution of education and training along with the development of the set of 57 core competencies for professional practitioners in pharmaceutical medicine are described within the competence framework of seven domains: discovery of medicines and early development; clinical development and clinical trials; medicines regulation; drug safety and surveillance; ethics and subject protection; healthcare marketplace; communication and management. The application of the core competencies in a harmonized, international platform of education and training in medicines development at the undergraduate, postgraduate and continuing professional development levels would invigorate the potential for having a competent workforce with the intent to provide faster access to better and appropriate medicines for patients worldwide.
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Affiliation(s)
- Peter D. Stonier
- Faculty of Pharmaceutical Medicine, Royal College of Physicians, London, United Kingdom
| | - Honorio Silva
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Woerden, Netherlands
| | - Alan Boyd
- Faculty of Pharmaceutical Medicine, Royal College of Physicians, London, United Kingdom
| | - Domenico Criscuolo
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Woerden, Netherlands
| | - Felicity J. Gabbay
- Faculty of Pharmaceutical Medicine, Royal College of Physicians, London, United Kingdom
| | - Kyoko Imamura
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Woerden, Netherlands
| | - Gustavo Kesselring
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Woerden, Netherlands
| | - Sandor Kerpel-Fronius
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Woerden, Netherlands
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Price T, Tredinnick-Rowe J, Walshe K, Tazzyman A, Ferguson J, Boyd A, Archer J, Bryce M. Reviving clinical governance? A qualitative study of the impact of professional regulatory reform on clinical governance in healthcare organisations in England. Health Policy 2020; 124:446-453. [PMID: 32044153 DOI: 10.1016/j.healthpol.2020.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Until recently, processes of professional regulation and organisational clinical governance in the UK have been largely separate. However, the introduction of medical revalidation in 2012 means that all doctors have to demonstrate periodically to the regulator that they are up to date and fit to practise, and as part of this process doctors must engage with clinical governance activities in the organisations in which they work. OBJECTIVE To explore how the recent implementation of medical revalidation has affected the arrangements for clinical governance in healthcare organisations in England. DESIGN Thematic analysis of interviews with 62 senior clinicians and non-clinicians in management or senior administrative roles, from a range of healthcare organisations in England. RESULTS Revalidation has engendered changes to clinical governance systems, resulting in: increased doctor engagement with clinical governance activities; new or improved systems for access to clinical governance data for doctors and leaders within healthcare organisations; and more leverage - through the Responsible Officer role - to enforce engagement with clinical governance. Organisational context has been an important mediator of the impact of revalidation on clinical governance. CONCLUSION Revalidation has increased alignment between systems for organisational and professional oversight and accountability, resulting in increased scrutiny of clinical practice. However, it is still a matter of conjecture whether this will in turn lead to improvements in medical performance.
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Affiliation(s)
- Tristan Price
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - John Tredinnick-Rowe
- NIHR Applied Research Collaboration South West Peninsula (PenARC), Faculty of Health: Medicine, Dentistry & Human Sciences, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, M13 9PL, UK.
| | - Abigail Tazzyman
- School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK.
| | - Jane Ferguson
- Alliance Manchester Business School, University of Manchester, M13 9PL, UK.
| | - Alan Boyd
- Alliance Manchester Business School, University of Manchester, M13 9PL, UK.
| | - Julian Archer
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Marie Bryce
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, PL4 8AA, UK.
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Morris T, Brostoff JM, Stonier PD, Boyd A. Evolution of Ethical Principles in the Practice of Pharmaceutical Medicine From a UK Perspective. Front Pharmacol 2020; 10:1525. [PMID: 32009950 PMCID: PMC6974548 DOI: 10.3389/fphar.2019.01525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/25/2019] [Indexed: 11/13/2022] Open
Abstract
Pharmaceutical medicine has evolved to be a distinct medical scientific discipline over time. Pharmaceutical medicine has distinctive features related to complex innovative medicines development activities in an often commercially focused competitive environment. This sometimes uneasy mix of professionalism and commercialisation demands of its medical and scientific researchers alike, a focus on strict adherence to ethical standards, guidelines, practices and behaviors in the interest of delivering new, effective, high-quality lifesaving and life-enhancing medicines quickly and reliably to patients in need. To support the speciality, codes of ethical standards and practices have been developed, with several being recently updated. These various codes are outlined in this paper along with relevant historical perspectives and interrelationship with concepts of professionalism. Reflecting the longer history of pharmaceutical medicine as a speciality in the UK and experience of the authors, there is a focus on the UK for the historical perspectives.
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Affiliation(s)
- Thomas Morris
- Faculty of Pharmaceutical Medicine, Royal College of Physicians, London, United Kingdom
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29
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Zada M, Geenty P, Lo Q, Boyd A, Devine K, Tchan M, Sadick N, Thomas L. 133 Left Ventricular Echocardiographic Structural Parameters That Determine Major Adverse Cardiovascular Events (MACE) in Fabry Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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30
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Zada M, Geenty P, Lo Q, Boyd A, Devine K, Tchan M, Sadick N, Thomas L. 107 Electrocardiographic Characteristics in Fabry Disease; Gender Based Differences. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Stefani L, Koltar A, Altman M, Boyd A, Richards D, Thomas L. 340 Exercise Related Changes in LA Phasic Function as Determined by 2D Speckle Tracking. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Geenty P, Sivapathan S, Deshmukh T, Brown P, Boyd A, Kwok F, Richards D, Altman M, Stewart G, Thomas L. P309 The use of echocardiographic parameters to predict clinical outcomes in AL-amyloidosis cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
AL-amyloidosis has a rapid clinical progression, with cardiac involvement associated with a particularly poor prognosis. Cardiac amyloidosis is diagnosed by either invasive biopsy or conventional echocardiographic parameters such as increased wall thickness, in the absence of other causes. More recently, novel parameters including 2D longitudinal strain have demonstrated diagnostic utility in a range of infiltrative cardiomyopathies including cardiac amyloidosis.
Aim/Method: We sought to evaluate traditional and novel echocardiographic parameters in their ability to predict adverse outcomes in a cohort of AL-amyloid patients. 80 patients who had transthoracic echocardiograms at a single centre were included. Comprehensive echocardiographic assessment was performed, including left ventricular ejection fraction (LVEF), LV Global Longitudinal Strain (GLS), LV mass (indexed to BSA). The primary endpoint was a composite of of major adverse cardiac events (MACE) and all-cause mortality, that was assessed by interrogation of the medical records on a specified censor date.
Results
At a mean follow-up (time from echo to censor date) of 5.4 ± 2.6years, 38/80 (47.5%) of patients experienced the primary endpoint of MACE or death, of which 25/80 (31%) were deaths. LVEF (59 ± 5.6%vs56 ± 6.4%, p = 0.04), GLS (17.4 ± 3.9%vs14.8 ± 4.9%, p = 0.01) basal longitudinal strain (12.3 ± 3.2%vs9.6 ± 3.9%, p = 0.002), indexed LV mass (107 ± 36g/m2vs130 ± 34g/m2, p = 0.06) and E/E’ (13.7 ± 4.9vs20.6 ± 9.6, p < 0.001) were all significantly different between patients who experienced the primary endpoint and those that didn’t. The strongest predictors of outcome were E/E’ (AUC 0.74), LV mass (AUC 0.73) and the ratio GLS:LV mass (AUC 0.73). An E/E’ of 15 had a sensitivity of 71% and specificity of 69%, while an indexed LV mass of 108 had a sensitivity and specificity of 74% and 67% respectively. GLS to LV mass as a cutoff of 0.16 had a sensitivity and specificity of 70% and 69% respectively.
Conclusion
In a cohort of 80 patients with AL-amyloid cardiomyopathy, almost half (47.5%) reached the primary composite endpoint. Diastolic dysfunction as expressed as E/E’, and LV mass were the most powerful predictors of outcome, while global longitudinal strain and LV basal strain were also reduced, and showed superiority over LV ejection fraction in predicting prognosis.
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Affiliation(s)
- P Geenty
- Westmead Hospital, Sydney, Australia
| | | | | | - P Brown
- Westmead Hospital, Sydney, Australia
| | - A Boyd
- Westmead Private Hospital, Cardiology Department, Sydney, Australia
| | - F Kwok
- Westmead Hospital, Sydney, Australia
| | - D Richards
- Westmead Private Hospital, Cardiology Department, Sydney, Australia
| | - M Altman
- Westmead Hospital, Sydney, Australia
| | - G Stewart
- Westmead Hospital, Sydney, Australia
| | - L Thomas
- Westmead Hospital, Sydney, Australia
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Tazzyman A, Ferguson J, Boyd A, Bryce M, Tredinnick-Rowe J, Price T, Walshe K. Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory. J Health Serv Res Policy 2020; 25:30-40. [PMID: 31112432 PMCID: PMC7307413 DOI: 10.1177/1355819619848017] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The introduction of medical revalidation in 2012 has been a controversial and radical change to medical regulation in the UK. It involved changes to the way organizations manage medical performance, and to the relationships between doctors, their employers and the professional regulatory body. In this paper, we explore the implementation of medical revalidation, analysing the change process and its consequences for doctors and organizations. Methods We conducted a qualitative investigation of the implementation of revalidation in 15 case study organizations in 2016–2017, collecting documents and undertaking a total of 80 interviews with medical and non-medical staff. We used Normalization Process Theory to frame and structure the analysis. Results Revalidation reforms were largely implemented successfully within and across our case study organizations, with evidence of growing acceptance of the purpose and processes of revalidation. There was an emergent shift from securing doctors’ compliance towards the use of revalidation to strengthen clinical governance, and towards evaluating revalidation processes and seeking to make them more effective. However, there was substantial variation in the implementation and impact of revalidation; it was still not fully understood by many doctors, and revalidation processes were highly reliant on a few key individuals in each organization. The changes brought about by revalidation have had consequences for the way in which doctors construct their identity and the way they relate to the organizations in which they work. Conclusion Despite considerable early scepticism and overt opposition in the medical profession, revalidation has become gradually accepted, embedded and even valued over time. Its impact and effectiveness are still questioned by many stakeholders, and the focus of attention has now shifted towards revising and improving the way revalidation works in practice.
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Affiliation(s)
- Abigail Tazzyman
- Research Associate, Alliance Manchester Business School,
University of Manchester, UK
| | - Jane Ferguson
- Research Associate, Alliance Manchester Business School,
University of Manchester, UK
| | - Alan Boyd
- Research Fellow, Alliance Manchester Business School, University
of Manchester, UK
| | | | | | | | - Kieran Walshe
- Professor of Health Policy & Management, Alliance Manchester
Business School, University of Manchester, UK
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34
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Geenty P, Shivapathan S, Deshmukh T, Brown P, Boyd A, Taylor M, Kwok F, Altman M, Richards D, Stewart G, Thomas L. P1543 The assessment of regional myocardial strain in classifying amyloid cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
An infiltrative cardiomyopathy is a common manifestation of AL-amyloidosis, with cardiac involvement associated with a poor prognosis. Wild-type transthyretin amyloidosis (wt-TTR), is a distinct clinical entity occurring predominantly in men > 65 yrs, that has gained interest recently due to novel treatment options. Regional strain analysis has been shown to discriminate both forms of cardiac amyloidosis from other causes of concentric left ventricular hypertrophy, with a characteristic pattern of ‘apical sparing’. Due to the significant difference in both the course of the disease and treatment options between groups, a non-invasive echocardiographic method of determining subtype would be valuable.
Aim/Method: We sought to compare traditional and novel echocardiographic parameters in a cohort of AL ( n = 80) and wild type (wt-TTR) amyloid ( n = 32) patients. All amyloid patients underwent comprehensive transthoracic echocardiography, including both conventional parameters and LV longitudinal strain. Further novel parameters were computed including the ratio of global longitudinal strain (GLS) to LV ejection fraction (LVEF), as well as GLS to indexed LV mass.
Results
wt-TTR patients had significantly greater LV mass (176 ± 59g/m2vs118 ± 37g/m2, p < 0.001), and worse diastolic dysfunction as expressed as E/E’ (21.5 ± 11vs17 ± 8, p = 0.04). LVEF was significantly lower in wt-TTR patients however remained in the normal range in both groups (53 ± 6%vs57 ± 6%, p = 0.001), whilst GLS was significantly reduced compared to AL-amyloid patients (11.5 ± 3.4%vs16.2 ± 4.6%, p < 0.001). LVEF:GLS was significantly higher in wt-TTR patients (4.93 ± 1.4vs3.87 ± 1.3, p = 0.001) reflecting a more profound reduction in strain with a relatively preserved ejection fraction. Similarly, the ratio of GLS to LV mass was significantly lower in wt-TTR amyloidosis (0.078 ± 0.05vs0.155 ± 0.07, p < 0.001), reflecting a more significant reduction in strain for a given wall thickness in wt-TTR patients. GLS:LV mass was the strongest discriminator between subtypes (AUC 0.82), with a cutoff of 0.09 giving a sensitivity and specificity of 71% and 80% respectively, for detecting wt-TTR.
Conclusion
In this cohort, patients with wt-TTR had significantly greater increase in LV wall thickness and diastolic dysfunction, which may in part reflect their increased age (77vs62). However, GLS was also significantly reduced compared to AL-amyloid, even when accounting for LV ejection fraction and LV mass, suggesting these composite parameters may have value in determining the subtype of cardiac amyloidosis.
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Affiliation(s)
- P Geenty
- Westmead Hospital, Sydney, Australia
| | | | | | - P Brown
- Westmead Hospital, Sydney, Australia
| | - A Boyd
- Westmead Private Hospital, Cardiology Department, Sydney, Australia
| | - M Taylor
- Westmead Hospital, Sydney, Australia
| | - F Kwok
- Westmead Hospital, Sydney, Australia
| | - M Altman
- Westmead Hospital, Sydney, Australia
| | - D Richards
- Westmead Private Hospital, Cardiology Department, Sydney, Australia
| | - G Stewart
- Westmead Hospital, Sydney, Australia
| | - L Thomas
- Westmead Hospital, Sydney, Australia
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Achterbergh RCA, Drückler S, van Rooijen MS, van Aar F, Slurink IAL, de Vries HJC, Boyd A. Sex, drugs, and sexually transmitted infections: A latent class analysis among men who have sex with men in Amsterdam and surrounding urban regions, the Netherlands. Drug Alcohol Depend 2020; 206:107526. [PMID: 31783312 DOI: 10.1016/j.drugalcdep.2019.06.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/04/2019] [Accepted: 06/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk for sexually transmitted infections (STI) and often have sex while under the influence of drugs (sexualized drug use). We aimed to identify classes of MSM in Amsterdam and in surrounding urban regions with distinctive patterns of sexualized drug use and their association with STI. METHODS In this cross-sectional study, data on MSM were collected at STI clinics in the Netherlands between September-December 2017. Information on drug use, sociodemographics and sexual risk behavior, including lab-confirmed STI (chlamydia, gonorrhea, syphilis and HIV) was collected and compared between Amsterdam and surrounding urban regions. Latent class analysis was used to identify classes with similar drug use patterns, which were then linked to sexual behavior and STI. RESULTS We included 4461 MSM who were a median 35 years old (IQR = 27-47) and mostly Dutch (56.9 %). Use of all drugs was more often reported in Amsterdam compared to surrounding regions (p<0.001). We identified four different classes based on sexualized drug use among Amsterdam participants and three classes in surrounding regions. In both regions, polydrug use classes (compared to classes of no drug use; alcohol use; or few, various drugs) were defined by higher numbers of sexual partners (median range 8-15 vs 4-6, respectively) and higher STI prevalence (range 30.5%-31.8% vs 18.6%-22.8%, respectively). CONCLUSION Given the high prevalence of risk behavior and STIs, MSM in urban settings partaking in sexualized polydrug use might benefit from tailored outreach, screening, and safe sex and drug use interventions.
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Affiliation(s)
- R C A Achterbergh
- STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - S Drückler
- STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - M S van Rooijen
- STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - F van Aar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - I A L Slurink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - H J C de Vries
- STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands; Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity (AI and II), Meibergdreef 9, Amsterdam, the Netherlands
| | - A Boyd
- Research and Prevention, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands; INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012 Paris, France.
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Boyd A, Lewis A, Dallas S, Xenakis E, Ramsey P. Comparison of obstetric to institutional antibiograms as an approach to advance antimicrobial stewardship in maternal care. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tazzyman A, Bryce M, Ferguson J, Walshe K, Boyd A, Price T, Tredinnick‐Rowe J. Reforming regulatory relationships: The impact of medical revalidation on doctors, employers, and the General Medical Council in the United Kingdom. Regul Gov 2019; 13:593-608. [PMID: 32684944 PMCID: PMC7357781 DOI: 10.1111/rego.12237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 06/11/2023]
Abstract
In 2012, medical regulation in the United Kingdom was fundamentally changed by the introduction of revalidation - a process by which all licensed doctors are required to regularly demonstrate that they are up to date and fit to practice in their chosen field and are able to provide a good level of care. This paper examines the implications of revalidation on the structure, governance, and performance management of the medical profession, as well as how it has changed the relationships between the regulator, employer organizations, and the profession. We conducted semi-structured interviews with clinical and non-clinical staff from a range of healthcare organizations. Our research suggests that organizations have become intermediaries in the relationship between the General Medical Council and doctors, enacting regulatory processes on its behalf and extending regulatory surveillance and oversight at local level. Doctors' autonomy has been reduced as they have become more accountable to and reliant on the organizations that employ them.
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Affiliation(s)
- Abigail Tazzyman
- Alliance Manchester Business School, University of ManchesterManchesterUK
| | | | - Jane Ferguson
- Alliance Manchester Business School, University of ManchesterManchesterUK
| | - Kieran Walshe
- Alliance Manchester Business School, University of ManchesterManchesterUK
| | - Alan Boyd
- Alliance Manchester Business School, University of ManchesterManchesterUK
| | - Tristan Price
- Faculty of Medicine and DentistryPlymouth UniversityPlymouthUK
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Collier V, Danford B, Boyd A. Erythema and blistering after sun exposure in a 12-year-old boy. Pediatr Dermatol 2019; 36:e83-e85. [PMID: 31290603 DOI: 10.1111/pde.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Victoria Collier
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brandon Danford
- Department of Dermatology, Vanderbilt University Hospital, Nashville, Tennessee
| | - Alan Boyd
- Department of Dermatology, Vanderbilt University Hospital, Nashville, Tennessee
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Mahdi H, Hasipek M, Guan Y, Grabowski D, Al-Sudani H, Parker Y, Boyd A, Rose P, Lindner D, Jha B. Combined therapy with HER2 and CDK4/6 inhibitors in HER2+ uterine and ovarian carcinomas: Synergistic effect with combined therapy. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mahdi H, Hasipek M, Guan Y, Grabowski D, Al-Sudani H, Parker Y, Boyd A, Rose P, Lindner D, Jha B. Dual anti-HER2 therapy in HER2+ uterine and ovarian carcinomas: Durable effect with combined therapy. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ferkh A, Brown P, O'Keefe E, Zada M, Duggins A, Thiagalingam A, Altman M, Boyd A, Byth K, Kizana E, Denniss AR, Thomas L. Clinical and echocardiographic characteristics of cardioembolic stroke. Eur J Neurol 2019; 26:1310-1317. [PMID: 31062440 DOI: 10.1111/ene.13981] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/30/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Ischaemic stroke frequently has a cardioembolic (CE) source. Clinical and echocardiographic parameters associated with CE stroke were evaluated. METHODS In all, 93 consecutive ischaemic stroke patients who underwent a transthoracic echocardiogram were retrospectively analysed; strokes were classified by TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Echocardiographic parameters related to CE stroke, including left atrial volumes and function, were compared to 73 healthy controls. RESULTS Of 93 patients (mean age 66.1 years, 56% male), nine (10%) had large artery atherosclerosis, 38 (41%) CE stroke, two (2%) small vessel disease, two (2%) other and 42 (45%) undetermined aetiology. Left atrial (LA) maximum volumes (LAVImax ) and minimum volumes (LAVImin ) were larger in the CE group than the non-CE group (45 vs. 32 ml/m2 , 32 vs. 13 ml/m2 , respectively, P < 0.001), whilst LA function indices including LA emptying fraction and LA function index (LAFI) were lower in the CE group (34% vs. 55%, and 0.12 vs. 0.35, respectively, P < 0.001). Adjusting for clinical characteristics, LAFI ≤0.3 was an independent predictor of CE stroke (adjusted odds ratio 5.3, P = 0.001). Additionally, LAVImax and LAVImin were larger (61 vs. 44 and 32 vs. 24 ml/m2 respectively, P < 0.01) and LAFI significantly lower (0.34 vs. 0.52, P < 0.001) in the undetermined aetiology group versus healthy controls. CONCLUSIONS Left atrial enlargement with reduced LA function was associated with CE stroke and LAFI was the best independent predictor. LA parameters were also altered in the undetermined aetiology group, suggesting an underlying LA myopathy in this subset.
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Affiliation(s)
- A Ferkh
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - P Brown
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - E O'Keefe
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - M Zada
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - A Duggins
- Neurology Department, Westmead Hospital, Sydney, NSW, Australia
| | - A Thiagalingam
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - M Altman
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - A Boyd
- University of Sydney, Camperdown, NSW, Australia
| | - K Byth
- University of Sydney, Camperdown, NSW, Australia
| | - E Kizana
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Institute of Medical Research, Sydney, NSW, Australia
| | - A R Denniss
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - L Thomas
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
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Meador KJ, Seliger J, Boyd A, Razavi B, Falco-Walter J, Le S, Loring DW. Comparative neuropsychological effects of carbamazepine and eslicarbazepine acetate. Epilepsy Behav 2019; 94:151-157. [PMID: 30939410 DOI: 10.1016/j.yebeh.2019.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/21/2019] [Indexed: 11/26/2022]
Abstract
People with epilepsy are at increased risk for neuropsychological dysfunction due to multiple factors, of which the most amendable are antiseizure medications (ASMs). Antiseizure medication effectiveness is frequently determined by tolerability. In this study, we compared the neuropsychological effects of eslicarbazepine acetate (ESL) and carbamazepine immediate-release (CBZ) using a randomized, double-blind, crossover design in healthy volunteers with a 2-week titration and 4-week maintenance phase in each treatment arm (CBZ = 400 mg BID and ESL = 800 mg qAM). Neuropsychological testing was performed at the initial visit, repeated at 1st baseline nondrug condition, end treatment #1, 2nd nondrug condition one month after treatment #1, end treatment #2, and 3rd nondrug condition one month after treatment #2. Neuropsychological testing was conducted 2 h after morning dose and included computer (i.e., dual task test, selective attention test, symbol digit, verbal memory, visuospatial memory, and 1- & 2-back continuous performance) and noncomputer tasks (i.e., Medical College of Georgia (MCG) paragraph memory, Stroop, Symbol Digit Modalities Test, Profile of Mood States). z-Scores calculated from nondrug conditions were used to compare ESL and CBZ for the 23 completers. Follow-up analyses included individual test scores and distribution of individual raw means. Mean blood levels on test day were CBZ = 8.9 μg/ml and ESL = 15.3 μg/ml. Omnibus z-score was significantly better for ESL (p = .0001). For individual measures, executive function and selective attention tests were statistically significantly better for ESL. Individual test raw means favored ESL over CBZ on 22 of 30 measures (p = .016, 2-tailed sign test). Eslicarbazepine acetate demonstrated less adverse neuropsychological effects than CBZ.
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Affiliation(s)
- Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Jordan Seliger
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Alan Boyd
- CNS Vital Signs, Morrisville, NC, USA.
| | - Babak Razavi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Jessica Falco-Walter
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Scheherazade Le
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - David W Loring
- Department of Neurology, Emory University, Atlanta, GA, USA.
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Wakeling J, Holmes S, Boyd A, Tredinnick-Rowe J, Cameron N, Marshall M, Bryce M, Archer J. Reflective Practice for Patient Benefit: An Analysis of Doctors' Appraisal Portfolios in Scotland. J Contin Educ Health Prof 2019; 39:13-20. [PMID: 30730475 DOI: 10.1097/ceh.0000000000000236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Reflective practice has become the cornerstone of continuing professional development for doctors, with the expectation that it helps to develop and sustain the workforce for patient benefit. Annual appraisal is mandatory for all practicing doctors in the United Kingdom as part of medical revalidation. Doctors submit a portfolio of supporting information forming the basis of their appraisal discussion where reflection on the information is mandated and evaluated by a colleague, acting as an appraiser. METHODS Using an in-depth case study approach, 18 online portfolios in Scotland were examined with a template developed to record the types of supporting information submitted and how far these showed reflection and/or changes to practice. Data from semistructured interviews with the doctors (n = 17) and their appraisers (n = 9) were used to contextualize and broaden our understanding of the portfolios. RESULTS Portfolios generally showed little written reflection, and most doctors were unenthusiastic about documenting reflective practice. Appraisals provided a forum for verbal reflection, which was often detailed in the appraisal summary. Portfolio examples showed that reflecting on continued professional development, audits, significant events, and colleague multisource feedback were sometimes considered to be useful. Reflecting on patient feedback was seen as less valuable because feedback tended to be uncritical. DISCUSSION The written reflection element of educational portfolios needs to be carefully considered because it is clear that many doctors do not find it a helpful exercise. Instead, using the portfolio to record topics covered by a reflective discussion with a facilitator would not only prove more amenable to many doctors but would also allay fears of documentary evidence being used in litigation.
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Affiliation(s)
- Judy Wakeling
- Dr. Wakeling: Research Lead-Medical, NHS Education for Scotland, Edinburgh, Scotland. Mrs. Holmes: Specialty Training Manager, Revalidation Support Unit, Wales Deanery, Cardiff, Wales. Mr. Boyd: Research Fellow in Healthcare and Public Sector Management, Alliance Manchester Business School, The University of Manchester, Manchester, England. Dr. Tredinnick-Rowe: Research Assistant, University of Plymouth, Plymouth, England. Mr. Cameron: National Appraisal Advisor for Medical Appraisal NHS Education for Scotland, Edinburgh, Scotland. Dr. Marshall: Professor of Healthcare Improvement at UCL, and Vice Chair (External Affairs) RCGP, and Program Director at UCLPartners, London, England. Dr. Bryce: Senior Research Fellow, Collaboration for the Advancement of Medical Education Research & Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, England. Dr. Archer: Honorary Professor in Medical Education Research, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, England
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Geenty P, Sivapathan S, Deshmukh T, Boyd A, Brown P, Altman M, Kwok F, Stewart G, Richards D, Thomas L. Right Ventricular Dysfunction in AL-Amyloidosis Cardiomyopathy. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Richardson E, Walshe K, Boyd A, Roberts J, Wenzel L, Robertson R, Smithson R. User involvement in regulation: A qualitative study of service user involvement in Care Quality Commission inspections of health and social care providers in England. Health Expect 2018; 22:245-253. [PMID: 30525272 PMCID: PMC6433317 DOI: 10.1111/hex.12849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 11/28/2022] Open
Abstract
Background High profile failures of care in the NHS have raised concerns about regulatory systems for health‐care professionals and organizations. In response, the Care Quality Commission (CQC), the regulator of health and social care in England overhauled its regulatory regime. It moved to inspections which made much greater use of expert knowledge, data and views from a range of stakeholders, including service users. Objective We explore the role of service users and citizens in health and social care regulation, including how CQC involved people in inspecting and rating health and social care providers. Design We analyse CQC reports and documents, and 61 interviews with CQC staff and representatives of groups of service users and citizens and voluntary sector organizations to explore the place of service user voice in regulatory processes. Results Care Quality Commission invited comments and facilitated the sharing of existing service user experiences and engaged with representatives of groups of service users and voluntary sector organizations. CQC involved service users in their inspections as “experts by experience.” Information from service users informed both the inspection regime and individual inspections, but CQC was less focused on giving feedback to service users who contributed to these activities. Discussion and conclusions Service users can make an important contribution to regulation by sharing their experiences and having their voices heard, but their involvement was somewhat transactional, and largely on terms set by CQC. There may be scope for CQC to build more enduring relationships with service user groups and to engage them more effectively in the regulatory regime.
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Affiliation(s)
- Emma Richardson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Alan Boyd
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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Harvey G, Llewellyn S, Maniatopoulos G, Boyd A, Procter R. Correction to: Facilitating the implementation of clinical technology in healthcare: what role does a national agency play? BMC Health Serv Res 2018; 18:438. [PMID: 29890983 PMCID: PMC5994838 DOI: 10.1186/s12913-018-3216-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
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Boyd A, Moh R, Maylin S, Abdou Chekaraou M, Mahjoub N, Gabillard D, Anglaret X, Eholié SP, Delaugerre C, Danel C, Zoulim F, Lacombe K. Precore G1896A mutation is associated with reduced rates of HBsAg seroclearance in treated HIV hepatitis B virus co-infected patients from Western Africa. J Viral Hepat 2018; 25:1121-1131. [PMID: 29660214 DOI: 10.1111/jvh.12914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/20/2018] [Indexed: 12/22/2022]
Abstract
The nucleotide substitution G1896A on the precore (pc) region has been implicated in virological and serological responses during treatment in hepatitis B virus (HBV)-infected patients. Whether this mutation affects the therapeutic course of HIV-HBV co-infected patients, especially from Western Africa, is unknown. In this prospective cohort study, 86 antiretroviral (ARV)-naïve HIV-HBV co-infected patients from Côte d'Ivoire, initiating ARV-treatment containing lamivudine (n = 53) or tenofovir (n = 33), had available baseline pc sequences. Association of the pcG1896A mutation with time to undetectable HBV-DNA, hepatitis B "e" antigen (HBeAg) seroclearance (in HBeAg-positive patients), and hepatitis B surface antigen (HBsAg) seroclearance was evaluated using Cox proportional hazards regression. At ARV-initiation, median HBV-DNA was 6.04 log10 copies/mL (IQR = 3.70-7.93) with 97.7% harbouring HBV genotype E. Baseline pcG1896A mutation was identified in 51 (59.3%) patients, who were more commonly HBeAg-negative (P < .001) and had basal core promotor A1762T/G1764A mutations (P < .001). Patients were followed for a median 36 months (IQR = 24-36). Cumulative proportion of undetectable HBV-DNA was significantly higher in patients with baseline mutation (pcG1896A = 86.6% vs no pcG1896A = 66.9%, P = .04), but not after adjusting for baseline HBV-DNA levels and anti-HBV agent (P = .2). No difference in cumulative proportion of HBeAg seroclearance was observed between mutation groups (pcG1896A = 57.1% vs no pcG1896A = 54.3%, P = .7). Significantly higher cumulative proportion of HBsAg seroclearance was observed in patients without this mutation (pcG1896A = 0% vs no pcG1896A = 36.9%, P < .001), even after adjusting for baseline HBsAg quantification and anti-HBV agent (P < .001). In conclusion, lacking the pcG1896A mutation before ARV initiation appeared to increase HBsAg seroclearance rates during treatment. The therapeutic implications of this mutation need further exploration in this setting.
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Affiliation(s)
- A Boyd
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - R Moh
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire.,Department of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire.,Medical School, University Felix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - S Maylin
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France.,Université Paris-Diderot, Paris, France
| | | | - N Mahjoub
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - D Gabillard
- INSERM, U1219, Bordeaux, France.,University of Bordeaux, ISPED, Bordeaux, France
| | - X Anglaret
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire.,INSERM, U1219, Bordeaux, France.,University of Bordeaux, ISPED, Bordeaux, France
| | - S P Eholié
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire.,Department of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire.,Medical School, University Felix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - C Delaugerre
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France.,Université Paris-Diderot, Paris, France.,INSERM U941, Paris, France
| | - C Danel
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire.,INSERM, U1219, Bordeaux, France.,University of Bordeaux, ISPED, Bordeaux, France
| | - F Zoulim
- INSERM U1052- Cancer Research Center of Lyon (CRCL), Lyon, France.,University of Lyon, UMR_S1052, CRCL, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Lyon, France
| | - K Lacombe
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
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Bryce M, Luscombe K, Boyd A, Tazzyman A, Tredinnick-Rowe J, Walshe K, Archer J. Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine. Soc Sci Med 2018; 213:98-105. [PMID: 30064094 PMCID: PMC6137071 DOI: 10.1016/j.socscimed.2018.07.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/26/2022]
Abstract
Doctors' work and the changing, contested meanings of medical professionalism have long been a focus for sociological research. Much recent attention has focused on those doctors working at the interface between healthcare management and medical practice, with such ‘hybrid’ doctor-managers providing valuable analytical material for exploring changes in how medical professionalism is understood. In the United Kingdom, significant structural changes to medical regulation, most notably the introduction of revalidation in 2012, have created a new hybrid group, Responsible Officers (ROs), responsible for making periodic recommendations about the on-going fitness to practise medicine of all other doctors in their organisation. Using qualitative data collected in a 2015 survey with 374 respondents, 63% of ROs in the UK, this paper analyses the RO role. Our findings show ROs to be a distinct emergent group of hybrid professionals and as such demonstrate restructuring within UK medicine. Occupying a position where multiple agendas converge, ROs' work expands professional regulation into the organisational sphere in new ways, as well as creating new lines of continuous accountability between the wider profession and the General Medical Council as medical regulator. Our exploration of ROs' approaches to their work offers new insights into the on-going development of medical professionalism, pointing to the emergence of a distinctly regulatory hybrid professionalism shaped by co-existing professional, managerial and regulatory logics, in an era of strengthened governance and complex policy change. Responsible Officers are a new governance elite group in the UK medical profession. They work at the nexus of professional, managerial and regulatory spheres. Differ from other doctor-managers due to accountability for medical performance. Organisational context shapes experiences of this new role. Regulatory reform has engendered a new form of hybrid professionalism.
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Affiliation(s)
- Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
| | - Kayleigh Luscombe
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
| | - Alan Boyd
- Alliance Manchester Business School, University of Manchester, Manchester, UK.
| | - Abigail Tazzyman
- Alliance Manchester Business School, University of Manchester, Manchester, UK.
| | - John Tredinnick-Rowe
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, UK.
| | - Julian Archer
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
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Harvey G, Llewellyn S, Maniatopoulos G, Boyd A, Procter R. Facilitating the implementation of clinical technology in healthcare: what role does a national agency play? BMC Health Serv Res 2018; 18:347. [PMID: 29743068 PMCID: PMC5944036 DOI: 10.1186/s12913-018-3176-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accelerating the implementation of new technology in healthcare is typically complex and multi-faceted. One strategy is to charge a national agency with the responsibility for facilitating implementation. This study examines the role of such an agency in the English National Health Service. In particular, it compares two different facilitation strategies employed by the agency to support the implementation of insulin pump therapy. METHODS The research involved an empirical case study of four healthcare organisations receiving different levels of facilitation from the national agency: two received active hands-on facilitation; one was the intended recipient of a more passive, web-based facilitation strategy; the other implemented the technology without any external facilitation. The primary method of data collection was semi-structured qualitative interviews with key individuals involved in implementation. The integrated-PARIHS framework was applied as a conceptual lens to analyse the data. RESULTS The two sites that received active facilitation from an Implementation Manager in the national agency made positive progress in implementing the technology. In both sites there was a high level of initial receptiveness to implementation. This was similar to a site that had successfully introduced insulin pump therapy without facilitation support from the national agency. By contrast, a site that did not have direct contact with the national agency made little progress with implementation, despite the availability of a web-based implementation resource. Clinicians expressed differences of opinion around the value and effectiveness of the technology and contextual barriers related to funding for implementation persisted. The national agency's intended roll out strategy using passive web-based facilitation appeared to have little impact. CONCLUSIONS When favourable conditions exist, in terms of agreement around the value of the technology, clinician receptiveness and motivation to change, active facilitation via an external agency can help to structure the implementation process and address contextual barriers. Passive facilitation using web-based implementation resources appears less effective. Moving from initial implementation to wider scale-up presents challenges and is an issue that warrants further attention.
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Affiliation(s)
- Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, 5005, Australia. .,Alliance Manchester Business School, University of Manchester, Booth Street East, Manchester, M13 9SS, UK.
| | - Sue Llewellyn
- Alliance Manchester Business School, University of Manchester, Booth Street East, Manchester, M13 9SS, UK
| | - Greg Maniatopoulos
- Institute of Health & Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Alan Boyd
- Alliance Manchester Business School, University of Manchester, Booth Street East, Manchester, M13 9SS, UK
| | - Rob Procter
- Department of Computer Science, University of Warwick, Warwick, CV4 7AL, UK
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Tazzyman A, Ferguson J, Walshe K, Boyd A, Tredinnick-Rowe J, Hillier C, Regan De Bere S, Archer J. The Evolving Purposes of Medical Revalidation in the United Kingdom: A Qualitative Study of Professional and Regulatory Narratives. Acad Med 2018; 93:642-647. [PMID: 29116977 PMCID: PMC5895134 DOI: 10.1097/acm.0000000000001993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE Previous research found professionalism and regulation to be competing discourses when plans for medical revalidation in the United Kingdom were being developed in 2011. The purpose of this study was to explore how these competing discourses developed and how the perceived purposes of revalidation evolved as the policy was implemented. METHOD Seventy-one interviews with 60 UK policy makers and senior health care leaders were conducted during the development and implementation of revalidation: 31 in 2011, 26 in 2013, and 14 in 2015. Interviewees were selected using purposeful sampling. Across all interviews, questions focused around three areas: individual roles in relation to revalidation; interviewees' understanding of revalidation, its purpose, and aims; and predictions or experiences of revalidation's impact. The first two interview sets also included questions about measurement and evaluation of revalidation. Data were analyzed using the constant comparative method to understand changes and continuities. RESULTS Two main discourses regarding the purpose of revalidation were present across the implementation period: professionalism and regulation. The nature of the relationship between these two purposes and how they were described changed over time, with the separate discourses converging, and early concerns about actual or potential conflict being replaced by perceptions of coexistence or codependency. CONCLUSIONS The changing nature of the discourse about revalidation suggests that early concerns about adverse consequences were not borne out as organizations and professionals engaged with implementation and experienced the realities of revalidation in practice. Reconciling professional and regulatory narratives was arguably necessary to the effective implementation of revalidation.
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Affiliation(s)
- Abigail Tazzyman
- 1A. Tazzyman is research associate, Alliance Manchester Business School, University of Manchester, Manchester, England
| | - Jane Ferguson
- 2J. Ferguson is research associate, Alliance Manchester Business School, University of Manchester, Manchester, England
| | - Kieran Walshe
- 3K. Walshe is professor of health policy and management, Alliance Manchester Business School, University of Manchester, Manchester, England
| | - Alan Boyd
- 4A. Boyd is research fellow, Alliance Manchester Business School, University of Manchester, Manchester, England
| | - John Tredinnick-Rowe
- 5J. Tredinnick-Rowe is research assistant, Plymouth University, Plymouth, England
| | - Charlotte Hillier
- 6C. Hillier was research associate, Alliance Manchester Business School, University of Manchester, Manchester, England
| | | | - Julian Archer
- 8J. Archer is senior clinical lecturer and director, Collaboration for the Advancement in Medical Education Research and Assessment, Plymouth University, Plymouth, England
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