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Segrott J, Channon S, Lloyd A, Glarou E, Henley J, Hughes J, Jacob N, Milosevic S, Moriarty Y, Pell B, Robling M, Strange H, Townson J, Brookes-Howell L. Integrating qualitative research within a clinical trials unit: developing strategies and understanding their implementation in contexts. Trials 2024; 25:323. [PMID: 38750606 PMCID: PMC11097452 DOI: 10.1186/s13063-024-08124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND/AIMS The value of using qualitative methods within clinical trials is widely recognised. How qualitative research is integrated within trials units to achieve this is less clear. This paper describes the process through which qualitative research has been integrated within Cardiff University's Centre for Trials Research (CTR) in Wales, UK. We highlight facilitators of, and challenges to, integration. METHODS We held group discussions on the work of the Qualitative Research Group (QRG) within CTR. The content of these discussions, materials for a presentation in CTR, and documents relating to the development of the QRG were interpreted at a workshop attended by group members. Normalisation Process Theory (NPT) was used to structure analysis. A writing group prepared a document for input from members of CTR, forming the basis of this paper. RESULTS Actions to integrate qualitative research comprised: its inclusion in Centre strategies; formation of a QRG with dedicated funding/roles; embedding of qualitative research within operating systems; capacity building/training; monitoring opportunities to include qualitative methods in studies; maximising the quality of qualitative research and developing methodological innovation. Facilitators of these actions included: the influence of the broader methodological landscape within trial/study design and its promotion of the value of qualitative research; and close physical proximity of CTR qualitative staff/students allowing sharing of methodological approaches. Introduction of innovative qualitative methods generated interest among other staff groups. Challenges included: pressure to under-resource qualitative components of research, preference for a statistical stance historically in some research areas and funding structures, and difficulties faced by qualitative researchers carving out individual academic profiles when working across trials/studies. CONCLUSIONS Given that CTUs are pivotal to the design and conduct of RCTs and related study types across multiple disciplines, integrating qualitative research into trials units is crucial if its contribution is to be fully realised. We have made explicit one trials unit's experience of embedding qualitative research and present this to open dialogue on ways to operationalise and optimise qualitative research in trials. NPT provides a valuable framework with which to theorise these processes, including the importance of sense-making and legitimisation when introducing new practices within organisations.
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Affiliation(s)
- Jeremy Segrott
- Centre for Trials Research, DECIPHer Centre, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Amy Lloyd
- Wales Centre for Public Policy, Cardiff University, Sbarc I Spark, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Eleni Glarou
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Josie Henley
- School of Social Sciences, Cardiff University, King Edward VII Avenue, Cardiff, CF10 3WA, UK
| | - Jacqueline Hughes
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Nina Jacob
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Sarah Milosevic
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Yvonne Moriarty
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Bethan Pell
- DECIPHer Centre, School of Social Sciences, Cardiff University, Sbarc I Spark, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Mike Robling
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Heather Strange
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Lucy Brookes-Howell
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
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Mayadev J, Rong Y, Toita T, Tarnawski R, Mahantshetty U, Rey F, Nunes A, Lloyd A, Wildsmith S, Dry H, Monk B. Durvalumab in Combination with Chemoradiotherapy (CRT) in Locally Advanced Cervical Cancer (LACC): Radiotherapy (RT) Delivery and Subgroup Analyses from CALLA. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.004] [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: 11/16/2022]
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Charuvila S, Lloyd A, Bhardwaj N, Lloyd D. 542 Laparoscopic Division of a Congenital Splenogonadal Portosystemic Shunt: A Case Report. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
We describe a rare congenital portosystemic shunt. A 37-year-old woman was found to have a previously unreported congenital shunt following investigations into secondary causes of hypertension. The abnormal venous shunt connected the splenic vein to the left ovarian vein. The patient underwent a laparoscopic procedure to successfully divide the shunt. She made a full recovery without complications. To our knowledge, this is the first presentation of a congenital portosystemic shunt involving the splenic and ovarian veins to be reported. This case demonstrates that such a shunt can be amenable for laparoscopic management. The case report shows preoperative scans and intraoperative images.
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Affiliation(s)
- S Charuvila
- University Hospitals Leicester , Leicester , United Kingdom
| | - A Lloyd
- Hull York Medical School , Hull , United Kingdom
| | - N Bhardwaj
- University Hospitals Leicester , Leicester , United Kingdom
| | - D Lloyd
- University Hospitals Leicester , Leicester , United Kingdom
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Roland D, Powell C, Lloyd A, Trubey R, Tume L, Sefton G, Huang C, Taiyari K, Strange H, Jacob N, Thomas-Jones E, Hood K, Allen D. Paediatric early warning systems: not a simple answer to a complex question. Arch Dis Child 2022; 108:archdischild-2022-323951. [PMID: 35868852 PMCID: PMC10176370 DOI: 10.1136/archdischild-2022-323951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/09/2022] [Indexed: 11/04/2022]
Abstract
Paediatric early warning systems (PEWS) to reduce in-hospital mortality have been a laudable endeavour. Evaluation of their impact has rarely examined the internal validity of the components of PEWS in achieving desired outcomes. We highlight the assumptions made regarding the mode of action of PEWS and, as PEWS become more commonplace, this paper asks whether we really understand their function, process and outcome.
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Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Colin Powell
- Department of Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Robert Trubey
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Lyvonne Tume
- School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Gerri Sefton
- Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Chao Huang
- Hull-York Medical School, University of Hull, Hull, UK
| | - Katie Taiyari
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Nina Jacob
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Davina Allen
- Centre for Trials Research, Cardiff University, Cardiff, UK
- School of Healthcare Sciences, Cardiff University Centre for Trials Research, Cardiff, Wales, UK
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Law BS, Madani G, Lloyd A, Gonsalves L, Hall L, Sujaraj A, Brassil T, Turbill C. Australia's 2019–20 mega‐fires are associated with lower occupancy of a rainforest‐dependent bat. Anim Conserv 2022. [DOI: 10.1111/acv.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- B. S. Law
- Forest Science, NSW Primary Industries Australia
| | | | - A. Lloyd
- Department of Planning Industry and Environment Coffs Harbour NSW Australia
| | - L. Gonsalves
- Forest Science, NSW Primary Industries Australia
| | - L. Hall
- 148 Headland Drive Gerroa NSW Australia
| | - A. Sujaraj
- 66 Oatlands St Wentworthville NSW Australia
| | - T. Brassil
- Forest Science, NSW Primary Industries Australia
| | - C. Turbill
- School of Science Western Sydney University, Hawkesbury Campus Richmond NSW Australia
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Hennessy G, Boland M, Bambrick M, Crone L, Lloyd A, Abdelwahab S, Downey E, Staunton M, Hambly N, Mhuircheartaigh NN, Kerr J, Power C, Duke D, Hill ADK. Value of long-term follow-up in surgically excised lesions of uncertain malignant potential in the breast – Is 5 years necessary? Clin Breast Cancer 2022; 22:699-704. [DOI: 10.1016/j.clbc.2022.05.009] [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] [Received: 08/26/2021] [Revised: 04/30/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
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8
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Allen D, Lloyd A, Edwards D, Hood K, Huang C, Hughes J, Jacob N, Lacy D, Moriarty Y, Oliver A, Preston J, Sefton G, Sinha I, Skone R, Strange H, Taiyari K, Thomas-Jones E, Trubey R, Tume L, Powell C, Roland D. Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme: the PUMA mixed methods study. BMC Health Serv Res 2022; 22:9. [PMID: 34974841 PMCID: PMC8722056 DOI: 10.1186/s12913-021-07314-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background Paediatric mortality rates in the United Kingdom are amongst the highest in Europe. Clinically missed deterioration is a contributory factor. Evidence to support any single intervention to address this problem is limited, but a cumulative body of research highlights the need for a systems approach. Methods An evidence-based, theoretically informed, paediatric early warning system improvement programme (PUMA Programme) was developed and implemented in two general hospitals (no onsite Paediatric Intensive Care Unit) and two tertiary hospitals (with onsite Paediatric Intensive Care Unit) in the United Kingdom. Designed to harness local expertise to implement contextually appropriate improvement initiatives, the PUMA Programme includes a propositional model of a paediatric early warning system, system assessment tools, guidance to support improvement initiatives and structured facilitation and support. Each hospital was evaluated using interrupted time series and qualitative case studies. The primary quantitative outcome was a composite metric (adverse events), representing the number of children monthly that experienced one of the following: mortality, cardiac arrest, respiratory arrest, unplanned admission to Paediatric Intensive Care Unit, or unplanned admission to Higher Dependency Unit. System changes were assessed qualitatively through observations of clinical practice and interviews with staff and parents. A qualitative evaluation of implementation processes was undertaken. Results All sites assessed their paediatric early warning systems and identified areas for improvement. All made contextually appropriate system changes, despite implementation challenges. There was a decline in the adverse event rate trend in three sites; in one site where system wide changes were organisationally supported, the decline was significant (ß = -0.09 (95% CI: − 0.15, − 0.05); p = < 0.001). Changes in trends coincided with implementation of site-specific changes. Conclusions System level change to improve paediatric early warning systems can bring about positive impacts on clinical outcomes, but in paediatric practice, where the patient population is smaller and clinical outcomes event rates are low, alternative outcome measures are required to support research and quality improvement beyond large specialist centres, and methodological work on rare events is indicated. With investment in the development of alternative outcome measures and methodologies, programmes like PUMA could improve mortality and morbidity in paediatrics and other patient populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07314-2.
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Affiliation(s)
- Davina Allen
- School of Healthcare Sciences, Cardiff University, Room 13.08, Eastgate House, Newport Road, Cardiff, CF24 0AB, UK.
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Dawn Edwards
- Children's Services, Swansea Bay University Health Board, Swansea, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Chao Huang
- Hull-York Medical School, University of Hull, Hull, UK
| | - Jacqueline Hughes
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Nina Jacob
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - David Lacy
- Arrow Park Hospital, Wirral University Teaching NHS Foundation Trust, Wirral, UK
| | - Yvonne Moriarty
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Alison Oliver
- Noah's Ark Children's Hospital for Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jennifer Preston
- Alder Hey Clinical Research Facility, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, UK
| | - Gerri Sefton
- Alder Hey Children's Hospital, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, UK
| | | | - Richard Skone
- Noah's Ark Children's Hospital for Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Heather Strange
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Khadijeh Taiyari
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Rob Trubey
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Lyvonne Tume
- School of Health and Society, University of Salford, Manchester, UK
| | - Colin Powell
- Department of Emergency Medicine, Sidra Medicine, Doha, Qatar.,Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Damian Roland
- Paediatric Emergency Medicine, Leicester Academic (PEMLA) Group, Emergency Department, University of Leicester, Leicester, UK.,SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK
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9
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Hainsworth L, Kosti A, Lloyd A, Kiddle A, Bamford R, Hunter I. Teaching the management of trauma patients through virtual reality. Ann R Coll Surg Engl 2021; 104:330-333. [PMID: 34928710 DOI: 10.1308/rcsann.2021.0181] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Virtual reality (VR) fully immersive interactive video teaching (VR FIIT) allows learners to develop through observing and interacting with complex realistic environments, developing technical and nontechnical skills. One such complex clinical environment is managing a trauma patient. Despite the significant developments in managing these patients, foundation doctors are frequently highly anxious due to their limited knowledge and experience. The aim of this project was twofold; to improve foundation doctor performance of managing trauma patients and to reduce their associated anxiety, through the use of VR teaching. METHODS A total of 14 foundation doctors were divided into two groups. One group underwent departmental teaching. The second group underwent departmental teaching and VR FIIT. We assessed the doctors via two methods. First, time taken to complete tasks correctly in trauma simulations was compared. Second, the doctors completed a self-reported level-based assessment questionnaire regarding anxiety and stress around trauma calls. RESULTS The VR FIIT intervention group were able to complete each task on average 118s faster than the standard group. The standard group missed essential tasks such as C-spine immobilisation. The VR FIIT group self-reported significantly lower levels of anxiety related to trauma calls. CONCLUSION VR teaching improves foundation doctor performance at managing simulated major trauma patients and decreases foundation doctor anxiety towards management and exposure of these clinical situations.
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10
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Spencer A, Rivero-Arias O, Wong R, Tsuchiya A, Bleichrodt H, Edward R, Norman R, Lloyd A, Clarke P. The QALY at 50: One story many voices. Soc Sci Med 2021; 296:114653. [DOI: 10.1016/j.socscimed.2021.114653] [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] [Received: 05/28/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
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11
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Jacob N, Burton C, Hale R, Jones A, Lloyd A, Rafferty AM, Allen D. Pro-judge study: Nurses' professional judgement in nurse staffing systems. J Adv Nurs 2021; 77:4226-4233. [PMID: 34138491 DOI: 10.1111/jan.14921] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
AIMS Aim of this study is to better understand the role of nurses' professional judgment in nurse staffing systems. DESIGN Qualitative comparative case study design of nurse staffing systems in England and Wales. METHODS Data will be collected through a variety of sources: individual interviews, observations of relevant meetings and analysis of key documents. Ethical approval for the study was granted in August 2020 from The Healthcare Research Ethics Committee (SREC reference: REC741). Data generation will be informed by science and technology studies and practice theories. DISCUSSION Ensuring adequate numbers of nurses are available to care for patients in response to shifting demand is an international policy priority. Emerging evidence on the use of formal workforce planning methodologies across the developed world highlights both the centrality of nurses' professional judgement in nurse staffing methodologies and the urgent need for theoretically informed research to better understand and conceptualise its contribution to decision-making. This study is designed to address this gap in understanding. It takes advantage of nurses' experiences of managing the service and staffing impacts of the Covid-19 pandemic and differences in strategic approaches to nurse staffing systems between England and Wales. IMPACT The research will: make visible the knowledge and skills that underpin professional judgement in nurse staffing decisions and provide a conceptual language with which to articulate this; lay the foundations for evidence-based programmes of nurse education and continuing professional development; furnish the evidence to inform the development of nurse-led decision support tools to augment professional judgement; and generate wider insights into the effectiveness of nurse staffing systems in practice.
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Affiliation(s)
- Nina Jacob
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Chris Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Rachel Hale
- School of Psychology, Cardiff University, Cardiff, UK
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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12
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Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E, Tadros G, Raguz I, San Martin A, Kraljević M, Mantziari S, Frey S, Gensthaler L, Sammalkorpi H, Garcia-Galocha JL, Zapata A, Tatarian T, Wiggins T, Bardisi E, Goreux JP, Vonlanthen R, Widmer J, Thalheimer A, Himpens J, Hollymann M, Welbourn R, Aggarwal R, Beekley A, Sepulveda M, Torres A, Juuti A, Salminen P, Prager G, Iannelli A, Suter M, Peterli R, Boza C, Rosenthal R, Higa K, Lannoo M, Hazebroek EJ, Dillemans B, Clavien PA, Puhan M, Raptis DA, Bueter M. Defining global benchmarks in elective secondary bariatric surgery comprising conversional, revisional and reversal procedures. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.039] [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] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Management of poor response and of long-term complications after bariatric surgery (BS) is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. Benchmarking uses best performance in a given field as reference point for improvement. Our aim was to define ‘‘best possible’’ outcomes for elective secondary BS.
Methods
The establishment of benchmarks in secondary BS followed a standardized methodology, based on recommendations of a Delphi consensus panel of experts. This multicenter study analyzed patients undergoing elective secondary BS in 18 high-volume centers on 4 continents from 06/2013 to 05/2019. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers. Benchmark cases had no: previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI>50kg/m2 or age>65 years. Descriptive statistics, multivariate logistic regression and data visualization were performed using the R software.
Results
Out of 44’884 elective bariatric procedures performed in the participating centers, 5’328 secondary BS cases were identified. The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8±10 years, 8.4±5.3 years after primary BS, with a body mass index 35.2±7kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.57% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.36) and after conversional or revisional procedures with gastrointestinal suture/stapling (OR 1.7). Benchmark cutoffs at 90-days postoperatively were ≤5.8% re-intervention and ≤8.8% re-operation rate. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation.
Conclusion
Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
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Affiliation(s)
- D Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Vannijvel
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - S Okkema
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - E Deleus
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Lloyd
- Department of Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, USA
| | - E Lo Menzo
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - G Tadros
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - I Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A San Martin
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - L Gensthaler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - H Sammalkorpi
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - J L Garcia-Galocha
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Zapata
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - T Tatarian
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - T Wiggins
- Bariatric and Metabolic Surgery Center, Musgrove Park Hospital, Taunton, United Kingdom
| | - E Bardisi
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - J -P Goreux
- Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium
| | - R Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Himpens
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - M Hollymann
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Aggarwal
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - A Beekley
- Bariatric and Metabolic Surgery Center, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - M Sepulveda
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - A Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Juuti
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - P Salminen
- Department of Surgery, University of Turku, Turku, Finland
| | - G Prager
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - A Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - M Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - C Boza
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - R Rosenthal
- Bariatric and Metabolic Surgery Department, Cleveland Clinic Florida, Weston, USA
| | - K Higa
- Bariatric and Metabolic Surgery Center, Fresno Heart and Surgical Hospital, Fresno, USA
| | - M Lannoo
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - E J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - B Dillemans
- Department of Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - P -A Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - D A Raptis
- Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, United Kingkom
| | - M Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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13
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Reyes L, A. Sanchez-Garcia M, Morrison T, Howden AJM, Watts ER, Arienti S, Sadiku P, Coelho P, Mirchandani AS, Zhang A, Hope D, Clark SK, Singleton J, Johnston S, Grecian R, Poon A, McNamara S, Harper I, Fourman MH, Brenes AJ, Pathak S, Lloyd A, Blanco GR, von Kriegsheim A, Ghesquiere B, Vermaelen W, Cologna CT, Dhaliwal K, Hirani N, Dockrell DH, Whyte MKB, Griffith D, Cantrell DA, Walmsley SR. -------A type I IFN, prothrombotic hyperinflammatory neutrophil signature is distinct for COVID-19 ARDS--. Wellcome Open Res 2021; 6:38. [PMID: 33997298 PMCID: PMC8112464 DOI: 10.12688/wellcomeopenres.16584.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) is a severe critical condition with a high mortality that is currently in focus given that it is associated with mortality caused by coronavirus disease 2019 (COVID-19). Neutrophils play a key role in the lung injury characteristic of non-COVID-19 ARDS and there is also accumulating evidence of neutrophil mediated lung injury in patients who succumb to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We undertook a functional proteomic and metabolomic survey of circulating neutrophil populations, comparing patients with COVID-19 ARDS and non-COVID-19 ARDS to understand the molecular basis of neutrophil dysregulation. Results: Expansion of the circulating neutrophil compartment and the presence of activated low and normal density mature and immature neutrophil populations occurs in ARDS, irrespective of cause. Release of neutrophil granule proteins, neutrophil activation of the clotting cascade and upregulation of the Mac-1 platelet binding complex with formation of neutrophil platelet aggregates is exaggerated in COVID-19 ARDS. Importantly, activation of components of the neutrophil type I interferon responses is seen in ARDS following infection with SARS-CoV-2, with associated rewiring of neutrophil metabolism, and the upregulation of antigen processing and presentation. Whilst dexamethasone treatment constricts the immature low density neutrophil population, it does not impact upon prothrombotic hyperinflammatory neutrophil signatures. Conclusions: Given the crucial role of neutrophils in ARDS and the evidence of a disordered myeloid response observed in COVID-19 patients, this work maps the molecular basis for neutrophil reprogramming in the distinct clinical entities of COVID-19 and non-COVID-19 ARDS.
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Affiliation(s)
- Leila Reyes
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Manuel A. Sanchez-Garcia
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Tyler Morrison
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Andy J. M. Howden
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Emily R. Watts
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Simone Arienti
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Pranvera Sadiku
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Patricia Coelho
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ananda S. Mirchandani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ailiang Zhang
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Hope
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah K. Clark
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jo Singleton
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Shonna Johnston
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Robert Grecian
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Azin Poon
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah McNamara
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Isla Harper
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Max Head Fourman
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Alejandro J. Brenes
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK,Centre for Gene Regulation and Expression, University of Dundee, Dundee, DD1 5EH, UK
| | - Shalini Pathak
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Amy Lloyd
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Giovanny Rodriguez Blanco
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alex von Kriegsheim
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Bart Ghesquiere
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Wesley Vermaelen
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Camila T. Cologna
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,NHS Lothian, Respiratory Medicine, Edinburgh Lung Fibrosis Clinic, Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - David H. Dockrell
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Moira K. B. Whyte
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Griffith
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Doreen A. Cantrell
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Sarah R. Walmsley
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,
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14
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Reyes L, A. Sanchez-Garcia M, Morrison T, Howden AJM, Watts ER, Arienti S, Sadiku P, Coelho P, Mirchandani AS, Zhang A, Hope D, Clark SK, Singleton J, Johnston S, Grecian R, Poon A, McNamara S, Harper I, Fourman MH, Brenes AJ, Pathak S, Lloyd A, Blanco GR, von Kriegsheim A, Ghesquiere B, Vermaelen W, Cologna CT, Dhaliwal K, Hirani N, Dockrell DH, Whyte MKB, Griffith D, Cantrell DA, Walmsley SR. -------A type I IFN, prothrombotic hyperinflammatory neutrophil signature is distinct for COVID-19 ARDS--. Wellcome Open Res 2021; 6:38. [PMID: 33997298 PMCID: PMC8112464 DOI: 10.12688/wellcomeopenres.16584.2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) is a severe critical condition with a high mortality that is currently in focus given that it is associated with mortality caused by coronavirus disease 2019 (COVID-19). Neutrophils play a key role in the lung injury characteristic of non-COVID-19 ARDS and there is also accumulating evidence of neutrophil mediated lung injury in patients who succumb to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We undertook a functional proteomic and metabolomic survey of circulating neutrophil populations, comparing patients with COVID-19 ARDS and non-COVID-19 ARDS to understand the molecular basis of neutrophil dysregulation. Results: Expansion of the circulating neutrophil compartment and the presence of activated low and normal density mature and immature neutrophil populations occurs in ARDS, irrespective of cause. Release of neutrophil granule proteins, neutrophil activation of the clotting cascade and upregulation of the Mac-1 platelet binding complex with formation of neutrophil platelet aggregates is exaggerated in COVID-19 ARDS. Importantly, activation of components of the neutrophil type I interferon responses is seen in ARDS following infection with SARS-CoV-2, with associated rewiring of neutrophil metabolism, and the upregulation of antigen processing and presentation. Whilst dexamethasone treatment constricts the immature low density neutrophil population, it does not impact upon prothrombotic hyperinflammatory neutrophil signatures. Conclusions: Given the crucial role of neutrophils in ARDS and the evidence of a disordered myeloid response observed in COVID-19 patients, this work maps the molecular basis for neutrophil reprogramming in the distinct clinical entities of COVID-19 and non-COVID-19 ARDS.
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Affiliation(s)
- Leila Reyes
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Manuel A. Sanchez-Garcia
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Tyler Morrison
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Andy J. M. Howden
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Emily R. Watts
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Simone Arienti
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Pranvera Sadiku
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Patricia Coelho
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ananda S. Mirchandani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ailiang Zhang
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Hope
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah K. Clark
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jo Singleton
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Shonna Johnston
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Robert Grecian
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Azin Poon
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah McNamara
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Isla Harper
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Max Head Fourman
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Alejandro J. Brenes
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK,Centre for Gene Regulation and Expression, University of Dundee, Dundee, DD1 5EH, UK
| | - Shalini Pathak
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Amy Lloyd
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Giovanny Rodriguez Blanco
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alex von Kriegsheim
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Bart Ghesquiere
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Wesley Vermaelen
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Camila T. Cologna
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,NHS Lothian, Respiratory Medicine, Edinburgh Lung Fibrosis Clinic, Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - David H. Dockrell
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Moira K. B. Whyte
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Griffith
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Doreen A. Cantrell
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Sarah R. Walmsley
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,
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Lloyd A, Ryan E, Boland M, Medani S, Elwahab A, Malone C, Sweeney K, Barry K, McLaughlin R, Lowery A, Kerin M. O39: THE HISTOPATHOLOGICAL AND MOLECULAR FEATURES OF BREAST CARCINOMA WITH HIGH-GRADE TUMOUR BUDDING. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Tumour budding (TB) is an adverse histological feature in many cancers. It is thought to represent epithelial-to-mesenchymal transition, a key step in the metastatic process. The role of TB in breast carcinoma (BC) remains unclear.
Aim
To investigate the relationship between TB and other histological and molecular features of BC.
Method
A systematic search was performed to identify studies that compared features of BC based on the presence or absence of high-grade TB. Dichotomous variables were pooled as odds ratios (OR) using the Cochran–Mantel–Haenszel method. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale (NOS).
Result
Seven studies with a total of 1040 patients (high grade TB n=519, 49.9%; low grade TB n=521, 50.1%) were included. A moderate- to high-risk of bias was noted. The median NOS was 7 (range 6-8). High-grade TB was significantly associated with lymph node involvement (OR 2.28, 95% c.i. 1.74 to 2.98, P<0.001) and lymphovascular invasion (OR 3.08, 95% c.i. 2.13 to 4.47, P<0.001). Regarding molecular subtypes, there was an increased likelihood of high-grade TB in oestrogen- (OR 1.66, 95% c.i. 1.21 to 2.29, P=0.002) and progesterone-receptor positive (OR 1.68, 95% c.i. 1.10 to 2.59, P=0.02) tumours. In contrast triple negative breast cancer had a reduced incidence of high-grade TB (OR 0.46, 95% c.i. 0.30 to 0.72, P=0.0006).
Conclusion
High-grade TB is enriched in hormone-positive BC and is associated with known adverse prognostic variables. TB may offer new insights into the metastatic processes of luminal BC.
Take-home message
High-grade TB is enriched in hormone-positive BC and is associated with known adverse prognostic variables. TB may offer new insights into the metastatic processes of luminal BC.
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Affiliation(s)
- A Lloyd
- Royal College of Surgeons Ireland
| | - E Ryan
- Galway University Hospital
| | - M Boland
- Royal College of Surgeons Ireland
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Thomas E, Lloyd A, Leopold N. 150 The Association Between Increasing Frailty and Greater Co-Morbidity and Surviving Cardio Pulmonary Resuscitation. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Population ageing is a triumph of public health and medical advancement but it can equally lead to burdensome and futile interventions at the end of natural life. This is especially relevant when offering treatments such as cardiopulmonary resuscitation (CPR) that can carry a significant burden of harm. The aim of this study was to investigate the association between increasing frailty and greater co-morbidity and surviving CPR.
Method
A retrospective analysis of prospectively collected data from contemporaneous patient notes and electronic patient records of all patients that suffered an in-hospital cardiac arrest between 1st April 2017 and March 31st 2018 in a tertiary hospital (that includes tertiary cardiology) in South Wales was undertaken.
Results
A total of 113 patient records were assessed. Average patient age was 74. Patient frailty was assessed based on calculation of Rockwood score (RS) and co-morbidity assessment based on Charlson index (CI). We identified a strong linear correlation between increasing CI and poor survival and rates of ROSC. No patient with a Charlson index of above 6 survived one year. Similarly, patients with a RS between 1–3 had a survival to discharge, 30 day and 1 year survival rate of 45.7%. Only 10.3% of those with a RS between 5–9 survived 1 year post cardiac arrest. No patient with a RS above 6 survived one year. No association between duration of CPR and patient frailty was identified. Increasing age was also found to be linearly associated with reduced likelihood of survival. This association was much less significant than the association with increasing RS or CI.
Conclusion
It is clear from our findings that both increasing patient frailty and level of co-morbidity significantly adversely affect survival from CPR. Accurate individualised assessment of both of these factors is therefore imperative when assessing the appropriateness of undertaking CPR.
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Affiliation(s)
- E Thomas
- Swansea Bay Health Board, Swansea
| | - A Lloyd
- Swansea Bay Health Board, Swansea
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17
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Özgüroğlu M, Goldman J, Reinmuth N, Chen Y, Dvorkin M, Trukhin D, Statsenko G, Hotta K, Ji J, Hochmair M, Voitko O, Havel L, Poltoratskiy A, Losonczy G, Verderame F, Thomas M, Zheng Y, Lloyd A, Jiang H, Paz-Ares L. LBA2 First-line durvalumab plus platinum-etoposide in extensive-stage (ES)-SCLC: Safety, pharmacokinetics (PK) and immunogenicity in CASPIAN. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz453.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Jacob N, Moriarty Y, Lloyd A, Mann M, Tume LN, Sefton G, Powell C, Roland D, Trubey R, Hood K, Allen D. Optimising paediatric afferent component early warning systems: a hermeneutic systematic literature review and model development. BMJ Open 2019; 9:e028796. [PMID: 31727645 PMCID: PMC6886951 DOI: 10.1136/bmjopen-2018-028796] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To identify the core components of successful early warning systems for detecting and initiating action in response to clinical deterioration in paediatric inpatients. METHODS A hermeneutic systematic literature review informed by translational mobilisation theory and normalisation process theory was used to synthesise 82 studies of paediatric and adult early warning systems and interventions to support the detection of clinical deterioration and escalation of care. This method, which is designed to develop understanding, enabled the development of a propositional model of an optimal afferent component early warning system. RESULTS Detecting deterioration and initiating action in response to clinical deterioration in paediatric inpatients involves several challenges, and the potential failure points in early warning systems are well documented. Track and trigger tools (TTT) are commonly used and have value in supporting key mechanisms of action but depend on certain preconditions for successful integration into practice. Several supplementary interventions have been proposed to improve the effectiveness of early warning systems but there is limited evidence to recommend their wider use, due to the weight and quality of the evidence; the extent to which systems are conditioned by the local clinical context; and the need to attend to system component relationships, which do not work in isolation. While it was not possible to make empirical recommendations for practice, the review methodology generated theoretical inferences about the core components of an optimal system for early warning systems. These are presented as a propositional model conceptualised as three subsystems: detection, planning and action. CONCLUSIONS There is a growing consensus of the need to think beyond TTTs in improving action to detect and respond to clinical deterioration. Clinical teams wishing to improve early warning systems can use the model to consider systematically the constellation of factors necessary to support detection, planning and action and consider how these arrangements can be implemented in their local context. PROSPERO REGISTRATION NUMBER CRD42015015326.
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Affiliation(s)
- Nina Jacob
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mala Mann
- University Library Services, Cardiff University, Cardiff, UK
| | - Lyvonne N Tume
- Faculty of Health and Applied Sciences (HAS), University of the West of England Bristol, Bristol, UK
| | - Gerri Sefton
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Colin Powell
- Department of Pediatric Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Damian Roland
- Emergency Department, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester, UK
- SAPPHIRE Group, University of Leicester Department of Health Sciences, Leicester, UK
| | - Robert Trubey
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Joseph-Williams N, Williams D, Wood F, Lloyd A, Brain K, Thomas N, Prichard A, Goodland A, McGarrigle H, Sweetland H, Edwards A. A descriptive model of shared decision making derived from routine implementation in clinical practice ('Implement-SDM'): Qualitative study. Patient Educ Couns 2019; 102:1774-1785. [PMID: 31351787 DOI: 10.1016/j.pec.2019.07.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice. METHODS Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed. RESULTS Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancer patients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited. CONCLUSION A more complex picture was observed compared with previous portrayals in current theoretical models. PRACTICE IIMPLICATIONS The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice.
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Affiliation(s)
- Natalie Joseph-Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK.
| | - Denitza Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Fiona Wood
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Amy Lloyd
- Cardiff University, College of Biomedical and Life Sciences, Centre for Trials Research, Cardiff, UK
| | - Katherine Brain
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Nerys Thomas
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Alison Prichard
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Annwen Goodland
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Helen McGarrigle
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Helen Sweetland
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Adrian Edwards
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
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20
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Williams D, Edwards A, Wood F, Lloyd A, Brain K, Thomas N, Prichard A, Goodland A, Sweetland H, McGarrigle H, Hill G, Joseph-Williams N. Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study. BMJ Open 2019; 9:e029485. [PMID: 31427333 PMCID: PMC6701565 DOI: 10.1136/bmjopen-2019-029485] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations. DESIGN Multi-method study using observational and self-reported measures of SDM and qualitative analysis. SETTING Breast care and predialysis teams who had already implemented SDM. PARTICIPANTS Breast care consultants, clinical nurse specialists and patients who were making decisions about treatment for early-stage breast cancer. Predialysis clinical nurse specialists and patients who needed to make dialysis treatment decisions. METHODS Consultations were audio recorded, transcribed and thematically analysed. SDM was measured using Observer OPTION-5 and a dyadic SureScore self-reported measure. RESULTS Twenty-two breast and 21 renal consultations were analysed. SureScore indicated that clinicians and patients felt SDM was occurring, but scores showed ceiling effects for most participants, making differentiation difficult. There was mismatch between SureScore and OPTION-5 score data, the latter showing that each consultation lacked at least some elements of SDM. Highest scoring items using OPTION-5 were 'incorporating patient preferences into decisions' for the breast team (mean 18.5, range 12.5-20, SD 2.39) and 'eliciting patient preferences to options' for the renal team (mean 16.15, range 10-20, SD 3.48). Thematic analysis identified that the SDM encounter is difficult to measure because decision-making is often distributed across encounters and time, with multiple people, it is contextually adapted and can involve multiple decisions. CONCLUSIONS Self-reported measures can broadly indicate satisfaction with SDM, but do not tell us about the quality of the interaction and are unlikely to capture the multi-staged nature of the SDM process. Observational measures provide an indication of the extent to which elements of SDM are present in the observed consultation, but cannot explain why some elements might not be present or scored lower. Findings are important when considering measuring SDM in practice.
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Affiliation(s)
- Denitza Williams
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Nerys Thomas
- Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Alison Prichard
- Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Annwen Goodland
- Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Helen Sweetland
- Cardiff Breast Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Helen McGarrigle
- Cardiff Breast Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Natalie Joseph-Williams
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
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21
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Trubey R, Huang C, Lugg-Widger FV, Hood K, Allen D, Edwards D, Lacy D, Lloyd A, Mann M, Mason B, Oliver A, Roland D, Sefton G, Skone R, Thomas-Jones E, Tume LN, Powell C. Validity and effectiveness of paediatric early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children: a systematic review. BMJ Open 2019; 9:e022105. [PMID: 31061010 PMCID: PMC6502038 DOI: 10.1136/bmjopen-2018-022105] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess (1) how well validated existing paediatric track and trigger tools (PTTT) are for predicting adverse outcomes in hospitalised children, and (2) how effective broader paediatric early warning systems are at reducing adverse outcomes in hospitalised children. DESIGN Systematic review. DATA SOURCES British Nursing Index, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effectiveness, EMBASE, Health Management Information Centre, Medline, Medline in Process, Scopus and Web of Knowledge searched through May 2018. ELIGIBILITY CRITERIA We included (1) papers reporting on the development or validation of a PTTT or (2) the implementation of a broader early warning system in paediatric units (age 0-18 years), where adverse outcome metrics were reported. Several study designs were considered. DATA EXTRACTION AND SYNTHESIS Data extraction was conducted by two independent reviewers using template forms. Studies were quality assessed using a modified Downs and Black rating scale. RESULTS 36 validation studies and 30 effectiveness studies were included, with 27 unique PTTT identified. Validation studies were largely retrospective case-control studies or chart reviews, while effectiveness studies were predominantly uncontrolled before-after studies. Metrics of adverse outcomes varied considerably. Some PTTT demonstrated good diagnostic accuracy in retrospective case-control studies (primarily for predicting paediatric intensive care unit transfers), but positive predictive value was consistently low, suggesting potential for alarm fatigue. A small number of effectiveness studies reported significant decreases in mortality, arrests or code calls, but were limited by methodological concerns. Overall, there was limited evidence of paediatric early warning system interventions leading to reductions in deterioration. CONCLUSION There are several fundamental methodological limitations in the PTTT literature, and the predominance of single-site studies carried out in specialist centres greatly limits generalisability. With limited evidence of effectiveness, calls to make PTTT mandatory across all paediatric units are not supported by the evidence base. PROSPERO REGISTRATION NUMBER CRD42015015326.
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Affiliation(s)
- Rob Trubey
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Chao Huang
- Hull York Medical School, University of Hull, Hull, UK
| | | | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Dawn Edwards
- Department of Paediatrics, Morriston Hospital, Swansea, UK
| | - David Lacy
- Wirral University Teaching Hospital, Wirral, UK
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mala Mann
- University Library Services, Cardiff University, Cardiff, UK
| | | | - Alison Oliver
- Department of Paediatric Intensive Care, Noah’s Ark Children’s Hospital for Wales, Cardiff, UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children’s Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Gerri Sefton
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Richard Skone
- Department of Paediatric Intensive Care, Noah’s Ark Children’s Hospital for Wales, Cardiff, UK
| | | | - Lyvonne N Tume
- Faculty of Health and Applied Sciences (HAS), University of the West of England Bristol, Bristol, UK
| | - Colin Powell
- Department of Pediatric Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Scovil CY, Delparte JJ, Walia S, Flett HM, Guy SD, Wallace M, Burns AS, Wolfe DL, Wolfe D, Kras-Dupuis A, Walia S, Guy S, Askes H, Casalino A, Fraser C, Paiva M, Miles S, Gagliardi J, Orenczuk S, Sommerdyk J, Genereaux M, Jarvis D, Wesenger J, Bloetjes L, Flett H, Burns A, Scovil C, Delparte J, Leber D, McMillan L, Domingo T, Wallace M, Stoesz B, Aguillon G, Koning C, Mumme L, Cwiklewich M, Bayless K, Crouse L, Crocker J, Erickson G, Mark M, Charbonneau R, Lloyd A, Van Doesburg C, Knox J, Wright P, Mouneimne M, Parmar R, Isaacs T, Reader J, Oga C, Birchall N, McKenzie N, Nicol S, Joly C, Laramée M, Robidoux I, Casimir M, Côté S, Lubin C, Lemay J, Beaulieu J, Truchon C, Noreau L, Lemay V, Vachon J, Bélanger D, Proteau F, O'Connell C, Savoie J, McCullum S, Brown J, Duda M, Bassett-Spiers K, Riopelle R, Hsieh J, Reinhart-McMillan W, Joshi P, Noonan V, Humphreys S, Hamilton L, MacIsaac G. Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network. Arch Phys Med Rehabil 2019; 100:327-335. [DOI: 10.1016/j.apmr.2018.07.444] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022]
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De Berdt P, Bottemanne P, Bianco J, Alhouayek M, Diogenes A, Lloyd A, Gerardo-Nava J, Brook GA, Miron V, Muccioli GG, Rieux AD. Author Correction: Stem cells from human apical papilla decrease neuro‑inflammation and stimulate oligodendrocyte progenitor differentiation via activin‑A secretion. Cell Mol Life Sci 2018; 75:2857. [PMID: 29569030 PMCID: PMC11105167 DOI: 10.1007/s00018-018-2801-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the original publication, sixth author's surname was incorrectly published as "Llyod" instead of "Lloyd". The correct name should read as "Amy Lloyd".
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Affiliation(s)
- Pauline De Berdt
- Louvain Drug Research Institute (LDRI), Advanced Drug Delivery and Biomaterials (ADDB), Université Catholique de Louvain, Avenue E. Mounier 73, B1 73.12, 1200, Brussels, Belgium
| | - Pauline Bottemanne
- Louvain Drug Research Institute, Bioanalysis and Pharmacology of Bioactive Lipids Research Group (BPBL), Université Catholique de Louvain, Avenue E. Mounier 73, B1 72.01, 1200, Brussels, Belgium
| | - John Bianco
- Louvain Drug Research Institute (LDRI), Advanced Drug Delivery and Biomaterials (ADDB), Université Catholique de Louvain, Avenue E. Mounier 73, B1 73.12, 1200, Brussels, Belgium
| | - Mireille Alhouayek
- Louvain Drug Research Institute, Bioanalysis and Pharmacology of Bioactive Lipids Research Group (BPBL), Université Catholique de Louvain, Avenue E. Mounier 73, B1 72.01, 1200, Brussels, Belgium
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Amy Lloyd
- MRC Center for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Jose Gerardo-Nava
- Institute of Neuropathology, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gary A Brook
- Institute of Neuropathology, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Véronique Miron
- MRC Center for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Giulio G Muccioli
- Louvain Drug Research Institute, Bioanalysis and Pharmacology of Bioactive Lipids Research Group (BPBL), Université Catholique de Louvain, Avenue E. Mounier 73, B1 72.01, 1200, Brussels, Belgium
| | - Anne des Rieux
- Louvain Drug Research Institute (LDRI), Advanced Drug Delivery and Biomaterials (ADDB), Université Catholique de Louvain, Avenue E. Mounier 73, B1 73.12, 1200, Brussels, Belgium.
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De Berdt P, Bottemanne P, Bianco J, Alhouayek M, Diogenes A, Lloyd A, Llyod A, Gerardo-Nava J, Brook GA, Miron V, Muccioli GG, Rieux AD. Stem cells from human apical papilla decrease neuro-inflammation and stimulate oligodendrocyte progenitor differentiation via activin-A secretion. Cell Mol Life Sci 2018; 75:2843-2856. [PMID: 29417177 PMCID: PMC11105403 DOI: 10.1007/s00018-018-2764-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/29/2017] [Revised: 01/08/2018] [Accepted: 01/29/2018] [Indexed: 02/06/2023]
Abstract
Secondary damage following spinal cord injury leads to non-reversible lesions and hampering of the reparative process. The local production of pro-inflammatory cytokines such as TNF-α can exacerbate these events. Oligodendrocyte death also occurs, followed by progressive demyelination leading to significant tissue degeneration. Dental stem cells from human apical papilla (SCAP) can be easily obtained at the removal of an adult immature tooth. This offers a minimally invasive approach to re-use this tissue as a source of stem cells, as compared to biopsying neural tissue from a patient with a spinal cord injury. We assessed the potential of SCAP to exert neuroprotective effects by investigating two possible modes of action: modulation of neuro-inflammation and oligodendrocyte progenitor cell (OPC) differentiation. SCAP were co-cultured with LPS-activated microglia, LPS-activated rat spinal cord organotypic sections (SCOS), and LPS-activated co-cultures of SCOS and spinal cord adult OPC. We showed for the first time that SCAP can induce a reduction of TNF-α expression and secretion in inflamed spinal cord tissues and can stimulate OPC differentiation via activin-A secretion. This work underlines the potential therapeutic benefits of SCAP for spinal cord injury repair.
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Affiliation(s)
- Pauline De Berdt
- Louvain Drug Research Institute (LDRI), Advanced Drug Delivery and Biomaterials (ADDB), Université Catholique de Louvain, Avenue E. Mounier 73, B1 73.12, 1200, Brussels, Belgium
| | - Pauline Bottemanne
- Louvain Drug Research Institute, Bioanalysis and Pharmacology of Bioactive Lipids Research Group (BPBL), Université Catholique de Louvain, Avenue E. Mounier 73, B1 72.01, 1200, Brussels, Belgium
| | - John Bianco
- Louvain Drug Research Institute (LDRI), Advanced Drug Delivery and Biomaterials (ADDB), Université Catholique de Louvain, Avenue E. Mounier 73, B1 73.12, 1200, Brussels, Belgium
| | - Mireille Alhouayek
- Louvain Drug Research Institute, Bioanalysis and Pharmacology of Bioactive Lipids Research Group (BPBL), Université Catholique de Louvain, Avenue E. Mounier 73, B1 72.01, 1200, Brussels, Belgium
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Amy Llyod
- MRC Center for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Jose Gerardo-Nava
- Institute of Neuropathology, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gary A Brook
- Institute of Neuropathology, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Véronique Miron
- MRC Center for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Giulio G Muccioli
- Louvain Drug Research Institute, Bioanalysis and Pharmacology of Bioactive Lipids Research Group (BPBL), Université Catholique de Louvain, Avenue E. Mounier 73, B1 72.01, 1200, Brussels, Belgium
| | - Anne des Rieux
- Louvain Drug Research Institute (LDRI), Advanced Drug Delivery and Biomaterials (ADDB), Université Catholique de Louvain, Avenue E. Mounier 73, B1 73.12, 1200, Brussels, Belgium.
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Thomas-Jones E, Lloyd A, Roland D, Sefton G, Tume L, Hood K, Huang C, Edwards D, Oliver A, Skone R, Lacy D, Sinha I, Preston J, Mason B, Jacob N, Trubey R, Strange H, Moriarty Y, Grant A, Allen D, Powell C. A prospective, mixed-methods, before and after study to identify the evidence base for the core components of an effective Paediatric Early Warning System and the development of an implementation package containing those core recommendations for use in the UK: Paediatric early warning system - utilisation and mortality avoidance- the PUMA study protocol. BMC Pediatr 2018; 18:244. [PMID: 30045717 PMCID: PMC6060472 DOI: 10.1186/s12887-018-1210-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In hospital, staff need to routinely monitor patients to identify those who are seriously ill, so that they receive timely treatment to improve their condition. A Paediatric Early Warning System is a multi-faceted socio-technical system to detect deterioration in children, which may or may not include a track and trigger tool. It functions to monitor, detect and prompt an urgent response to signs of deterioration, with the aim of preventing morbidity and mortality. The purpose of this study is to develop an evidence-based improvement programme to optimise the effectiveness of Paediatric Early Warning Systems in different inpatient contexts, and to evaluate the feasibility and potential effectiveness of the programme in predicting deterioration and triggering timely interventions. METHODS This study will be conducted in two district and two specialist children's hospitals. It deploys an Interrupted Time Series (ITS) design in conjunction with ethnographic cases studies with embedded process evaluation. Informed by Translational Mobilisation Theory and Normalisation Process Theory, the study is underpinned by a functions based approach to improvement. Workstream (1) will develop an evidence-based improvement programme to optimise Paediatric Early Warning System based on systematic reviews. Workstream (2) consists of observation and recording outcomes in current practice in the four sites, implementation of the improvement programme and concurrent process evaluation, and evaluation of the impact of the programme. Outcomes will be mortality and critical events, unplanned admission to Paediatric Intensive Care (PICU) or Paediatric High Dependency Unit (PHDU), cardiac arrest, respiratory arrest, medical emergencies requiring immediate assistance, reviews by PICU staff, and critical deterioration, with qualitative evidence of the impact of the intervention on Paediatric Early Warning System and learning from the implementation process. DISCUSSION This paper presents the background, rationale and design for this mixed methods study. This will be the most comprehensive study of Paediatric Early Warning Systems and the first to deploy a functions-based approach to improvement in the UK with the aim to improve paediatric patient safety and reduce mortality. Our findings will inform recommendations about the safety processes for every hospital treating paediatric in-patients across the NHS. TRIAL REGISTRATION Sponsor: Cardiff University, 30-36 Newport Road, Cardiff, CF24 0DE Sponsor ref.: SPON1362-14. Funder: National Institute for Health Research, Health Services & Delivery Research Programme (NIHR HS&DR) Funder reference: 12/178/17. Research Ethics Committee reference: 15/SW/0084 [13/04/2015]. PROSPERO reference: CRD42015015326 [23/01/2015]. ISRCTN 94228292 https://doi.org/10.1186/ISRCTN94228292 [date of application 13/05/2015; date of registration: 18/08/2015]. Prospective registration prior to data collection and participant consent commencing in September 2014.
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Affiliation(s)
- Emma Thomas-Jones
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Cardiff, CF14 4YS, UK.
| | - Amy Lloyd
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, Centre for Medicine, Leciester Univeristy, LE1 7RH, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
| | - Gerri Sefton
- Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L14 5AB, UK
| | | | - Kerry Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Chao Huang
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Dawn Edwards
- Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, SA6 6NL, UK
| | - Alison Oliver
- Noah's Ark Children's Hospital of Wales, Cardiff and Vale University Health Board, Heath Park, Cardiff, CF14 4XN, UK
| | - Richard Skone
- Noah's Ark Children's Hospital of Wales, Cardiff and Vale University Health Board, Heath Park, Cardiff, CF14 4XN, UK
| | - David Lacy
- Noah's Ark Children's Hospital of Wales, Cardiff and Vale University Health Board, Heath Park, Cardiff, CF14 4XN, UK
| | - Ian Sinha
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
| | - Jenny Preston
- NIHR NIHR Alder Hey Clinical Research Facility, Eaton Rd, Liverpool, L12 2AP, UK
| | - Brendan Mason
- Swansea University Medical School, Swansea University, Grove Building, Singleton Park, Swansea, SA2 8PP, UK
| | - Nina Jacob
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Robert Trubey
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Heather Strange
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Yvonne Moriarty
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Aimee Grant
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, East Gate House, 35-43 Newport Road, Cardiff, CF24 0AB, UK
| | - Colin Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.,Arrowe Park Hospital, Arrowe Park Road, Merseyside, Wirral, CH49 5PE, UK
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Gollins S, Massalha S, Mullard A, Williams RM, Lloyd A, Morris J, Garcia-Alonso A. A Prospective Phase I/II Study of Docetaxel, Cisplatin and Continuous Capecitabine in Advanced Oesophago-Gastric Cancer (NWCOG-3). Clin Oncol (R Coll Radiol) 2018; 30:409-417. [PMID: 29573846 DOI: 10.1016/j.clon.2018.03.002] [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: 12/15/2017] [Accepted: 01/24/2018] [Indexed: 10/17/2022]
Abstract
AIMS This open-label prospective phase I/II dose-escalation study determined the maximum tolerated dose (MTD) and then evaluated response, safety and feasibility of a novel combination of docetaxel, cisplatinum and capecitabine (DCC) in chemotherapy-naive patients with advanced oesophago-gastric carcinoma. MATERIALS AND METHODS Patients with adenocarcinoma or squamous cell carcinoma of the oesophagus or stomach, of good performance status, deemed too advanced for curative treatment, were given systematically increasing doses of 3 weekly DCC to ascertain the MTD. Phase II administered up to six cycles of DCC at the MTD, assessing response and toxicity. RESULTS Between November 2007 and November 2012, 15 patients were recruited into phase I and 41 into phase II. The MDT was a 21 day cycle of docetaxel 60 mg/m2 IV day 1, cisplatinum 60 mg/m2 IV day 1 and oral capecitabine 1000 mg/m2 daily in two divided doses for days 1-21. The most common phase II grade 3-4 toxicities were neutropenia 88% (10% febrile neutropenia), fatigue 15%, sensory neuropathy 10% and non-neutropenic infection 10%. The overall response rate was 51%, median progression-free survival was 7.4 months (confidence interval 6.7-9.4) and median overall survival was 10.9 months (confidence interval 7.7-13.7). CONCLUSION DCC was tolerable and feasible with promising efficacy, and may be suitable for future investigation in both first-line metastatic and neoadjuvant settings.
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Affiliation(s)
- S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK.
| | - S Massalha
- Ysbyty Gwynedd, Penrhosgarnedd, Bangor, UK
| | - A Mullard
- Ysbyty Gwynedd, Penrhosgarnedd, Bangor, UK
| | | | - A Lloyd
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK
| | - J Morris
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK
| | - A Garcia-Alonso
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK
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Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, Cochran N, Frosch D, Galasiński D, Gulbrandsen P, Han PKJ, Härter M, Kinnersley P, Lloyd A, Mishra M, Perestelo-Perez L, Scholl I, Tomori K, Trevena L, Witteman HO, Van der Weijden T. A three-talk model for shared decision making: multistage consultation process. BMJ 2017; 359:j4891. [PMID: 29109079 PMCID: PMC5683042 DOI: 10.1136/bmj.j4891] [Citation(s) in RCA: 403] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement.Design Multistage consultation process.Setting Key informant group, communities of interest, and survey of clinical specialties.Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties.Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals.Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.
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Affiliation(s)
- Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Marie Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Julia Song
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Johanna Aarts
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Zackary Berger
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
| | - Nan Cochran
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Dominick Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | | | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, HØKH Research Centre, Akershus University Hospital Sykehusveien 25, Lørenskog, Norway
| | - Paul K J Han
- Center for Outcomes Research & Evaluation, Maine Medical Center, Portland, Maine, USA
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Paul Kinnersley
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - Amy Lloyd
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Manish Mishra
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | | | - Isabelle Scholl
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Kounosuke Tomori
- Department of Occupational therapy, Tokyo University of Technology, Nishikamata, Ohtaku, Tokyo, Japan
| | - Lyndal Trevena
- Discipline of General Practice, Sydney School of Public Health, University of Sydney, NSW, Australia
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec, Canada
| | - Trudy Van der Weijden
- Department of Family Medicine, School CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
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Cunningham E, Amin J, Bretana N, Luciani F, Degenhardt L, Larney S, Hajarizadeh B, Dore G, Lloyd A, Grebely J. P10 Injecting risk behaviours among people who inject drugs in an Australian prison setting, 2005–2014: the HITS-p study. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30751-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bergin ART, Hovey E, Lloyd A, Marx G, Parente P, Rapke T, de Souza P. Docetaxel-related fatigue in men with metastatic prostate cancer: a descriptive analysis. Support Care Cancer 2017; 25:2871-2879. [PMID: 28429147 DOI: 10.1007/s00520-017-3706-8] [Citation(s) in RCA: 5] [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: 10/09/2016] [Accepted: 04/10/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Fatigue is a prevalent and debilitating side effect of docetaxel chemotherapy in metastatic prostate cancer. A better understanding of the kinetics and nature of docetaxel-related fatigue may provide a framework for intervention. METHODS This secondary analysis was performed using the MOTIF database, from a phase III, randomised, double-blind, placebo-controlled study of modafinil (200 mg/day for 15 days) for docetaxel-related fatigue in men with metastatic prostate cancer [1]. The pattern of fatigue was analysed using the MDASI (MD Anderson Symptom Inventory) score. The impact of modafinil, cumulative docetaxel exposure, age and smoking status on fatigue kinetics were explored. Fatigue-related symptoms were assessed using the SOMA6 (fatigue and related symptoms) subset of the SPHERE (Somatic and Psychological Health Report). Mood was tracked using the short form 36 health survey questionnaire (SF-36). RESULTS Across four docetaxel cycles, fatigue scores were higher in the first week and decreased over weeks two and three. Whilst men randomised to modafinil had reduced fatigue scores, cumulative docetaxel had little impact. Younger men (55-68 years) had significantly reduced fatigue scores, whereas current and ex-smokers had higher scores. There was no significant change in mood status or haemoglobin across treatment cycles. Men described both 'somnolence' and 'muscle fatigue' contributing significantly to their symptom complex. CONCLUSIONS Assessment and management of docetaxel-related fatigue remains an important challenge. Given the complex, multifactorial nature of fatigue, identification through structured interview and interventions targeted to specific 'at risk' groups may be the most beneficial. Understanding the temporal pattern (kinetics) and nature of fatigue is critical to guide this process.
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Affiliation(s)
- A R T Bergin
- Eastern Health, Box Hill Hospital, 8 Arnold St, Box Hill, Victoria, Australia.
| | - E Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Barker St, Randwick, New South Wales, Australia.,University of New South Wales, Kensington, New South Wales, Australia
| | - A Lloyd
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Barker St, Randwick, New South Wales, Australia.,University of New South Wales, Kensington, New South Wales, Australia.,Inflammation and Infection Research Centre (IIRC), School of Medical Sciences and National Centre for Cancer Survivorship (NCCS), Randwick, New South Wales, Australia
| | - G Marx
- Sydney Adventist Hospital Clinical Trials Unit & Integrated Cancer Centre, 185 Fox Valley Rd, Wahroonga, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - P Parente
- Eastern Health, Box Hill Hospital, 8 Arnold St, Box Hill, Victoria, Australia.,Eastern Health, Monash University Clinical School, 5 Arnold St, Box Hill, Victoria, Australia
| | - T Rapke
- Sanofi Aventis, Sydney, New South Wales, Australia
| | - P de Souza
- Liverpool Hospital, Goulburn Street, Liverpool, New South Wales, Australia.,Western Sydney University, Penrith, New South Wales, Australia
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Joseph-Williams N, Lloyd A, Edwards A, Stobbart L, Tomson D, Macphail S, Dodd C, Brain K, Elwyn G, Thomson R. Implementing shared decision making in the NHS: lessons from the MAGIC programme. BMJ 2017; 357:j1744. [PMID: 28420639 PMCID: PMC6284240 DOI: 10.1136/bmj.j1744] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Shared decision making requires a shift in attitudes at all levels but can become part of routine practice with the right support, say Natalie Joseph-Williams and colleagues
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Affiliation(s)
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Lynne Stobbart
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - David Tomson
- Collingwood Surgery, North Shields, UK
- Collingwood Surgery, North Shields, UK
| | - Sheila Macphail
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Carole Dodd
- CK Health Consultancy, Newcastle upon Tyne, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Glyn Elwyn
- CK Health Consultancy, Newcastle upon Tyne, UK
| | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Brison DR, Hooper M, Critchlow JD, Hunter HR, Arnesen R, Lloyd A, Horne G. Reducing risk in the IVF laboratory: implementation of a double witnessing system. ACTA ACUST UNITED AC 2016. [DOI: 10.1258/1356262041591131] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Durand MA, Bekker HL, Casula A, Elias R, Ferraro A, Lloyd A, van der Veer SN, Metcalfe W, Mooney A, Thomson RG, Tomson CRV. Can we routinely measure patient involvement in treatment decision-making in chronic kidney care? A service evaluation in 27 renal units in the UK. Clin Kidney J 2016; 9:252-9. [PMID: 26985377 PMCID: PMC4792631 DOI: 10.1093/ckj/sfw003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/08/2016] [Indexed: 11/26/2022] Open
Abstract
Background Shared decision making is considered an important aspect of chronic disease management. We explored the feasibility of routinely measuring kidney patients' involvement in making decisions about renal replacement therapy (RRT) in National Health Service settings. Methods We disseminated a 17-item paper questionnaire on involvement in decision-making among adult patients with established kidney failure who made a decision about RRT in the previous 90 days (Phase 1) and patients who had been receiving RRT for 90–180 days (Phase 2). Recruitment rates were calculated as the ratio between the number of included and expected eligible patients (I : E ratio). We assessed our sample's representativeness by comparing demographics between participants and incident patients in the UK Renal Registry. Results Three hundred and five (Phase 1) and 187 (Phase 2) patients were included. For Phase 1, the I : E ratio was 0.44 (range, 0.08–2.80) compared with 0.27 (range, 0.04–1.05) in Phase 2. Study participants were more likely to be white compared with incident RRT patients (88 versus 77%; P < 0.0001). We found no difference in age, gender or social deprivation. In Phases 1 and 2, the majority reported a collaborative decision-making style (73 and 69%), and had no decisional conflict (85 and 76%); the median score for shared decision-making experience was 12.5 (Phase 1) and 10 (Phase 2) out of 20. Conclusion Our study shows the importance of assessing the feasibility of data collection in a chronic disease context prior to implementation in routine practice. Routine measurement of patient involvement in established kidney disease treatment decisions is feasible, but there are challenges in selecting the measure needed to capture experience of involvement, reducing variation in response rate by service and identifying when to capture experience in a service managing people's chronic disease over time.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA; Department of Psychology, University of Hertfordshire, Hatfield, UK
| | - Hilary L Bekker
- Leeds Institute of Health Sciences , University of Leeds , Leeds , UK
| | | | - Robert Elias
- King's College Hospital , Denmark Hill, London , UK
| | | | - Amy Lloyd
- Cochrane Institute of Primary Care and Public Health , Cardiff University , Cardiff , UK
| | - Sabine N van der Veer
- European Renal Best Practice (ERBP) Methods Support Team , University Hospital Ghent , Ghent , Belgium
| | | | | | - Richard G Thomson
- Institute of Health and Society , Newcastle University , Newcastle upon Tyne , UK
| | - Charles R V Tomson
- Department of Renal Medicine , Freeman Hospital , Newcastle upon Tyne , UK
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Hagan A, Macfarlane W, Lloyd A, Phillips G, Holden R, Bascal Z, Whomsley R, Kilpatrick H, Tang Y, Lewis A, Namur J, Pascale F, Pelage J. In vitro and in vivo characterisation of a multiple tyrosine kinase inhibitor drug eluting bead. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Timofeeva MN, Kinnersley B, Farrington SM, Whiffin N, Palles C, Svinti V, Lloyd A, Gorman M, Ooi LY, Hosking F, Barclay E, Zgaga L, Dobbins S, Martin L, Theodoratou E, Broderick P, Tenesa A, Smillie C, Grimes G, Hayward C, Campbell A, Porteous D, Deary IJ, Harris SE, Northwood EL, Barrett JH, Smith G, Wolf R, Forman D, Morreau H, Ruano D, Tops C, Wijnen J, Schrumpf M, Boot A, Vasen HFA, Hes FJ, van Wezel T, Franke A, Lieb W, Schafmayer C, Hampe J, Buch S, Propping P, Hemminki K, Försti A, Westers H, Hofstra R, Pinheiro M, Pinto C, Teixeira M, Ruiz-Ponte C, Fernández-Rozadilla C, Carracedo A, Castells A, Castellví-Bel S, Campbell H, Bishop DT, Tomlinson IPM, Dunlop MG, Houlston RS. Recurrent Coding Sequence Variation Explains Only A Small Fraction of the Genetic Architecture of Colorectal Cancer. Sci Rep 2015; 5:16286. [PMID: 26553438 PMCID: PMC4639776 DOI: 10.1038/srep16286] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/21/2015] [Indexed: 12/21/2022] Open
Abstract
Whilst common genetic variation in many non-coding genomic regulatory regions are known to impart risk of colorectal cancer (CRC), much of the heritability of CRC remains unexplained. To examine the role of recurrent coding sequence variation in CRC aetiology, we genotyped 12,638 CRCs cases and 29,045 controls from six European populations. Single-variant analysis identified a coding variant (rs3184504) in SH2B3 (12q24) associated with CRC risk (OR = 1.08, P = 3.9 × 10(-7)), and novel damaging coding variants in 3 genes previously tagged by GWAS efforts; rs16888728 (8q24) in UTP23 (OR = 1.15, P = 1.4 × 10(-7)); rs6580742 and rs12303082 (12q13) in FAM186A (OR = 1.11, P = 1.2 × 10(-7) and OR = 1.09, P = 7.4 × 10(-8)); rs1129406 (12q13) in ATF1 (OR = 1.11, P = 8.3 × 10(-9)), all reaching exome-wide significance levels. Gene based tests identified associations between CRC and PCDHGA genes (P < 2.90 × 10(-6)). We found an excess of rare, damaging variants in base-excision (P = 2.4 × 10(-4)) and DNA mismatch repair genes (P = 6.1 × 10(-4)) consistent with a recessive mode of inheritance. This study comprehensively explores the contribution of coding sequence variation to CRC risk, identifying associations with coding variation in 4 genes and PCDHG gene cluster and several candidate recessive alleles. However, these findings suggest that recurrent, low-frequency coding variants account for a minority of the unexplained heritability of CRC.
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Affiliation(s)
- Maria N. Timofeeva
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Ben Kinnersley
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Susan M. Farrington
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Nicola Whiffin
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Claire Palles
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Victoria Svinti
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Amy Lloyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Maggie Gorman
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Li-Yin Ooi
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Fay Hosking
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Ella Barclay
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Lina Zgaga
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Sara Dobbins
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Lynn Martin
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Evropi Theodoratou
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Peter Broderick
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Albert Tenesa
- Roslin Institute, University of Edinburgh, Easter Bush, Roslin EH25 9RG, United Kingdom
- Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Claire Smillie
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Graeme Grimes
- Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Caroline Hayward
- Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Archie Campbell
- Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
- Generation Scotland, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - David Porteous
- Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
- Generation Scotland, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Ian J. Deary
- University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, United Kingdom
| | - Sarah E. Harris
- Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
- University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, United Kingdom
| | - Emma L. Northwood
- Section of Epidemiology & Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, St James’s University Hospital, Leeds, UK
| | - Jennifer H. Barrett
- Section of Epidemiology & Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, St James’s University Hospital, Leeds, UK
| | - Gillian Smith
- Medical Research Institute, University of Dundee, Dundee, UK
| | - Roland Wolf
- Medical Research Institute, University of Dundee, Dundee, UK
| | | | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, The Netherlands
| | - Dina Ruano
- Department of Pathology, Leiden University Medical Center, The Netherlands
| | - Carli Tops
- Department of Clinical Genetics, Leiden University Medical Center, The Netherlands
| | - Juul Wijnen
- Department of Human Genetics, Leiden University Medical Center, The Netherlands
| | - Melanie Schrumpf
- Department of Pathology, Leiden University Medical Center, The Netherlands
| | - Arnoud Boot
- Department of Pathology, Leiden University Medical Center, The Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology, Leiden University Medical Center, The Netherlands
| | - Frederik J. Hes
- Department of Clinical Genetics, Leiden University Medical Center, The Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, The Netherlands
| | - Andre Franke
- Institute of Clinical Molecular Biology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Wolgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel
| | - Clemens Schafmayer
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Stephan Buch
- Medical Department 1, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Peter Propping
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 205 02 Malmö, Sweden
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 205 02 Malmö, Sweden
| | - Helga Westers
- University of Groningen, University Medical Centre Groningen, Department of Genetics, PO Box 30001, 9700 RB Groningen, the Netherlands
| | - Robert Hofstra
- University of Groningen, University Medical Centre Groningen, Department of Genetics, PO Box 30001, 9700 RB Groningen, the Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, the Netherlands
| | - Manuela Pinheiro
- Department of Genetics, Portuguese Oncology Institute and Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Carla Pinto
- Department of Genetics, Portuguese Oncology Institute and Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Manuel Teixeira
- Department of Genetics, Portuguese Oncology Institute and Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Clara Ruiz-Ponte
- Fundación Pública Galega de Medicina Xenómica (FPGMX), Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Genomics Medicine Group, Hospital Clínico, 15706 Santiago de Compostela, University of Santiago de Compostela, Galicia, Spain
| | - Ceres Fernández-Rozadilla
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
- Fundación Pública Galega de Medicina Xenómica (FPGMX), Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Genomics Medicine Group, Hospital Clínico, 15706 Santiago de Compostela, University of Santiago de Compostela, Galicia, Spain
| | - Angel Carracedo
- Fundación Pública Galega de Medicina Xenómica (FPGMX), Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Genomics Medicine Group, Hospital Clínico, 15706 Santiago de Compostela, University of Santiago de Compostela, Galicia, Spain
| | - Antoni Castells
- Servei de Gastroenterologia, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Sergi Castellví-Bel
- Servei de Gastroenterologia, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Harry Campbell
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - D. Timothy Bishop
- Section of Epidemiology & Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, St James’s University Hospital, Leeds, UK
| | - Ian P M Tomlinson
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Malcolm G. Dunlop
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - Richard S. Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
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Litchfield K, Holroyd A, Lloyd A, Broderick P, Nsengimana J, Eeles R, Easton DF, Dudakia D, Bishop DT, Reid A, Huddart RA, Grotmol T, Wiklund F, Shipley J, Houlston RS, Turnbull C. Identification of four new susceptibility loci for testicular germ cell tumour. Nat Commun 2015; 6:8690. [PMID: 26503584 PMCID: PMC4846317 DOI: 10.1038/ncomms9690] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/17/2015] [Indexed: 02/06/2023] Open
Abstract
Genome-wide association studies (GWAS) have identified multiple risk loci for testicular germ cell tumour (TGCT), revealing a polygenic model of disease susceptibility strongly influenced by common variation. To identify additional single-nucleotide polymorphisms (SNPs) associated with TGCT, we conducted a multistage GWAS with a combined data set of >25,000 individuals (6,059 cases and 19,094 controls). We identified new risk loci for TGCT at 3q23 (rs11705932, TFDP2, P=1.5 × 10(-9)), 11q14.1 (rs7107174, GAB2, P=9.7 × 10(-11)), 16p13.13 (rs4561483, GSPT1, P=1.6 × 10(-8)) and 16q24.2 (rs55637647, ZFPM1, P=3.4 × 10(-9)). We additionally present detailed functional analysis of these loci, identifying a statistically significant relationship between rs4561483 risk genotype and increased GSPT1 expression in TGCT patient samples. These findings provide additional support for a polygenic model of TGCT risk and further insight into the biological basis of disease development.
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Affiliation(s)
- Kevin Litchfield
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Amy Holroyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Amy Lloyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Peter Broderick
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Jérémie Nsengimana
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, Leeds LS9 7TF, UK
| | - Rosalind Eeles
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Douglas F Easton
- Cancer Research UK, Genetic Epidemiology Unit, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Darshna Dudakia
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - D. Timothy Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, Leeds LS9 7TF, UK
| | - Alison Reid
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Robert A. Huddart
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Tom Grotmol
- Department of Research, Cancer Registry of Norway, 0369 Oslo, Norway
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Janet Shipley
- Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London SM2 5NG, UK
| | - Richard S. Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
- William Harvey Research Institute, Queen Mary University, London EC1M 6BQ, UK
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Spelman T, Morris MD, Zang G, Rice T, Page K, Maher L, Lloyd A, Grebely J, Dore GJ, Kim AY, Shoukry NH, Hellard M, Bruneau J. A longitudinal study of hepatitis C virus testing and infection status notification on behaviour change in people who inject drugs. J Epidemiol Community Health 2015; 69:745-52. [PMID: 25814695 PMCID: PMC4515217 DOI: 10.1136/jech-2014-205224] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 11/10/2014] [Accepted: 02/26/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) testing and counselling have the potential to impact individual behaviour and transmission dynamics at the population level. Evidence of the impact of an HCV-positive status notification on injection risk reduction is limited. The objective of our study was to (1) assess drug and alcohol use and injection risk behaviours following notification; (2) to compare behaviour change in people who inject drugs (PWID) who received a positive test result and those who remained negative; and (3) to assess the effect of age on risk behaviour. METHODS Data from the International Collaboration of Incident HIV and HCV Infection in Injecting Cohorts (InC3 Study) were analysed. Participants who were initially HCV seronegative were followed prospectively with periodic HCV blood testing and post-test disclosure and interview-administered questionnaires assessing drug use and injection behaviours. Multivariable generalised estimating equations were used to assess behavioural changes over time. RESULTS Notification of an HCV-positive test was independently associated with a small increase in alcohol use relative to notification of a negative test. No significant differences in postnotification injection drug use, receptive sharing of ancillary injecting equipment and syringe borrowing postnotification were observed between diagnosis groups. Younger PWID receiving a positive HCV test notification demonstrated a significant increase in subsequent alcohol use compared with younger HCV negative. CONCLUSIONS The proportion of PWID reporting alcohol use increased among those receiving an HCV-positive notification, increased the frequency of alcohol use postnotification, while no reduction in injection drug use behaviours was observed between notification groups. These findings underscore the need to develop novel communication strategies during post-test notification to improve their impact on subsequent alcohol use and risk behaviours.
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Affiliation(s)
- T Spelman
- Centre of Population Health, Burnet Institute, Melbourne, Victoria, Australia
| | - M D Morris
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - G Zang
- Centre Hospitalier de l'Université de Montréal Research Center (CRCHUM), Université de Montréal, Montréal, Canada
| | - T Rice
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - K Page
- Department of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico Health Sciences Center
| | - L Maher
- Kirby Institute, UNSW Australia, Sydney, Australia
| | - A Lloyd
- UNSW Australia, Sydney, Australia
| | - J Grebely
- Kirby Institute, UNSW Australia, Sydney, Australia
| | - G J Dore
- Kirby Institute, UNSW Australia, Sydney, Australia
| | - A Y Kim
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - N H Shoukry
- Centre Hospitalier de l'Université de Montréal Research Center (CRCHUM), Université de Montréal, Montréal, Canada
| | - M Hellard
- Centre of Population Health, Burnet Institute, Melbourne, Victoria, Australia
| | - J Bruneau
- Centre Hospitalier de l'Université de Montréal Research Center (CRCHUM), Université de Montréal, Montréal, Canada
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Lloyd A. National child measurement programme: does it work? Perspect Public Health 2015; 135:128-9. [DOI: 10.1177/1757913914566546] [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: 11/15/2022]
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Amadio PC, Lloyd A, Amundson BA. Commentary on P. C. Cavadas, A. Pérez-García, A. Thione and C. Lorca-García, single-stage reconstruction of flexor tendons with vascularized tendon transfers. J Hand Surg Eur Vol 2015; 40:269-70. [PMID: 25698799 DOI: 10.1177/1753193414552944] [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: 02/03/2023]
Affiliation(s)
- Peter C Amadio
- Professor of Orthopedic Surgery Mayo Clinic Rochester, MN USA
| | - A Lloyd
- Professor of Orthopedic Surgery Mayo Clinic Rochester, MN USA
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Kendall M, Carduff E, Lloyd A, Kimbell B, Pinnock H, Murray SA. DANCING TO A DIFFERENT TUNE: LIVING AND DYING WITH CANCER, ORGAN FAILURE AND PHYSICAL FRAILTY. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nafees B, Lloyd A, Kennedy-Martin T, Hynd S. How diabetes and insulin therapy affects the lives of people with type 1 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Oostendorp LJM, Durand MA, Lloyd A, Elwyn G. Measuring organisational readiness for patient engagement (MORE): an international online Delphi consensus study. BMC Health Serv Res 2015; 15:61. [PMID: 25879457 PMCID: PMC4334597 DOI: 10.1186/s12913-015-0717-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 01/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Widespread implementation of patient engagement by organisations and clinical teams is not a reality yet. The aim of this study is to develop a measure of organisational readiness for patient engagement designed to monitor and facilitate a healthcare organisation’s willingness and ability to effectively implement patient engagement in healthcare. Methods The development of the MORE (Measuring Organisational Readiness for patient Engagement) scale was guided by Weiner’s theory of organisational readiness for change. Weiner postulates that an organisation’s readiness is determined by both the willingness and ability to implement the change (i.e. in this context: patient engagement). A first version of the scale was developed based on a literature search and evaluation of pre-existing tools. We invited multi-disciplinary stakeholders to participate in a two-round online Delphi survey. Respondents were asked to rate the importance of each proposed item, and to comment on the proposed domains and items. Second round participants received feedback from the first round and were asked to re-rate the importance of the revised, new and unchanged items, and to provide comments. Results The first version of the scale contained 51 items divided into three domains: (1) Respondents’ characteristics; (2) the organisation’s willingness to implement patient engagement; and (3) the organisation’s ability to implement patient engagement. 131 respondents from 16 countries (health care managers, policy makers, clinicians, patients and patient representatives, researchers, and other stakeholders) completed the first survey, and 72 of them also completed the second survey. During the Delphi process, 34 items were reworded, 8 new items were added, 5 items were removed, and 18 were combined. The scale’s instructions were revised. The final version of MORE totalled 38 items; 5 on stakeholders, 13 on an organisation’s willingness to implement, and 20 on an organisation’s ability to implement patient engagement in healthcare. Conclusions The Delphi technique was successfully used to refine the scale’s instructions, domains and items, using input from a broad range of international stakeholders, hoping that MORE can be applied in a variety of healthcare contexts worldwide. Further assessment is needed to determine the psychometric properties of the scale.
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Affiliation(s)
- Linda J M Oostendorp
- Department of Psychology, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield, UK.
| | - Marie-Anne Durand
- Department of Psychology, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield, UK. .,The Dartmouth Institute for Health Policy and Clinical Practice, HB 7256, Dartmouth College, Hanover, NH, 03755, USA.
| | - Amy Lloyd
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, UK.
| | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, USA.
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Chubb D, Broderick P, Frampton M, Kinnersley B, Sherborne A, Penegar S, Lloyd A, Ma YP, Dobbins SE, Houlston RS. Genetic diagnosis of high-penetrance susceptibility for colorectal cancer (CRC) is achievable for a high proportion of familial CRC by exome sequencing. J Clin Oncol 2015; 33:426-32. [PMID: 25559809 DOI: 10.1200/jco.2014.56.5689] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Knowledge of the contribution of high-penetrance susceptibility to familial colorectal cancer (CRC) is relevant to the counseling, treatment, and surveillance of CRC patients and families. PATIENTS AND METHODS To quantify the impact of germline mutation to familial CRC, we sequenced the mismatch repair genes (MMR) APC, MUTYH, and SMAD4/BMPR1A in 626 early-onset familial CRC cases ascertained through a population-based United Kingdom national registry. In addition, we evaluated the contribution of mutations in the exonuclease domain (exodom) of POLE and POLD1 genes that have recently been reported to confer CRC risk. RESULTS Overall mutations (pathogenic, likely pathogenic) in MMR genes make the highest contribution to familial CRC (10.9%). Mutations in the other established CRC genes account for 3.3% of cases. POLE/POLD1 exodom mutations were identified in three patients with family histories consistent with dominant transmission of CRC. Collectively, mutations in the known genes account for 14.2% of familial CRC (89 of 626 cases; 95% CI = 11.5, 17.2). CONCLUSION A genetic diagnosis is feasible in a high proportion of familial CRC. Mainstreaming such analysis in clinical practice should enable the medical management of patients and their families to be optimized. Findings suggest CRC screening of POLE and POLD1 mutation carriers should be comparable to that afforded to those at risk of HNPCC. Although the risk of CRC associated with unexplained familial CRC is in general moderate, in some families the risk is substantive and likely to be the consequence of unidentified genes, as exemplified by POLE and POLD1. Our findings have utility in the design of genetic analyses to identify such novel CRC risk genes.
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Affiliation(s)
- Daniel Chubb
- All authors: Institute of Cancer Research, London, United Kingdom
| | - Peter Broderick
- All authors: Institute of Cancer Research, London, United Kingdom
| | - Matthew Frampton
- All authors: Institute of Cancer Research, London, United Kingdom
| | - Ben Kinnersley
- All authors: Institute of Cancer Research, London, United Kingdom
| | - Amy Sherborne
- All authors: Institute of Cancer Research, London, United Kingdom
| | - Steven Penegar
- All authors: Institute of Cancer Research, London, United Kingdom
| | - Amy Lloyd
- All authors: Institute of Cancer Research, London, United Kingdom
| | - Yussanne P Ma
- All authors: Institute of Cancer Research, London, United Kingdom
| | - Sara E Dobbins
- All authors: Institute of Cancer Research, London, United Kingdom
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Tavella R, O’Toole K, Tirimacco R, Lloyd A, Pennington K, Drilling S, Poulsen V, Berry N, Clark R, Astley C, Keech W. Cardiac rehabilitation referral and completion: results from the South Australian minimum dataset for cardiac rehabilitation programs. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hoogendoorn M, Feenstra T, Asukai Y, Borg S, Hansen RN, Jansson SA, Samyshkin Y, Wacker M, Briggs A, Lloyd A, Sullivan SD, Rutten-van Mölken MP. Cost-Effectiveness Models for Chronic Obstructive Pulmonary Disease (COPD): Cross-Model Comparison of Hypothetical Treatment Scenarios. Value Health 2014; 17:A557-A558. [PMID: 27201829 DOI: 10.1016/j.jval.2014.08.1836] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M Hoogendoorn
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Y Asukai
- IMS Health, Economics and Outcomes Research, London, UK
| | - S Borg
- The Swedish Institute for Health Economics, Lund, Sweden
| | - R N Hansen
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | | | - Y Samyshkin
- IMS Health, Economics and Outcomes Research, London, UK
| | - M Wacker
- Helmholtz Zentrum Munchen, Neuherberg, Germany
| | - A Briggs
- University of Glasgow, Glasgow, UK
| | - A Lloyd
- IMS Health, Economics and Outcomes Research, London, UK
| | - S D Sullivan
- University of Washington, Pharmaceutical Outcomes Research and Policy Program, Seattle, WA, USA
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Ballinger R, Friedemann C, Golics CJ, Lloyd A, Doyle S. Impact of Non-Consented Switch and Subsequent Switch in Asthma Medication: Qualitative Study of Patient Perspective in the UK. Value Health 2014; 17:A602. [PMID: 27202080 DOI: 10.1016/j.jval.2014.08.2089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | - S Doyle
- GlaxoSmithKline, Uxbridge, UK
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Hudgens S, Briggs A, Tremblay G, Forsythe A, Lloyd A. Comparison of Methods to Estimate Health State Utilities in Metastatic Breast Cancer (MBC). Value Health 2014; 17:A557. [PMID: 27201830 DOI: 10.1016/j.jval.2014.08.1835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- S Hudgens
- Clinical Outcomes Solutions, Tucson, AZ, USA
| | - A Briggs
- University of Glasgow, Glasgow, UK
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Elwyn G, Lloyd A, May C, van der Weijden T, Stiggelbout A, Edwards A, Frosch DL, Rapley T, Barr P, Walsh T, Grande SW, Montori V, Epstein R. Collaborative deliberation: a model for patient care. Patient Educ Couns 2014; 97:158-164. [PMID: 25175366 DOI: 10.1016/j.pec.2014.07.027] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/04/2014] [Accepted: 07/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Existing theoretical work in decision making and behavior change has focused on how individuals arrive at decisions or form intentions. Less attention has been given to theorizing the requirements that might be necessary for individuals to work collaboratively to address difficult decisions, consider new alternatives, or change behaviors. The goal of this work was to develop, as a forerunner to a middle range theory, a conceptual model that considers the process of supporting patients to consider alternative health care options, in collaboration with clinicians, and others. METHODS Theory building among researchers with experience and expertise in clinician-patient communication, using an iterative cycle of discussions. RESULTS We developed a model composed of five inter-related propositions that serve as a foundation for clinical communication processes that honor the ethical principles of respecting individual agency, autonomy, and an empathic approach to practice. We named the model 'collaborative deliberation.' The propositions describe: (1) constructive interpersonal engagement, (2) recognition of alternative actions, (3) comparative learning, (4) preference construction and elicitation, and (5) preference integration. CONCLUSIONS We believe the model underpins multiple suggested approaches to clinical practice that take the form of patient centered care, motivational interviewing, goal setting, action planning, and shared decision making.
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Affiliation(s)
- Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA.
| | - Amy Lloyd
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, UK
| | - Trudy van der Weijden
- School Caphri, Department of Family Medicine, Maastricht University, The Netherlands
| | - Anne Stiggelbout
- Department of Medical Decision Making, Leiden University, The Netherlands
| | - Adrian Edwards
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, UK
| | - Dominick L Frosch
- Gordon and Betty Moore Foundation, USA; Department of Medicine, The University of California, Los Angeles, USA; Palo Alto Medical Foundation Research Institute, USA
| | - Tim Rapley
- Institute of Health & Society, Newcastle University, UK
| | - Paul Barr
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA
| | - Thom Walsh
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA
| | - Stuart W Grande
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA
| | - Victor Montori
- Health Care Delivery Research Program, Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, USA
| | - Ronald Epstein
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester, USA
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Troelsgaard A, Pitcher A, Granados D, Hemels M, Lloyd A. The Cost-Effectiveness of Canagliflozin Compared With Liraglutide in Patients With Type 2 Diabetes Inadequately Controlled With Metformin and Sulfonylurea In France. Value Health 2014; 17:A346-A347. [PMID: 27200657 DOI: 10.1016/j.jval.2014.08.707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Kerr C, Fordham B, de Freitas HM, Pelletier CL, Lloyd A. Health State Utility Valuation in Radio-Iodine Refractory Differentiated Thyroid Cancer (RR-DTC). Value Health 2014; 17:A646. [PMID: 27202322 DOI: 10.1016/j.jval.2014.08.2339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Whiffin N, Hosking FJ, Farrington SM, Palles C, Dobbins SE, Zgaga L, Lloyd A, Kinnersley B, Gorman M, Tenesa A, Broderick P, Wang Y, Barclay E, Hayward C, Martin L, Buchanan DD, Win AK, Hopper J, Jenkins M, Lindor NM, Newcomb PA, Gallinger S, Conti D, Schumacher F, Casey G, Liu T, Campbell H, Lindblom A, Houlston RS, Tomlinson IP, Dunlop MG. Identification of susceptibility loci for colorectal cancer in a genome-wide meta-analysis. Hum Mol Genet 2014; 23:4729-37. [PMID: 24737748 PMCID: PMC4133584 DOI: 10.1093/hmg/ddu177] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [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: 01/07/2014] [Revised: 04/03/2014] [Accepted: 04/10/2014] [Indexed: 02/06/2023] Open
Abstract
To identify common variants influencing colorectal cancer (CRC) risk, we performed a meta-analysis of five genome-wide association studies, comprising 5626 cases and 7817 controls of European descent. We conducted replication of top ranked single nucleotide polymorphisms (SNPs) in additional series totalling 14 037 cases and 15 937 controls, identifying a new CRC risk locus at 10q24.2 [rs1035209; odds ratio (OR) = 1.13, P = 4.54 × 10(-11)]. We also performed meta-analysis of our studies, with previously published data, of several recently purported CRC risk loci. We failed to find convincing evidence for a previously reported genome-wide association at rs11903757 (2q32.3). Of the three additional loci for which evidence of an association in Europeans has been previously described we failed to show an association between rs59336 (12q24.21) and CRC risk. However, for the other two SNPs, our analyses demonstrated new, formally significant associations with CRC. These are rs3217810 intronic in CCND2 (12p13.32; OR = 1.19, P = 2.16 × 10(-10)) and rs10911251 near LAMC1 (1q25.3; OR = 1.09, P = 1.75 × 10(-8)). Additionally, we found some evidence to support a relationship between, rs647161, rs2423297 and rs10774214 and CRC risk originally identified in East Asians in our European datasets. Our findings provide further insights into the genetic and biological basis of inherited genetic susceptibility to CRC.
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Affiliation(s)
- Nicola Whiffin
- Molecular and Population Genetics, Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Fay J Hosking
- Molecular and Population Genetics, Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Susan M Farrington
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh EH4 2XU, UK
| | - Claire Palles
- Wellcome Trust Centre for Human Genetics, Oxford, UK
| | - Sara E Dobbins
- Molecular and Population Genetics, Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Lina Zgaga
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh EH4 2XU, UK
| | - Amy Lloyd
- Molecular and Population Genetics, Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Ben Kinnersley
- Molecular and Population Genetics, Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Maggie Gorman
- Wellcome Trust Centre for Human Genetics, Oxford, UK
| | - Albert Tenesa
- The Roslin Institute, University of Edinburgh, Easter Bush, Roslin EH25 9RG, UK
| | - Peter Broderick
- Molecular and Population Genetics, Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Yufei Wang
- Molecular and Population Genetics, Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Ella Barclay
- Wellcome Trust Centre for Human Genetics, Oxford, UK
| | - Caroline Hayward
- Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Lynn Martin
- Wellcome Trust Centre for Human Genetics, Oxford, UK
| | - Daniel D Buchanan
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Queensland, Australia
| | - Aung Ko Win
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Victoria, Australia
| | - John Hopper
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Victoria, Australia
| | - Mark Jenkins
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Victoria, Australia
| | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Polly A Newcomb
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Steve Gallinger
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - David Conti
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Fred Schumacher
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Graham Casey
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tao Liu
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Richard S Houlston
- Molecular and Population Genetics, Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Ian P Tomlinson
- The Roslin Institute, University of Edinburgh, Easter Bush, Roslin EH25 9RG, UK
| | - Malcolm G Dunlop
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital Edinburgh, Crewe Road, Edinburgh EH4 2XU, UK
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