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Tsocheva I, Scales J, Dove R, Chavda J, Kalsi H, Wood HE, Colligan G, Cross L, Newby C, Hall A, Keating M, Sartori L, Moon J, Thomson A, Tomini F, Murray A, Hamad W, Tijm S, Hirst A, Vincent BP, Kotala P, Balkwill F, Mihaylova B, Grigg J, Quint JK, Fletcher M, Mon-Williams M, Wright J, van Sluijs E, Beevers S, Randhawa G, Eldridge S, Sheikh A, Gauderman W, Kelly F, Mudway IS, Griffiths CJ. Investigating the impact of London's ultra low emission zone on children's health: children's health in London and Luton (CHILL) protocol for a prospective parallel cohort study. BMC Pediatr 2023; 23:556. [PMID: 37925402 PMCID: PMC10625305 DOI: 10.1186/s12887-023-04384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Air pollution harms health across the life course. Children are at particular risk of adverse effects during development, which may impact on health in later life. Interventions that improve air quality are urgently needed both to improve public health now, and prevent longer-term increased vulnerability to chronic disease. Low Emission Zones are a public health policy intervention aimed at reducing traffic-derived contributions to urban air pollution, but evidence that they deliver health benefits is lacking. We describe a natural experiment study (CHILL: Children's Health in London and Luton) to evaluate the impacts of the introduction of London's Ultra Low Emission Zone (ULEZ) on children's health. METHODS CHILL is a prospective two-arm parallel longitudinal cohort study recruiting children at age 6-9 years from primary schools in Central London (the focus of the first phase of the ULEZ) and Luton (a comparator site), with the primary outcome being the impact of changes in annual air pollutant exposures (nitrogen oxides [NOx], nitrogen dioxide [NO2], particulate matter with a diameter of less than 2.5micrograms [PM2.5], and less than 10 micrograms [PM10]) across the two sites on lung function growth, measured as post-bronchodilator forced expiratory volume in one second (FEV1) over five years. Secondary outcomes include physical activity, cognitive development, mental health, quality of life, health inequalities, and a range of respiratory and health economic data. DISCUSSION CHILL's prospective parallel cohort design will enable robust conclusions to be drawn on the effectiveness of the ULEZ at improving air quality and delivering improvements in children's respiratory health. With increasing proportions of the world's population now living in large urban areas exceeding World Health Organisation air pollution limit guidelines, our study findings will have important implications for the design and implementation of Low Emission and Clean Air Zones in the UK, and worldwide. CLINICALTRIALS GOV: NCT04695093 (05/01/2021).
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Affiliation(s)
- Ivelina Tsocheva
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Bedfordshire, LU2 8LE, UK.
- Asthma UK Centre for Applied Research, London, UK.
| | - James Scales
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rosamund Dove
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jasmine Chavda
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Bedfordshire, LU2 8LE, UK
- Asthma UK Centre for Applied Research, London, UK
| | - Harpal Kalsi
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Helen E Wood
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Grainne Colligan
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Louise Cross
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris Newby
- Asthma UK Centre for Applied Research, London, UK
- University of Nottingham, Nottingham, UK
| | - Amy Hall
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mia Keating
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Luke Sartori
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jessica Moon
- Asthma UK Centre for Applied Research, London, UK
- Centre of the Cell, Queen Mary University of London, London, UK
| | - Ann Thomson
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Florian Tomini
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Aisling Murray
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Wasim Hamad
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah Tijm
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alice Hirst
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Centre of the Cell, Queen Mary University of London, London, UK
| | - Britzer Paul Vincent
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Bedfordshire, LU2 8LE, UK
- Asthma UK Centre for Applied Research, London, UK
| | - Pavani Kotala
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Bedfordshire, LU2 8LE, UK
- Asthma UK Centre for Applied Research, London, UK
| | | | - Borislava Mihaylova
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonathan Grigg
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Monica Fletcher
- Asthma UK Centre for Applied Research, London, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - John Wright
- Bradford Institute for Health Research, Bradford, UK
| | | | - Sean Beevers
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Bedfordshire, LU2 8LE, UK
- Asthma UK Centre for Applied Research, London, UK
| | - Sandra Eldridge
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, London, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
- MRC - Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - William Gauderman
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Frank Kelly
- Asthma UK Centre for Applied Research, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Ian S Mudway
- Asthma UK Centre for Applied Research, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Christopher J Griffiths
- Asthma UK Centre for Applied Research, London, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- MRC - Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
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Berman DM, Lee AY, Lesurf R, Patel PG, Ebrahimizadeh W, Bayani J, Lee LA, Boufaied N, Selvarajah S, Jamaspishvili T, Guérard KP, Dion D, Kawashima A, Clarke GM, How N, Jackson CL, Scarlata E, Siddiqui K, Okello JBA, Aprikian AG, Moussa M, Finelli A, Chin J, Brimo F, Bauman G, Loblaw A, Venkateswaran V, Buttyan R, Chevalier S, Thomson A, Park PC, Siemens DR, Lapointe J, Boutros PC, Bartlett JMS. Multimodal Biomarkers That Predict the Presence of Gleason Pattern 4: Potential Impact for Active Surveillance. J Urol 2023; 210:257-271. [PMID: 37126232 DOI: 10.1097/ju.0000000000003507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE Latent grade group ≥2 prostate cancer can impact the performance of active surveillance protocols. To date, molecular biomarkers for active surveillance have relied solely on RNA or protein. We trained and independently validated multimodal (mRNA abundance, DNA methylation, and/or DNA copy number) biomarkers that more accurately separate grade group 1 from grade group ≥2 cancers. MATERIALS AND METHODS Low- and intermediate-risk prostate cancer patients were assigned to training (n=333) and validation (n=202) cohorts. We profiled the abundance of 342 mRNAs, 100 DNA copy number alteration loci, and 14 hypermethylation sites at 2 locations per tumor. Using the training cohort with cross-validation, we evaluated methods for training classifiers of pathological grade group ≥2 in centrally reviewed radical prostatectomies. We trained 2 distinct classifiers, PRONTO-e and PRONTO-m, and validated them in an independent radical prostatectomy cohort. RESULTS PRONTO-e comprises 353 mRNA and copy number alteration features. PRONTO-m includes 94 clinical, mRNAs, copy number alterations, and methylation features at 14 and 12 loci, respectively. In independent validation, PRONTO-e and PRONTO-m predicted grade group ≥2 with respective true-positive rates of 0.81 and 0.76, and false-positive rates of 0.43 and 0.26. Both classifiers were resistant to sampling error and identified more upgrading cases than a well-validated presurgical risk calculator, CAPRA (Cancer of the Prostate Risk Assessment; P < .001). CONCLUSIONS Two grade group classifiers with superior accuracy were developed by incorporating RNA and DNA features and validated in an independent cohort. Upon further validation in biopsy samples, classifiers with these performance characteristics could refine selection of men for active surveillance, extending their treatment-free survival and intervals between surveillance.
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Affiliation(s)
- D M Berman
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - A Y Lee
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - R Lesurf
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Now with Hospital for Sick Children, Toronto, Ontario, Canada
| | - P G Patel
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Now with Hospital for Sick Children, Toronto, Ontario, Canada
| | - W Ebrahimizadeh
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Now with IMV Inc, Dartmouth, Nova Scotia, Canada
| | - J Bayani
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
| | - L A Lee
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - N Boufaied
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - S Selvarajah
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Now with University Health Network, Toronto, Ontario, Canada
| | - T Jamaspishvili
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - K-P Guérard
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - D Dion
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - A Kawashima
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Now with Osaka University, Osaka, Japan
| | - G M Clarke
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - N How
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - C L Jackson
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - E Scarlata
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - K Siddiqui
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Now with Sultan Qaboos University Hospital, Seeb, Oman
| | - J B A Okello
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - A G Aprikian
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - M Moussa
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - A Finelli
- Princess Margaret Cancer Centre. Toronto, Ontario, Canada
- Departments of Surgery and Oncology, University of Toronto, Toronto, Ontario, Canada
| | - J Chin
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - F Brimo
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - G Bauman
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - A Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Departments of Radiation Oncology and Health Policy Management and Evaluation, University of Toronto, Toronto
| | - V Venkateswaran
- Departments of Surgery and Oncology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - R Buttyan
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada
- Departments of Experimental Medicine and Interdisciplinary Oncology, Vancouver, British Columbia, Canada
| | - S Chevalier
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - A Thomson
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Now with College of Science and Engineering Biology, University of Edinburgh, Edinburgh, United Kingdom
| | - P C Park
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Now with Department of Pathology, Shared Health, Winnipeg, Manitoba, Canada
| | - D R Siemens
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Departments of Urology, Oncology and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - J Lapointe
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - P C Boutros
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Now with University of California, Los Angeles, Los Angeles, California, United States
| | - J M S Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom
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Edwards MR, Forbes G, Walker N, Morton DG, Mythen MG, Murray D, Anderson I, Mihaylova B, Thomson A, Taylor M, Hollyman M, Phillips R, Young K, Kahan BC, Pearse RM, Grocott MPW. Fluid Optimisation in Emergency Laparotomy (FLO-ELA) Trial: study protocol for a multi-centre randomised trial of cardiac output-guided fluid therapy compared to usual care in patients undergoing major emergency gastrointestinal surgery. Trials 2023; 24:313. [PMID: 37149623 PMCID: PMC10163929 DOI: 10.1186/s13063-023-07275-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Postoperative morbidity and mortality in patients undergoing major emergency gastrointestinal surgery are a major burden on healthcare systems. Optimal management of perioperative intravenous fluids may reduce mortality rates and improve outcomes from surgery. Previous small trials of cardiac-output guided haemodynamic therapy algorithms in patients undergoing gastrointestinal surgery have suggested this intervention results in reduced complications and a modest reduction in mortality. However, this existing evidence is based mainly on elective (planned) surgery, with little evaluation in the emergency setting. There are fundamental clinical and pathophysiological differences between the planned and emergency surgical setting which may influence the effects of this intervention. A large definitive trial in emergency surgery is needed to confirm or refute the potential benefits observed in elective surgery and to inform widespread clinical practice. METHODS The FLO-ELA trial is a multi-centre, parallel-group, open, randomised controlled trial. 3138 patients aged 50 and over undergoing major emergency gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intra-venous fluid, or usual care without cardiac output monitoring. The trial intervention will be carried out during surgery and for up to 6 h postoperatively. The trial is funded through an efficient design call by the National Institute for Health and Care Research Health Technology Assessment (NIHR HTA) programme and uses existing routinely collected datasets for the majority of data collection. The primary outcome is the number of days alive and out of hospital within 90 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation. Participant recruitment started in September 2017 with a 1-year internal pilot phase and is ongoing at the time of publication. DISCUSSION This will be the largest contemporary randomised trial examining the effectiveness of perioperative cardiac output-guided haemodynamic therapy in patients undergoing major emergency gastrointestinal surgery. The multi-centre design and broad inclusion criteria support the external validity of the trial. Although the clinical teams delivering the trial interventions will not be blinded, significant trial outcome measures are objective and not subject to detection bias. TRIAL REGISTRATION ISRCTN 14729158. Registered on 02 May 2017.
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Affiliation(s)
- Mark R Edwards
- Department of Anaesthesia, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
- Perioperative & Critical Care Research Group, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust / University of Southampton, Southampton, UK.
| | - Gordon Forbes
- Department of Biostatistics & Health Informatics, King's College London, London, UK
| | - Neil Walker
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Dion G Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Monty G Mythen
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
| | - Dave Murray
- James Cook University Hospital, Middlesbrough, UK
| | - Iain Anderson
- Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
| | - Borislava Mihaylova
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Mary University of London, London, Queen, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ann Thomson
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Matt Taylor
- Department of Critical Care, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | | | - Rachel Phillips
- School of Public Health, Imperial College London, London, UK
| | | | - Brennan C Kahan
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - Rupert M Pearse
- Faculty of Medicine & Dentistry, Mary University of London, London, Queen, UK
| | - Michael P W Grocott
- Perioperative & Critical Care Research Group, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust / University of Southampton, Southampton, UK
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Hall P, Howell S, Venkitaraman R, Thomson A, Raja F, King J, Michie C, Khan S, Brunt A, Gahir D, McAdam K, Cooner J, Kane N. P084 Socioeconomic Outcomes With Ribociclib in Patients With HR+, HER2– Advanced Breast Cancer (ABC) in UK Real-world Settings. Breast 2023. [DOI: 10.1016/s0960-9776(23)00201-1] [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: 03/18/2023] Open
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Alberto M, Thomson A, Jack G. Minimally invasive pyeloplasty in adults: A systematic review on stent vs. stentless technique. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01047-3] [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: 02/12/2023]
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Lim KH, Dorris C, Thomson A, Ardis M, Devlin B, Gray G. 715 Implementation of Enhanced Recovery After Surgery (ERAS) in Total Laryngectomies. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.195] [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: 11/07/2022]
Abstract
Abstract
Aim
The Enhanced Recovery After Surgery (ERAS) protocol for total laryngectomies was first implemented in our tertiary head and neck centre from November 2019. It includes pre-operative carbohydrate loading and an early swallow test which facilitates recommencement of oral intake to improve outcomes. Protocol adherence rate and patient outcomes were measured to determine the effectiveness and benefits of ERAS in laryngectomy patients.
Method
22 total laryngectomy patients from November 2019 to September 2021 were enrolled onto the ERAS protocol, 18 primary and 3 salvage cases. An analysis of the respective patient cohorts was performed to determine adherence to the ERAS protocol and outcomes such as complications and length of inpatient stay were measured.
Results
19 patients (86%) received pre-operative carbohydrate loading successfully, while 3 patients were contraindicated due to background of diabetes. Early swallow test was performed in 59% of patients. Potential reasons for delay were stoma dehiscence or clinical suspicion of neo-pharyngeal leak. 59% of primary cases were deemed medically fit for discharge within the target timeframe of 12–14 days whereas no target was set for salvage cases due to expected poor healing. Main complication in primary cases was neo-pharyngeal leak followed by stoma dehiscence with 28% and 11% respectively.
Conclusion
Limitations of our study include small sample size due to the COVID-19 pandemic. Despite its infancy, the ERAS protocol has achieved good outcomes in early recommencement of oral intake post-laryngectomy and encouraging early safe discharge from hospital. Future plans include establishment of Prehab Clinic and application of ERAS to neck dissection patients.
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Affiliation(s)
- KH Lim
- Royal Victoria Hospital , Belfast , United Kingdom
| | - C Dorris
- Royal Victoria Hospital , Belfast , United Kingdom
| | - A Thomson
- Royal Victoria Hospital , Belfast , United Kingdom
| | - M Ardis
- Royal Victoria Hospital , Belfast , United Kingdom
| | - B Devlin
- Royal Victoria Hospital , Belfast , United Kingdom
| | - G Gray
- Royal Victoria Hospital , Belfast , United Kingdom
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Schow DC, Thomson A, Trusty WT, Buchi-Fotre L. Use of a Research as Intervention Approach to Explore Telebehavioral Health Services During the COVID-19 Pandemic in Southeastern Idaho. J Prim Care Community Health 2022; 13:21501319211072998. [PMID: 35068255 PMCID: PMC8793381 DOI: 10.1177/21501319211072998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Since the inception of the COVID-19 pandemic, telebehavioral health services have been a key contributor to continuation of care in rural and underserved areas of southeastern Idaho. Providers of telebehavioral health services faced numerous challenges as they navigated rapidly shifting regulations, variable access to internet and their own personal understandings of practice. Objective: This study aimed to characterize provider experiences, generate policy- and practice-level recommendations, and raise awareness among community stakeholders regarding telebehavioral health in southeastern Idaho. Methods: Using a newly developed conceptual/analytical framework, a research-as-intervention strategy was employed to conduct and analyze semi-structured interviews, short writings, and photographs from 7 primary care and behavioral health providers in the region. Results: Providers shared examples from practice that addressed technology and training, access-to-care, safety, changing provider roles, payment for services, treatments that are not well suited to telehealth and the nuances of living and working in newly forged spaces of care. Conclusions: Providers found promise in telebehavioral health’s utility as a hybrid model of care, but it must be supported by flexible legislation and policy. For example, it would help to make reimbursement expansions permanent and to simplify inter-jurisdictional practice options. Cross-sharing of information between licensing boards could help providers from various disciplines understand the parameters within which their colleagues must work.
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Morgan E, Thomson A, Kolmajer K, Murch S, Upton J, Williams T. An Examination of Inpatient Care of Heart Failure Patients: A Nursing-Led Review. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.060] [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]
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Katz T, Oh R, Thomson A, Widger J. ePS4.10 The principles of the Toyota Production System (TPS) applied to an inpatient food service model can improve nutritional outcomes for children with cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30319-2] [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: 11/25/2022]
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Stockler M, Martin A, Dhillon H, Davis I, Chi K, Chowdhury S, Horvath L, Lawrence N, Marx G, Caffrey JM, McDermott R, North S, Parnis F, Pook D, Reaume M, Sandhu S, Tan T, Thomson A, Zielinski R, Sweeney C. Health-related quality of life (HRQL) in a randomized phase III trial of enzalutamide with standard first-line therapy for metastatic, hormone-sensitive prostate cancer (mHSPC): ENZAMET (ANZUP 1304), an ANZUP-led, international, co-operative group trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Peden CJ, Stephens T, Martin G, Kahan BC, Thomson A, Everingham K, Kocman D, Lourtie J, Drake S, Girling A, Lilford R, Rivett K, Wells D, Mahajan R, Holt P, Yang F, Walker S, Richardson G, Kerry S, Anderson I, Murray D, Cromwell D, Phull M, Grocott MPW, Bion J, Pearse RM. A national quality improvement programme to improve survival after emergency abdominal surgery: the EPOCH stepped-wedge cluster RCT. Health Serv Deliv Res 2019. [DOI: 10.3310/hsdr07320] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients.
Objectives
The objectives were to assess whether or not the QI programme improves 90-day survival after emergency abdominal surgery; to assess effects on 180-day survival, hospital stay and hospital readmission; and to better understand these findings through an integrated process evaluation, ethnographic study and cost-effectiveness analysis.
Design
This was a stepped-wedge cluster randomised trial. Hospitals were organised into 15 geographical clusters, and commenced the QI programme in random order over 85 weeks. Analyses were performed on an intention-to-treat basis. The primary outcome was analysed using a mixed-effects parametric survival model, adjusting for time-related effects. Ethnographic and economics data were collected in six hospitals. The process evaluation included all hospitals.
Setting
The trial was set in acute surgical services of 93 NHS hospitals.
Participants
Patients aged ≥ 40 years who were undergoing emergency abdominal surgery were eligible.
Intervention
The intervention was a QI programme to implement an evidence-based care pathway.
Main outcome measures
The primary outcome measure was mortality within 90 days of surgery. Secondary outcomes were mortality within 180 days, length of hospital stay and hospital readmission within 180 days. The main economic measure was the quality-adjusted life-years.
Data sources
Data were obtained from the National Emergency Laparotomy Audit database; qualitative interviews and ethnographic observations; quality-of-life and NHS resource use data were collected via questionnaires.
Results
Of 15,873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 participants in the usual care group and 7374 in the QI group. The primary outcome occurred in 1393 participants in the usual care group (16%), compared with 1210 patients in the QI group (16%) [QI vs. usual care hazard ratio (HR) 1.11, 95% confidence interval (CI) 0.96 to 1.28]. No differences were found in mortality at 180 days or hospital readmission; there was a small increase in hospital stay in the QI group (HR for discharge 0.90, 95% CI 0.83 to 0.97). There were only modest improvements in care processes following QI implementation. The ethnographic study revealed good QI engagement, but limited time and resources to implement change, affecting which processes teams addressed, the rate of change and eventual success. In some sites, there were challenges around prioritising the intervention in busy environments and in obtaining senior engagement. The intervention is unlikely to be cost-effective at standard cost-effectiveness thresholds, but may be cost-effective over the lifetime horizon.
Limitations
Substantial delays were encountered in securing data access to national registries. Fewer patients than expected underwent surgery and the mortality rate was lower than anticipated.
Conclusions
There was no survival benefit from a QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. The modest impact of the intervention on process measures, despite good clinician engagement, may have been limited by the time and resources needed to improve patient care.
Future work
Future QI programmes must balance intervention complexity with the practical realities of NHS services to ensure that such programmes can be delivered with the resources available.
Trial registration
Current Controlled Trials ISRCTN80682973 and The Lancet protocol 13PRT/7655.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Carol J Peden
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tim Stephens
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Graham Martin
- Health Sciences, University of Leicester, Leicester, UK
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Ann Thomson
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Kirsty Everingham
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - David Kocman
- Health Sciences, University of Leicester, Leicester, UK
| | | | | | - Alan Girling
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Ravi Mahajan
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Peter Holt
- Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Fan Yang
- Centre for Health Economics, University of York, York, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | | | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Iain Anderson
- Salford Royal Hospital NHS Foundation Trust, Manchester, UK
| | - Dave Murray
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - David Cromwell
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mandeep Phull
- William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Anaesthesia and Intensive Care, Queen’s Hospital, Romford, UK
| | - Mike PW Grocott
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Anaesthesia and Critical Care Research Unit, University of Southampton, Southampton, UK
| | - Julian Bion
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Rupert M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
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Toor IS, Rückerl D, Mair I, Thomson A, Rossi AG, Newby DE, Allen JE, Gray GA. Enhanced monocyte recruitment and delayed alternative macrophage polarization accompanies impaired repair following myocardial infarction in C57BL/6 compared to BALB/c mice. Clin Exp Immunol 2019; 198:83-93. [PMID: 31119724 PMCID: PMC6718279 DOI: 10.1111/cei.13330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 12/24/2022] Open
Abstract
Activation of the innate immune response following myocardial infarction (MI) is essential for infarct repair. Preclinical models of MI commonly use C57BL/6 mice, which have a type 1‐dominant immune response, whereas other mouse strains such as BALB/c mice have a type 2‐dominant immune response. We compared C57BL/6 and BALB/c mice to investigate whether predisposition towards a proinflammatory phenotype influences the dynamics of the innate immune response to MI and associated infarct healing and the risk of cardiac rupture. MI was induced by permanent coronary artery ligation in 12–15‐week‐old male wild‐type BALB/c and C57BL/6 mice. Prior to MI, C57BL/6 mice had a lower proportion of CD206+ anti‐inflammatory macrophages in the heart and an expanded blood pool of proinflammatory Ly6Chigh monocytes in comparison to BALB/c mice. The systemic inflammatory response in C57BL/6 mice following MI was more pronounced, with greater peripheral blood Ly6Chigh monocytosis, splenic Ly6Chigh monocyte mobilization and myeloid cell infiltration of pericardial adipose tissue. This led to an increased and prolonged macrophage accumulation, as well as delayed transition towards anti‐inflammatory macrophage polarization in the infarct zone and surrounding tissues of C57BL/6 mice. These findings accompanied a higher rate of mortality due to cardiac rupture in C57BL/6 mice compared with BALB/c mice. We conclude that lower post‐MI survival of C57BL/6 mice over BALB/c mice is mediated in part by a more pronounced and prolonged inflammatory response. Outcomes in BALB/c mice highlight the therapeutic potential of modulating resolution of the innate immune response following MI for the benefit of successful infarct healing.
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Affiliation(s)
- I S Toor
- BHF/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - D Rückerl
- Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Edinburgh, UK
| | - I Mair
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - A Thomson
- BHF/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - A G Rossi
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - D E Newby
- BHF/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J E Allen
- Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Edinburgh, UK
| | - G A Gray
- BHF/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Peden CJ, Stephens T, Martin G, Kahan BC, Thomson A, Rivett K, Wells D, Richardson G, Kerry S, Bion J, Pearse RM. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Lancet 2019; 393:2213-2221. [PMID: 31030986 DOI: 10.1016/s0140-6736(18)32521-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Carol J Peden
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tim Stephens
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Graham Martin
- Health Sciences, University of Leicester, Leicester, UK
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, London, UK
| | - Ann Thomson
- Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, London, UK
| | | | | | | | - Sally Kerry
- Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, London, UK
| | - Julian Bion
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Rupert M Pearse
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK.
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Thomson A, Mumtaz S, Siddiqi J. Trismus with unilateral facial and neck swelling: an unusual case of Sjogren's Syndrome. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thomson A, Parrish J, Liggins S. Does the knowledge equate to the competence: a case of an emergency admission following post operative complications after same day implant placement. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.175] [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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Thomson A, Parrish J, Polina H, Siddiqi J. Diagnosis of acute myeloid Leukaemia from an emergency referral of facial swelling of suspected dental abscess. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.319] [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]
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Thomson A, Tielens S, Schuhmann T, De Graaf T, Kenis G, Rutten B, Sack A. The effect of transcranial magnetic stimulation on living human neurons. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Edwards MR, Forbes G, MacDonald N, Berdunov V, Mihaylova B, Dias P, Thomson A, Grocott MP, Mythen MG, Gillies MA, Sander M, Phan TD, Evered L, Wijeysundera DN, McCluskey SA, Aldecoa C, Ripollés-Melchor J, Hofer CK, Abukhudair H, Szczeklik W, Grigoras I, Hajjar LA, Kahan BC, Pearse RM. Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery. BMJ Open 2019; 9:e023455. [PMID: 30647034 PMCID: PMC6341180 DOI: 10.1136/bmjopen-2018-023455] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Postoperative morbidity and mortality in older patients with comorbidities undergoing gastrointestinal surgery are a major burden on healthcare systems. Infections after surgery are common in such patients, prolonging hospitalisation and reducing postoperative short-term and long-term survival. Optimal management of perioperative intravenous fluids and inotropic drugs may reduce infection rates and improve outcomes from surgery. Previous small trials of cardiac-output-guided haemodynamic therapy algorithms suggested a modest reduction in postoperative morbidity. A large definitive trial is needed to confirm or refute this and inform widespread clinical practice. METHODS The Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is a multicentre, international, parallel group, open, randomised controlled trial. 2502 high-risk patients undergoing major elective gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intravenous fluid combined with low-dose inotrope infusion, or usual care. The trial intervention will be carried out during and for 4 hours after surgery. The primary outcome is postoperative infection of Clavien-Dindo grade II or higher within 30 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation; however, outcome assessors will be blinded when feasible. Participant recruitment started in January 2017 and is scheduled to last 3 years, within 50 hospitals worldwide. ETHICS/DISSEMINATION The OPTIMISE II trial has been approved by the UK National Research Ethics Service and has been approved by responsible ethics committees in all participating countries. The findings will be disseminated through publication in a widely accessible peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER ISRCTN39653756.
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Affiliation(s)
- Mark R Edwards
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Acute, Critical & Perioperative Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Gordon Forbes
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Neil MacDonald
- Department of Perioperative and Pain Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Vladislav Berdunov
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Borislava Mihaylova
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Ann Thomson
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Michael Pw Grocott
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Acute, Critical & Perioperative Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Monty G Mythen
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
| | - Mike A Gillies
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael Sander
- Department of Anaesthesiology and Intensive Care Medicine, UKGM University Hospital Gießen, Justus-Liebig-University Giessen, Gießen, Germany
| | - Tuong D Phan
- St Vincent's Hospital Melbourne, and Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Australia
| | - Lisbeth Evered
- St Vincent's Hospital Melbourne, and Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Australia
| | - Duminda N Wijeysundera
- Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Canada
| | - Stuart A McCluskey
- Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Canada
| | - Cesar Aldecoa
- Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - Christoph K Hofer
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital, Zurich, Switzerland
| | | | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Ioana Grigoras
- Regional Institute of Oncology Iasi, "Grigore T Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Ludhmila A Hajjar
- Intensive Care Unit, Department of Cardiopneumology, University of Sao Paulo, São Paulo, Brazil
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
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Ho SF, Thomson A, Kerr A. 52FEEDBACK INTEGRATED REHABILITATION FOR SIT-TO-STAND TRAINING (FIRST): A PILOT RANDOMISED CONTROLLED TRIAL. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S F Ho
- Biomedical Engineering, The University of Strathclyde, Glasgow, Scotland, U.K
| | - A Thomson
- Biomedical Engineering, The University of Strathclyde, Glasgow, Scotland, U.K
| | - A Kerr
- Biomedical Engineering, The University of Strathclyde, Glasgow, Scotland, U.K
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Flores CJ, Quested B, Spigiel T, Thomson A, Saxon B. Junior doctors' perspectives on transfusion education in Australia. Vox Sang 2018; 113:441-448. [PMID: 29740847 DOI: 10.1111/vox.12654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early postgraduate training is a critical period to develop skills and to influence future clinical practice. Little is known about Australian junior doctors' existing transfusion knowledge and its application in patient care. This study explored their transfusion practice education preferences, developed tools to assist their practice and assessed the usefulness of these tools. METHODS A design-based study was conducted in two phases from April 2016 to March 2017. Phase 1 involved focus group sessions in six hospitals. Transcripts of audio recordings were analysed using thematic analysis. Findings were considered when developing transfusion practice support tools. Phase 2 surveyed junior doctors' response to the tools provided during orientation in five hospitals. Participation was voluntary. RESULTS Fifty-two junior doctors participated in the focus groups. Their priority was to be able to practice safely, appropriately and confidently. Preferred format for transfusion learning included expert-led face-to-face education; printed tools, for example lanyard cards; and for one app that covers essential aspects of transfusion practice. Adverse events management and practical transfusion prescribing were topics of most importance. Thirty-nine survey respondents found the transfusion practice support tools useful and recommended their use to complement practice. CONCLUSION There is a need for improved education to ensure best transfusion practice and patient outcomes. Australian junior doctors want immediate, practical, reliable transfusion information from credible sources to support them in practicing safely and confidently. Their educational needs are driven by real-time patient management. Promotion of the available resources and tools provided by the blood sector is important.
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Affiliation(s)
- C J Flores
- Clinical Services and Research Division, Australian Red Cross Blood Service, Melbourne, VIC, Australia
| | - B Quested
- Clinical Services and Research Division, Australian Red Cross Blood Service, Adelaide, SA, Australia
| | - T Spigiel
- Clinical Services and Research Division, Australian Red Cross Blood Service, Adelaide, SA, Australia
| | - A Thomson
- Clinical Services and Research Division, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - B Saxon
- Clinical Services and Research Division, Australian Red Cross Blood Service, Adelaide, SA, Australia
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Knazovicky D, Helgeson E, Case B, Thomson A, Gruen M, Maixner W, Lascelles B. Replicate Effects and Test–Retest Reliability of Quantitative Sensory Threshold Testing in Dogs with and without Chronic Pain. Vet Comp Orthop Traumatol 2018. [DOI: 10.1055/s-0038-1660882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D. Knazovicky
- Comparative Pain Research and Education Centre, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States
| | - E. Helgeson
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, United States
| | - B. Case
- Comparative Pain Research and Education Centre, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States
| | - A. Thomson
- Comparative Pain Research and Education Centre, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States
| | - M. Gruen
- Comparative Pain Research and Education Centre, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States
| | - W. Maixner
- Canine Cognition Center, Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, United States
| | - B. Lascelles
- Comparative Pain Research and Education Centre, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States
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Dubuisson N, Paterson A, Turner B, Westcott M, Thomson A, Giovannoni G. Self-monitoring visual function via a smartphone application. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3559] [Citation(s) in RCA: 3] [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: 11/16/2022]
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Atkin W, Wooldrage K, Brenner A, Martin J, Shah U, Perera S, Lucas F, Brown JP, Kralj-Hans I, Greliak P, Pack K, Wood J, Thomson A, Veitch A, Duffy SW, Cross AJ. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. Lancet Oncol 2017; 18:823-834. [PMID: 28457708 PMCID: PMC5461371 DOI: 10.1016/s1470-2045(17)30187-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Removal of adenomas reduces colorectal cancer incidence and mortality; however, the benefit of surveillance colonoscopy on colorectal cancer risk remains unclear. We examined heterogeneity in colorectal cancer incidence in intermediate-risk patients and the effect of surveillance on colorectal cancer incidence. METHODS We did this retrospective, multicentre, cohort study using routine lower gastrointestinal endoscopy and pathology data from patients who, after baseline colonoscopy and polypectomy, were diagnosed with intermediate-risk adenomas mostly (>99%) between Jan 1, 1990, and Dec 31, 2010, at 17 hospitals in the UK. These patients are currently offered surveillance colonoscopy at intervals of 3 years. Patients were followed up through to Dec 31, 2014.We assessed the effect of surveillance on colorectal cancer incidence using Cox regression with adjustment for patient, procedural, and polyp characteristics. We defined lower-risk and higher-risk subgroups on the basis of polyp and procedural characteristics identified as colorectal cancer risk factors. We estimated colorectal cancer incidence and standardised incidence ratios (SIRs) using as standard the general population of England in 2007. This trial is registered, number ISRCTN15213649. FINDINGS 253 798 patients who underwent colonic endoscopy were identified, of whom 11 944 with intermediate-risk adenomas were included in this analysis. After a median follow-up of 7·9 years (IQR 5·6-11·1), 210 colorectal cancers were diagnosed. 5019 (42%) patients did not attend surveillance and 6925 (58%) attended one or more surveillance visits. Compared to no surveillance, one or two surveillance visits were associated with a significant reduction in colorectal cancer incidence rate (adjusted hazard ratio 0·57, 95% CI 0·40-0·80 for one visit; 0·51, 0·31-0·84 for two visits). Without surveillance, colorectal cancer incidence in patients with a suboptimal quality colonoscopy, proximal polyps, or a high-grade or large adenoma (≥20 mm) at baseline (8865 [74%] patients) was significantly higher than in the general population (SIR 1·30, 95% CI 1·06-1·57). By contrast, in patients without these features, colorectal cancer incidence was lower than that of the general population (SIR 0·51, 95% CI 0·29-0·84). INTERPRETATION Colonoscopy surveillance benefits most patients with intermediate-risk adenomas. However, some patients are already at low risk after baseline colonoscopy and the value of surveillance for them is unclear. FUNDING National Institute for Health Research Health Technology Assessment, Cancer Research UK.
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Affiliation(s)
- Wendy Atkin
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Amy Brenner
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jessica Martin
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Urvi Shah
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sajith Perera
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Fiona Lucas
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jeremy P Brown
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ines Kralj-Hans
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Greliak
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Pack
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jill Wood
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ann Thomson
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, UK
| | - Amanda J Cross
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
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Atkin W, Brenner A, Martin J, Wooldrage K, Shah U, Lucas F, Greliak P, Pack K, Kralj-Hans I, Thomson A, Perera S, Wood J, Miles A, Wardle J, Kearns B, Tappenden P, Myles J, Veitch A, Duffy SW. The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations. Health Technol Assess 2017; 21:1-536. [PMID: 28621643 PMCID: PMC5483643 DOI: 10.3310/hta21250] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The UK guideline recommends 3-yearly surveillance for patients with intermediate-risk (IR) adenomas. No study has examined whether or not this group has heterogeneity in surveillance needs. OBJECTIVES To examine the effect of surveillance on colorectal cancer (CRC) incidence; assess heterogeneity in risk; and identify the optimum frequency of surveillance, the psychological impact of surveillance, and the cost-effectiveness of alternative follow-up strategies. DESIGN Retrospective multicentre cohort study. SETTING Routine endoscopy and pathology data from 17 UK hospitals (n = 11,944), and a screening data set comprising three pooled cohorts (n = 2352), followed up using cancer registries. SUBJECTS Patients with IR adenoma(s) (three or four small adenomas or one or two large adenomas). PRIMARY OUTCOMES Advanced adenoma (AA) and CRC detected at follow-up visits, and CRC incidence after baseline and first follow-up. METHODS The effects of surveillance on long-term CRC incidence and of interval length on findings at follow-up were examined using proportional hazards and logistic regression, adjusting for patient, procedural and polyp characteristics. Lower-intermediate-risk (LIR) subgroups and higher-intermediate-risk (HIR) subgroups were defined, based on predictors of CRC risk. A model-based cost-utility analysis compared 13 surveillance strategies. Between-group analyses of variance were used to test for differences in bowel cancer worry between screening outcome groups (n = 35,700). A limitation of using routine hospital data is the potential for missed examinations and underestimation of the effect of interval and surveillance. RESULTS In the hospital data set, 168 CRCs occurred during 81,442 person-years (pys) of follow-up [206 per 100,000 pys, 95% confidence interval (CI) 177 to 240 pys]. One surveillance significantly lowered CRC incidence, both overall [hazard ratio (HR) 0.51, 95% CI 0.34 to 0.77] and in the HIR subgroup (n = 9265; HR 0.50, 95% CI 0.34 to 0.76). In the LIR subgroup (n = 2679) the benefit of surveillance was less clear (HR 0.62, 95% CI 0.16 to 2.43). Additional surveillance lowered CRC risk in the HIR subgroup by a further 15% (HR 0.36, 95% CI 0.20 to 0.62). The odds of detecting AA and CRC at first follow-up (FUV1) increased by 18% [odds ratio (OR) 1.18, 95% CI 1.12 to 1.24] and 32% (OR 1.32, 95% CI 1.20 to 1.46) per year increase in interval, respectively, and the odds of advanced neoplasia at second follow-up increased by 22% (OR 1.22, 95% CI 1.09 to 1.36), after adjustment. Detection rates of AA and CRC remained below 10% and 1%, respectively, with intervals to 3 years. In the screening data set, 32 CRCs occurred during 25,745 pys of follow-up (124 per 100,000 pys, 95% CI 88 to 176 pys). One follow-up conferred a significant 73% reduction in CRC incidence (HR 0.27, 95% CI 0.10 to 0.71). Owing to the small number of end points in this data set, no other outcome was significant. Although post-screening bowel cancer worry was higher in people who were offered surveillance, worry was due to polyp detection rather than surveillance. The economic evaluation, using data from the hospital data set, suggested that 3-yearly colonoscopic surveillance without an age cut-off would produce the greatest health gain. CONCLUSIONS A single surveillance benefited all IR patients by lowering their CRC risk. We identified a higher-risk subgroup that benefited from further surveillance, and a lower-risk subgroup that may require only one follow-up. A surveillance interval of 3 years seems suitable for most IR patients. These findings should be validated in other studies to confirm whether or not one surveillance visit provides adequate protection for the lower-risk subgroup of intermediate-risk patients. STUDY REGISTRATION Current Controlled Trials ISRCTN15213649. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Wendy Atkin
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Amy Brenner
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jessica Martin
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Katherine Wooldrage
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Urvi Shah
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Fiona Lucas
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Greliak
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Pack
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ines Kralj-Hans
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ann Thomson
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sajith Perera
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jill Wood
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Centre, University College London, London, UK
| | - Benjamin Kearns
- School of Health and Related Research (ScHARR), Health Economics and Decision Science Section, University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- School of Health and Related Research (ScHARR), Health Economics and Decision Science Section, University of Sheffield, Sheffield, UK
| | - Jonathan Myles
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Whiteley R, Einarsson E, Thomson A, Hansen C. Is the swing or stance phase more likely to injure the hamstrings during running? An EMG investigation using a reduced bodyweight (Alter-G®) treadmill. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.220] [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: 10/20/2022]
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Simpson N, Simpson G, Laney R, Thomson A, Wheatley D, Ellis R, Mcgrane J. OC-0558: Automated VMAT planning in prostate cancer patients using a Single Arc SIB Technique. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thomson A, Whiteley R, Bleakley C. Shoe–surface interaction and lower extremity injury in the football codes: A systematic review and meta-analysis. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.460] [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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Pasu S, Bunce C, Hooper R, Thomson A, Bainbridge J. PIMS (Positioning In Macular hole Surgery) trial - a multicentre interventional comparative randomised controlled clinical trial comparing face-down positioning, with an inactive face-forward position on the outcome of surgery for large macular holes: study protocol for a randomised controlled trial. Trials 2015; 16:527. [PMID: 26576755 PMCID: PMC4650938 DOI: 10.1186/s13063-015-1048-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 02/05/2015] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Idiopathic macular holes are an important cause of blindness. They have an annual incidence of 8 per 100,000 individuals, and prevalence of 0.2 to 3.3 per 1000 individuals with visual impairment. The condition occurs more frequently in adults aged 75 years or older. Macular holes can be repaired by surgery in which the causative tractional forces in the eye are released and a temporary bubble of gas is injected. To promote successful hole closure individuals may be advised to maintain a face-down position for up to 10 days following surgery. The aim of this study is to determine whether advice to position face-down improves the surgical success rate of closure of large (>400 μm) macular holes, and thereby reduces the need for further surgery. METHODS/DESIGN This will be a multicentre interventional, comparative randomised controlled clinical trial comparing face-down positioning with face-forward positioning. At the conclusion of standardised surgery across all sites, participants still eligible for inclusion will be allocated randomly 1:1 to 1 of the 2 treatment arms stratified by site, using random permuted blocks of size 4 or 6 in equal proportions. We will recruit 192 participants having surgery for large macular holes (>400 μm); 96 in each of the 2 arms of the study. The primary objective is to determine the impact of face-down positioning on the likelihood of closure of large (≥400 μm) full-thickness macular holes following surgery. DISCUSSION This will be the first multicentre randomised control trial to investigate the value of face-down positioning following macular hole standardised surgery. TRIAL REGISTRATION UK CRN: 17966 (date of registration 26 November 2014).
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Affiliation(s)
- Saruban Pasu
- Moorfields Eye Hospital NHS Foundation Trust, City Road, EC1V 2PD, London, UK. .,NIHR Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Catey Bunce
- Moorfields Eye Hospital NHS Foundation Trust, City Road, EC1V 2PD, London, UK. .,NIHR Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Richard Hooper
- Pragmatic Clinical Trial Unit, Blizard Institute Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK.
| | - Ann Thomson
- Pragmatic Clinical Trial Unit, Blizard Institute Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK.
| | - James Bainbridge
- Moorfields Eye Hospital NHS Foundation Trust, City Road, EC1V 2PD, London, UK. .,NIHR Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
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Ngo L, Ho H, Hunter P, Quinn K, Thomson A, Pearson G. Post-mortem prediction of primal and selected retail cut weights of New Zealand lamb from carcass and animal characteristics. Meat Sci 2015; 112:39-45. [PMID: 26519607 DOI: 10.1016/j.meatsci.2015.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/24/2022]
Abstract
Post-mortem measurements (cold weight, grade and external carcass linear dimensions) as well as live animal data (age, breed, sex) were used to predict ovine primal and retail cut weights for 792 lamb carcases. Significant levels of variance could be explained using these predictors. The predictive power of those measurements on primal and retail cut weights was studied by using the results from principal component analysis and the absolute value of the t-statistics of the linear regression model. High prediction accuracy for primal cut weight was achieved (adjusted R(2) up to 0.95), as well as moderate accuracy for key retail cut weight: tenderloins (adj-R(2)=0.60), loin (adj-R(2)=0.62), French rack (adj-R(2)=0.76) and rump (adj-R(2)=0.75). The carcass cold weight had the best predictive power, with the accuracy increasing by around 10% after including the next three most significant variables.
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Affiliation(s)
- L Ngo
- Auckland Bioengineering Institute, University of Auckland, New Zealand; Arts et Métiers ParisTech, France
| | - H Ho
- Auckland Bioengineering Institute, University of Auckland, New Zealand.
| | - P Hunter
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - K Quinn
- Silver Fern Farms Ltd, New Zealand
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Smith MD, Russell T, Thomson A, MacIntyre E, Devane H, Howe E, Tucker K. 43 Frontal plane knee and pelvis angles during single leg squat and step down tasks do not differ between people with and without chronic ankle instability. Br J Sports Med 2015. [DOI: 10.1136/bjsports-2015-095573.43] [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: 11/03/2022]
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Maitin-Casalis N, Neeman T, Thomson A. Protective effect of advanced age on post-ERCP pancreatitis and unplanned hospitalisation. Intern Med J 2015; 45:1020-5. [DOI: 10.1111/imj.12844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 06/18/2015] [Indexed: 02/03/2023]
Affiliation(s)
- N. Maitin-Casalis
- Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - T. Neeman
- Statistical Consulting Unit; Australian National University; Canberra Australian Capital Territory Australia
| | - A. Thomson
- Australian National University Medical School; Canberra Australian Capital Territory Australia
- Gastroenterology Unit; The Canberra Hospital; Canberra Australian Capital Territory Australia
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Aldridge T, Thomson A, Ilankovan V. Abnormal anatomy of inferior orbital fissure and herniation of buccal fat pad. Br J Oral Maxillofac Surg 2015; 53:92-3. [DOI: 10.1016/j.bjoms.2014.09.020] [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] [Received: 02/04/2014] [Accepted: 09/24/2014] [Indexed: 11/16/2022]
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Wheelock A, Parand A, Rigole B, Thomson A, Miraldo M, Vincent C, Sevdalis N. Personal context and childhood experiences affect adult vaccination behaviour. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku161.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wheelock A, Thomson A, Rigole B, Miraldo M, Vincent C, Sevdalis N. Trust and adult vaccination: what matters the most? Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku151.017] [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: 11/13/2022] Open
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Thomson A, Purvis G, McGrane J, Palmer J, Mathew J. The Molecular Profile of Matched Primary Breast Cancer and Resected or Biopsied Brain Metastases. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu329.6] [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: 11/13/2022] Open
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Abstract
INTRODUCTION The aim of this study was to determine the efficacy and complications of postoperative endoscopic retrograde cholangiopancreatography (ERCP) in confirming and treating choledocholithiasis found at intraoperative cholangiography during laparoscopic cholecystectomy. METHODS Patients who had undergone ERCP following a cholecystectomy between 2008 and 2011 with an indication of intraoperative cholangiography findings consistent with choledocholithiasis were identified from a prospectively collected database of a single endoscopist. Deep biliary access rate, confirmation of choledocholithiasis, clearance rate of bile duct stones, delay between cholecystectomy and postoperative ERCP, and the complication rates following the procedure were analysed. RESULTS The median age of the 41 patients (16 male, 25 female) was 42 years (range: 18–82 years). Sixteen surgeons performed the operations with a median delay of 6 days (range: 1–103 days) between cholecystectomy and postoperative ERCP. Common bile duct access was achieved in 100% of the patients, with ERCP taking a median time of 16 minutes (range: 6–40 minutes). Initial ERCP confirmed the presence of a stone in 30 patients (73%) and successful stone removal occurred in 28 of these 30 patients (93%) during the first ERCP and in the remaining 2 on a subsequent ERCP. Following ERCP, two patients (4.9%) experienced extended hospital stays for four and eight days owing to complications, including one patient (2.4%) with mild acute pancreatitis. CONCLUSIONS This study demonstrates that postoperative ERCP is highly effective in both confirming and treating choledocholithiasis. However, there is a significant risk of short-term complications that must be taken into consideration when deciding management.
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Affiliation(s)
- A P Lynn
- Canberra Hospital, The Australian National University, Australia
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Gruen ME, Griffith E, Thomson A, Simpson W, Lascelles BDX. Detection of clinically relevant pain relief in cats with degenerative joint disease associated pain. J Vet Intern Med 2014; 28:346-50. [PMID: 24512390 PMCID: PMC4064787 DOI: 10.1111/jvim.12312] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/20/2013] [Accepted: 12/26/2013] [Indexed: 11/30/2022] Open
Abstract
Background Detection of clinically relevant pain relief in cats with degenerative joint disease (DJD) is complicated by a lack of validated outcome measures and a placebo effect. Hypothesis/Objectives To evaluate a novel approach for detection of pain relief in cats with DJD. Animals Fifty‐eight client‐owned cats. Methods Prospective, double‐masked, placebo‐controlled, stratified, randomized, clinical study. Enrolled cats were 6–21 years of age, with owner‐observed mobility impairment, evidence of pain in at least 2 joints during orthopedic examination, and overlapping radiographic evidence of DJD, and underwent a 2‐week baseline period, 3‐week treatment period with placebo or meloxicam, and 3‐week masked washout period. Outcome measures were evaluated at days 0, 15, 36, and 57. Results Both groups significantly improved after the treatment period (day 36) on client‐specific outcome measures (CSOM) and feline musculoskeletal pain index (FMPI) (P < .0001 for both); there was no difference between the groups on CSOM or FMPI score improvement. After the masked washout period, more cats that received meloxicam during the treatment period had a clinically relevant decrease in CSOM score (P = .048) and FMPI score (P = .021) than cats that received placebo. Conclusions and Clinical Importance Using both a client‐specific and a general clinical metrology instrument, owners of cats with DJD were able to detect evident recurrence of clinical signs after withdrawal of active medication than after withdrawal of placebo, and that this study design might be a novel and useful way to circumvent the placebo effect and detect the efficacy of pain‐relieving medications.
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Affiliation(s)
- M E Gruen
- Comparative Pain Research Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, Raleigh, NC
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Nicholson S, Hall E, Harland SJ, Chester JD, Pickering L, Barber J, Elliott T, Thomson A, Burnett S, Cruickshank C, Carrington B, Waters R, Bahl A. Phase II trial of docetaxel, cisplatin and 5FU chemotherapy in locally advanced and metastatic penis cancer (CRUK/09/001). Br J Cancer 2013; 109:2554-9. [PMID: 24169355 PMCID: PMC3833214 DOI: 10.1038/bjc.2013.620] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/11/2013] [Accepted: 09/15/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Penis cancer is rare and clinical trial evidence on which to base treatment decisions is limited. Case reports suggest that the combination of docetaxel, cisplatin and 5-flurouracil (TPF) is highly active in this disease. METHODS Twenty-nine patients with locally advanced or metastatic squamous carcinoma of the penis were recruited into a single-arm phase II trial from nine UK centres. Up to three cycles of chemotherapy were received (docetaxel 75 mg m(-2) day 1, cisplatin 60 mg m(-2) day 1, 5-flurouracil 750 mg m(-2) per day days 1-5, repeated every 3 weeks). Primary outcome was objective response (assessed by RECIST). Fourteen or more responses in 26 evaluable patients were required to confirm a response rate of 60% or higher (Fleming-A'Hern design), warranting further evaluation. Secondary endpoints included toxicity and survival. RESULTS 10/26 evaluable patients (38.5%, 95% CI: 20.2-59.4) achieved an objective response. Two patients with locally advanced disease achieved radiological complete remission. 65.5% of patients experienced at least one grade 3/4 adverse event. CONCLUSION Docetaxel, cisplatin and 5FU did not reach the pre-determined threshold for further research and caused significant toxicity. Our results do not support the routine use of TPF. The observed complete responses support further investigation of combination chemotherapy in the neoadjuvant setting.
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Affiliation(s)
- S Nicholson
- Imperial College Healthcare NHS Trust, Department of Medical Oncology, Charing Cross Hospital, London W6 8RF, UK
| | - E Hall
- The Institute of Cancer Research, Clinical Trials & Statistics Unit, 123 Old Brompton Road, London SW7 3RP, UK
| | - S J Harland
- Department of Oncology, University College London Hospitals NHSFT, 250 Euston Road, London NW1 2PG, UK
| | - J D Chester
- Leeds Institute of Molecular Medicine, University of Leeds and St. James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - L Pickering
- Department of Oncology, St. Georges Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - J Barber
- Velindre Cancer Centre, Velindre Hospital, Velindre Road, Whitchurch, Cardiff CF14 2TL, UK
| | - T Elliott
- Department of Clinical Oncology, The Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK
| | - A Thomson
- Department of Oncology, Royal Cornwall Hospital, London Road, Treliske, Truro TR1 3LJ, UK
| | - S Burnett
- The Institute of Cancer Research, Clinical Trials & Statistics Unit, 123 Old Brompton Road, London SW7 3RP, UK
| | - C Cruickshank
- The Institute of Cancer Research, Clinical Trials & Statistics Unit, 123 Old Brompton Road, London SW7 3RP, UK
| | - B Carrington
- Department of Diagnostic Radiotherapy, The Christie Hospital, Manchester, UK
| | - R Waters
- The Institute of Cancer Research, Clinical Trials & Statistics Unit, 123 Old Brompton Road, London SW7 3RP, UK
| | - A Bahl
- Bristol Haematology and Oncology Centre, Horfield Road, Bristol BS2 8ED, UK
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Thomson A. Inaugural Speech Delivered at the Opening of the Conference. Acta Radiol 2013. [DOI: 10.1177/028418515404100102] [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: 11/17/2022]
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Isom M, Fox J, Francis J, Thomson A. A daily board round improves communication and discharge planning on an elderly medicine ward. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.571] [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: 11/16/2022]
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Benito J, Depuy V, Hardie E, Zamprogno H, Thomson A, Simpson W, Roe S, Hansen B, Lascelles BDX. Reliability and discriminatory testing of a client-based metrology instrument, feline musculoskeletal pain index (FMPI) for the evaluation of degenerative joint disease-associated pain in cats. Vet J 2013; 196:368-73. [PMID: 23369382 DOI: 10.1016/j.tvjl.2012.12.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 11/15/2012] [Accepted: 12/19/2012] [Indexed: 11/17/2022]
Affiliation(s)
- J Benito
- Comparative Pain Research Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Benito J, Hansen B, DePuy V, Davidson G, Thomson A, Simpson W, Roe S, Hardie E, Lascelles B. Feline Musculoskeletal Pain Index: Responsiveness and Testing of Criterion Validity. J Vet Intern Med 2013; 27:474-82. [DOI: 10.1111/jvim.12077] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/28/2013] [Accepted: 02/12/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- J. Benito
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - B. Hansen
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - V. DePuy
- Bowden Statistical Consulting; Oxford NC
| | - G.S. Davidson
- Clinical Pharmacy Services; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - A. Thomson
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - W. Simpson
- Morrisville Cat Hospital; Morrisville NC
| | - S. Roe
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - E. Hardie
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - B.D.X. Lascelles
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
- Department of Clinical Sciences; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
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Thomson A. Guidelines on guidelines - the impact of the Web. Intern Med J 2012; 42:1275-6. [PMID: 23157531 DOI: 10.1111/j.1445-5994.2012.02958.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 09/11/2012] [Indexed: 11/29/2022]
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Morgan M, Helsdon J, Thomson A. Clinical recall from the NHS Breast Screening Programme: is it worth doing? Breast Cancer Res 2012. [PMCID: PMC3542670 DOI: 10.1186/bcr3289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Boraei A, Stoyanova E, Thomson A. W478 AN AUDIT TO INVESTIGATE THE ROLE OF LAPAROSCOPY FOR THE MANAGEMENT OF CHRONIC PELVIC PAIN. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)62197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Freeman RM, Pantazis K, Thomson A, Frappell J, Bombieri L, Moran P, Slack M, Scott P, Waterfield M. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J 2012; 24:377-84. [PMID: 22864764 DOI: 10.1007/s00192-012-1885-x] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/30/2012] [Indexed: 12/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This prospective multi-centre true two-sided equivalence trial was designed to test the clinical equivalence of open (ASCP) and laparoscopic (LSCP) sacrocolpopexy using objective and subjective outcomes METHODS The study was carried out in three urogynaecology units in England, UK and the patient population consisted of women referred with symptomatic and bothersome post-hysterectomy vaginal vault prolapse at least 1 cm above or beyond the hymeneal remnants. The interventions were either abdominal or laparoscopic sacrocolpopexy following randomisation to one of the types of surgery. RESULTS For the primary outcome (point C on the POP-Q) the results at 1 year were -6.63 cm for the open ASCP and -6.67 cm for the LSCP respectively. Subjective outcomes at 1 year showed that 90% of the ASCP group and 80% of the LSCP group were "much better". There were improvements with regard to blood loss, haemoglobin and shorter length of stay in the LSCP group compared with the ASCP group. CONCLUSION This fully powered randomised controlled trial comparing open and laparoscopic sacrocolpopexy has shown clinical equivalence.
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Affiliation(s)
- R M Freeman
- Urogynaecology Unit, Directorate of Women's Health, Derriford Hospital, Plymouth PL6 8DH, UK.
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Calle A, Racosta JM, Fontela ME, Gonzalez Toledo M, Jauregui A, Munoz Giacomelli F, Pagani Cassara F, Thomson A. The Pleomorphism of Electroencephalogram in Non Convulsive Status Epilepticus (P02.165). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.165] [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] Open
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