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Hafez AT, Aly M, Omar I, Richardson G, James K. Does open or closed reduction with internal fixation reduces the incidence of complications in neck of femur fractures in pediatrics: a meta-analysis and systematic review. J Pediatr Orthop B 2024:01202412-990000000-00200. [PMID: 38700872 DOI: 10.1097/bpb.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
The neck of femur fracture (FNF) in children is a rare injury with a high incidence of complications such as avascular necrosis (AVN), coxa-vara and nonunion. The aim of this review is to compare the incidence of complications between open reduction with internal fixation (ORIF) and closed reduction with internal fixation (CRIF) of FNF in children. Two independent reviewers searched EMBASE, MEDLINE, COCHRANE and PUBMED databases from inception until April 2022 according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies included comparison of complications between open and closed approaches with fixation of FNF in patients less than 18 years old. Publication bias was assessed using Egger's test while the Newcastle-Ottawa tool was used to assess the methodological quality of the studies. A total of 724 hip fractures from 15 included studies received either ORIF or CRIF. Overall, the rate of AVN was approximately 21.7% without statistical significance between both reduction methods [relative risk (RR) = 0.909, using fixed effect model at 95% confidence interval (CI, 0.678-1.217)]. No significant heterogeneity among AVN studies ( I2 = 3.79%, P = 0.409). Similarly, neither coxa-vara nor nonunion rates were statistically significant in both treatment groups (RR = 0.693 and RR = 0.506, respectively). Coxa-vara studies showed mild heterogeneity ( I2 = 27.8%, P = 0.218), while significant publication bias was encountered in nonunion studies ( P = 0.048). No significant difference in the incidence of AVN, coxa-vara and nonunion between ORIF or CRIF of FNF in children. High-quality studies as Randomised Controlled Trials can resolve the inconsistency and heterogeneity of other risk factors including age, initial displacement, fracture type, reduction quality and time to fixation.
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Affiliation(s)
- Ahmed T Hafez
- University College London Hospitals NHS Foundation Trust
- The Blizard Institute Centre for Trauma Sciences, Queen Mary University of London Barts and the London School of Medicine and Dentistry, London
| | - Mohammed Aly
- University College London Hospitals NHS Foundation Trust
- The Blizard Institute Centre for Trauma Sciences, Queen Mary University of London Barts and the London School of Medicine and Dentistry, London
| | - Islam Omar
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim
| | | | - Kyle James
- The Blizard Institute Centre for Trauma Sciences, Queen Mary University of London Barts and the London School of Medicine and Dentistry, London
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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2
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Feathers JR, Richardson G, Cornier A, Rebuffa N, Sloan B, Muthayya P. The Use of Oxandrolone in the Management of Severe Burns: A Multi-service Survey of Burns Centres and Units Across the United Kingdom. Cureus 2024; 16:e57167. [PMID: 38681282 PMCID: PMC11056024 DOI: 10.7759/cureus.57167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Severe thermal burns are a catastrophic injury. Those surviving the initial insult are subject to life-long disability, prolonged hospital admission, nutritional issues and poor wound healing. Oxandrolone has been shown to reduce hospital duration and promote lean body mass. Despite not being licenced for use in burns trauma within the United Kingdom (UK), services across the country utilise Oxandrolone in the management of severe burns. We aim to analyse the use of Oxandrolone in major burns across burns services within the UK. Methods We conducted a survey across all burn centres and units across the UK. Any burns service provider with experience in patient management of patients sustaining burns with a total body surface area >15% was included. All services were identified using the British Burns Association website. We conducted a survey of all centres and units and contacted them via telephone through the trust's switchboard. Responses were accepted from any healthcare staff familiar with the day-to-day in-patient care of patients on the ward. Services with no in-patient services were excluded. Results A total of 24 burns centres and services responded to our survey. Twelve of the respondents were in a burns unit and 12 were in a burns centre. Eight respondents were paediatric facilities, and the remaining 16 dealt with adult burns. In total, 16/24 (66.6%) services reported using Oxandrolone. Conversely, 8/24 (33.3%) burns services denied using Oxandrolone. 7/12 (58.3%) burns units use Oxandrolone in the management of burns. 5/12 (42.7%) burns units do not use Oxandrolone in severe burns. 9/12 (75%) of burns centres described using Oxandrolone, whilst the remaining 3/12 (25%) did not. Discussion Oxandrolone is used varyingly across burns services across the UK. Burns centres were more likely to use Oxandrolone compared to units. We also find that more paediatric services used Oxandrolone in comparison to adult services. Studies have shown that the benefit of Oxandrolone is not age-dependent. Further work is required to assess the impact of this medication on patients with severe burns and national guidance would help further improve burns management across the UK.
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Affiliation(s)
- Jacob R Feathers
- Trauma and Orthopaedics, Cwm Taf Morgannwg University Health Board, Llantrisant, GBR
| | - George Richardson
- Trauma and Orthopaedics, Barts Health National Health Service Trust, London, GBR
| | - Alice Cornier
- Medicine, Cwm Taf Morgannwg University Health Board, Llantrisant, GBR
| | - Nick Rebuffa
- Radiology, Leeds Teaching Hospitals National Health Service Trust, Leeds, GBR
| | - Brendan Sloan
- Burns Department, Mid Yorkshire Teaching National Health Service Trust, Wakefield, GBR
| | - Preetha Muthayya
- Burns Department, Mid Yorkshire Teaching National Health Service Trust, Wakefield, GBR
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3
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Lewis D, Hannan CJ, Plitt AR, Snyder LR, Richardson G, King AT, Hammerbeck-Ward C, Pathmanaban ON, Neff BA, Driscoll CL, Van Gompel JJ, Carlson ML, Lane JI, Lloyd SK, Freeman SR, Laitt RD, Abdulla S, Siripurapu R, Potter GM, Link MJ, Rutherford SA. Intraoperative diagnosis of facial schwannomas: a multicenter summation of clinical experience, preoperative avoidance, and intraoperative management protocol. J Neurosurg 2023; 139:972-983. [PMID: 36933255 DOI: 10.3171/2023.2.jns222368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/02/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Preoperative differentiation of facial nerve schwannoma (FNS) from vestibular schwannoma (VS) can be challenging, and failure to differentiate between these two pathologies can result in potentially avoidable facial nerve injury. This study presents the combined experience of two high-volume centers in the management of intraoperatively diagnosed FNSs. The authors highlight clinical and imaging features that can distinguish FNS from VS and provide an algorithm to help manage intraoperatively diagnosed FNS. METHODS Operative records of 1484 presumed sporadic VS resections between January 2012 and December 2021 were reviewed, and patients with intraoperatively diagnosed FNSs were identified. Clinical data and preoperative imaging were retrospectively reviewed for features suggestive of FNS, and factors associated with good postoperative facial nerve function (House-Brackmann [HB] grade ≤ 2) were identified. A preoperative imaging protocol for suspected VS and recommendations for surgical decision-making following an intraoperative FNS diagnosis were created. RESULTS Nineteen patients (1.3%) with FNSs were identified. All patients had normal facial motor function preoperatively. In 12 patients (63%), preoperative imaging demonstrated no features suggestive of FNS, with the remainder showing subtle enhancement of the geniculate/labyrinthine facial segment, widening/erosion of the fallopian canal, or multiple tumor nodules in retrospect. Eleven (57.9%) of the 19 patients underwent a retrosigmoid craniotomy, and in the remaining patients, a translabyrinthine (n = 6) or transotic (n = 2) approach was used. Following FNS diagnosis, 6 (32%) of the tumors underwent gross-total resection (GTR) and cable nerve grafting, 6 (32%) underwent subtotal resection (STR) and bony decompression of the meatal facial nerve segment, and 7 (36%) underwent bony decompression only. All patients undergoing subtotal debulking or bony decompression exhibited normal postoperative facial function (HB grade I). At the last clinical follow-up, patients who underwent GTR with a facial nerve graft had HB grade III (3 of 6 patients) or IV facial function. Tumor recurrence/regrowth occurred in 3 patients (16%), all of whom had been treated with either bony decompression or STR. CONCLUSIONS Intraoperative diagnosis of an FNS during a presumed VS resection is rare, but its incidence can be reduced further by maintaining a high index of suspicion and undertaking further imaging in patients with atypical clinical or imaging features. If an intraoperative diagnosis does occur, conservative surgical management with bony decompression of the facial nerve only is recommended, unless there is significant mass effect on surrounding structures.
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Affiliation(s)
- Daniel Lewis
- 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester
- 2Geoffrey Jefferson Brain Research Centre, Manchester
- 3Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester
| | - Cathal John Hannan
- 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester
- 2Geoffrey Jefferson Brain Research Centre, Manchester
- 4Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Aaron R Plitt
- Departments of5Neurologic Surgery and
- 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Andrew T King
- 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester
- 2Geoffrey Jefferson Brain Research Centre, Manchester
- 4Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | | | - Omar N Pathmanaban
- 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester
- 2Geoffrey Jefferson Brain Research Centre, Manchester
- 3Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester
| | - Brian A Neff
- Departments of5Neurologic Surgery and
- 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Colin L Driscoll
- Departments of5Neurologic Surgery and
- 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jamie J Van Gompel
- Departments of5Neurologic Surgery and
- 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- Departments of5Neurologic Surgery and
- 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - John I Lane
- Departments of5Neurologic Surgery and
- 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Simon K Lloyd
- 9Department of Otolaryngology, Salford Royal Hospital, Manchester
- 10Department of Otolaryngology, Manchester Royal Infirmary, Manchester
- 11Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester; and
| | - Simon R Freeman
- 9Department of Otolaryngology, Salford Royal Hospital, Manchester
- 10Department of Otolaryngology, Manchester Royal Infirmary, Manchester
| | - Roger D Laitt
- 12Department of Neuroradiology, Manchester Centre for Clinical Neuroscience, Manchester, United Kingdom
| | - Sarah Abdulla
- 12Department of Neuroradiology, Manchester Centre for Clinical Neuroscience, Manchester, United Kingdom
| | - Rekha Siripurapu
- 12Department of Neuroradiology, Manchester Centre for Clinical Neuroscience, Manchester, United Kingdom
| | - Gillian M Potter
- 12Department of Neuroradiology, Manchester Centre for Clinical Neuroscience, Manchester, United Kingdom
| | - Michael J Link
- Departments of5Neurologic Surgery and
- 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Scott A Rutherford
- 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester
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Porfírio JCC, de Moraes YL, Richardson G. Do health beliefs link Dark Triad traits to COVID-19 behaviors? Replicating Nowak et al. (2020) in a Brazilian sample. Personality and Individual Differences 2023. [DOI: 10.1016/j.paid.2022.111910] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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5
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Spyridopoulos I, Bawamia B, Spray L, Wangsaputra V, Stellos K, Bennaceur K, Kharatikoopaei E, Ogundimu E, Gale CP, Keavney B, Maier R, Hancock H, Richardson G, Austin D. Activation of mitochondrial telomerase reverses relative lymphopenia post myocardial infarction: results from the randomised, double-blinded TACTIC phase IIa pilot trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Immune ageing is a phenomenon which includes lymphopenia, expansion of pro-inflammatory T-lymphocyte subsets and telomere shortening. While lymphopenia predicts mortality after myocardial infarction (MI), MI itself leads to both an increase in terminally differentiated memory CD8+ T-lymphocytes (CD8+ TEMRAs) and a decrease in telomere length. Activation of telomerase has been shown to ameliorate lymphopenia, and improve heart function after MI in mouse models. TA-65 is an oral telomerase activator, which may ameliorate immune ageing and improve outcome after MI.
Methods
This double-blinded, randomized placebo-controlled pilot study evaluated the use of TA-65 in 90 MI patients over 65 years, the average onset age for immune ageing. Patients were randomised to either TA-65 (16 mg daily, n=45) or placebo (n=45) for 12 months. The majority of patients underwent percutaneous coronary intervention (87%) or coronary artery bypass surgery (2%) as treatment for their index MI. The pre-defined primary endpoint was the proportion of CD8+ TEMRA T-lymphocytes at 12 months, a marker of immune ageing. A linear mixed effects model was used for the analysis.
Results
The proportion of CD8+ TEMRAs after 12 months did not differ between the 2 treatment groups, although only increased significantly in the placebo group (+2.2%, 95% CI: 0.14–4.24). TA-65 was well tolerated, with total adverse events lower in the treatment group (TA-65 vs. placebo group: n=130 vs. n=185). We observed at 12 months a 62% reduction in mean high-sensitivity CRP (hsCRP: TA-65 vs. placebo group: 1.1±0.9 vs. 2.9±6.4 mg/L) and a 15%-increase in mean peripheral blood lymphocytes in TA-65 after 12 months. In the whole sample, among those who were treated with TA-65 compared to Placebo, after 12 months peripheral blood lymphocytes increased (+285 cells /μl, 95% CI: 117–452). The latter was due to significant increases in the TA-65 group from baseline to 12 months across all major lymphocyte populations: CD3+ (+15%), CD4+ (+14%),CD8+ T-lymphocytes (+19%), B-lymphocytes (+17%) and natural killer cells (+12%), while no changes occurred in major lymphocyte populations in the placebo group over the course of the study.
Conclusion
In this randomised clinical trial, we found that while CD8+ TEMRAs were not significantly altered after 12 months, the telomerase activator TA-65 significantly increased all major lymphocyte subsets and substantially reduced hsCRP at 12 months in patients with MI. These findings suggest TA-65 holds great promise in potentially reducing inflammation while improving an age-related decline in major lymphocyte populations, thereby enhancing immunity. A larger, multicentre, powered phase IIb efficacy trial to examine the potential effect of TA-65 in prognosis and heart function after MI is therefore warranted.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): TA-Science, New York, USA
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Affiliation(s)
| | - B Bawamia
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | - L Spray
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | - V Wangsaputra
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | - K Stellos
- European Center for Angioscience , Mannheim , Germany
| | - K Bennaceur
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | | | - E Ogundimu
- Durham University , Durham , United Kingdom
| | - C P Gale
- Leeds Teaching Hospitals , Leeds , United Kingdom
| | - B Keavney
- University of Manchester , Manchester , United Kingdom
| | - R Maier
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | - H Hancock
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | - G Richardson
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | - D Austin
- James Cook University Hospital , Middlesbrough , United Kingdom
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6
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Bakhsh A, Gillespie C, Kumar S, Richardson G, Mustafa A, Mirza N, Jenkinson M. Systemic Inflammation Is Implicated in De Novo Seizures Following Meningioma Resection. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.015] [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: 11/14/2022] Open
Abstract
Abstract
AIMS
To investigate the association between perioperative peripheral blood inflammatory markers and seizures in patients who have undergone meningioma resection.
METHOD
A single neurosurgery tertiary centre blood bank database was screened to extract pre-operative and post-operative white cell count (WCC), neutrophils, lymphocytes, monocytes, platelets and neutrophil-lymphocyte ratio (NLR) and derived NLR (dNLR). All patients who underwent resection of meningioma from 2012 to 2020 were eligible. Patients were excluded if they had an inflammatory condition, peri-operative infection, medical illness or operative complication.
RESULTS
30 patients suffered pre-operative seizures only, 16 experienced de novo post-operative seizures within 1 year and 42 patients did not experience seizures throughout their treatment timeline. In those who had never had a seizure, there was a significant increase in WCC post-operatively (15.2 vs. 10.6 × 109/L (95% CI 2.1-8.2), p=0.02). Patients who suffered de novo seizures had a significantly higher post-operative day 1 to 4 WCC than those with no seizures (21.1 vs. 14.8 × 109/L (2.1-12.6), p=0.48). However, this difference of WCC was poorly predictive of de novo seizures at one year (AUC 0.61). There was no difference in pre-operative inflammatory markers between pre-operative seizure patients, de novo seizure or never seizure patients.
CONCLUSION
There is a significantly higher post-operative systemic inflammatory response in patients who suffered de novoseizures after meningioma resection. Peripheral blood markers have the potential to predict seizures in patients with meningioma.
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Richardson G, Joumah A, Al-Ashqar M, Bakhshayesh P, Kanakaris N. 874 Impact of Covid-19 Measures on Surgical Site Infection Rate in Orthopaedic Patients. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Rate of surgical site infections (SSI) in orthopaedic surgery is low but can have disastrous consequences. The aim of this study was to assess the impact of Covid-19 measures on the rate of SSI and subsequent readmissions in orthopaedic patients.
Method
Retrospective, observational study comparing rates of SSI in orthopaedic patients who underwent surgery prior to the Covid-19 lockdown versus that of patients who underwent surgery during the lockdown period. A total of 1151 patients were identified using electronic clinical records over two different time periods: 3 months pre Covid-19 lockdown (n=680) and 3 months during the Covid-19 lockdown (n=470). Patients were followed up for 1 year following their initial procedure. Primary outcome was readmission for SSI.
Results
The most commonly performed procedures were arthroplasty and manipulation under anaesthesia with 119 in lockdown vs 101 non-lockdown (p=0.001). The readmission rate was higher in the lockdown group with 61 (13%) vs 44 (6.5%) in the non-lockdown group (p <0.001). However, the majority were due to other surgical complications such as dislocations. Interestingly, the SSI rates were very similar with 24 (5%) in lockdown vs 28 (4%) in non-lockdown (p=0.472). Twenty patients (4.2%) required a secondary procedure for their SSI in the lockdown group vs 24 (3.5%) in non-lockdown (p=0.381). Mortality rate was similar at 44 (9.3%) in lockdown vs 61 (9.0%; p=0.836).
Conclusion
Whilst Covid-19 precautions were associated with higher readmission rates, there was no significant difference in rate of SSI between the two groups.
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Affiliation(s)
- G Richardson
- Leeds General Infirmary , Leeds , United Kingdom
| | - A Joumah
- Leeds General Infirmary , Leeds , United Kingdom
| | - M Al-Ashqar
- Leeds General Infirmary , Leeds , United Kingdom
| | | | - N Kanakaris
- Leeds General Infirmary , Leeds , United Kingdom
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, 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M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Tekkis NP, Rafi D, Brown S, Courtney A, Kawka M, Howell AM, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Brown S, Kawka M, Mclean K, Savva N, Wilkinson P, Sam AH, Singal A, Chia C, Chia W, Ganesananthan S, Ooi SZY, Pengelly S, Wellington J, Mak S, Subbiah Ponniah H, Heyes A, Aberman I, Ahmed T, Al-Shamaa S, Appleton L, Arshad A, Awan H, Baig Q, Benedict K, Berkes S, Citeroni NL, Damani A, de Sancha A, Fisayo T, Gupta S, Haq M, Heer B, Jones A, Khan H, Kim H, Meiyalagan N, Miller G, Minta N, Mirza L, Mohamed F, Ramjan F, Read P, Soni L, Tailor V, Tas RN, Vorona M, Walker M, Winkler T, Bardon A, Acquaah J, Ball T, Bani W, Elmasry A, Hussein F, Kolluri M, Lusta H, Newman J, Nott M, Perwaiz MI, Rayner R, Shah A, Shaw I, Yu K, Cairns M, Clough R, Gaier S, Hirani D, Jeyapalan T, Li Y, Patel CR, Shabir H, Wang YA, Weatherhead A, Dhiran A, Renney O, Wells P, Ferguson S, Joyce A, Mergo A, Adebayo O, Ahmad J, Akande O, Ang G, Aniereobi E, Awasthi S, Banjoko A, Bates J, Chibada C, Clarke N, Craner I, Desai DD, Dixon K, Duffaydar HI, Kuti M, Mughal AZ, Nair D, Pham MC, Preest GG, Reid R, Sachdeva GS, Selvaratnam K, Sheikh J, Soran V, Stoney N, Wheatle M, Howarth K, Knapp-Wilson A, Lee KS, Mampitiya N, Masson C, McAlinden JJ, McGowan N, Parmar SC, Robinson B, Wahid S, Willis L, Risquet R, Adebayo A, Dhingra L, Kathiravelupillai S, Narayanan R, Soni J, Ghafourian P, Hounat A, Lennon KA, Abdi Mohamud M, Chou W, Chong L, Graham CJ, Piya S, Riad AM, Vennard S, Wang J, Kawar L, Maseland C, Myatt R, Tengku Saifudin TNS, Yong SQ, Douglas F, Ogbechie C, Sharma K, Zafar L, Bajomo MO, Byrne MHV, Obi C, Oluyomi DI, Patsalides MA, Rajananthanan A, Richardson G, Clarke A, Roxas A, Adeboye W, Argus L, McSweeney J, Rahman-Chowdhury M, Hettiarachchi DS, Masood MT, Antypas A, Thomas M, de Andres Crespo M, Zimmerman M, Dhillon A, Abraha S, Burton O, Jalal AHB, Bailey B, Casey A, Kathiravelupillai A, Missir E, Boult H, Campen D, Collins JM, Dulai S, Elhassan M, Foster Z, Horton E, Jones E, Mahapatra S, Nancarrow T, Nyamapfene T, Rimmer A, Robberstad M, Robson-Brown S, Saeed A, Sarwar Y, Taylor C, Vetere G, Whelan MK, Williams J, Zahid D, Chand C, Matthews M. The impact of the COVID-19 pandemic on UK medical education. A nationwide student survey. Med Teach 2022; 44:574-575. [PMID: 34428109 DOI: 10.1080/0142159x.2021.1962835] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Damir Rafi
- School of Medicine, Imperial College London, London, UK
| | - Sam Brown
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Alona Courtney
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Michal Kawka
- School of Medicine, Imperial College London, London, UK
| | - Ann-Marie Howell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kenneth McLean
- Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Matthew Gardiner
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | | | - Peter Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Paris Tekkis
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Amir H Sam
- School of Medicine, Imperial College London, London, UK
| | - Nicos Savva
- Division of Management Science and Operations, London Business School, London, UK
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- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - T Ball
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - W Bani
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Elmasry
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - F Hussein
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Kolluri
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - H Lusta
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - J Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Nott
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M I Perwaiz
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - R Rayner
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Shah
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - I Shaw
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - K Yu
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | | | | | - S Gaier
- Queen Mary University of London
| | | | | | - Y Li
- Queen Mary University of London
| | | | | | | | | | - A Dhiran
- St George's Hospital Medical School
| | - O Renney
- St George's Hospital Medical School
| | - P Wells
- St George's Hospital Medical School
| | | | - A Joyce
- The Queen's University of Belfast
| | | | | | - J Ahmad
- The University of Birmingham
| | | | - G Ang
- The University of Birmingham
| | | | | | | | - J Bates
- The University of Birmingham
| | | | | | | | | | - K Dixon
- The University of Birmingham
| | | | - M Kuti
- The University of Birmingham
| | | | - D Nair
- The University of Birmingham
| | | | | | - R Reid
- The University of Birmingham
| | | | | | | | - V Soran
- The University of Birmingham
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Soni
- The University of Cambridge
| | | | | | | | | | - W Chou
- The University of East Anglia
| | | | | | - S Piya
- The University of Edinburgh
| | | | | | - J Wang
- The University of Edinburgh
| | | | | | | | | | | | | | | | | | | | | | | | - C Obi
- The University of Leicester
| | | | | | | | | | | | | | | | - L Argus
- The University of Manchester
| | | | | | | | | | | | | | | | | | | | | | | | | | - B Bailey
- University of Brighton and Sussex
| | - A Casey
- University of Brighton and Sussex
| | | | - E Missir
- University of Brighton and Sussex
| | - H Boult
- University of Exeter Medical School
| | - D Campen
- University of Exeter Medical School
| | | | - S Dulai
- University of Exeter Medical School
| | | | - Z Foster
- University of Exeter Medical School
| | - E Horton
- University of Exeter Medical School
| | - E Jones
- University of Exeter Medical School
| | | | | | | | - A Rimmer
- University of Exeter Medical School
| | | | | | - A Saeed
- University of Exeter Medical School
| | - Y Sarwar
- University of Exeter Medical School
| | - C Taylor
- University of Exeter Medical School
| | - G Vetere
- University of Exeter Medical School
| | | | | | - D Zahid
- University of Exeter Medical School
| | - C Chand
- University of Hull and the University of York
| | - M Matthews
- University of Hull and the University of York
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Affiliation(s)
- Benjamin G. Hearn
- College of Education, Criminal Justice, and Human Services University of Cincinnati Cincinnati Ohio USA
| | - Michael D. Brubaker
- College of Education, Criminal Justice, and Human Services University of Cincinnati Cincinnati Ohio USA
| | - George Richardson
- College of Education, Criminal Justice, and Human Services University of Cincinnati Cincinnati Ohio USA
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Richardson G, Tolcher A, Parnis F, Park J, Hamid A, She K, Liu L, Zheng S, Liu G, Li X, Li B, Wang X, Chen M, Fischkoff S, Gong H, Luo P. 137P Phase I dose-finding study of a novel anti-CTLA-4 antibody ADG116 as monotherapy in patients with advanced solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.156] [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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12
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Shafi SQ, Brown S, Khaw RA, Hirniak J, Burke JR, Giwa L, Marson L, Hill A, Lobo D, Glasbey JC, McLean KA, Patel T, Liu G, Singal A, Nam R, Kathiravelupillai A, Chia WL, Ooi SZY, Matthews M, Ponniah SH, Komor J, Heyes A, Tushingham S, Hettiarachchi DS, K T, Gaier S, Jordan C, Joyce A, Johnston E, Valentine K, Nagassima K, Reis RD, O'Sullivan M, Tittawella A, Geary E, Thorpe C, Jalal AHB, Georgi M, Mergo A, Ramsay E, Sheikh J, Ashok A, Lee KS, Risquet R, Kathiravelupillai S, Chia D, Al Majid S, Matloob Ahmad AE, Hounat A, Shafi S, Wang J, Cambridge WA, Kawar L, Maseland T, Sharma K, Moses J, Patsalides MA, Brown S, Jaffer A, Feeney K, Richardson G, Joseph JP, Argus L, Sara X, Antypas A, de Andres Crespo M, Daly E, Abraha S. Medical student engagement with surgery and research during the COVID-19 pandemic: Supporting the future workforce for post-pandemic surgical recovery. Int J Surg 2021; 95:106105. [PMID: 34597820 PMCID: PMC8479464 DOI: 10.1016/j.ijsu.2021.106105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Shiraz Q Shafi
- University of Dundee, United Kingdom University of Leicester, United Kingdom Newcastle University, United Kingdom St George's, University of London, United Kingdom University of Leeds, United Kingdom Queen Victoria Hospital NHS Foundation Trust, United Kingdom University of Edinburgh, United Kingdom Royal College of Surgeons in Ireland, Ireland University of Nottingham, United Kingdom University of Birmingham, United Kingdom Anglia Ruskin University, United Kingdom Aston University, United Kingdom Brighton and Sussex Medical School, United Kingdom Cardiff University, United Kingdom Hull-York Medical School, United Kingdom Imperial College London, United Kingdom Keele University, United Kingdom Queen Mary University of London, United Kingdom Queen's University Belfast, United Kingdom Trinity College Dublin, Ireland University College Cork, Ireland University College Dublin, Ireland University College London, United Kingdom University of Aberdeen, United Kingdom University of Bristol, United Kingdom University of Buckingham, United Kingdom University of Cambridge, United Kingdom University of Central Lancashire, United Kingdom University of Glasgow, United Kingdom University of Limerick, Ireland University of Liverpool, United Kingdom University of Manchester, United Kingdom University of Oxford, United Kingdom University of Warwick, United Kingdom
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Richardson G, Gillespie C, Mustafa M, Taweel B, Millward C, Islim A, Jenkinson M. Re-operation for recurrent intracranial meningioma – is it worth it? Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab195.054] [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: 11/12/2022] Open
Abstract
Abstract
Aims
Meningioma is the commonest primary brain tumour. Despite surgery, meningiomas can recur. Surgery is usually the first line treatment for recurrent meningioma. The aim was to determine the risk factors associated with clinical outcomes (performance status, morbidity, mortality, recurrence) following re-operation for recurrence of intracranial meningioma.
Method
Retrospective cohort study (1998-2018). Eligible patients had re-operation for local recurrence of a previously operated meningioma. Collected data included baseline clinical and imaging characteristic. Primary outcome measure was performance status after each re-operation. Secondary outcome measures were medical and surgical morbidity, recurrence-free survival (RFS) and overall survival (OS).
Results
Fifty-eight patients were eligible (38 female, mean age at 1st re-operation 56 years (SD=11.4)). Eleven patients (18.9%) had 2 re-operations and 3 patients (3.4%) had 3 re-operations. Median follow up was 125.5 months (IQR 73-191.5). Median time to 1st recurrence and 1st re-operation were 36.5 (IQR 24.2–79.1) and 43.8 months (IQR 22.9–102.7), respectively. Fifteen patients (25.9%) had worse performance status after 1st re-operation, compared to 6.9% (n=4) after the primary operation (Figure 1). Complication rate was 32.8% (n=19) after the primary operation compared to 46.6% (n=27) after 1st re-operation. At primary operation, there were 29 (50%) grade 1, 26 (44.8%) grade 2, and 1 (1.7%) grade 3 tumours. Median RFS after first re-operation was 68 months (95% CI 45.5-90.5) (figure 2). Median OS was 312 months (95% CI 236.9-387.1) (Figure 3). Post-operative complications were a risk factor for worsened performance status following re-operation (OR 4.91, 95% CI 1.3-18.4).
Conclusion
Re-operation is associated with a worse performance status and increased risk of complications. Re-operating meningiomas for radiological recurrence without symptoms increases patient morbidity. Shared-care management decision should be made with patients when considering operating for radiological recurrence only.
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Norrington M, Millward C, Doherty J, Mustafa M, Humphries T, Gillespie C, Richardson G, Islim A, Jenkinson M, Brodbelt A. Cranial Meningiomas Requiring Cranioplasty. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab195.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Bone infiltration in association with intracranial meningioma (4.5% of cases) and primary intraosseous meningioma (2%) are rare. Management can be challenging, as cranial vault reconstruction may be required. This study aimed to examine the surgical techniques used and outcomes in this patient population.
Method
A single-centre, retrospective cohort study was conducted between January 2010 and September 2020. All adult patients who required cranial reconstruction due to bone involvement of their meningioma were included. Patient demographics, tumour characteristics, operative details, complications, and outcomes were examined. Statistical analyses were performed using SPSS v24.0.
Results
There were 30 patients (17 female; 56.7%), median age 54 yrs (range 28-86 yrs), of whom 25 (83.3%) had bone infiltration, and 5 (16.7%) had primary intraosseous meningioma. Only 10 patients had a Simpson I or II resection. Twenty-eight had 'on-table' primary cranioplasties. Materials used were titanium (n=13; 43.3%), acrylic (n=10; 33.3%), PMMA (n=5; 16.7%), and hydroxyapatite (n=2; 6.7%). There were 9 (mostly minor) surgical complications and only one wound infection. Twelve patients had WHO grade II tumours, and 14 required radiotherapy. Ten patients (33.3%) had re-operation for recurrent tumour, with a median time to progression of 41 months. At 6 months, 24 patients had a performance score less than 2.
Conclusion
On-table cranioplasty provides a lower risk surgical option for patients with high risk meningiomas.
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Fu S, Pasic A, Richardson G, Vranjes Z, Meniawy T, de Jong P, Donate F, Samatar A, Rodriguez J, Pultar P, Voliotis D. 562TiP A phase Ib dose-escalation study of ZN-c3, a WEE1 inhibitor, in combination with chemotherapy in patients with platinum-resistant or -refractory ovarian, peritoneal, or fallopian tube cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hlay JK, Albert G, Batres C, Richardson G, Placek C, Arnocky S, Lieberman D, Hodges-Simeon CR. The evolution of disgust for pathogen detection and avoidance. Sci Rep 2021; 11:13468. [PMID: 34188198 PMCID: PMC8241835 DOI: 10.1038/s41598-021-91712-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/19/2021] [Indexed: 11/08/2022] Open
Abstract
The behavioral immune system posits that disgust functions to protect animals from pathogen exposure. Therefore, cues of pathogen risk should be a primary driver influencing variation in disgust. Yet, to our knowledge, neither the relationship between current pathogen risk and disgust, nor the correlation between objective and perceived pathogen risk have been addressed using ecologically valid measures in a global sample. The current article reports two studies addressing these gaps. In Study 1, we include a global sample (n = 361) and tested the influence of both perceived pathogen exposure and an objective measure of pathogen risk-local communicable infectious disease mortality rates-on individual differences in pathogen and sexual disgust sensitivities. In Study 2, we first replicate Study 1's analyses in another large sample (n = 821), targeting four countries (US, Italy, Brazil, and India); we then replaced objective and perceived pathogen risk with variables specific to the SARS-CoV-2 pandemic. In Study 1, both local infection mortality rates and perceived infection exposure predicted unique variance in pathogen and sexual disgust. In Study 2, we found that perceived infection exposure positively predicted sexual disgust, as predicted. When substituting perceived and objective SARS-CoV-2 risk in our models, perceived risk of contracting SARS-CoV-2 positively predicted pathogen and sexual disgust, and state case rates negatively predicted pathogen disgust. Further, in both studies, objective measures of risk (i.e., local infection mortality and SARS-CoV-2 rates) positively correlated with subjective measures of risk (i.e., perceived infection exposure and perceived SARS-CoV-2 risk). Ultimately, these results provide two pieces of foundational evidence for the behavioral immune system: 1) perceptions of pathogen risk accurately assay local, objective mortality risk across countries, and 2) both perceived and objective pathogen risk explain variance in disgust levels.
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Affiliation(s)
- Jessica K Hlay
- Department of Anthropology, Boston University, 232 Bay State Rd. #105, Boston, MA, 02215, USA
| | - Graham Albert
- Department of Anthropology, Boston University, 232 Bay State Rd. #105, Boston, MA, 02215, USA
| | - Carlota Batres
- Department of Psychology, Franklin & Marshall College, Lancaster, PA, USA
| | - George Richardson
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Caitlyn Placek
- Department of Anthropology, Ball State University, Muncie, IN, USA
| | - Steven Arnocky
- Department of Psychology, Nipissing University, North Bay, ON, Canada
| | - Debra Lieberman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Carolyn R Hodges-Simeon
- Department of Anthropology, Boston University, 232 Bay State Rd. #105, Boston, MA, 02215, USA.
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Richardson G, Kichenadasse G, Ganju V, Xu J, Van H, Kong P, Yang F, Wei Y, Lu Y, Guo K, Donato L, Xu T, Coward J. MA06.09 Preliminary Safety, Efficacy Results of KN046 (Bispecific Anti-PD-L1/CTLA4) in Subjects With Rare Thoracic Tumors. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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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Stirling R, Brand M, Earnest A, Antippa P, Ball D, Bartlett J, Blum R, Briggs L, Caldecott M, Conron M, Jennings B, Langton D, Millar J, Mitchell P, Olesen I, Parente P, Richardson G, See K, Torres J, Underhill C, Wright G, Stenger M, Mcneil J, Zalcberg J. OA05.06 Lessons Learned from the Victorian Lung Cancer Registry: Opportunities for Quality Improvement in Lung Cancer Management and Outcomes. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spray L, Park C, Cormack S, Mohammad A, Panahi P, Boag S, Bennaceur K, Richardson G, Arthur H, Stellos K, Spyridopoulos I. Role of CMV-serostatus and CX3CR1 on lymphocyte kinetics and left ventricular remodelling in patients with acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with latent cytomegalovirus (CMV) infection have higher rates of adverse cardiovascular outcomes, but the reasons for this remain elusive. CMV-induced changes to T-lymphocyte populations, with a proliferation of CMV-specific, CX3CR1+ effector memory cells, may contribute. Effector T-cells are associated with cardiovascular mortality in CMV positive patients, and ischaemia-reperfusion injury after ST-elevation myocardial infarction (STEMI) and primary percutaneous coronary intervention (pPCI).
Purpose
To investigate the effect of CMV status on lymphocyte kinetics and cardiac MRI (cMRI) parameters in 52 STEMI patients receiving pPCI, and examine the prognostic relevance of pre-reperfusion lymphocyte count in a large cohort.
Methods
We retrospectively analysed the association between pre-reperfusion lymphocyte count, troponin, and long-term survival in 4874 consecutive STEMI patients. Using flow cytometry, we analysed lymphocyte kinetics in 52 STEMI patients, of known CMV status, during and after pPCI. We assessed the impact of CMV status on infarct size, left-ventricular (LV) function and microvascular obstruction with cMRI in the first week after reperfusion in 101 patients. Repeat cMRI at 12 weeks, to assess LV remodelling, was obtained in 48 patients.
Results
Pre-reperfusion lymphopenia is an independent predictor of mortality over 7.5 years (hazard ratio for lowest vs highest quartile: 2.0; 95% CI 1.7–2.4; p<0.001), and is associated with higher admission troponins (p<0.001 for lowest vs second-lowest quartile), suggesting lymphocyte count falls prior to reperfusion in response to myocardial injury. CMV positive patients had more cytotoxic T-cells, strongly expressing the fractalkine receptor, CX3CR1. In CMV positive patients these cells fell dramatically by 90 minutes post-reperfusion, and dropped more sharply in patients with extensive microvascular obstruction on cMRI (p≤0.05 in all effector subsets). CX3CR1 expression was lower at 90 minutes post-reperfusion than at 24 hours (return to physiological expression) in all effector T-cell subsets. All subsets lost a similar proportion of their 24-hour value, but consistently lost a larger proportion in CMV positive patients (−27% in CMV+, −18% in CMV−; p=0.007). CX3CR1 expression falls in the presence of fractalkine, and we hypothesise that membrane-bound fractalkine is induced more strongly in CMV positive patients, as soluble fractalkine levels were similar. At 12 weeks, LV remodeling was worse in CMV positive patients (change in end-diastolic volume: +10.7ml vs −6.1ml; p=0.02).
Conclusions
Lymphopenia occurs prior to reperfusion in STEMI, and predicts long-term mortality. Effector T-cells drop substantially after reperfusion only in CMV positive patients, likely mediated by CX3CR1-fractalkine interaction, and this is associated with adverse cMRI findings. Remodeling is worse in CMV positive patients at 12 weeks post-STEMI.
Lymphocytes, troponin and survival
Funding Acknowledgement
Type of funding source: Public Institution(s)
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Affiliation(s)
- L Spray
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - C Park
- Newcastle University, Translational and Clinical Research Institute, Newcastle Upon Tyne, United Kingdom
| | - S Cormack
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - A Mohammad
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - P Panahi
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - S Boag
- Newcastle University, Translational and Clinical Research Institute, Newcastle Upon Tyne, United Kingdom
| | - K Bennaceur
- Newcastle University, Translational and Clinical Research Institute, Newcastle Upon Tyne, United Kingdom
| | - G Richardson
- Newcastle University, Biosciences institute, Newcastle Upon Tyne, United Kingdom
| | - H Arthur
- Newcastle University, Biosciences institute, Newcastle Upon Tyne, United Kingdom
| | - K Stellos
- Newcastle University, Biosciences institute, Newcastle Upon Tyne, United Kingdom
| | - I Spyridopoulos
- Newcastle University, Translational and Clinical Research Institute, Newcastle Upon Tyne, United Kingdom
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Evans N, Anton A, Wong R, Lok S, De Boer R, Malik L, Greenberg S, Yeo B, Nott L, Richardson G, Collins I, Torres J, Barnett F, Gibbs P, Devitt B. 51P Real world outcomes in elderly women with HER2-positive advanced breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Adu N, Richardson G, Tseng M. Periodogram ordinate: Spatial model with near unit roots and dependent errors. Stat Probab Lett 2020. [DOI: 10.1016/j.spl.2019.108615] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Scott R, Ellis L, Khanom A, Rhydderch M, Richardson G, Russell D, Russell I, Snooks H. Health experiences of asylum seekers and refugees in Wales. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
There are concerns that people seeking sanctuary (asylum seekers and refugees) in Wales, UK, have unmet health needs and face difficulties accessing services, but little collated evidence. This study addressed this gap to inform policy and practice in reducing health inequities. It aimed to: investigate the health, wellbeing and healthcare experiences of adults seeking sanctuary in Wales, including the views of healthcare recipients and providers; and establish what helped or hindered the healthcare experiences of those seeking sanctuary. It is the most comprehensive study of this population in Wales.
A mixed-method approach was taken, including a literature search, a cross-sectional survey of 210 adults seeking sanctuary, telephone interviews with 32 health professionals and third sector support workers, and 8 focus groups including 57 people seeking sanctuary and those supporting them.
Eight trained volunteer peer researchers, themselves asylum seekers or refugees, administered the surveys. Interviews were digitally recorded, transcribed and analysed using a standard framework.
The literature search identified 5 themes that help or hinder people seeking sanctuary to access healthcare. The survey found 79% of respondents attended an initial health assessment on arriving in Wales, with 94% currently registered with Primary healthcare. 64% reported difficulties in accessing health services. Awareness of services was mixed, with 66% having used healthcare in working hours (planned) and 28% out of hours (unplanned).
Mainstream health professionals felt they lack capacity to deliver care effectively due to time and other pressures on the healthcare system and the need for appropriate translation/interpretation services.
This study triangulates the experiences of people seeking sanctuary with those providing healthcare and general support. Peer researchers maximised sanctuary seekers’ participation. Many of its methods and findings have relevance to other countries in Europe.
Key messages
Improving health equity is key to realising Wales’ ambition to become a Nation of Sanctuary. Peer Researchers enabled participation by sanctuary seekers and revealed useful findings to steer future policy and practice.
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Affiliation(s)
- R Scott
- Policy & International Health, Public Health Wales, Cardiff, UK
| | - L Ellis
- Policy & International Health, Public Health Wales, Cardiff, UK
| | - A Khanom
- Patient and Population Health and Informatics, Swansea University, Swansea, UK
| | - M Rhydderch
- Displaced People in Action, Displaced People in Action, Cardiff, UK
| | - G Richardson
- Policy & International Health, Public Health Wales, Cardiff, UK
| | - D Russell
- Patient and Population Health and Informatics, Swansea University, Swansea, UK
| | - I Russell
- Patient and Population Health and Informatics, Swansea University, Swansea, UK
| | - H Snooks
- Patient and Population Health and Informatics, Swansea University, Swansea, UK
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Lai J, Antill Y, Richardson G, Vereker M, David S. Abstract P6-14-07: Not presented. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-14-07] [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: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the conference.
Citation Format: Lai J, Antill Y, Richardson G, Vereker M, David S. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-14-07.
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Affiliation(s)
- J Lai
- Oncology Clinics Victoria, Cabrini Health, Melbourne, VIC, Australia; Cabrini Health, Melbourne, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Y Antill
- Oncology Clinics Victoria, Cabrini Health, Melbourne, VIC, Australia; Cabrini Health, Melbourne, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - G Richardson
- Oncology Clinics Victoria, Cabrini Health, Melbourne, VIC, Australia; Cabrini Health, Melbourne, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - M Vereker
- Oncology Clinics Victoria, Cabrini Health, Melbourne, VIC, Australia; Cabrini Health, Melbourne, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - S David
- Oncology Clinics Victoria, Cabrini Health, Melbourne, VIC, Australia; Cabrini Health, Melbourne, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Duarte A, Bojke C, Cayton W, Salawu A, Case B, Bojke L, Richardson G. Impact of specialist rehabilitation services on hospital length of stay and associated costs. Eur J Health Econ 2018; 19:1027-1034. [PMID: 29282588 PMCID: PMC6105206 DOI: 10.1007/s10198-017-0952-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Provision of specialist rehabilitation services in North Yorkshire and Humberside may be suboptimal. Local commissioning bodies need to prioritise investments in health care, but previous studies provide limited evidence to inform the decision to expand existing services on the basis of cost-effectiveness. We examine the impact of specialist rehabilitation services in the subregion on hospital length of stay (LoS) and associated costs compared to routine care. METHODS Comparison of hospital LoS and associated costs in centres with greater access (Hull) and limited access (i.e. routine care, York and Northern Lincolnshire), to specialist rehabilitation services for patients with complex disabilities following illness or injury, using Hospital Episodes Statistics data. RESULTS Average LoS and duration costs by Healthcare Resource Group (HRG) were lower for the majority of patients with greater access to specialist rehabilitation compared to routine care. Difference in LoS between groups widened with level of complexity within each HRG. For the more frequent HRG codes, the LoS difference was as high as 34 days longer for York compared to Hull and £7900 more costly. CONCLUSION Rehabilitation patients within York and Northern Lincolnshire areas appear to have longer LoS and higher associated costs compared to those admitted to the Hull Trust. This analysis suggests that specialist rehabilitation may be cost saving compared to routine care and supports the case for expansion of the existing services to improve coverage in the area.
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Affiliation(s)
- A Duarte
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK.
| | - C Bojke
- Faculty of Medicine and Health, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - W Cayton
- Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - A Salawu
- Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
- Hull York Medical School, Hull, HU6 7RX, UK
- Department of Health, Sports and Exercise Science, University of Hull, Hull, HU6 7RX, UK
| | - B Case
- NHS Vale of York Clinical Commissioning Group, York, YO1 6GA, UK
| | - L Bojke
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - G Richardson
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
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Barbieri M, Richardson G, Paisley S. The cost-effectiveness of follow-up strategies after cancer treatment: a systematic literature review. Br Med Bull 2018; 126:85-100. [PMID: 29659715 DOI: 10.1093/bmb/ldy011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/18/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The cost of treatment and follow-up of cancer patients in the UK is substantial. In a budget-constrained system such as the NHS, it is necessary to consider the cost-effectiveness of the range of management strategies at different points on cancer patients' care pathways to ensure that they provide adequate value for money. SOURCES OF DATA We conducted a systematic literature review to explore the cost-effectiveness of follow-up strategies of patients previously treated for cancer with the aim of informing UK policy. All papers that were considered to be economic evaluations in the subject areas described above were extracted. AREAS OF AGREEMENT The existing literature suggests that intensive follow-up of patients with colorectal disease is likely to be cost-effective, but the opposite holds for breast cancer. AREAS OF CONTROVERSY Interventions and strategies for follow-up in cancer patients were variable across type of cancer and setting. Drawing general conclusions about the cost-effectiveness of these interventions/strategies is difficult. GROWING POINTS The search identified 2036 references but applying inclusion/exclusion criteria a total of 44 articles were included in the analysis. Breast cancer was the most common (n = 11) cancer type followed by colorectal (n = 10) cancer. In general, there were relatively few studies of cost-effectiveness of follow-up that could influence UK guidance. Where there was evidence, in the most part, NICE guidance broadly reflected this evidence. AREAS TIMELY TO DEVELOP RESEARCH In terms of future research around the timing, frequency and composition of follow-ups, this is dependent on the type of cancer being considered. Nevertheless, across most cancers, the possibility of remote follow-up (or testing) by health professionals other than hospital consultants in other settings appears to warrant further work.
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Affiliation(s)
- M Barbieri
- Centre for Health Economics, University of York, Heslington, York, UK
| | - G Richardson
- Centre for Health Economics, University of York, Heslington, York, UK
| | - S Paisley
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK
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Ellis L, Richardson G, Dyakova M, Stielke A. 2.11-P6What is the effect of health service experiences on the health and well-being of adult asylum seekers and refugees in Wales? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.078] [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: 11/13/2022] Open
Affiliation(s)
- L Ellis
- Public Health Wales, Cardiff, United Kingdom
| | | | - M Dyakova
- Public Health Wales, Cardiff, United Kingdom
| | - A Stielke
- Public Health Wales, Cardiff, United Kingdom
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Richardson G, Marshall D, Keevil BG. Prediction of haematocrit in dried blood spots from the measurement of haemoglobin using commercially available sodium lauryl sulphate. Ann Clin Biochem 2017; 55:363-367. [PMID: 28774182 DOI: 10.1177/0004563217726809] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background When preparing dried blood spots (DBSs), haematocrit (Hct) can affect the ability of the blood to spread through the filter paper, thus resulting in varying quantities of sample being measured when fixed subpunches of the DBSs are taken. It may be important to predict the sample Hct to correct volume differences. Methods Blood (10 µL) was applied to Perkin Elmer 226® paper. The samples ( n = 165) were allowed to dry for 24 h, and the entire blood spots were cut out. Subpunch analysis was also performed on blood spots prepared from 75 µL EDTA blood, taking 6 mm subpunches centrally and peripherally from the spots ( n = 59). The spots were eluted with 100 µL water, and a 10 µL aliquot of lysate was added to sulfolyser reagent (80 µL) in a microtitre plate. Hb was measured at 550 nm using an ELISA plate reader. DBS samples were compared against blood samples measured on a routine Sysmex XN-9000 analyser. Results The Passing and Bablock regression showed Hct (DBS-predicted) = 0.99 Hct (Sysmex) -0.02, R2 = 0.87. Intra-assay imprecision measured at Hct values of 0.27, 0.40 and 0.52, gave CVs of 4.1%, 2.8% and 4.2%, respectively. Inter-assay imprecision showed CVs of 6.2%, 5.2% and 4.2%, respectively. DBS samples were stable for up to two days at 60℃, one month at room temperature and six months at 4℃. Conclusion This method provides a simple and fast estimation of predicted Hct in dried blood spots.
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Affiliation(s)
- G Richardson
- Department of Clinical Biochemistry, University Hospital of South Manchester, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - D Marshall
- Department of Clinical Biochemistry, University Hospital of South Manchester, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - B G Keevil
- Department of Clinical Biochemistry, University Hospital of South Manchester, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Meniawy T, Richardson G, Townsend A, Desai J, Gan H, Friedlander M, Horvath L, Jameson M, Sandhu S, Wu Z, Qin Z, Kang K, Markman B. Preliminary results from a subset of patients (pts) with advanced ovarian cancer (OC) in a dose-escalation/expansion study of BGB-A317, an anti-PD-1 monoclonal antibody (mAb). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.023] [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: 11/14/2022] Open
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29
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Kissane DW, Bobevski I, Gaitanis P, Brooker J, Michael N, Lethborg C, Richardson G, Webster P, Hempton C. Exploratory examination of the utility of demoralization as a diagnostic specifier for adjustment disorder and major depression. Gen Hosp Psychiatry 2017. [PMID: 28622810 DOI: 10.1016/j.genhosppsych.2017.01.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Demoralization, a state of lowered morale and poor coping, has a prevalence of 13-18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of "with demoralization" as a diagnostic specifier for adjustment and depressive disorders. METHOD Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility. RESULTS Vignettes were assessed by 280 clinicians; 77% supported utility of the category 'adjustment disorder with demoralization' compared to 33% supporting 'adjustment disorder with anxiety' (McNemar test, p<0.001), while 83% supported the utility of 'with demoralization' for major depressive episode, matching 83% perceiving utility for 'with melancholia.' Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization. CONCLUSION Clinicians perceived the specifier 'with demoralization' to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.
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Affiliation(s)
- D W Kissane
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Malvern, VIC, Australia.
| | - I Bobevski
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - P Gaitanis
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - J Brooker
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Malvern, VIC, Australia
| | - N Michael
- Palliative Care Research Department, Cabrini Health, Malvern, VIC, Australia; University of Notre Dame, Sydney School of Medicine, Sydney, Australia
| | - C Lethborg
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Department of Oncology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - G Richardson
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Department of Oncology, Cabrini Health, Malvern, VIC, Australia
| | - P Webster
- Department of General Practice, Monash University, Clayton, VIC, Australia
| | - C Hempton
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Malvern, VIC, Australia
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Cheong J, Oliphant R, Richardson G, Rickard MJFX, Keshava A. The use of warmed, humidified CO 2 during open abdominal surgery: a modified delivery technique. Tech Coloproctol 2017; 21:309-310. [PMID: 28361208 DOI: 10.1007/s10151-017-1603-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
Affiliation(s)
- J Cheong
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School, University of Sydney, Sydney, NSW, Australia.
| | - R Oliphant
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - G Richardson
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - M J F X Rickard
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - A Keshava
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School, University of Sydney, Sydney, NSW, Australia
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Abstract
A growing literature has linked religiousness and spirituality (R/S) to substance use and abuse. However, it is not clear that R/S has causal effects on substance use. Currently, there is a relative lack of genetically sensitive examinations in the literature attendant to R/S effects. Given that behavioral genetic analyses have illustrated the influence of genetic factors on substance use and adherence to R/S worldviews, genetic confounding is a concern. The current study employed a sample of monozygotic twins discordant on religiousness, spirituality, and spiritual transformation to assess effects on substance use and abuse. Bivariate and multivariate models indicated a general lack of effect of R/S on substance use and abuse but did illustrate a dampening influence of religiousness on general (but not problematic) alcohol use. The findings highlight the importance of controlling for genetic and shared familial factors in examinations of the religiousness–spirituality–substance use nexus.
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Oliphant R, Richardson G, Keshava A. Laparoscopic use of the Contour ® Curved Cutter Stapler device via a glove port: a modified technique. Tech Coloproctol 2016; 21:59-60. [PMID: 27888439 DOI: 10.1007/s10151-016-1553-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Affiliation(s)
- R Oliphant
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School, University of Sydney, Hospital Road, Concord, NSW, 2139, Australia.
| | - G Richardson
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School, University of Sydney, Hospital Road, Concord, NSW, 2139, Australia
| | - A Keshava
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School, University of Sydney, Hospital Road, Concord, NSW, 2139, Australia
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Erhabor O, Richardson G, Mohammed I, Thornton C, Bark J, Hurst M, Hamer D, Kinsella R. Evaluation of the QBC Star centrifugal three-part differential haematology system. Br J Biomed Sci 2016; 70:67-74. [DOI: 10.1080/09674845.2013.11669938] [Citation(s) in RCA: 7] [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] [Indexed: 10/21/2022]
Affiliation(s)
- O. Erhabor
- Blood Sciences, Department of Laboratory Medicine, Royal Bolton Hospital
| | - G. Richardson
- Blood Sciences, Department of Laboratory Medicine, Royal Bolton Hospital
| | - I. Mohammed
- Blood Sciences, Department of Laboratory Medicine, Royal Bolton Hospital
| | - C. Thornton
- Blood Sciences, Department of Laboratory Medicine, Royal Bolton Hospital
| | - J. Bark
- Blood Sciences, Department of Laboratory Medicine, Royal Bolton Hospital
| | - M. Hurst
- Blood Sciences, Department of Laboratory Medicine, Royal Bolton Hospital
| | - D. Hamer
- Blood Sciences, Department of Laboratory Medicine, Royal Bolton Hospital
| | - R. Kinsella
- Blood Sciences, Department of Laboratory Medicine, Royal Bolton Hospital
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Duarte A, Walker J, Walker S, Richardson G, Holm Hansen C, Martin P, Murray G, Sculpher M, Sharpe M. Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer. J Psychosom Res 2015; 79:465-70. [PMID: 26652589 PMCID: PMC4678258 DOI: 10.1016/j.jpsychores.2015.10.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/26/2015] [Accepted: 10/30/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective. METHODS Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £ 20,000 to £ 30,000 per QALY gained. RESULTS DCPC cost on average £ 631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £ 9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £ 20,000 per QALY for the base case and scenario analyses. CONCLUSIONS Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings.
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Affiliation(s)
- A Duarte
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - J Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
| | - S Walker
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - G Richardson
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - C Holm Hansen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
| | - P Martin
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
| | - G Murray
- University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK.
| | - M Sculpher
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - M Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
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James J, Davidson KE, Richardson G, Grimstead C, Cable J. Reduced aggression and foraging efficiency of invasive signal crayfish (Pacifastacus leniusculus) infested with non-native branchiobdellidans (Annelida: Clitellata). Parasit Vectors 2015; 8:596. [PMID: 26577082 PMCID: PMC4650921 DOI: 10.1186/s13071-015-1199-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biological invasions are a principal threat to global biodiversity and identifying the determinants of non-native species' success is a conservation priority. Through their ability to regulate host populations, parasites are increasingly considered as important in determining the outcome of species' invasions. Here, we present novel evidence that the common crayfish ecto-symbiont, Xironogiton victoriensis (Annelida: Clitellata) can affect the behaviour of a widespread and ecologically important invader, the signal crayfish (Pacifastacus leniusculus). METHODS To assess the signal crayfish-X. victoriensis relationship naïve crayfish were infested with an intensity of worms typically observed under natural conditions. Over a 10-week period the growth rate and survivorship of these animals was monitored and compared to those of uninfested counterparts. Complementary dyadic competition and foraging experiments were run to assess the behaviour of infested compared to uninfested animals. These data were analysed using General Linear Models and Generalized Linear Mixed Models. RESULTS Whilst X. victoriensis did not affect the growth rate or survivorship of signal crayfish under laboratory conditions, infested animals were significantly less aggressive and poorer foragers than uninfested individuals. CONCLUSIONS Through reducing aggression and foraging efficiency, infestation with X. victoriensis may disrupt the social structure, and potentially growth rate and/or dispersal of afflicted crayfish populations, with potential effects on their invasion dynamics. This is important given the widespread invasive range of crayfish and their functional roles as ecosystem engineers and keystone species.
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Affiliation(s)
- J James
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK.
| | - K E Davidson
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK.
| | - G Richardson
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK.
| | - C Grimstead
- Natural Resources Wales, Rivers House, St. Mellons, Cardiff, CF3 0EY, UK.
| | - J Cable
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK.
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Richardson G, Giannopoulou C, Barber S, Bingham D. Cost-effectiveness of a playground based intervention to improve physical activity. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Demetri G, Patel S, Thomas S, Livingston M, Undevia S, Richardson G, Singh A, Seth R, Forscher C, Hinshaw I, Hussein A, D'Amato G, Chawla S, Khokhar N, Park Y, Knoblauch R, Parekh T, Maki R, Mehren MV. 3436 Efficacy and safety of trabectedin (T) or dacarbazine (D) for treatment of patients (pts) with advanced leiomyosarcoma (LMS) or liposarcoma (LPS) after prior chemotherapy. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31909-8] [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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Field K, Shapiro J, Wong HL, Tacey M, Nott L, Tran B, Turner N, Ananda S, Richardson G, Jennens R, Wong R, Power J, Burge M, Gibbs P. Treatment and outcomes of metastatic colorectal cancer in Australia: defining differences between public and private practice. Intern Med J 2015; 45:267-74. [DOI: 10.1111/imj.12643] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 11/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
- K. Field
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - J. Shapiro
- Department of Medical Oncology; Cabrini Health; Melbourne Victoria Australia
- Faculty of Medicine; Monash University; Melbourne Victoria Australia
| | - H.-L. Wong
- Systems Biology and Personalised Medicine Division; Walter and Eliza Hall Institute; Melbourne Victoria Australia
- Faculty of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - M. Tacey
- Department of Statistics; Melbourne EpiCentre; Melbourne Victoria Australia
| | - L. Nott
- Department of Medical Oncology; Royal Hobart Hospital; Hobart Australia
| | - B. Tran
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
- Systems Biology and Personalised Medicine Division; Walter and Eliza Hall Institute; Melbourne Victoria Australia
- Faculty of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - N. Turner
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
- Systems Biology and Personalised Medicine Division; Walter and Eliza Hall Institute; Melbourne Victoria Australia
| | - S. Ananda
- Department of Medical Oncology; Western Hospital; Melbourne Victoria Australia
| | - G. Richardson
- Department of Medical Oncology; Cabrini Health; Melbourne Victoria Australia
| | - R. Jennens
- Department of Medical Oncology; Epworth Health; Hobart Australia
| | - R. Wong
- Department of Medical Oncology; Box Hill Hospital; Hobart Australia
| | - J. Power
- Department of Medical Oncology; Launceston Hospital; Launceston Tasmania Australia
| | - M. Burge
- Department of Medical Oncology; Royal Brisbane Hospital; Brisbane Queensland Australia
| | - P. Gibbs
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
- Systems Biology and Personalised Medicine Division; Walter and Eliza Hall Institute; Melbourne Victoria Australia
- Faculty of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Medical Oncology; Western Hospital; Melbourne Victoria Australia
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Abstract
Metal-on-metal resurfacing of the hip (MoMHR) has enjoyed a resurgence in the last decade, but is now again in question as a routine option for osteoarthritis of the hip. Proponents of hip resurfacing suggest that its survival is superior to that of conventional hip replacement (THR), and that hip resurfacing is less invasive, is easier to revise than THR, and provides superior functional outcomes. Our argument serves to illustrate that none of these proposed advantages have been realised and new and unanticipated serious complications, such as pseudotumors, have been associated with the procedure. As such, we feel that the routine use of MoMHR is not justified. Cite this article: Bone Joint J 2014;96-B(11 Suppl A):17–21.
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Affiliation(s)
- M. J. Dunbar
- Halifax Infirmary Hospital, 1796
Summer Street, Halifax, B3H
3A7, Canada
| | - V. Prasad
- Halifax Infirmary Hospital, 1796
Summer Street, Halifax, B3H
3A7, Canada
| | - B. Weerts
- Halifax Infirmary Hospital, 1796
Summer Street, Halifax, B3H
3A7, Canada
| | - G. Richardson
- Halifax Infirmary Hospital, 1796
Summer Street, Halifax, B3H
3A7, Canada
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Kelly DJ, White C, Richardson G. Noninfarct related artery embolic protection during primary PCI. Catheter Cardiovasc Interv 2014; 84:E18-20. [PMID: 24375849 DOI: 10.1002/ccd.22809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 08/29/2010] [Accepted: 08/31/2010] [Indexed: 11/11/2022]
Abstract
A 66-year old man presented with antero-lateral STEMI. An ulcerated plaque and thrombus were seen in the proximal LAD. We were unable to pass a thrombectomy catheter down the LAD. To avoid embolisation of debris a Spider FX distal protection device was placed into the circumflex artery. Following stent implantation the patient developed chest pain with inferolateral ST depression. Thrombus was extracted from the circumflex artery within the distal protection device. Noninfract related artery distal protection during primary PCI may be an appropriate safeguard where thrombectomy is not possible in an infarct-related left coronary branch.
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Affiliation(s)
- D J Kelly
- Glenfield hospital, Cardiology, Groby Road, Leicester, United Kingdom, LE3 9QP
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Wong HL, Field K, Harol M, Tran B, Tie J, Shapiro J, Wong R, Yip D, Nott L, Richardson G, McKendrick J, Gibbs P. P0183 Resection of colorectal cancer metastases in routine practice. Eur J Cancer 2014. [DOI: 10.1016/j.ejca.2014.03.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Walker S, Walker J, Richardson G, Palmer S, Wu Q, Gilbody S, Martin P, Hansen CH, Sawhney A, Murray G, Sculpher M, Sharpe M. Cost-effectiveness of combining systematic identification and treatment of co-morbid major depression for people with chronic diseases: the example of cancer. Psychol Med 2014; 44:1451-1460. [PMID: 23962484 DOI: 10.1017/s0033291713002079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Co-morbid major depression occurs in approximately 10% of people suffering from a chronic medical condition such as cancer. Systematic integrated management that includes both identification and treatment has been advocated. However, we lack information on the cost-effectiveness of this combined approach, as published evaluations have focused solely on the systematic (collaborative care) treatment stage. We therefore aimed to use the best available evidence to estimate the cost-effectiveness of systematic integrated management (both identification and treatment) compared with usual practice, for patients attending specialist cancer clinics. METHOD We conducted a cost-effectiveness analysis using a decision analytic model structured to reflect both the identification and treatment processes. Evidence was taken from reviews of relevant clinical trials and from observational studies, together with data from a large depression screening service. Sensitivity and scenario analyses were undertaken to determine the effects of variations in depression incidence rates, time horizons and patient characteristics. RESULTS Systematic integrated depression management generated more costs than usual practice, but also more quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was £11,765 per QALY. This finding was robust to tests of uncertainty and variation in key model parameters. CONCLUSIONS Systematic integrated management of co-morbid major depression in cancer patients is likely to be cost-effective at widely accepted threshold values and may be a better way of generating QALYs for cancer patients than some existing medical and surgical treatments. It could usefully be applied to other chronic medical conditions.
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Affiliation(s)
- S Walker
- Centre for Health Economics, University of York, Heslington, York, UK
| | - J Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - G Richardson
- Centre for Health Economics, University of York, Heslington, York, UK
| | - S Palmer
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Q Wu
- Department of Health Sciences, University of York, Heslington, York, UK
| | - S Gilbody
- Department of Health Sciences, University of York, Heslington, York, UK
| | - P Martin
- Psychological Medicine Research, University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - C Holm Hansen
- Psychological Medicine Research, University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - A Sawhney
- Psychological Medicine Research, University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - G Murray
- University of Edinburgh Centre for Population Health Sciences, Edinburgh, UK
| | - M Sculpher
- Centre for Health Economics, University of York, Heslington, York, UK
| | - M Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
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Abstract
Satisfaction is increasingly employed as an outcome measure for a successful total knee replacement (TKR). Satisfaction as an outcome measure encompasses many different intrinsic and extrinsic factors related to a person's experience before and after TKR. The Swedish Knee Arthroplasty Registry has previously demonstrated on a large population study that 17% of TKR recipients are not satisfied with their TKR outcome. This finding has been replicated in other countries. Similar significant factors emerged from these registry studies that are related to satisfaction. It would appear that satisfaction is better after more chronic diseases and whether the TKR results in pain relief or improved function. Importantly, unmet pre-operative expectations are a significant predictor for dissatisfaction following a TKR. It may be possible to improve rates by addressing the issues surrounding pain, function and expectation before embarking on surgery.
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Affiliation(s)
- M J Dunbar
- Dalhousie University, Room 4822, Halifax Infirmary Hospital, 1796 Summer Street, Halifax, Nova Scotia, B3H 3A7, Canada
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Richardson G. Challenges of Treating Patients with Cancer in Australia. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt438.3] [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: 11/14/2022] Open
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Richardson G, Eick SA. English health visitors' perceptions of conducting indoor environmental assessments: barriers and facilitators. Public Health Nurs 2013; 31:336-43. [PMID: 24099582 DOI: 10.1111/phn.12077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this qualitative research was to explore health visitors' perceptions of assessing their clients' homes and providing evidence-informed advice about environmental health. DESIGN AND SAMPLE Between 2004 and 2007, an explorative study was conducted in Plymouth, England, during which interviews were held with health visitors trained to conduct environmental assessments in combination with routine visits. MEASURES Face-to-face, semi-structured interviews were conducted. Content analysis was used to explore emergent themes. RESULTS The health visitors perceived that assessing the indoor environment was relevant to their role; however, conducting environmental measurements within routine visits was not feasible. The main barriers were the changing roles of health visitors (reducing time available), the time implications of being perceived as an environmental expert, and the impact on clients, such as raising expectations, imposing opinions on the state of clients' homes, and expecting clients to implement advice. Facilitators included the natural link to health visitors' roles, the ability to provide evidence of an environmental risk, and the satisfaction of observing clients implementing advice. CONCLUSIONS Health visitors lacked propositional knowledge on the indoor environment, highlighting a need for more training. Access to an environmental assessment system increased the health visitors' confidence in dealing with indoor environmental issues.
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Dillon E, Durham W, Casperson S, Horstman A, Randolph K, Danesi C, Hatch S, McCammon S, Levine L, Willis M, Richardson G, Urban R, Sheffield-Moore M. Testosterone Therapy is Anti-Cachectic in Cancer Patients Receiving Standard of Care Chemotherapy. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Parke E, Hart J, Baldock D, Barchard K, Etcoff L, Allen D, Stolberg P, Nardi N, Cohen J, Jones W, Loe S, Etcoff L, Delgaty L, Tan A, Bunner M, Delgaty L, Tan A, Bunner M, Tan A, Delgaty L, Bunner M, Tan A, Delgaty L, Bunner M, Goodman G, Kim W, Nolty A, Marion S, Davis A, Finch W, Piehl J, Moss L, Nogin R, Dean R, Davis J, Lindstrom W, Poon M, Fonseca F, Bure-Reyes A, Stewart J, Golden C, Fonseca F, Bure-Reyes A, Stewart J, Golden C, Fields K, Hill B, Corley E, Russ K, Boettcher A, Musso M, Rohling M, Rowden A, Downing K, Benners M, Miller D, Maricle D, Dugbartey T, Anum A, Anderson J, Daniel M, Hoskins L, Gillis K, Khen S, Carter K, Ayers C, Neeland I, Cullum M, Weiner M, Rossetti H, Buddin W, Mahal S, Schroeder R, Baade L, Macaluso M, Phelps K, Evans C, Clark J, Vickery C, Chow J, Stokic D, Phelps K, Evans C, Watson S, Odom R, Clark J, Clark J, Odom R, Evans C, Vickery C, Thompson J, Noggle C, Kane C, Kecala N, Lane E, Raymond M, Woods S, Iudicello J, Dawson M, Ghias A, Choe M, Yudovin S, McArthur D, Asarnow R, Giza C, Babikian T, Tun S, O'Neil M, Ensley M, Storzbach D, Ellis R, O'Neil M, Carlson K, Storzbach D, Brenner L, Freeman M, Quinones A, Motu'apuaka M, Ensley M, Kansagara D, Brickell T, Grant I, Lange R, Kennedy J, Ivins B, Marshall K, Prokhorenko O, French L, Brickell T, Lange R, Bhagwat A, French L, Weber E, Nemeth D, Songy C, Gremillion A, Lange R, Brubacher J, Shewchuk J, Heran M, Jarrett M, Rauscher A, Iverson G, Woods S, Ukueberuwa D, Medaglia J, Hillary F, Meyer J, Vargas G, Rabinowitz A, Barwick F, Arnett P, Levan A, Gale S, Atkinson J, Boettcher A, Hill B, Rohling M, Stolberg P, Hart J, Allen D, Mayfield J, Ellis M, Marion SD, Houshyarnejad A, Grant I, Akarakian R, Kernan C, Babikian T, Asarnow R, Bens M, Fisher M, Garrett C, Vinogradov S, Walker K, Torstrick A, Uderman J, Wellington R, Zhao L, Fromm N, Dahdah M, Salisbury D, Monden K, Lande E, Wanlass R, Fong G, Smith K, Miele A, Novakovic-Agopian T, Chen A, Rome S, Rossi A, Abrams G, Murphy M, Binder D, Muir J, Carlin G, Loya F, Rabinovitz B, Bruhns M, Adler M, Schleicher-Dilks S, Messerly J, Babika C, Ukpabi C, Golden C, Schleicher-Dilks S, Coad S, Messerly J, Schaffer S, Babika C, Golden C, Cowad S, Paisley S, Fontanetta R, Messerly J, Golden C, Holder C, Kloezeman K, Henry B, Burns W, Patt V, Minassian A, Perry W, Cooper L, Allen D, Vogel S, Woolery H, Ciobanu C, Simone A, Bedard A, Olivier T, O'Neill S, Rajendran K, Halperin J, Rudd-Barnard A, Steenari M, Murry J, Le M, Becker T, Mucci G, Zupanc M, Shapiro E, Santos O, Cadavid N, Giese E, Londono N, Osmon D, Zamzow J, Culnan E, D'Argenio D, Mosti C, Spiers M, Schleicher-Dilks S, Kloss J, Curiel A, Miller K, Olmstead R, Gottuso A, Saucier C, Miller J, Dye R, Small G, Kent A, Andrews P, Puente N, Terry D, Faraco C, Brown C, Patel A, Siegel J, Miller L, Lee B, Joan M, Thaler N, Fontanetta R, Carla F, Allen D, Nguyen T, Glass L, Coles C, Julie K, May P, Sowell E, Jones K, Riley E, Demsky Y, Mattson S, Allart A, Freer B, Tiersky L, Sunderaraman P, Sylvester P, Ang J, Schultheis M, Newton S, Holland A, Burns K, Bunting J, Taylor J, Muetze H, Coe M, Harrison D, Putnam M, Tiersky L, Freer B, Holland A, Newton S, Sakamoto M, Bunting J, Taylor J, Coe M, Harrison D, Musso M, Hill B, Barker A, Pella R, Gouvier W, Davis J, Woods S, Wall J, Etherton J, Brand T, Hummer B, O'Shea C, Segovia J, Thomlinson S, Schulze E, Roskos P, Gfeller J, Loftis J, Fogel T, Barrera K, Sherzai A, Chappell A, Harrison A, Armstrong I, Flaro L, Pedersen H, Shultz LS, Roper B, Huckans M, Basso M, Silk-Eglit G, Stenclik J, Miele A, Lynch J, McCaffrey R, Silk-Eglit G, Stenclik J, Miele A, Lynch J, Musso M, McCaffrey R, Martin P, VonDran E, Baade L, Heinrichs R, Schroeder R, Hunter B, Calloway J, Rolin S, Akeson S, Westervelt H, Mohammed S, An K, Jeffay E, Zakzanis K, Lynch A, Drasnin D, Ikanga J, Graham O, Reid M, Cooper D, Long J, Lange R, Kennedy J, Hopewell C, Lukaszewska B, Pachalska M, Bidzan M, Lipowska M, McCutcheon L, Kaup A, Park J, Morgan E, Kenton J, Norman M, Martin P, Netson K, Woods S, Smith M, Paulsen J, Hahn-Ketter A, Paxton J, Fink J, Kelley K, Lee R, Pliskin N, Segala L, Vasilev G, Bozgunov K, Naslednikova R, Raynov I, Gonzalez R, Vassileva J, Bonilla X, Fedio A, Johnson K, Sexton J, Blackstone K, Weber E, Moore D, Grant I, Woods S, Pimental P, Welch M, Ring M, Stranks E, Crowe S, Jaehnert S, Ellis C, Prince C, Wheaton V, Schwartz D, Loftis J, Fuller B, Hoffman W, Huckans M, Turecka S, McKeever J, Morse C, Schultheis M, Dinishak D, Dasher N, Vik P, Hachey D, Bowman B, Van Ness E, Williams C, Zamzow J, Sunderaraman P, Kloss J, Spiers M, Swirsky-Sacchetti T, Alhassoon O, Taylor M, Sorg S, Schweinsburg B, Stricker N, Kimmel C, Grant I, Alhassoon O, Taylor M, Sorg S, Schweinsburg B, Stephan R, Stricker N, Grant I, Hertza J, Tyson K, Northington S, Loughan A, Perna R, Davis A, Collier M, Schroeder R, Buddin W, Schroeder R, Moore C, Andrew W, Ghelani A, Kim J, Curri M, Patel S, Denney D, Taylor S, Huberman S, Greenberg B, Lacritz L, Brown D, Hughes S, Greenberg B, Lacritz L, Vargas V, Upshaw N, Whigham K, Peery S, Casto B, Barker L, Otero T, La D, Nunan-Saah J, Phoong M, Gill S, Melville T, Harley A, Gomez R, Adler M, Tsou J, Schleicher-Dilks S, Golden C, Tsou J, Schleicher-Dilks S, Adler M, Golden C, Cowad S, Link J, Barker T, Gulliver K, Golden C, Young K, Moses J, Lum J, Vik P, Legarreta M, Van Ness E, Williams C, Dasher N, Williams C, Vik P, Dasher N, Van Ness E, Bowman B, Nakhutina L, Margolis S, Baek R, Gonzalez J, Hill F, England H, Horne-Moyer L, Stringer A, DeFilippis N, Lyon A, Giovannetti T, Fanning M, Heverly-Fitt S, Stambrook E, Price C, Selnes O, Floyd T, Vogt E, Thiruselvam I, Quasney E, Hoelzle J, Grant N, Moses J, Matevosyan A, Delano-Wood L, Alhassoon O, Hanson K, Lanni E, Luc N, Kim R, Schiehser D, Benners M, Downing K, Rowden A, Miller D, Maricle D, Kaminetskaya M, Moses J, Tai C, Kaminetskaya M, Melville T, Poole J, Scott R, Hays F, Walsh B, Mihailescu C, Douangratdy M, Scott B, Draffkorn C, Andrews P, Schmitt A, Waksmunski C, Brady K, Andrews A, Golden C, Olivier T, Espinoza K, Sterk V, Spengler K, Golden C, Olivier T, Spengler K, Sterk V, Espinoza K, Golden C, Gross J, DeFilippis N, Neiman-Kimel J, Romers C, Isaacs C, Soper H, Sordahl J, Tai C, Moses J, D'Orio V, Glukhovsky L, Beier M, Shuman M, Spat J, Foley F, Guatney L, Bott N, Moses J, Miranda C, Renteria MA, Rosario A, Sheynin J, Fuentes A, Byrd D, Mindt MR, Batchelor E, Meyers J, Patt V, Thomas M, Minassian A, Geyer M, Brown G, Perry W, Smith C, Kiefel J, Rooney A, Gouaux B, Ellis R, Grant I, Moore D, Graefe A, Wyman-Chick K, Daniel M, Beene K, Jaehnert S, Choi A, Moses J, Iudicello J, Henry B, Minassian A, Perry W, Marquine M, Morgan E, Letendre S, Ellis R, Woods S, Grant I, Heaton R, Constantine K, Fine J, Palewjala M, Macher R, Guatney L, Earleywine M, Draffkorn C, Scott B, Andrews P, Schmitt A, Dudley M, Silk-Eglit G, Stenclik J, Miele A, Lynch J, McCaffrey R, Scharaga E, Gomes W, McGinley J, Miles-Mason E, Colvin M, Carrion L, Romers C, Soper H, Zec R, Kohlrus S, Fritz S, Robbs R, Ala T, Zec R, Fritz S, Kohlrus S, Robbs R, Ala T, Edwards M, Hall J, O'Bryant S, Miller J, Dye R, Miller K, Baerresen K, Small G, Moskowitz J, Puente A, Ahmed F, Faraco C, Brown C, Evans S, Chu K, Miller L, Young-Bernier M, Tanguay A, Tremblay F, Davidson P, Duda B, Puente A, Terry D, Kent A, Patel A, Miller L, Junod A, Marion SD, Harrington M, Fonteh A, Gurnani A, John S, Gavett B, Diaz-Santos M, Mauro S, Beaute J, Cronin-Golomb A, Fazeli P, Gouaux B, Rosario D, Heaton R, Moore D, Puente A, Lindbergh C, Chu K, Evans S, Terry D, Duda B, Mackillop J, Miller S, Greco S, Klimik L, Cohen J, Robbins J, Lashley L, Schleicher-Dilks S, Golden C, Kunkes I, Culotta V, Kunkes I, Griffits K, Loughan A, Perna R, Hertza J, Cohen M, Northington S, Tyson K, Musielak K, Fine J, Kaczorowski J, Doty N, Braaten E, Shah S, Nemanim N, Singer E, Hinkin C, Levine A, Gold A, Evankovich K, Lotze T, Yoshida H, O'Bryan S, Roberg B, Glusman M, Ness A, Thelen J, Wilson L, Feaster T, Bruce J, Lobue C, Brown D, Hughes S, Greenberg B, Lacritz L, Bristow-Murray B, Andrews A, Bermudez C, Golden C, Moore R, Pulver A, Patterson T, Bowie C, Harvey P, Jeste D, Mausbach B, Wingo J, Fink J, Lee R, Pliskin N, Legenkaya A, Henry B, Minassian A, Perry W, McKeever J, Morse C, Thomas F, Schultheis M, Ruocco A, Daros A, Gill S, Grimm D, Saini G, Relova R, Hoblyn J, Lee T, Stasio C, Mahncke H, Drag L, Grimm D, Gill S, Saini G, Relova R, Hoblyn J, Lee T, Stasio C, Mahncke H, Drag L, Verbiest R, Ringdahl E, Thaler N, Sutton G, Vogel S, Reyes A, Ringdahl E, Vogel S, Freeman A, Call E, Allen D, March E, Salzberg M, Vogel S, Ringdahl E, Freeman A, Dadis F, Allen D, Sisk S, Ringdahl E, Vogel S, Freeman A, Allen D, DiGangi J, Silva L, Pliskin N, Thieme B, Daniel M, Jaehnert S, Noggle C, Thompson J, Kecala N, Lane E, Kane C, Noggle C, Thompson J, Lane E, Kecala N, Kane C, Palmer G, Happe M, Paxson J, Jurek B, 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Steed A, Kark S, Lafleche G, Brown T, Bogdanova Y, Strongin E, Spickler C, Drasnin D, Strongin C, Poreh A, Houshyarnejad A, Ellis M, Babikian T, Kernan C, Asarnow R, Didehbani N, Cullum M, Loneman L, Mansinghani S, Hart J, Fischer J. POSTER SESSIONS SCHEDULE. Arch Clin Neuropsychol 2013. [DOI: 10.1093/arclin/act054] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Richardson G, Rugg T. Peter Francis Kennedy. Assoc Med J 2013. [DOI: 10.1136/bmj.f413] [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: 11/04/2022]
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Maund E, Craig D, Suekarran S, Neilson A, Wright K, Brealey S, Dennis L, Goodchild L, Hanchard N, Rangan A, Richardson G, Robertson J, McDaid C. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess 2012; 16:1-264. [PMID: 22405512 DOI: 10.3310/hta16110] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Frozen shoulder is condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately 1 to 3 years' duration, though incomplete resolution can occur. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of treatments for primary frozen shoulder, identify the most appropriate intervention by stage of condition and highlight any gaps in the evidence. DATA SOURCES A systematic review was conducted. Nineteen databases and other sources including the Cumulative Index to Nursing and Allied Health (CINAHL), Science Citation Index, BIOSIS Previews and Database of Abstracts of Reviews of Effects (DARE) were searched up to March 2010 and EMBASE and MEDLINE up to January 2011, without language restrictions. MEDLINE, CINAHL and PsycINFO were searched in June 2010 for studies of patients' views about treatment. REVIEW METHODS Randomised controlled trials (RCTs) evaluating physical therapies, arthrographic distension, steroid injection, sodium hyaluronate injection, manipulation under anaesthesia, capsular release or watchful waiting, alone or in combination were eligible for inclusion. Patients with primary frozen shoulder (with or without diabetes) were included. Quasi-experimental studies were included in the absence of RCTs and case series for manipulation under anaesthesia (MUA) and capsular release only. Full economic evaluations meeting the intervention and population inclusion criteria of the clinical review were included. Two researchers independently screened studies for relevance based on the inclusion criteria. One reviewer extracted data and assessed study quality; this was checked by a second reviewer. The main outcomes of interest were pain, range of movement, function and disability, quality of life and adverse events. The analysis comprised a narrative synthesis and pair-wise meta-analysis. A mixed-treatment comparison (MTC) was also undertaken. An economic decision model was intended, but was found to be implausible because of a lack of available evidence. Resource use was estimated from clinical advisors and combined with quality-adjusted life-years obtained through mapping to present tentative cost-effectiveness results. RESULTS Thirty-one clinical effectiveness studies and one economic evaluation were included. The clinical effectiveness studies evaluated steroid injection, sodium hyaluronate, supervised neglect, physical therapy (mainly physiotherapy), acupuncture, MUA, distension and capsular release. Many of the studies identified were at high risk of bias. Because of variation in the interventions and comparators few studies could be pooled in a meta-analysis. Based on single RCTs, and for some outcomes only, short-wave diathermy may be more effective than home exercise. High-grade mobilisation may be more effective than low-grade mobilisation in a population in which most patients have already had treatment. Data from two RCTs showed that there may be benefit from adding a single intra-articular steroid injection to home exercise in patients with frozen shoulder of < 6 months' duration. The same two trials showed that there may be benefit from adding physiotherapy (including mobilisation) to a single steroid injection. Based on a network of nine studies the MTC found that steroid combined with physiotherapy was the only treatment showing a statistically and clinically significant beneficial treatment effect compared with placebo for short-term pain (standardised mean difference -1.58, 95% credible interval -2.96 to -0.42). This analysis was based on only a subset of the evidence, which may explain why the findings are only partly supportive of the main analysis. No studies of patients' views about the treatments were identified. Average costs ranged from £36.16 for unguided steroid injections to £2204 for capsular release. The findings of the mapping suggest a positive relationship between outcome and European Quality of Life-5 Dimensions (EQ-5D) score: a decreasing visual analogue scale score (less pain) was accompanied by an increasing (better) EQ-5D score. The one published economic evaluation suggested that low-grade mobilisation may be more cost-effective than high-grade mobilisation. Our tentative cost-effectiveness analysis suggested that steroid alone may be more cost-effective than steroid plus physiotherapy or physiotherapy alone. These results are very uncertain. LIMITATIONS The key limitation was the lack of data available. It was not possible to undertake the planned synthesis exploring the influence of stage of frozen shoulder or the presence of diabetes on treatment effect. As a result of study diversity and poor reporting of outcome data there were few instances where the planned quantitative synthesis was possible or appropriate. Most of the included studies had a small number of participants and may have been underpowered. The lack of available data made the development of a decision-analytic model implausible. We found little evidence on treatment related to stage of condition, treatment pathways, the impact on quality of life, associated resource use and no information on utilities. Without making a number of questionable assumptions modelling was not possible. CONCLUSIONS There was limited clinical evidence on the effectiveness of treatments for primary frozen shoulder. The economic evidence was so limited that no conclusions can be made about the cost-effectiveness of the different treatments. High-quality primary research is required.
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Affiliation(s)
- E Maund
- Centre for Reviews and Dissemination, University of York, York, UK
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