1
|
Bloemeke-Cammin J, Groene O, Ballester M, Guanais F, Groenewegen P, Kendir C, Porter I, Rehsi A, Rijken M, Spreeuwenberg P, Suñol R, Valderas JM, Williams R, van den Berg M. International cross-cultural development and field testing of the primary care practice questionnaire for the PaRIS survey (PaRIS-PCPQ). BMC Prim Care 2024; 25:168. [PMID: 38760733 PMCID: PMC11100105 DOI: 10.1186/s12875-024-02375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/09/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The PaRIS survey, an initiative of the Organisation for Economic Co-operation and Development (OECD), aims to assess health systems performance in delivering primary care by measuring the care experiences and outcomes of people over 45 who used primary care services in the past six months. In addition, linked data from primary care practices are collected to analyse how the organisation of primary care practices and their care processes impact care experiences and outcomes. This article describes the development and validation of the primary care practice questionnaire for the PaRIS survey, the PaRIS-PCPQ. METHOD The PaRIS-PCPQ was developed based on domains of primary care practice and professional characteristics included in the PaRIS conceptual framework. Questionnaire development was conducted in four phases: (1) a multi-step consensus-based development of the source questionnaire, (2) translation of the English source questionnaire into 17 languages, (3) cross-national cognitive testing with primary care professionals in participating countries, and (4) cross-national field-testing. RESULTS 70 items were selected from 7 existing questionnaires on primary care characteristics, of which 49 were included in a first draft. Feedback from stakeholders resulted in a modified 34-item version (practice profile, care coordination, chronic care management, patient follow-up, and respondent characteristics) designed to be completed online by medical or non-medical staff working in a primary care practice. Cognitive testing led to changes in the source questionnaire as well as to country specific localisations. The resulting 32-item questionnaire was piloted in an online survey and field test. Data from 540 primary care practices from 17 countries were collected and analysed. Final revision resulted in a 34-item questionnaire. CONCLUSIONS The cross-national development of a primary care practice questionnaire is challenging due to the differences in care delivery systems. Rigorous translation and cognitive testing as well as stakeholder engagement helped to overcome most challenges. The PaRIS-PCPQ will be used to assess how key characteristics of primary care practices relate to the care experiences and outcomes of people living with chronic conditions. As such, policymakers and care providers will be informed about the performance of primary care from the patient's perspective.
Collapse
Affiliation(s)
- Janika Bloemeke-Cammin
- Department Research & Innovation, OptiMedis AG, Burchardstraße 17, 20095, Hamburg, Germany
| | - Oliver Groene
- Department Research & Innovation, OptiMedis AG, Burchardstraße 17, 20095, Hamburg, Germany.
- Faculty of Management, Economics and Society, University of Witten/Herdecke, Witten, Germany.
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Frederico Guanais
- OECD, Health Division, Directorate for Employment, Labour and Social Affairs, Paris, France
| | - Peter Groenewegen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Candan Kendir
- OECD, Health Division, Directorate for Employment, Labour and Social Affairs, Paris, France
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ian Porter
- Health Services & Policy Research Group, University of Exeter, Exeter, UK
| | | | - Mieke Rijken
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Peter Spreeuwenberg
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Jose Maria Valderas
- Health Services & Policy Research Group, University of Exeter, Exeter, UK
- Centre for Research in Health Systems Performance, Yon Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | | | - Michael van den Berg
- OECD, Health Division, Directorate for Employment, Labour and Social Affairs, Paris, France
| |
Collapse
|
2
|
Vetere A, Di Girolamo N, Porter I, Tollefson C, Di Ianni F, Nardini G. Sex identification in juvenile and adult Indonesian blue-tongued skinks (Tiliqua gigas) through cystoscopy and accuracy of contrast radiography. J Am Vet Med Assoc 2023; 261:1-8. [PMID: 37673215 DOI: 10.2460/javma.23.04.0200] [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: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To describe a nonsurgical endoscopic technique for sex identification in Indonesian blue-tongued skinks (Tiliqua gigas) and to assess accuracy of contrast radiography of the hemipenile/hemiclitoral pouches. ANIMALS 42 clinically healthy Indonesian blue-tongued skinks between 6 months and 3 years old and weighing between 22 and 550 g. METHODS Cystoscopy was performed under general anesthesia. Gonads were visualized through the transparency of the urinary bladder, and their gross morphology was described. Contrast was applied in the tail pouches before obtaining full-body radiographs. Two radiologists, blinded to the sex of the skink, evaluated the radiographs. RESULTS Cystoscopy was achieved in all 42 skinks. Visualization of the gonads through the urinary bladder was possible in 41 (98%; 95% CI, 87% to 99%) of the skinks, with 18 of them identified as males and 23 identified as females. Median procedure time was 60 seconds (range, 25 to 180 seconds) and was not associated with procedure order (-0.69; 95% CI, -1.83 to 0.45) or with the weight (0.02 g; 95% CI, -0.07 to 1.0) or the identified sex (11.7; 95% CI, -15.07 to 38.45) of the skink. Radiographs had a sensitivity of 69.6% (95% CI, 47.1% to 86.8%) and a specificity of 75.0% (47.6% to 92.7%) to identify female skinks. All the skinks recovered uneventfully. CLINICAL RELEVANCE Cystoscopic sex identification is feasible in Indonesian blue-tongued skinks of various age and size. Considering the difficulty in identifying their sex otherwise, this technique could provide a significant improvement in the veterinary care of this species. In this population, contrast radiographs showed limited accuracy for sex identification.
Collapse
Affiliation(s)
- Alessandro Vetere
- 1Exotic Animal Service, Clinica Veterinaria Modena Sud, Spilamberto, Italy
| | - Nicola Di Girolamo
- 2Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Ian Porter
- 2Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Christopher Tollefson
- 2Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | | | - Giordano Nardini
- 1Exotic Animal Service, Clinica Veterinaria Modena Sud, Spilamberto, Italy
| |
Collapse
|
3
|
Larrabee S, Nugen S, Bruhn A, Porter I, Stowe S, Adler A, Martin-Flores M, Araos J. Three-dimensional electrical impedance tomography to study regional ventilation/perfusion ratios in anesthetized pigs. Am J Physiol Lung Cell Mol Physiol 2023; 325:L638-L646. [PMID: 37724348 DOI: 10.1152/ajplung.00180.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
This study aimed to develop a three-dimensional (3-D) method for assessing ventilation/perfusion (V/Q̇) ratios in a pig model of hemodynamic perturbations using electrical impedance tomography (EIT). To evaluate the physiological coherence of changes in EIT-derived V/Q̇ ratios, global EIT-derived V/Q̇ mismatches were compared with global gold standards. The study found regional heterogeneity in the distribution of V/Q̇ ratios in both the ventrodorsal and craniocaudal directions. Although global EIT-derived indices of V/Q̇ mismatch consistently underestimated both low and high V/Q̇ mismatch compared with global gold standards, the direction of the change was similar. We made the software available at no cost for other researchers to use. Future studies should compare regional V/Q̇ ratios determined by our method against other regional, high-resolution methods.NEW & NOTEWORTHY In this study, we introduce a novel 3-D method for assessing ventilation-perfusion (V/Q̇) ratios using electrical impedance tomography (EIT). Heterogeneity in V/Q̇ distribution showcases the significant potential for enhanced understanding of pulmonary conditions. This work signifies a substantial step forward in the application of EIT for monitoring and managing lung diseases.
Collapse
Affiliation(s)
- Shannon Larrabee
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Sarah Nugen
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ian Porter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Symon Stowe
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Manuel Martin-Flores
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Joaquin Araos
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| |
Collapse
|
4
|
Buote NJ, Porter I, Loftus J, Cummings B, Dakin GF. Laparoscopic vertical sleeve gastrectomy in felines: A cadaveric feasibility study and experimental case series in two cats. Vet Surg 2023; 52:878-887. [PMID: 35861398 DOI: 10.1111/vsu.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/10/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the feasibility of laparoscopic vertical sleeve gastrectomy (LVSG) in feline cadavers using endoscopic stapling equipment and report clinical outcomes in two live feline subjects. STUDY DESIGN Cadaveric study and experimental case series. ANIMALS Ten feline cadavers; two feline subjects. METHODS LVSG technique was refined on feline cadavers and included retraction of the liver, dissection of the stomach, assessment of proper location for gastrectomy via stapling, and leak testing. Appropriateness of gastrectomy, gastrectomy %, surgical times and complications were recorded. The procedure was performed on two live feline subjects, and they were followed for 4 months to report surgical complications. RESULTS LVSG was completed in 9/10 cadavers and both live patients. Stenosis at the incisura was recorded in 2/9 cadavers. No obvious leaks were seen in the 8 cadavers that were tested or either live patient. The mean surgical time for all cadaver procedures and live patients was 110.4 and 115 minutes, respectively. Mean weight of resected cadaver stomach was 10 g and the mean % of the total stomach weight resected was 27.6%. No intra- or postoperative surgical complications occurred in the live subjects. CONCLUSION LVSG technique appears feasible and safe for use in live patients. CLINICAL RELEVANCE This LVSG technique may be safely used for partial gastric resection in cats. Further studies are necessary to determine if it is effective at reversing the effects of obesity and diabetes in this population.
Collapse
Affiliation(s)
- Nicole J Buote
- Department of Clinical Sciences, Soft Tissue Surgery, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Ian Porter
- Department of Clinical Sciences, Diagnostic Imaging, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - John Loftus
- Department of Clinical Sciences, Internal Medicine, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Bethany Cummings
- Department of Surgery, College of Biological Sciences, University of California Davis, Davis, California, USA
| | - Gregory F Dakin
- Department of Bariatric Surgery, Weill Cornell Medical College, New York City, New York, USA
| |
Collapse
|
5
|
Kuvaldina AB, Buote N, Campoy L, Porter I, Hayes GM. Development of a minimally invasive endoscopic technique for excisional biopsy of the axillary lymph nodes in dogs. Vet Surg 2023; 52:888-896. [PMID: 36281637 DOI: 10.1111/vsu.13901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/31/2022] [Accepted: 09/01/2022] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To develop and describe a minimally invasive technique for excisional biopsy of the axillary lymph nodes in dogs. STUDY DESIGN Descriptive cadaver and clinical case series. ANIMALS Four canine cadavers and three clinical patients. METHODS A 3D computed tomographic reconstruction of the canine axilla was used to identify an optimal avenue of approach to the lymph nodes. This approach was refined using endoscopic techniques in four cadavers (six procedures) and potential surgical hazards, landmarks, and the surgical time required for excisional biopsy of the nodes was recorded. The procedure was then performed in three clinical cases. RESULTS Axillary lymph node removal was achieved using an endoscopic technique with surgical times of 58 and 35 minutes in two of three clinical cases. The third case required conversion to an open approach after endoscopic identification of the node. No major complications were encountered. CONCLUSION Excisional biopsy of the axillary lymph nodes can be performed successfully using a minimally invasive technique in the dog. Further investigation in clinical cases is needed to determine the risks and complications of this procedure. CLINICAL SIGNIFICANCE Minimally invasive excisional biopsy of the axillary lymph nodes in dogs can be performed and may have a role in assisting with staging and local disease control in oncologic cases.
Collapse
Affiliation(s)
| | - Nicole Buote
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Luis Campoy
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Ian Porter
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Galina M Hayes
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| |
Collapse
|
6
|
Buote NJ, Porter I, Dakin GF. 3D printed cannulas for use in laparoscopic surgery in feline patients: A cadaveric study and case series. Vet Surg 2023; 52:870-877. [PMID: 35815791 DOI: 10.1111/vsu.13849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/23/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate custom 3D printed laparoscopic cannulas (3DPC) in a feline cadaveric abdominal surgery model and report their use in two live feline subjects. STUDY DESIGN Experimental cadaver study, live subject case series. ANIMALS Ten feline cadavers; two feline subjects. METHODS Custom 3DPCs were initially modeled in a PLA filament material and then created in an autoclavable dental resin for use in live patients. The surgery time, number of surgical collisions and cannula complications were recorded during cadaver procedures before and after use of 3DPCs. Cannula complications were recorded during live procedures and patients were followed to suture removal to record any incisional complications. RESULTS There was a significant reduction in mean surgical time (125.6 vs. 95.2 min, p = 0.03), mean number of instrument collisions (6.8 vs. 2.6, p = 0.03), and mean number of cannula complications (10 vs. 2.2, p = 0.03) with the use of only 3DPCs during the procedure. During the live procedures the use of the 3DPCs was successful and no postoperative complications occurred at the incision sites. CONCLUSION The use of customized 3DPCs may improve surgical dexterity and decrease complications in advanced procedures and was not associated with any clinical complications in two cats. The use of 3DPCs in veterinary medicine may allow for wider practice of laparoscopic techniques in small animals.
Collapse
Affiliation(s)
- Nicole J Buote
- Department of Clinical Sciences, Soft Tissue Surgery, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Ian Porter
- Department of Clinical Sciences, Diagnostic Imaging, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Gregory F Dakin
- Department of Bariatric Surgery, Weill Cornell Medical College, New York, New York City, USA
| |
Collapse
|
7
|
Welch B, Ogilvie A, Porter I, Bourassi E. Cricopharyngeal and thyropharyngeal myectomy for management of cricopharyngeal achalasia in a 6-month-old coton de Tulear dog. Can Vet J 2023; 64:633-638. [PMID: 37397703 PMCID: PMC10286150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
A 6-week-old intact female coton de Tulear dog presented to a veterinary teaching hospital (VTH) internal medicine service for dysphagia that was persistent since birth. The patient was diagnosed with cricopharyngeal achalasia based on a fluoroscopic swallow study. To facilitate surgical intervention, a percutaneous endoscopic gastrostomy (PEG) tube was placed to bypass the upper esophageal sphincter and provide nutritional support until the dog was larger. At 6 mo of age, the dog underwent unilateral cricopharyngeal and thyropharyngeal myectomy. Marked improvement in dysphagia was noted immediately postoperatively. Improvement in dysphagia persisted in this dog, with continued marked improvement in clinical signs noted 1 y postoperatively. Key clinical message: Cricopharyngeal achalasia can be successfully managed with surgical intervention with a good long-term prognosis. Before surgical intervention, nutritional support is of critical importance. A combined procedure of cricopharyngeal and thyropharyngeal myectomy may be associated with outcomes superior to those of alternative procedures.
Collapse
Affiliation(s)
- Bryan Welch
- Department of Small Animal Internal Medicine, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3
| | - Adam Ogilvie
- Department of Small Animal Internal Medicine, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3
| | - Ian Porter
- Department of Small Animal Internal Medicine, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3
| | - Emilia Bourassi
- Department of Small Animal Internal Medicine, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3
| |
Collapse
|
8
|
Lu SC, Porter I, Valderas JM, Harrison CJ, Sidey-Gibbons C. Effectiveness of routine provision of feedback from patient-reported outcome measurements for cancer care improvement: a systematic review and meta-analysis. J Patient Rep Outcomes 2023; 7:54. [PMID: 37277575 DOI: 10.1186/s41687-023-00578-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Research shows that feeding back patient-reported outcome information to clinicians and/or patients could be associated with improved care processes and patient outcomes. Quantitative syntheses of intervention effects on oncology patient outcomes are lacking. OBJECTIVE To determine the effects of patient-reported outcome measure (PROM) feedback intervention on oncology patient outcomes. DATA SOURCES We identified relevant studies from 116 references included in our previous Cochrane review assessing the intervention for the general population. In May 2022, we conducted a systematic search in five bibliography databases using predefined keywords for additional studies published after the Cochrane review. STUDY SELECTION We included randomized controlled trials evaluating the effects of PROM feedback intervention on processes and outcomes of care for oncology patients. DATA EXTRACTION AND SYNTHESIS We used the meta-analytic approach to synthesize across studies measuring the same outcomes. We estimated pooled effects of the intervention on outcomes using Cohen's d for continuous data and risk ratio (RR) with a 95% confidence interval for dichotomous data. We used a descriptive approach to summarize studies which reported insufficient data for a meta-analysis. MAIN OUTCOME(S) AND MEASURES(S) Health-related quality of life (HRQL), symptoms, patient-healthcare provider communication, number of visits and hospitalizations, number of adverse events, and overall survival. RESULTS We included 29 studies involving 7071 cancer participants. A small number of studies was available for each metanalysis (median = 3 studies, ranging from 2 to 9 studies) due to heterogeneity in the evaluation of the trials. We found that the intervention improved HRQL (Cohen's d = 0.23, 95% CI 0.11-0.34), mental functioning (Cohen's d = 0.14, 95% CI 0.02-0.26), patient-healthcare provider communication (Cohen's d = 0.41, 95% CI 0.20-0.62), and 1-year overall survival (OR = 0.64, 95% CI 0.48-0.86). The risk of bias across studies was considerable in the domains of allocation concealment, blinding, and intervention contamination. CONCLUSIONS AND RELEVANCE Although we found evidence to support the intervention for highly relevant outcomes, our conclusions are tempered by the high risk of bias relating mainly to intervention design. PROM feedback for oncology patients may improve processes and outcomes for cancer patients but more high-quality evidence is required.
Collapse
Affiliation(s)
- Sheng-Chieh Lu
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 6565 MD Anderson Blvd., Houston, TX, 77030, USA
| | - I Porter
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - J M Valderas
- Department of Family Medicine, National University Health System, Singapore, Singapore
- Centre for Health Services Research, National University Health System, Singapore, Singapore
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - C J Harrison
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Chris Sidey-Gibbons
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 6565 MD Anderson Blvd., Houston, TX, 77030, USA.
| |
Collapse
|
9
|
Basran PS, Porter I. Radiomics in veterinary medicine: Overview, methods, and applications. Vet Radiol Ultrasound 2022; 63 Suppl 1:828-839. [PMID: 36514226 DOI: 10.1111/vru.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/24/2021] [Accepted: 11/10/2021] [Indexed: 12/15/2022] Open
Abstract
Radiomics, or quantitative image analysis from radiographic image data, borrows the suffix from other emerging -omics fields of study, such as genomics, proteomics, and metabolomics. This report provides an overview of the general principles of how radiomic features are computed, describes major types of morphological, first order, and texture features, and the applications, challenges, and opportunities of radiomics as applied in veterinary medicine. Some advantages radiomics has over traditional semantic radiological features include standardized methodology in computing semantic features, the ability to compute features in multi-dimensional images, their newfound associations with genomic and pathological abnormalities, and the number of perceptible and imperceptible features available for regression or classification modeling. Some challenges in deploying radiomics in a clinical setting include sensitivity to image acquisition settings and image artifacts, pre- and post-image reconstruction and calculation settings, variability in feature estimates stemming from inter- and intra-observer contouring errors, and challenges with software and data harmonization and generalizability of findings given the challenges of small sample size and patient selection bias in veterinary medicine. Despite this, radiomics has enormous potential in patient-centric diagnostics, prognosis, and theragnostics. Fully leveraging the utility of radiomics in veterinary medicine will require inter-institutional collaborations, data harmonization, and data sharing strategies amongst institutions, transparent and robust model development, and multi-disciplinary efforts within and outside the veterinary medical imaging community.
Collapse
Affiliation(s)
- Parminder S Basran
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Ian Porter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| |
Collapse
|
10
|
de Boer D, van den Berg M, Ballester M, Bloemeke J, Boerma W, de Bienassis K, Groenewegen P, Groene O, Kendir C, Klazinga N, Porter I, Sunol R, Thomas L, Valderas JM, Williams R, Rijken M. Assessing the outcomes and experiences of care from the perspective of people living with chronic conditions, to support countries in developing people-centred policies and practices: study protocol of the International Survey of People Living with Chronic Conditions (PaRIS survey). BMJ Open 2022; 12:e061424. [PMID: 36123114 PMCID: PMC9486339 DOI: 10.1136/bmjopen-2022-061424] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In view of growing populations with chronic conditions, many countries are redesigning their health systems. However, little information is available about how health systems perform from the perspective of people living with chronic conditions. The Organisation for Economic Co-operation and Development (OECD) Member States therefore mandated the OECD to initiate the International Survey of People Living with Chronic Conditions (PaRIS survey), which aims to provide insight in outcomes and experiences of care as reported by people living with chronic conditions. The PaRIS-SUR consortium has been tasked by the OECD to support the development and implementation of the survey. METHODS AND ANALYSIS As primary care services play a pivotal role in the management of chronic conditions, the PaRIS survey will be implemented in the primary care setting. Data will be collected with a survey among users of primary care services aged 45 years or older, of whom many have chronic conditions. An additional survey is conducted among their primary care providers. The nested study design will allow analysis of the patient-reported data in relation to characteristics of and care provided by primary care providers within and across countries. In 2022, the survey will be tested in a Field Trial in participating countries. Data for cross-country comparison will be collected by the Main Survey in 2023. ETHICS AND DISSEMINATION Informed consent will be obtained from primary care providers and service users. National Project Managers search ethical approval of the survey in their country, if required. Reporting by the OECD will focus on questions for international comparison. A secured information technology platform will be developed for participants and stakeholders in countries to receive feedback and answer their own questions. Findings will also be disseminated through an international OECD flagship report, conferences, scientific papers and policy briefs, to inform strategies to improve care for people living with chronic conditions throughout the world.
Collapse
Affiliation(s)
- Dolf de Boer
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | | | - Marta Ballester
- Fundacion Avedis Donabedian, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain
| | | | - Wienke Boerma
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | | | - Peter Groenewegen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of Sociology / Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | | | - Candan Kendir
- Organisation for Economic Co-operation and Development, Paris, France
| | - Niek Klazinga
- Organisation for Economic Co-operation and Development, Paris, France
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Rosa Sunol
- Fundacion Avedis Donabedian, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain
| | | | - Jose Maria Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
- Department of Family Medicine, National University Health System, Singapore
| | | | - Mieke Rijken
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of Health and Social Care Management, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
11
|
Lawler PE, Wood JH, Alleva NE, Rishniw M, Porter I, Johnson PJ. Comparison of Surgical Outcomes Associated With Compression Secondary to Hemorrhage and Intervertebral Disk Extrusions in Dogs. Front Vet Sci 2022; 9:889113. [PMID: 35859807 PMCID: PMC9289558 DOI: 10.3389/fvets.2022.889113] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Acute intervertebral disk extrusion (IVDE) is one of the most commonly reported neurologic disorders seen in veterinary practice. There is a recognized subset of IVDE cases that have a hemorrhagic inflammatory reaction within the epidural space that causes compression in addition to compression from herniated disk material. Previous reports have been conflicting in the outcomes of these cases. The goals of this retrospective case-control cross-sectional study are to (1) compare the success rate of routine surgical decompression in dogs with DEEH compression compared to Modified Frankel Score (MFS) matched dogs with non-hemorrhagic disk extrusions; (2) evaluate the extent of spinal cord compression on MRI compared to final patient outcomes in DEEH compression and (3) determine the surgical compression to decompression ratio and its relation to patient outcomes in cases of DEEH compression. A total of 143 dogs were included in this study and divided into two groups: DEEH compression dogs (n = 78) and non-hemorrhagic IVDE dogs (n = 65). Outcomes were assigned for each patient [0 = deceased, 1 = alive and non-ambulatory (MFS 0–3), 2 = alive and ambulatory (MFS 4 or 5)] in both groups. Outcomes of DEEH and non-hemorrhagic IVDE did not differ when taken to surgery with comparable success rates when stratified by MFS. Similarly, outcomes did not differ between DEEH and non-hemorrhagic IVDE dogs when assessed by compression to decompression ratio. Dogs with DEEH compression had more compressed sites than dogs with non-hemorrhagic IVDE (P = 0.001) and had more sites decompressed surgically than dogs with non-hemorrhagic IVDE (P < 0.001). Consequently, the compression to decompression ratio did not differ between the two groups (P = 0.52). Our results support the finding that when a similar level of surgical decompression is achieved, dogs with DEEH compression have similar outcomes to dogs with non-hemorrhagic IVDE for similar degrees of neurological dysfunction.
Collapse
Affiliation(s)
- Patricia E. Lawler
- Department of Clinical Sciences, Cornell University School of Veterinary Medicine, Ithaca, NY, United States
- *Correspondence: Patricia E. Lawler
| | - Jonathan H. Wood
- Department of Clinical Sciences, Cornell University School of Veterinary Medicine, Ithaca, NY, United States
| | - Nicole E. Alleva
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - Mark Rishniw
- Department of Clinical Sciences, Cornell University School of Veterinary Medicine, Ithaca, NY, United States
| | - Ian Porter
- Department of Clinical Sciences, Cornell University School of Veterinary Medicine, Ithaca, NY, United States
| | - Phillipa J. Johnson
- Department of Clinical Sciences, Cornell University School of Veterinary Medicine, Ithaca, NY, United States
| |
Collapse
|
12
|
Menard J, Porter I, Lerer A, Robbins S, Johnson PJ, Goggs R. Serial evaluation of thoracic radiographs and acute phase proteins in dogs with pneumonia. J Vet Intern Med 2022; 36:1430-1443. [PMID: 35616241 PMCID: PMC9308444 DOI: 10.1111/jvim.16448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/04/2022] [Indexed: 01/03/2023] Open
Abstract
Background Acute phase proteins (APP) may guide treatment of pneumonia in dogs but correlations with radiographic abnormalities are poorly characterized. Objectives Develop a thoracic radiographic severity scoring system (TRSS), assess correlation of radiographic changes with APP concentrations, and compare time to APP and radiograph normalization with duration of antimicrobials treatment. Animals Sixteen client‐owned dogs, 12 with aspiration pneumonia, and 4 with community‐acquired pneumonia. Methods Concentrations of C‐reactive protein (CRP), serum amyloid A (SAA), and haptoglobin were measured on days 1, 3, 7, 14, 28, and 60 and orthogonal 2‐view thoracic radiographs were obtained on days 1, 7, 14, 28, and 60. Treatment was clinician‐guided and blinded to APP concentrations. Radiographic severity scores were assigned by blinded, randomized retrospective review by 2 board‐certified radiologists with arbitration by a third radiologist. Results Median (interquartile range [IQR]) time to normalization of CRP (7 days [7‐14]) and SAA concentrations (7 days [7‐14]) were shorter than antimicrobial treatment duration (17.5 days [14.5‐33.5]; P = .001 and .002, respectively) and TRSS normalization (14 days [8.8‐52], P = .02 and .02, respectively). The CRP and SAA concentrations were positively correlated with TRSS (CRP rs, 0.643; SAA rs, 0.634; both P < .0001). Both CRP and SAA identified normal thoracic radiographs area under the curve (AUC) 0.873 and 0.817, respectively, both P < .0001. Interobserver agreement for TRSS assignment was moderate (κ, .499; P < .0001). Conclusion and Clinical Importance Concentrations of CRP and SAA normalized before radiographic resolution and before clinicians discontinued antimicrobial treatment. The CRP and SAA concentrations may guide duration of antimicrobial treatment for dogs with pneumonia.
Collapse
Affiliation(s)
- Julie Menard
- Department of Veterinary Clinical and Diagnostic Science, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ian Porter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Assaf Lerer
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Sarah Robbins
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Philippa J Johnson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| |
Collapse
|
13
|
Bowen A, Shamritsky D, Santana J, Porter I, Feldman E, Pownder SL, Koff MF, Hayashi K, Hernandez CJ. Animal Models of Bone Marrow Lesions in Osteoarthritis. JBMR Plus 2022; 6:e10609. [PMID: 35309864 PMCID: PMC8914161 DOI: 10.1002/jbm4.10609] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/22/2021] [Accepted: 01/13/2022] [Indexed: 11/08/2022] Open
Abstract
Bone marrow lesions are abnormalities in magnetic resonance images that have been associated with joint pain and osteoarthritis in clinical studies. Increases in the volume of bone marrow lesions have been associated with progression of joint degeneration, leading to the suggestion that bone marrow lesions may be an early indicator of—or even a contributor to—cartilage loss preceding irreversible damage to the joint. Despite evidence that bone marrow lesions play a role in osteoarthritis pathology, very little is known about the natural history of bone marrow lesions and their contribution to joint degeneration. As a result, there are limited data regarding the cell activity within a bone marrow lesion and any associated bone‐cartilage cross‐talk. Animal models provide the best approach for understanding bone marrow lesions at their early, reversible stages. Here, we review the few animal studies of bone marrow lesions. An ideal animal model of a bone marrow lesion occurs in joints large enough to accurately measure bone marrow lesion volume. Additionally, the ideal animal model would facilitate the study of bone‐cartilage cross‐talk by generating the bone marrow lesion immediately adjacent to subchondral bone and would do so without causing direct damage to neighboring soft tissues to isolate the effects of the bone marrow lesion on cartilage loss. Early reports demonstrate the feasibility of such an animal model. Given the irreversible nature of osteoarthritic changes in the joint, factors such as bone marrow lesions that are present early in disease pathogenesis remain an enticing target for new therapeutic approaches. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Andrew Bowen
- Sibley School of Mechanical and Aerospace Engineering Cornell University Ithaca New York USA
| | - David Shamritsky
- Sibley School of Mechanical and Aerospace Engineering Cornell University Ithaca New York USA
| | - Josue Santana
- Sibley School of Mechanical and Aerospace Engineering Cornell University Ithaca New York USA
- Meinig School of Biomedical Engineering Cornell University Ithaca New York USA
| | - Ian Porter
- College of Veterinary Medicine Cornell University Ithaca New York
| | - Erica Feldman
- College of Veterinary Medicine Cornell University Ithaca New York
| | | | | | - Kei Hayashi
- College of Veterinary Medicine Cornell University Ithaca New York
| | - Christopher J Hernandez
- Sibley School of Mechanical and Aerospace Engineering Cornell University Ithaca New York USA
- Hospital for Special Surgery New York New York USA
| |
Collapse
|
14
|
Porter I, Theodoulou E, Holen I, Harper-Wynne C, Baron-Hay S, Wilson C, Brown J. Adoption of adjuvant bisphosphonates for early breast cancer into standard clinical practice: Challenges and lessons learnt from comparison of the UK and Australian experience. J Bone Oncol 2021; 31:100402. [PMID: 34804788 PMCID: PMC8581365 DOI: 10.1016/j.jbo.2021.100402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022] Open
Abstract
Adoption of adjuvant bisphosphonates for early breast cancer into standard clinical practice. UK and Australian experience of adjuvant bisphosphonates in early breast cancer. Pathway taken for adjuvant bisphosphonates implementation in the UK. Steps to increase update of adjuvant bisphosphonates in early breast cancer. Improve the care of women with early breast cancer.
International guidelines recommend adjuvant bisphosphonates (BPs) for post-menopausal women with early breast cancer to reduce recurrence and mortality. However, globally, wide variation exists in their adoption. In the UK, adjuvant BPs were a recommendation in the breast cancer Clinical Reference Group service specification and were included as a priority for implementation by the national oncologists group UK Breast Cancer Group in November 2015, promoting national uptake, guidance and funding arrangements. In 2018, adjuvant BPs were recommended by the UKs National Institute for Health and Care Excellence. In Australia, adjuvant BPs are still ‘off-label’ and do not receive national reimbursement or endorsement. To date there has been no research into the prescribing habits of these agents in Australia. With the aim to gather data on adjuvant BPs prescribing practices, online surveys were developed and disseminated to breast oncologists in both countries between December 2018 and June 2019. Almost all of the UK oncologists prescribed adjuvant BPs, demonstrating that education, endorsement from professional bodies, presence of national guidelines and funding decisions have been critical to implementation. In contrast, only 48% of the Australian responders prescribed adjuvant BPs, while 83% reported that they would prescribe them if funding was available. Lack of local protocol guidance was also seen as a major barrier. This study was intended to assess the pathway taken for adjuvant BP implementation in the UK and how it might inform changes in Australian practice and also guide other countries with similar issues with the ultimate aim of improving the care of women with early breast cancer globally.
Collapse
Affiliation(s)
- I Porter
- Royal North Shore Hospital, Sydney, Australia
| | - E Theodoulou
- Department of Oncology and Metabolism, University of Sheffield, Weston Park Cancer Centre, Sheffield, United Kingdom.,Sheffield Experimental Cancer Medicine Centre, Sheffield, United Kingdom
| | - I Holen
- Department of Oncology and Metabolism, University of Sheffield, Weston Park Cancer Centre, Sheffield, United Kingdom.,Sheffield Experimental Cancer Medicine Centre, Sheffield, United Kingdom
| | - C Harper-Wynne
- Kent Oncology Centre, Maidstone Tunbridge Wells NHS Trust, United Kingdom
| | - S Baron-Hay
- Royal North Shore Hospital, Sydney, Australia
| | - C Wilson
- Department of Oncology and Metabolism, University of Sheffield, Weston Park Cancer Centre, Sheffield, United Kingdom.,Sheffield Experimental Cancer Medicine Centre, Sheffield, United Kingdom
| | - J Brown
- Department of Oncology and Metabolism, University of Sheffield, Weston Park Cancer Centre, Sheffield, United Kingdom.,Sheffield Experimental Cancer Medicine Centre, Sheffield, United Kingdom
| |
Collapse
|
15
|
Davey AF, Coombes J, Porter I, Green C, Mewse AJ, Valderas JM. Development of a conceptual model for research on cyclical variation of patient reported outcome measurements (PROMs) in patients with chronic conditions: a scoping review. J Patient Rep Outcomes 2021; 5:117. [PMID: 34735641 PMCID: PMC8568745 DOI: 10.1186/s41687-021-00395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although circadian, seasonal, and other cycles have been observed for a number of chronic conditions, their impact on patient reported outcomes measurements (PROMs) has not been systematically explored, rendering our understanding of the effect of time of measurement on PROM scores very limited. The aim was to conduct a scoping review to determine what is known about how intra-individual cyclical variation might affect the way individuals with chronic conditions respond to patient-reported outcome measures. Methods A protocol of a systematic scoping review was registered on PROSPERO (CRD42017058365). We developed a search strategy based on previous relevant reviews and implemented it in: MEDLINE, Embase, PsycINFO, and CINAHL. No restrictions were placed on article types and backward and forward citation searches were conducted. Screening and data extraction were independently completed by up to four reviewers. An adapted version of CASP criteria was used to appraise the quality of included articles. Concepts that were important in understanding the impact of cyclical variation on PROM scores were elicited from the papers and iteratively refined through discussion amongst the authors. Results 2420 references resulted from the searches, with 33 articles meeting the inclusion criteria. Most study designs included observational research (particularly ecological momentary assessment), 2 were RCTs and 2 were systematic reviews. Studies mainly focused on specific health conditions: mental health, respiratory and musculoskeletal. There was a lack of qualitative research and theoretical framework to explore these concepts more fully. Five overarching concepts emerged: variation in outcomes, variation of scores, psychological status, individual factors, and environmental/situational factors. A conceptual model was developed outlining the relationships between these concepts. Conclusions There is empirical evidence that supports cyclical variation in PROM scores across different chronic conditions, with potential very significant implications for administration and interpretation of PROMs. The proposed conceptual model can support further research in this area. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00395-x.
Collapse
Affiliation(s)
- A F Davey
- Health Services and Policy Research Group, Exeter Collaboration for Academic Primary Care, NIHR PenARC, University of Exeter Medical School, University of Exeter, Exeter, UK. .,Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - J Coombes
- Health Services and Policy Research Group, Exeter Collaboration for Academic Primary Care, NIHR PenARC, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - I Porter
- Health Services and Policy Research Group, Exeter Collaboration for Academic Primary Care, NIHR PenARC, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - C Green
- Health Economics Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.,Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - A J Mewse
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - J M Valderas
- Health Services and Policy Research Group, Exeter Collaboration for Academic Primary Care, NIHR PenARC, University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
16
|
Gangannagaripalli J, Porter I, Davey A, Ricci Cabello I, Greenhalgh J, Anderson R, Briscoe S, Hughes C, Payne R, Cockcroft E, Harris J, Bramwell C, Valderas JM. STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background
Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults.
Objectives
To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts.
Design
A realist synthesis.
Setting
Primary care, hospital care and nursing homes.
Patients
Patients aged ≥ 65 years.
Interventions
Any intervention based on the use of the STOPP/START tools.
Review methods
Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies.
Results
We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs.
Limitations
None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse.
Conclusions
No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings.
Study registration
This study is registered as PROSPERO CRD42018110795.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Ignacio Ricci Cabello
- Gerència d’Atenció Primària de Mallorca, Fundació Institut d’Investigació Sanitària Illes Balears – IdISBa, Mallorca, Spain
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Rob Anderson
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
- Evidence Synthesis & Modelling for Health Improvement (ESMI) Research Group, University of Exeter Medical School, Exeter, UK
| | - Simon Briscoe
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Carmel Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Rupert Payne
- Population Health Sciences, University of Bristol, Bristol Medical School, Bristol, UK
| | - Emma Cockcroft
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jim Harris
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Charlotte Bramwell
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| |
Collapse
|
17
|
Araos J, Lacitignola L, de Monte V, Stabile M, Porter I, Hurtado DE, Perez A, Crovace A, Grasso S, Martin-Flores M, Staffieri F. Evaluation of Lung Aeration and Respiratory System Mechanics in Obese Dogs Ventilated With Tidal Volumes Based on Ideal vs. Current Body Weight. Front Vet Sci 2021; 8:704863. [PMID: 34660755 PMCID: PMC8517180 DOI: 10.3389/fvets.2021.704863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022] Open
Abstract
We describe the respiratory mechanics and lung aeration in anesthetized obese dogs ventilated with tidal volumes (VT) based on ideal (VTi) vs. current (VTc) body weight. Six dogs with body condition scores ≥ 8/9 were included. End-expiratory respiratory mechanics and end-expiratory CT-scan were obtained at baseline for each dog. Thereafter, dogs were ventilated with VT 15 ml kg−1 based on VTi and VTc, applied randomly. Respiratory mechanics and CT-scan were repeated at end-inspiration during VTi and VTc. Data analyzed with linear mixed models and reported as mean ± SD or median [range]. Statistical significance p < 0.05. The elastance of the lung, chest wall and respiratory system indexed by ideal body weight (IBW) were positively correlated with body fat percentage, whereas the functional residual capacity indexed by IBW was negatively correlated with body fat percentage. At end-expiration, aeration (%) was: hyperaeration 0.03 [0.00–3.35], normoaeration 69.7 [44.6–82.2], hypoaeration 29.3 [13.6–49.4] and nonaeration (1.06% [0.37–6.02]). Next to the diaphragm, normoaeration dropped to 12 ± 11% and hypoaeration increased to 90 ± 8%. No differences in aeration between groups were found at end-inspiration. Airway driving pressure (cm H2O) was higher (p = 0.002) during VTc (9.8 ± 0.7) compared with VTi (7.6 ± 0.4). Lung strain was higher (p = 0.014) during VTc (55 ± 21%) than VTi (38 ± 10%). The stress index was higher (p = 0.012) during VTc (SI = 1.07 [0.14]) compared with VTi (SI = 0.93 [0.18]). This study indicates that body fat percentage influences the magnitude of lung, chest wall, and total respiratory system elastance and resistance, as well as functional residual capacity. Further, these results indicate that obese dogs have extensive areas of hypoaerated lungs, especially in caudodorsal regions. Finally, lung strain and airway driving pressure, surrogates of lung deformation, are higher during VTc than during VTi, suggesting that in obese anesthetized dogs, ventilation protocols based on IBW may be advantageous.
Collapse
Affiliation(s)
- Joaquin Araos
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Valentina de Monte
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Marzia Stabile
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Ian Porter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Daniel E Hurtado
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile
| | - Agustín Perez
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Antonio Crovace
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Salvatore Grasso
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Manuel Martin-Flores
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| |
Collapse
|
18
|
Gibbons C, Porter I, Gonçalves-Bradley DC, Stoilov S, Ricci-Cabello I, Tsangaris E, Gangannagaripalli J, Davey A, Gibbons EJ, Kotzeva A, Evans J, van der Wees PJ, Kontopantelis E, Greenhalgh J, Bower P, Alonso J, Valderas JM. Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice. Cochrane Database Syst Rev 2021; 10:CD011589. [PMID: 34637526 PMCID: PMC8509115 DOI: 10.1002/14651858.cd011589.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.
Collapse
Affiliation(s)
| | - Ian Porter
- Health Services & Policy Research, University of Exeter Medical School, Exeter, UK
| | - Daniela C Gonçalves-Bradley
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stanimir Stoilov
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Elizabeth J Gibbons
- PROM Group, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Kotzeva
- Health Technology Assessment Department, Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Jonathan Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jordi Alonso
- CIBER Epidemiologia y Salud Publica (CIBERESP), IMIM-Hospital del mar, Barcelona, Spain
| | - Jose M Valderas
- Health Services & Policy Research, Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research, NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| |
Collapse
|
19
|
Hampton PJ, Berth-Jones J, Duarte Williamson CE, Hay R, Leslie TA, Porter I, Rauz S, Seukeran D, Winn RT, Hashme M, Exton LS, Mohd Mustapa MF, Manounah L. British Association of Dermatologists guidelines for the management of people with rosacea 2021. Br J Dermatol 2021; 185:725-735. [PMID: 33993465 DOI: 10.1111/bjd.20485] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- P J Hampton
- Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - J Berth-Jones
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.,Patient representative
| | | | - R Hay
- St John's Institute of Dermatology, Kings College London, London, SE1 9RT, UK
| | - T A Leslie
- Royal Free Hospital, London, NW3 2QG, UK
| | | | - S Rauz
- University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham & Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, B18 7QH, UK.,Royal College of Ophthalmologists, NW1 2HD, UK
| | - D Seukeran
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, TS4 3BW, UK
| | - R T Winn
- Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - L Manounah
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | | |
Collapse
|
20
|
Porter I, Davey A, Gangannagaripalli J, Evans J, Bramwell C, Evans P, Gibbons C, Valderas JM. Integrating Patient Reported Outcome Measures (PROMs) into routine nurse-led primary care for patients with multimorbidity: a feasibility and acceptability study. Health Qual Life Outcomes 2021; 19:133. [PMID: 33902607 PMCID: PMC8074460 DOI: 10.1186/s12955-021-01748-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The use of Patient Reported Outcome Measures (PROMS) in clinical practice has the potential to promote patient-centred care and improve patients' quality of life. Individualized PROMs may be particularly helpful in identifying, prioritizing and monitoring health problems of patients with multimorbidity. We aimed to develop an intervention centred around PROMs feedback as part of Primary Care annual reviews for patients with multimorbidity and evaluate its feasibility and acceptability. METHODS We developed a nurse-oriented intervention including (a) training of nurses on PROMs; (b) administration to patients with multimorbidity of individualized and standardized PROMS; and (c) feedback to both patients and nurses of PROMs scores and interpretation guidance. We then tailored the intervention to patients with two or more highly prevalent conditions (asthma, COPD, diabetes, heart failure, depression, and hip/knee osteoarthritis) and designed a non-controlled feasibility and acceptability evaluation in a convenience sample of primary care practices (5). PROMs were administered and scores fed back immediately ahead of scheduled annual reviews with nurses. Patients and nurses rated the acceptability of the intervention using with a brief survey including optional free comments. Thematic analysis of qualitative interviews with a sample of participating patients (10) and nurses (4) and of survey free comments was conducted for further in-depth evaluation of acceptability. Feasibility was estimated based on rates of participation and completion. RESULTS Out of 68 recruited patients (mean age 70; 47% female), 68 completed the PROMs (100%), received feedback (100%) and confirmed nurse awareness of their scores (100%). Most patients (83%) "agreed"/"strongly agreed" that the PROMs feedback had been useful, a view supported by nurses in 89% of reviews. Thematic analysis of rich qualitative data on PROMS administration, feedback and role in annual reviews indicated that both patients and nurses perceived the intervention as acceptable and promising, emphasizing its comprehensiveness and patient-centredness. CONCLUSIONS We have developed and tested an intervention focusing on routine PROM assessment of patients with multimorbidity in Primary Care. Preliminary findings support its feasibility and a high degree of acceptability from both patients and nurses. The next step is to conduct a full-scale trial for evaluating the effectiveness of the proposed intervention.
Collapse
Affiliation(s)
- Ian Porter
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK.
| | - Antoinette Davey
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
| | | | - Jonathan Evans
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
| | - Charlotte Bramwell
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
| | - Philip Evans
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
- NIHR Clinical Research Network, England, UK
| | - Chris Gibbons
- Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose M Valderas
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
- St Leonard's Practice, Exeter, UK
- NIHR PenARC, University of Exeter, Exeter, UK
| |
Collapse
|
21
|
Robert J, Gomes FE, Porter I, Sumner JP. Orbital apex syndrome secondary to an orbital sarcoma in a dog. Can Vet J 2021; 62:27-31. [PMID: 33390595 PMCID: PMC7739388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 12-year-old castrated male cocker spaniel dog was presented with a 4-week history of left episcleral injection and pawing at the face. Clinical examination findings included left internal and external ophthalmoplegia, left dorsal strabismus, pain opening the mouth, and intermittent amaurosis. Imaging studies revealed a left orbital apex mass with adjacent sphenoid bone lysis and extension into the cranial cavity. A left exenteration was performed and histopathology confirmed an orbital soft tissue sarcoma. Key clinical message: This report describes an orbital tumor causing orbital apex syndrome. This condition should be differentiated from cavernous sinus syndrome as the latter does not course with optic neuropathy.
Collapse
Affiliation(s)
- Jayden Robert
- Cornell University - College of Veterinary Medicine, Ithaca, New York, USA
| | | | - Ian Porter
- Cornell University - College of Veterinary Medicine, Ithaca, New York, USA
| | - Julia P Sumner
- Cornell University - College of Veterinary Medicine, Ithaca, New York, USA
| |
Collapse
|
22
|
Walsh ND, Porter I. What Is Your Diagnosis? J Am Vet Med Assoc 2020; 257:697-700. [DOI: 10.2460/javma.257.7.697] [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: 11/20/2022]
|
23
|
Espinheira Gomes FNCM, Porter I, Sumner JP. Transorbital postcaruncular endoscopic surgery as an alternative to orbital exploratory surgery: A cadaveric study and case report in a dog with an orbital sarcoma. Vet Surg 2020; 49:1359-1366. [PMID: 32491232 DOI: 10.1111/vsu.13446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/09/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a postcaruncular approach for transorbital endoscopy as an alternative, minimally invasive technique to access the orbital apex. STUDY DESIGN Ex vivo and prospective clinical case report. ANIMALS A 12-year-old male castrated cocker spaniel and three cadaver heads (one large breed dolichocephalic, one medium-sized breed mesocephalic, and one small breed brachycephalic). METHODS Transorbital endoscopy was performed to obtain biopsies of an orbital apex mass by using a postcaruncular approach. A 2.7-mm 30° rigid endoscope fitted with a cystoscope working sheath was used with the aid of a blunt suction-dissector and fluid ingress. This procedure was first performed on three cadavers to assess feasibility and later performed in a clinical case. RESULTS By using a transorbital postcaruncular approach, it was possible to visualize and obtain biopsies from structures within the orbital apex with minimal perioperative morbidity. Dissection and expansion of the working space was facilitated with the aid of fluid ingress; however, judicious use of fluids is recommended because secondary orbital edema and chemosis can occur. CONCLUSION Transorbital endoscopy via a postcaruncular approach is feasible. CLINICAL SIGNIFICANCE This technique should be considered in cases in which a histological diagnosis is required prior to definitive treatment as a method to obtain biopsy samples of the orbital apex region without major surgical dissection.
Collapse
Affiliation(s)
| | - Ian Porter
- Cornell University College of Veterinary Medicine, Ithaca, New York
| | - Julia P Sumner
- Cornell University College of Veterinary Medicine, Ithaca, New York
| |
Collapse
|
24
|
Riches D, Porter I, Dingle G, Gendall A, Grover S. Soil greenhouse gas emissions from Australian sports fields. Sci Total Environ 2020; 707:134420. [PMID: 31863982 DOI: 10.1016/j.scitotenv.2019.134420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 06/10/2023]
Abstract
Managed turf is a potential net source of greenhouse gas (GHG) emissions. While most studies to date have focused on non-sports turf, sports turf may pose an even greater risk of high GHG emissions due to the generally more intensive fertiliser, irrigation and mowing regimes. This study used manual and automated chambers to measure nitrous oxide (N2O) and methane (CH4) emissions from three sports fields and an area of non-sports turf in southern Australia. Over 213 days (autumn to late spring), the average daily N2O emission was 37.6 g N ha-1day-1 at a sports field monitored at least weekly and cumulative N2O emission was 2.5 times higher than the adjacent non-sports turf. Less frequent seasonal sampling at two other sports fields showed average N2O daily emission ranging from 26 to 90 g N ha-1 day-1. Management practices associated with periods of relatively high N2O emissions were surface renovation and herbicide application. CH4 emissions at all of the sports fields were generally negligible with the exception of brief periods when soil was waterlogged following heavy rainfall where emissions of up to 1.3 kg C ha-1 day-1 were recorded. Controlled release and nitrification inhibitor containing fertilisers didn't reduce N2O, CH4 or CO2 emissions relative to urea in a short term experiment. The N2O emissions from the sports fields, and even the lower emissions from the non-sports turf, were relatively high compared to other land uses in Australia highlighting the importance of accounting for these emissions at a national level and investigating mitigation practices.
Collapse
Affiliation(s)
- David Riches
- Department of Animal Plant and Soil Sciences, La Trobe University, Bundoora, Vic, Australia.
| | - Ian Porter
- Department of Animal Plant and Soil Sciences, La Trobe University, Bundoora, Vic, Australia
| | - Greg Dingle
- Department of Management, Sport and Tourism, La Trobe University, Bundoora, Vic, Australia
| | - Anthony Gendall
- Department of Animal Plant and Soil Sciences, La Trobe University, Bundoora, Vic, Australia
| | - Samantha Grover
- Applied Chemistry and Environmental Science, School of Science, RMIT University, Melbourne, Vic, Australia
| |
Collapse
|
25
|
Ng KK, Rine S, Choi E, Fiani N, Porter I, Fink L, Peralta S. Mandibular Carnassial Tooth Malformations in 6 Dogs-Micro-Computed Tomography and Histology Findings. Front Vet Sci 2019; 6:464. [PMID: 31956654 PMCID: PMC6951429 DOI: 10.3389/fvets.2019.00464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/29/2019] [Indexed: 02/04/2023] Open
Abstract
Objective: To document the clinical, radiographic, and histological characteristics of mandibular first molar teeth with developmental abnormalities previously attributed to dens invaginatus and enamel pearls in dogs. Materials and Methods: Affected mandibular first molar teeth from dogs were evaluated grossly and via intraoral radiography. Endodontically and/or periodontally compromised teeth were extracted and subjected to some combination of micro-computed tomography, histopathology, and immunohistochemistry with anti-amelogenin antibody. Results: Six dogs with developmental abnormalities of mandibular first molar teeth were identified, representing 11 affected teeth. The condition was bilateral in 5 dogs, while in 1 dog, only one mandibular first molar tooth was present. Patient weight ranged from 1.7 to 6 kg (median = 4.09 kg). On intraoral radiographs, root convergence or parallelism was noted in 6 of 11 teeth, and root dilaceration was noted in 3 of 11 teeth. Eight teeth required extraction due to periapical lucencies or periodontitis. On micro-CT, the abnormal teeth were characterized by the presence of abnormal, heterogenous hard tissue with beam attenuation characteristics midway between that of enamel and dentin. Enamel fissures were identified in 4 of 8 teeth, while ectopic radicular enamel was identified in 2 of 8 teeth. The abnormal tissue was traversed by channels measuring 20-40 μm in diameter. Channels communicated with the enamel fissures in 2/8 teeth, the furcation in 2/8 teeth and the pulp in 4/8 teeth. The abnormal tissue was frequently surrounded by disorganized dentin. Histologic features of enamel and dentin were absent from the abnormal tissue and immunohistochemistry to detect amelogenin in the abnormal tissue was negative in all samples. Conclusion: The dental abnormalities described here correspond to a previously unrecognized developmental abnormality involving the mandibular first molar teeth in dogs. The developmental origin of the abnormal tissue could not be ascertained, and further investigations are required to determine the mode of formation, origin of the abnormal tissue, and factors associated with development. These developmental abnormalities more closely resemble molar-incisor malformation, rather than dens invaginatus or enamel pearls as described in humans. The authors propose that affected mandibular first molar teeth simply be referred to as having carnassial tooth malformations.
Collapse
Affiliation(s)
- Kevin K Ng
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Stacy Rine
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Eunju Choi
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Nadine Fiani
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Ian Porter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Lisa Fink
- Arizona Veterinary Dental Specialists, Scottsdale, AZ, United States
| | - Santiago Peralta
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| |
Collapse
|
26
|
Evans JP, Smith C, Porter I, Gangannagaripalli J, Goodwin V, Valderas J. Patient-centred outcomes in lateral elbow tendinopathy: A systematic review of available evidence in UK populations. Shoulder Elbow 2019; 11:440-449. [PMID: 32269604 PMCID: PMC7094069] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 07/03/2018] [Indexed: 02/10/2023]
Abstract
BACKGROUND For Patient-Reported Outcome Measures to be useful, they must have evidenced reliability, validity and responsiveness in both the condition and population of interest. The aim of this study is to systematically review the evidence for Patient-Reported Outcome Measures in UK patients with lateral elbow tendinopathy. METHODS A systematic search was performed in Ovid MEDLINE, Embase and CINAHL. Studies were included if reporting administration of Patient-Reported Outcome Measures in UK populations with lateral elbow tendinopathy. Patient-Reported Outcome Measures characteristics and target populations were assessed using a structured classification system. Patient-Reported Outcome Measures reporting in randomised controlled trials was assessed against Consolidated Standards of Reporting Trials (CONSORT) standards (Patient-Reported Outcome extension). RESULTS A total of 16 articles were included. Out of seven different Patient-Reported Outcome Measures, there was evidence of partial validation for five. The assessment of validity, reliability and responsiveness of all Patient-Reported Outcome Measures in lateral elbow tendinopathy UK populations extended to just 20 individual patients. No articles conformed to the CONSORT Patient-Reported Outcome extension standards. CONCLUSION There exists a paucity of data on the psychometrics of Patient-Reported Outcome Measures in UK lateral elbow tendinopathy populations. Without these data, trial design and interpretation are significantly hindered. The high prevalence of this condition and significant volume of studies being conducted into novel treatments highlight the need for this knowledge gap to be resolved.
Collapse
Affiliation(s)
- Jonathan P Evans
- Royal Devon and Exeter NHS Foundation
Trust, Exeter, UK
- Health Services and Policy Research
Group, University of Exeter, Exeter, UK
| | - Chris Smith
- Royal Devon and Exeter NHS Foundation
Trust, Exeter, UK
| | - Ian Porter
- National Institute for Health Research
(NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC)
South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jaheeda Gangannagaripalli
- National Institute for Health Research
(NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC)
South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Vicki Goodwin
- National Institute for Health Research
(NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC)
South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jose Valderas
- Health Services and Policy Research
Group, University of Exeter, Exeter, UK
| |
Collapse
|
27
|
Evans JP, Porter I, Gangannagaripalli JB, Bramwell C, Davey A, Smith CD, Fine N, Goodwin VA, Valderas JM. Assessing Patient-Centred Outcomes in Lateral Elbow Tendinopathy: A Systematic Review and Standardised Comparison of English Language Clinical Rating Systems. Sports Med Open 2019; 5:10. [PMID: 30895407 PMCID: PMC6426924 DOI: 10.1186/s40798-019-0183-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022]
Abstract
Background Lateral elbow tendinopathy (LET) is a common condition affecting adults. Although a lack of treatment consensus continues to prompt numerous effectiveness studies, there is a paucity of clear guidance on the choice of outcome measure. Our aim was to undertake a standardised evaluation of the available clinical rating systems that report patient-centred outcomes in LET. Methods A systematic review of studies reporting the development, assessment of metric properties and/or use of instruments aiming to quantify LET-specific patient-centred outcome measures was conducted in MEDLINE, Embase and CINAHL (inception-2017) adhering to PRISMA guidance. The evidence for each instrument was independently assessed by two reviewers using the standardised evaluating measures of patient-reported outcomes (EMPRO) method evaluating overall and attribute-specific instrument performance (metric properties and usability). EMPRO scores > 50/100 were considered indicative of high performance. Results Out of 7261 references, we identified 105 articles reporting on 15 instruments for EMPRO analysis. Median performance score was 41.6 (range 21.6–72.5), with four instruments meeting high-performance criteria: quick Disabilities of the Arm Shoulder and Hand score (qDASH) (72.5), DASH (66.9), Oxford Elbow Score (OES) (66.6) and Patient-Rated Tennis Elbow Evaluation (PRTEE) (57.0). One hundred seventy-nine articles reported instrument use internationally with DASH as the most frequent (29.7% articles) followed by PRTEE (25.6%), MEPS (15.1%) and qDASH (8.1%). The correlation between frequency of use and performance was r = 0.35 (95%CI − 0.11; 0.83). Conclusions This is the first study to provide standardised guidance on the choice of measures for LET. A large number of clinical rating systems are both available and being used for patients with LETs. Robust evidence is available for four measures, the DASH, QDASH, PRTEE and OES. The use of instruments in the literature is only in part explained by instrument performance. Electronic supplementary material The online version of this article (10.1186/s40798-019-0183-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jonathan Peter Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK. .,Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | | | - Charlotte Bramwell
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Chris D Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nicola Fine
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Victoria A Goodwin
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| |
Collapse
|
28
|
Mounce LTA, Campbell JL, Henley WE, Tejerina Arreal MC, Porter I, Valderas JM. Predicting Incident Multimorbidity. Ann Fam Med 2018; 16:322-329. [PMID: 29987080 PMCID: PMC6037507 DOI: 10.1370/afm.2271] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/03/2018] [Accepted: 04/19/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Multimorbidity is associated with adverse outcomes, yet research on the determinants of its incidence is lacking. We investigated which sociodemographic, health, and individual lifestyle (eg, physical activity, smoking behavior, body mass index) characteristics predict new cases of multimorbidity. METHODS We used data from 4,564 participants aged 50 years and older in the English Longitudinal Study of Aging that included a 10-year follow-up period. Discrete time-to-event (complementary log-log) models were constructed for exploring the associations of baseline characteristics with outcomes between 2002-2003 and 2012-2013 separately for participants with no initial conditions (n = 1,377) developing multimorbidity, any increase in conditions within 10 years regardless of initial conditions, and the impact of individual conditions on incident multimorbidity. RESULTS The risks of developing multimorbidity were positively associated with age, and they were greater for the least wealthy, for participants who were obese, and for those who reported the lowest levels of physical activity or an external locus of control (believing that life events are outside of one's control) for all groups regardless of baseline conditions (all linear trends <.05). No significant associations were observed for sex, educational attainment, or social detachment. For participants with any increase in conditions (n = 4,564), a history of smoking was the only additional predictor. For participants with a single baseline condition (n = 1,534), chronic obstructive pulmonary disease (COPD), asthma, and arrhythmia showed the strongest associations with subsequent multimorbidity. CONCLUSIONS Our findings support the development and implementation of a strategy targeting the prevention of multimorbidity for susceptible groups. This approach should incorporate behavior change addressing lifestyle factors and target health-related locus of control.
Collapse
Affiliation(s)
- Luke T A Mounce
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon, United Kingdom
| | - John L Campbell
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon, United Kingdom
| | - William E Henley
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon, United Kingdom
| | | | - Ian Porter
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon, United Kingdom
| | - Jose M Valderas
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon, United Kingdom
| |
Collapse
|
29
|
Sweet D, Byng R, Webber M, Enki DG, Porter I, Larsen J, Huxley P, Pinfold V. Personal well-being networks, social capital and severe mental illness: exploratory study. Br J Psychiatry 2018; 212:308-317. [PMID: 28982657 DOI: 10.1192/bjp.bp.117.203950] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 11/23/2022]
Abstract
BACKGROUND Connectedness is a central dimension of personal recovery from severe mental illness (SMI). Research reports that people with SMI have lower social capital and poorer-quality social networks compared to the general population.AimsTo identify personal well-being network (PWN) types and explore additional insights from mapping connections to places and activities alongside social ties. METHOD We carried out 150 interviews with individuals with SMI and mapped social ties, places and activities and their impact on well-being. PWN types were developed using social network analysis and hierarchical k-means clustering of this data. RESULTS Three PWN types were identified: formal and sparse; family and stable; and diverse and active. Well-being and social capital varied within and among types. Place and activity data indicated important contextual differences within social connections that were not found by mapping social networks alone. CONCLUSIONS Place locations and meaningful activities are important aspects of people's social worlds. Mapped alongside social networks, PWNs have important implications for person-centred recovery approaches through providing a broader understanding of individual's lives and resources.Declaration of interestNone.
Collapse
Affiliation(s)
| | - Richard Byng
- Peninsula Schools of Medicine and Dentistry,Plymouth University,Plymouth
| | | | | | - Ian Porter
- Primary Care Research,Peninsula Schools of Medicine and Dentistry,Plymouth University,Plymouth
| | | | - Peter Huxley
- Centre for Mental Health and Society,School of Social Sciences,Bangor
| | | |
Collapse
|
30
|
Evans JP, Smith CD, Fine NF, Porter I, Gangannagaripalli J, Goodwin VA, Valderas JM. Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use. J Shoulder Elbow Surg 2018; 27:e98-e106. [PMID: 29444754 DOI: 10.1016/j.jse.2017.12.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient's view of his or her own health. The choice of clinical rating system should be supported by its performance against established quality standards. METHODS A search strategy was developed to identify all studies that reported the use of clinical rating systems in the elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed, and the outcome measure used. RESULTS We identified 980 studies that reported clinical rating system use. Seventy-two separate rating systems were identified. Forty-one percent of studies used ≥2 separate measures. Overall, 54% of studies used the Mayo Elbow Performance Score (MEPS). For arthroplasty, 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), and 7% used QuickDASH. For trauma, 66.7% used MEPS, 32% used DASH, and 23% used the Morrey Score. For tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation (PRTEE), and 13% used MEPS. Over time, there was an increased proportional use of the MEPS, DASH, QuickDASH, PRTEE, and the Oxford Elbow Score. CONCLUSIONS This study identified a wide choice and usage of clinical rating systems in the elbow literature. Numerous studies reported measures without a history of either a specific pathology or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This was not demonstrated currently.
Collapse
Affiliation(s)
- Jonathan P Evans
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; Health Services and Policy Research Group, University of Exeter, Exeter, UK; National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK.
| | - Chris D Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nicola F Fine
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
| | | | - Victoria A Goodwin
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
| |
Collapse
|
31
|
Quinn C, Denman K, Smithson P, Owens C, Sheaff R, Campbell J, Porter I, Annison J, Byng R. General practitioner contributions to achieving sustained healthcare for offenders: a qualitative study. BMC Fam Pract 2018; 19:22. [PMID: 29390968 PMCID: PMC5796354 DOI: 10.1186/s12875-018-0708-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 01/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Offenders frequently have substantial healthcare needs and, like many other socially marginalised groups, often receive healthcare in inverse proportion to their needs. Improved continuity of healthcare over time could contribute to addressing these needs. General Practitioners need to be able to support people with complex social and medical problems, even in systems that are not specifically designed to manage individuals with such degrees of complexity. We aimed to examine offenders' perspectives on factors that contributed to, or worked against, creating and sustaining their access to healthcare. METHODS From a sample of 200 participants serving community or prison sentences in South West (SW) and South East (SE) England, who were interviewed about their health care experiences as part of the Care for Offenders: Continuity of Access (COCOA) study, we purposively sampled 22 participants for this sub-study, based on service use. These interviews were transcribed verbatim. A thematic analytic approach initially applied 5 a priori codes based on access and different components of continuity. Data were then examined for factors that contributed to achieving and disrupting access and continuity. RESULTS Participants described how their own life situations and behaviours contributed to their problems in accessing healthcare and also identified barriers created by existing access arrangements. They also highlighted how some General Practitioners used their initiative and skills to 'workaround' the system, and build positive relationships with them; feeling listened to and building trust were particularly valued, as was clear communication. Limitations faced by General Practitioners included a lack of appropriate services to refer people to, where the offender patients would meet the access criteria, and disagreements regarding medication prescriptions. CONCLUSIONS General Practitioners can make a positive contribution to supporting access to healthcare for an under-served population by facilitating more flexible and less formal access arrangements, by using their relationship skills, and by problem-solving. General Practitioners should recognise their potential to transform people's experience of healthcare whilst working in imperfect systems, particularly with vulnerable and marginalised groups who have complex medical and social needs.
Collapse
Affiliation(s)
- Cath Quinn
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
| | - Katie Denman
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
| | | | - Christabel Owens
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Rod Sheaff
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
| | - John Campbell
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Ian Porter
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Jill Annison
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
| | - Richard Byng
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
| |
Collapse
|
32
|
Abstract
Assertive community treatment (ACT) was developed in the early 1970s as a means of coordinating the care of people with severe mental illness in the community. A Cochrane review of the effectiveness of ACT for the general adult population found that people receiving ACT were more likely to engage with services, and were less likely to be admitted to hospital (Marshall & Lockwood, 2000). The National Service Framework for Mental Health (Department of Health, 1999) and the NHS Plan (Department of Health, 2000) called for a total of 220 assertive outreach teams by April 2003.
Collapse
|
33
|
Velikova G, Valderas JM, Potter C, Batchelder L, A’Court C, Baker M, Bostock J, Coulter A, Fitzpatrick R, Forder J, Fox D, Geneen L, Gibbons E, Jenkinson C, Jones K, Kelly L, Peters M, Mulhern B, Labeit A, Rowen D, Meadows K, Elliott J, Brazier J, Knowles E, Keetharuth A, Brazier J, Connell J, Carlton J, Buck LT, Ricketts T, Barkham M, Goswami P, Salek S, Ionova T, Oliva E, Fielding AK, Karakantza M, Al-Ismail S, Collins GP, McConnell S, Langton C, Jennings DM, Else R, Kell J, Ward H, Day S, Lumley E, Phillips P, Duncan R, Buckley-Woods H, Aber A, Jones G, Michaels J, Porter I, Gangannagaripalli J, Davey A, Ricci-Cabello I, Haywood K, Hansen ST, Valderas J, Roberts D, Gumber A, Podmore B, Hutchings A, van der Meulen J, Aggarwal A, Konan S, Price A, Jackson W, Bottomley N, Philiips M, Knightley-Day T, Beard D, Gibbons E, Fitzpatrick R, Greenhalgh J, Gooding K, Gibbons E, Valderas C, Wright J, Dalkin S, Meads D, Black N, Fawkes C, Froud R, Carnes D, Price A, Cook J, Dakin H, Smith J, Kang S, Beard D, Griffiths C, Guest E, Harcourt D, Murphy M, Hollinghurst S, Salisbury C, Carlton J, Elliott J, Rowen D, Gao A, Price A, Beard D, Lemanska A, Chen T, Dearnaley DP, Jena R, Sydes M, Faithfull S, Ades AE, Kounali D, Lu G, Rombach I, Gray A, Jenkinson C, Rivero-Arias O, Holch P, Holmes M, Rodgers Z, Dickinson S, Clayton B, Davidson S, Routledge J, Glennon J, Henry AM, Franks K, Velikova G, Maguire R, McCann L, Young T, Armes J, Harris J, Miaskowski C, Kotronoulas G, Miller M, Ream E, Patiraki E, Geiger A, Berg GV, Flowerday A, Donnan P, McCrone P, Apostolidis K, Fox P, Furlong E, Kearney N, Gibbons C, Fischer F, Gibbons C, Coste J, Martinez JV, Rose M, Leplege A, Shingler S, Aldhouse N, Al-Zubeidi T, Trigg A, Kitchen H, Davey A, Porter I, Green C, Valderas JM, Coast J, Smith S, Hendriks J, Black N, Shah K, Rivero-Arias O, Ramos-Goni JM, Kreimeier S, Herdman M, Devlin N, Finch AP, Brazier JE, Mukuria C, Zamora B, Parkin D, Feng Y, Bateman A, Herdman M, Devlin N, Patton T, Gutacker N, Shah K. Proceedings of Patient Reported Outcome Measure's (PROMs) Conference Oxford 2017: Advances in Patient Reported Outcomes Research : Oxford, UK. 8th June 2017. Health Qual Life Outcomes 2017; 15:185. [PMID: 29035171 PMCID: PMC5667589 DOI: 10.1186/s12955-017-0757-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
34
|
Scheer C, Rowlings D, Firrell M, Deuter P, Morris S, Riches D, Porter I, Grace P. Nitrification inhibitors can increase post-harvest nitrous oxide emissions in an intensive vegetable production system. Sci Rep 2017; 7:43677. [PMID: 28266551 PMCID: PMC5339787 DOI: 10.1038/srep43677] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [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: 12/01/2016] [Accepted: 01/27/2017] [Indexed: 11/26/2022] Open
Abstract
To investigate the effect of nitrification inhibitors (NIs) 3,4-dimethylpyrazole phosphate (DMPP) and 3-methylpyrazole 1,2,4-triazole (3MP + TZ), on N2O emissions and yield from a typical vegetable rotation in sub-tropical Australia we monitored soil N2O fluxes continuously over an entire year using an automated greenhouse gas measurement system. The temporal variation of N2O fluxes showed only low emissions over the vegetable cropping phases, but significantly higher emissions were observed post-harvest accounting for 50–70% of the annual emissions. NIs reduced N2O emissions by 20–60% over the vegetable cropping phases; however, this mitigation was offset by elevated N2O emissions from the NIs treatments over the post-harvest fallow period. Annual N2O emissions from the conventional fertiliser, the DMPP treatment, and the 3MP + TZ treatment were 1.3, 1.1 and 1.6 (sem = 0.2) kg-N ha−1 year−1, respectively. This study highlights that the use of NIs in vegetable systems can lead to elevated N2O emissions by storing N in the soil profile that is available to soil microbes during the decomposition of the vegetable residues. Hence the use of NIs in vegetable systems has to be treated carefully and fertiliser rates need to be adjusted to avoid an oversupply of N during the post-harvest phase.
Collapse
Affiliation(s)
- Clemens Scheer
- Institute for Future Environments, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - David Rowlings
- Institute for Future Environments, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Mary Firrell
- Department of Agriculture, Fisheries and Forestry (Queensland), Gatton Research Station, QLD 4343, Australia
| | - Peter Deuter
- Department of Agriculture, Fisheries and Forestry (Queensland), Gatton Research Station, QLD 4343, Australia
| | - Stephen Morris
- NSW Department of Primary Industries, Wollongbar Primary Industries Institute, Wollongbar NSW 2480, Australia
| | - David Riches
- School of Life Sciences, LaTrobe University, Bundoora, Vic 3083, Australia
| | - Ian Porter
- School of Life Sciences, LaTrobe University, Bundoora, Vic 3083, Australia
| | - Peter Grace
- Institute for Future Environments, Queensland University of Technology, Brisbane, QLD 4000, Australia
| |
Collapse
|
35
|
Croudace T, Brazier J, Gutacker N, Street A, Robotham D, Waterman S, Rose D, Satkunanathan S, Wykes T, Nasr N, Enderby P, Carlton J, Rowen D, Elliott J, Brazier J, Stevens K, Basarir H, Labeit A, Murphy M, Hollinghurst S, Salisbury C, Marley D, Wilson J, Barrat A, Roy B, Rombach I, Burke Ó, Jenkinson C, Gray A, Rivero-Arias O, Porter I, Gangannagaripalli J, Bramwell C, Valderas JM, Holch P, Davidson S, Routledge J, Henry A, Franks K, Gilbert A, Absolom K, Velikova G, Porter I, Valderas JM, Boehnke JR, Trigg A, Howells R, Singh J, Pokhrel S, Longworth L, Potter C, Hunter C, Kelly L, Gibbons E, Forder J, Coulter A, Fitzpatrick R, Peters M. Proceedings of Patient Reported Outcome Measure’s (PROMs) Conference Sheffield 2016: advances in patient reported outcomes research. Health Qual Life Outcomes 2016. [PMCID: PMC5073844 DOI: 10.1186/s12955-016-0540-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
S1 Using computerized adaptive testing Tim Croudace S2 Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policy John Brazier O1 “Am I going to get better?”—Using PROMs to inform patients about the likely benefit of surgery Nils Gutacker, Andrew Street O2 Identifying Patient Reported Outcome Measures for an electronic Personal Health Record Dan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til Wykes O3 Examining the change process over time qualitatively: transformative learning and response shift Nasrin Nasr, Pamela Enderby O4 Developing a PROM to evaluate self-management in diabetes (HASMID): giving patients a voice Jill Carlton, Donna Rowen, Jackie Elliott, John Brazier, Katherine Stevens, Hasan Basarir, Alex Labeit O5 Development of the Primary Care Outcomes Questionnaire (PCOQ) Mairead Murphy, Sandra Hollinghurst, Chris Salisbury O6 Developing the PKEX score- a multimodal assessment tool for patients with shoulder problems Dominic Marley, James Wilson, Amy Barrat, Bibhas Roy O7 Applying multiple imputation to multi-item patient reported outcome measures: advantages and disadvantages of imputing at the item, sub-scale or score level Ines Rombach, Órlaith Burke, Crispin Jenkinson, Alastair Gray, Oliver Rivero-Arias O8 Integrating Patient Reported Outcome Measures (PROMs) into routine primary care for patients with multimorbidity: a feasibility study Ian Porter, Jaheeda Gangannagaripalli, Charlotte Bramwell, Jose M. Valderas O9 eRAPID: electronic self-report and management of adverse-events for pelvic radiotherapy (RT) patients Patricia Holch, Susan Davidson, Jacki Routledge, Ann Henry, Kevin Franks, Alex Gilbert, Kate Absolom & Galina Velikova O10 Patient reported outcomes (PROMs) based recommendation in clinical guidance for the management of chronic conditions in the United Kingdom Ian Porter, Jose M.Valderas O11 Cross-sectional and longitudinal parameter shifts in epidemiological data: measurement invariance and response shifts in cohort and survey data describing the UK’s Quality of Life Jan R. Boehnke O12 Patient-reported outcomes within health technology decision making: current status and implications for future policy Andrew Trigg, Ruth Howells O13 Can social care needs and well-being be explained by the EQ-5D? Analysis of Health Survey for England dataset Jeshika Singh, Subhash Pokhrel, Louise Longworth O14 Where patients and policy meet: exploring individual-level use of the Long-Term Conditions Questionnaire (LTCQ) Caroline Potter, Cheryl Hunter, Laura Kelly, Elizabeth Gibbons, Julian Forder, Angela Coulter, Ray Fitzpatrick, Michele Peters
Collapse
|
36
|
Porter I, Gonçalves-Bradley D, Ricci-Cabello I, Gibbons C, Gangannagaripalli J, Fitzpatrick R, Black N, Greenhalgh J, Valderas JM. Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities. J Comp Eff Res 2016; 5:507-19. [PMID: 27427277 DOI: 10.2217/cer-2015-0014] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [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: 12/21/2022] Open
Abstract
Patient-reported outcomes (PROs) are reports of the status of a patient's health condition that come directly from the patient. While PRO measures are a well-developed technology with robust standards in research, their use for informing healthcare decisions is still poorly understood. We review relevant examples of their application in the provision of healthcare and examine the challenges associated with implementing PROs in clinical settings. We evaluate evidence for their use and examine barriers to their uptake, and present an evidence-based framework for the successful implementation of PROs in clinical practice. We discuss current and future developments for the use of PROs in clinical practice, such as individualized measurement and computer-adaptive testing.
Collapse
Affiliation(s)
- Ian Porter
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx) (Person centerd Care), University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Gibbons
- Primary Care Unit, Cambridge Center for Health Services Research, University of Cambridge, UK.,The Psychometrics Centre, Judge Business School, University of Cambridge, UK
| | - Jaheeda Gangannagaripalli
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx) (Person centerd Care), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Jose M Valderas
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx) (Person centerd Care), University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
37
|
Porter I, Knight TW, Raynaud P. Potential Impacts of Modeling Full Reactor Cores Using Combined Fuel Performance and Thermal Hydraulics Codes. NUCL TECHNOL 2015. [DOI: 10.13182/nt14-100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ian Porter
- University of South Carolina, 300 Main Street, Columbia, South Carolina 29208
- U.S. Nuclear Regulatory Commission, Washington, D.C. 20555
| | - Travis W. Knight
- University of South Carolina, 300 Main Street, Columbia, South Carolina 29208
| | | |
Collapse
|
38
|
Pinfold V, Sweet D, Porter I, Quinn C, Byng R, Griffiths C, Billsborough J, Enki DG, Chandler R, Webber M, Larsen J, Carpenter J, Huxley P. Improving community health networks for people with severe mental illness: a case study investigation. Health Services and Delivery Research 2015. [DOI: 10.3310/hsdr03050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IntroductionPolicy drivers in mental health to address personal recovery, stigma and poor physical health indicate that new service solutions are required. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness (SMI) to benefit health and wellbeing.MethodsA five-module mixed-methods design was undertaken in two study sites. Data were collected from 150 network-mapping interviews and 41 in-depth follow-up interviews with people with SMI; in-depth interviews with 30 organisation stakeholders and 12 organisation leaders; and 44 telephone interviews with practitioners. We undertook a three-stage synthesis process including independent lived experience feedback, and a patient and public involvement team participated in tool design, data collection, analysis and write-up.ResultsThree personal network types were found in our study using the community health network approach: diverse and active; family and stable; formal and sparse. Controlled for other factors we found only four variables significantly associated with which network type a participant had: living alone or not; housing status; formal education; long-term sickness or disability. Diagnosis was not a factor. These variables are challenging to address but they do point to potential for network change. The qualitative interviews with people with SMI provided further understanding of connection-building and resource utilisation. We explored individual agency across each network type, and identified recognition of the importance and value of social support and active connection management alongside the risks of isolation, even for those most affected by mental illness. We identified tensions in personal networks, be that relationships with practitioners or families, dealing with the impact of stigma, or frustrations of not being in employment, which all impact on network resources and well-being. The value of connectedness within personal networks of people, place and activity for supporting recovery was evident in shaping identity, providing meaning to life and sense of belonging, gaining access to new resources, structuring routines and helping individuals ‘move on’ in their recovery journey.Health-care practitioners recognised that social factors were important in recovery but reported system-level barriers (workload, administrative bureaucracy, limited contact time with clients) in addressing these issues fully. Even practitioners working in third-sector services whose remit involved increasing clients’ social connection faced restrictions due to being evaluated by outcome criteria that limited holistic recovery-focused practices. Service providers were keen to promote recovery-focused approaches. We found contrasts between recovery ideology within mental health policy and recovery practice on the ground. In particular, the social aspects of supporting people with SMI are often underprioritised in the health-care system. In a demanding and changing context, strategic multiagency working was seen as crucial but we found few examples of embedded multisector organisation partnerships.ConclusionWhile our exploratory study has limitations, findings suggest potential for people with SMI to be supported to become more active managers of their personal networks to support well-being regardless of current network type. The health and social care system does not currently deliver multiagency integrated solutions to support SMI and social recovery.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
| | | | - Ian Porter
- Primary Care Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Cath Quinn
- Primary Care Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Richard Byng
- Primary Care Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | | | | | - Doyo Gragn Enki
- Primary Care Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Ruth Chandler
- Sussex Partnership NHS Foundation Trust, West Sussex, UK
| | - Martin Webber
- International Centre for Mental Health Social Research, University of York, York, UK
| | | | - John Carpenter
- Department of Social Work and Applied Social Sciences, University of Bristol, Bristol, UK
| | - Peter Huxley
- Centre for Social Work and Social Care Research, University of Swansea, Swansea, UK
| |
Collapse
|
39
|
Hamid A, Shapiro JD, McMurrick P, Bell S, Porter I, Carne P, Haydon AM. Do patients achieving pathologic complete response (pCR) following neoadjuvant treatment for locally advanced rectal cancer (LARC) need adjuvant chemotherapy? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
40
|
Porter I, Pizano M, Besri M, Mattner S, Fraser P. PROGRESS IN THE GLOBAL PHASE OUT OF METHYL BROMIDE AND THE RELATIVE EFFECTIVENESS OF SOIL DISINFESTATION STRATEGIES. ACTA ACUST UNITED AC 2010. [DOI: 10.17660/actahortic.2010.883.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
41
|
|
42
|
Maksoud A, Porter I, Schneider K, Joseph R, Lebourveau P, Meyers D. 2 THE RELATIONSHIP OF AGE AND LEFT VENTRICULAR DIASTOLIC FUNCTION.:. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0015.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
43
|
Maksoud A, Porter I, Schneider K, Joseph R, Lebourveau P, Meyers D. The Relationship of Age and Left Ventricular Diastolic Function. J Investig Med 2006. [DOI: 10.1177/108155890605402s02] [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: 01/09/2023]
Affiliation(s)
- A. Maksoud
- Kansas University Medical Center. Kansas City, KS
| | - I. Porter
- Kansas University Medical Center. Kansas City, KS
| | - K. Schneider
- Kansas University Medical Center. Kansas City, KS
| | - R. Joseph
- Kansas University Medical Center. Kansas City, KS
| | | | - D. Meyers
- Kansas University Medical Center. Kansas City, KS
| |
Collapse
|
44
|
Poulsen MG, Rischin D, Porter I, Walpole E, Harvey J, Hamilton C, Keller J, Tripcony L. Does chemotherapy improve survival in high-risk stage I and II Merkel cell carcinoma of the skin? Int J Radiat Oncol Biol Phys 2005; 64:114-9. [PMID: 16125873 DOI: 10.1016/j.ijrobp.2005.04.042] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2005] [Revised: 04/14/2005] [Accepted: 04/15/2005] [Indexed: 11/20/2022]
Abstract
PURPOSE The effectiveness of synchronous carboplatin, etoposide, and radiation therapy in improving survival was evaluated by comparison of a matched set of historic control subjects with patients treated in a prospective Phase II study that used synchronous chemotherapy and radiation and adjuvant chemotherapy. PATIENTS AND METHODS Patients were included in the analysis if they had disease localized to the primary site and nodes, and they were required to have at least one of the following high-risk features: recurrence after initial therapy, involved nodes, primary size greater than 1 cm, or gross residual disease after surgery. All patients who received chemotherapy were treated in a standardized fashion as part of a Phase II study (Trans-Tasman Radiation Oncology Group TROG 96:07) from 1997 to 2001. Radiation was delivered to the primary site and nodes to a dose of 50 Gy in 25 fractions over 5 weeks, and synchronous carboplatin (AUC 4.5) and etoposide, 80 mg/m(2) i.v. on Days 1 to 3, were given in Weeks 1, 4, 7, and 10. The historic group represents a single institution's experience from 1988 to 1996 and was treated with surgery and radiation alone, and patients were included if they fulfilled the eligibility criteria of TROG 96:07. Patients with occult cutaneous disease were not included for the purpose of this analysis. Because of imbalances in the prognostic variables between the two treatment groups, comparisons were made by application of Cox's proportional hazard modeling. Overall survival, disease-specific survival, locoregional control, and distant control were used as endpoints for the study. RESULTS Of the 102 patients who had high-risk Stage I and II disease, 40 were treated with chemotherapy (TROG 96:07) and 62 were treated without chemotherapy (historic control subjects). When Cox's proportional hazards modeling was applied, the only significant factors for overall survival were recurrent disease, age, and the presence of residual disease. For disease-specific survival, recurrent disease was the only significant factor. Primary site on the lower limb had an adverse effect on locoregional control. For distant control, the only significant factor was residual disease. CONCLUSIONS The multivariate analysis suggests chemotherapy has no effect on survival, but because of the wide confidence limits, a chemotherapy effect cannot be excluded. A study of this size is inadequately powered to detect small improvements in survival, and a larger randomized study remains the only way to truly confirm whether chemotherapy improves the results in high-risk MCC.
Collapse
Affiliation(s)
- Michael G Poulsen
- University of Queensland, Southern Zone Radiation Oncology, Raymond Tce, South Brisbane, QLD, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Thistlethwaite P, Porter I, Evans N. Photophysics of the aniline blue fluorophore: a fluorescent probe showing specificity toward (1 .fwdarw. 3)-.beta.-D-glucans. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100412a036] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Grogan S, Conner M, Norman P, Willits D, Porter I. Validation of a questionnaire measuring patient satisfaction with general practitioner services. Qual Health Care 2000; 9:210-5. [PMID: 11101705 PMCID: PMC1743536 DOI: 10.1136/qhc.9.4.210] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND In order that patient satisfaction may be assessed in a meaningful way, measures that are valid and reliable are required. This study was undertaken to assess the construct validity and internal reliability of the previously developed Patient Satisfaction Questionnaire (PSQ). METHOD A total of 1390 patients from five practices in the North of England, the Midlands, and Scotland completed the questionnaire. Responses were checked for construct validity (including confirmatory factor analysis to check the factor structure of the scale) and internal reliability. RESULTS Confirmatory factor analysis showed that items loaded on the appropriate factors in a five factor model (doctors, nurses, access, appointments, and facilities). Scores on the specific subscales showed highly significant positive correlations with general satisfaction subscale scores suggesting construct validity. Also, the prediction (derived from past research) that older people would be more satisfied with the service was borne out by the results (F (4, 1312) = 57.10; p < 0.0001), providing further construct validation. The five specific subscales (doctors, nurses, access, appointments, and facilities), the general satisfaction subscale, and the questionnaire as a whole were found to have high internal reliability (Cronbach's alpha = 0.74-0.95). CONCLUSION The results suggest that the PSQ is a valid and internally reliable tool for assessing patient satisfaction with general practitioner services.
Collapse
Affiliation(s)
- S Grogan
- Department of Psychology and Speech Pathology, Manchester Metropolitan University, Elizabeth Gaskell Building, Manchester M13 0JA
| | | | | | | | | |
Collapse
|
48
|
Sheard T, Evans J, Cash D, Hicks J, King A, Morgan N, Nereli B, Porter I, Rees H, Sandford J, Slinn R, Sunder K. A CAT-derived one to three session intervention for repeated deliberate self-harm: a description of the model and initial experience of trainee psychiatrists in using it. Br J Med Psychol 2000; 73 ( Pt 2):179-96. [PMID: 10874478 DOI: 10.1348/000711200160417] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe a new Cognitive Analytic Therapy (CAT)-based intervention for those who repeatedly self-harm. It is specifically designed to be deliverable by staff with no training in psychotherapy. The intervention is simply manualized into sequential tasks that are mediated by new CAT-style standardized tools. A particular feature of this intervention is the deliberate use of feelings elicited in the therapist ('counter-transference') as (a) a guide to how professional poise is being threatened or lost and (b) an indicator of the appropriate focus for this very brief therapy. The psychiatrists' reflection on their elicited feelings is mediated by a new CAT tool, the 'Assessor's Response File' developed in this project. Audiotape analysis suggested that following a very brief learning period, trainee psychiatrists were able to adhere to the structure of the model and arrive at an appropriate reformulation in the first session but tended to be collusive in reciprocating the patients' dysfunctional coping styles.
Collapse
Affiliation(s)
- T Sheard
- Division of Psychiatry, University of Bristol, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Baumiller RC, Comley S, Cunningham G, Fisher N, Fox L, Henderson M, Lebel R, McGrath G, Pelias MZ, Porter I, Roper Willson N. Code of ethical principles for genetics professionals. Am J Med Genet 1996; 65:177-8. [PMID: 9240739 DOI: 10.1002/(sici)1096-8628(19961028)65:3<177::aid-ajmg1>3.0.co;2-n] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
50
|
Baumiller RC, Cunningham G, Fisher N, Fox L, Henderson M, Lebel R, McGrath G, Pelias MZ, Porter I, Seydel F, Roper Willson N. Code of ethical principles for genetics professionals: an explication. Am J Med Genet 1996; 65:179-83. [PMID: 9240740 DOI: 10.1002/(sici)1096-8628(19961028)65:3<179::aid-ajmg2>3.0.co;2-l] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|