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Disease burden of diabetes, diabetic retinopathy and their future projections in the UK: cross-sectional analyses of a primary care database

Por: Haider · S. · Thayakaran · R. · Subramanian · A. · Toulis · K. A. · Moore · D. · Price · M. J. · Nirantharakumar · K.
Objectives

To estimate the current disease burden, trends and future projections for diabetes mellitus (DM) and diabetic retinopathy (DR) in the IQVIA Medical Research Data (IMRD).

Participants/design/setting

We performed a cross-sectional study of patients aged 12 and above to determine the prevalence of DM and DR from the IMRD database (primary care database) in January 2017, involving a total population of 1 80 824 patients with DM. We also carried out a series of cross-sectional studies to investigate prevalence trends, and then applied a double exponential smoothing model to forecast the future burden of DM and DR in the UK.

Results

The crude DM prevalence in 2017 was 5.2%. The DR, sight-threatening retinopathy (STR) and diabetic maculopathy prevalence figures in 2017 were 33.78%, 12.28% and 7.86%, respectively, in our IMRD cross-sectional study. There were upward trends in the prevalence of DM, DR and STR, most marked and accelerating in STR in type 1 DM but slowing in type 2 DM, and in the overall prevalence of DR.

Conclusion

Our results suggest differential rising trends in the prevalence of DM and DR. Preventive strategies, as well as treatment services planning, can be based on these projected prevalence estimates. Improvements that are necessary for the optimisation of care pathways, and preparations to meet demand and capacity challenges, can also be based on this information. The limitations of the study can be overcome by a future collaborative study linking DR screening and hospital eye services data.

Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank

Por: Mathioudakis · A. G. · Miligkos · M. · Boccabella · C. · Alimani · G. S. · Custovic · A. · Deschildre · A. · Ducharme · F. M. · Kalayci · O. · Murray · C. · Garcia · A. N. · Phipatanakul · W. · Price · D. · Sheikh · A. · Agache · I. O. · Bacharier · L. · Beloukas · A. · Bentley · A. · Bo
Introduction

Clinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted.

Methods and analysis

Standard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively.

Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence.

Ethics and dissemination

Ethics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank.

PROSPERO registration numbers

CRD42020132990, CRD42020171624.

The use of vascularised muscle flaps for treatment or prevention of wound complications following arterial surgery in the groin

Abstract

Wound complications following arterial surgery in the groin are relatively common and can result in significant morbidity and mortality. Vascularised muscle flaps (VMF) may be used as an adjunct to aid healing, either to manage complications or prophylactically. This series describes 46 patients who received sartorius or gracilis muscle flaps, of which 70% were performed as a salvage procedure to treat complications ranging from wound breakdown to vascular graft infection. The remaining 30% were performed at the time of the arterial surgery in patients with risk factors such as re‐do surgery or immunosuppression. The peri‐operative mortality rate was 9% and the major amputation rate was 26%, reflecting the complexity of patients that require intervention. Overall, 85% achieved successful healing in the groin without the need for further treatment following VMF. Only one case of flap necrosis occurred. Wound healing complications occurred more commonly after sartorius muscle flaps. The gracilis muscle offers a bulkier mass and greater mobility and so may be preferable, particularly for larger groin defects. This series has shown that VMF offer a safe and reliable option for selected cases to achieve wound healing in the groin in patients with often significant co‐morbidities.

Randomised controlled trial of tailored support to increase physical activity and reduce smoking in smokers not immediately ready to quit: protocol for the Trial of physical Activity-assisted Reduction of Smoking (TARS) Study

Por: Taylor · A. · Thompson · T. P. · Ussher · M. · Aveyard · P. · Murray · R. L. · Harris · T. · Creanor · S. · Green · C. · Streeter · A. J. · Chynoweth · J. · Ingram · W. · Greaves · C. J. · Hancocks · H. · Snowsill · T. · Callaghan · L. · Price · L. · Horrell · J. · King · J. · Gude · A. · Ge
Introduction

Smoking reduction can lead to increased success in quitting. This study aims to determine if a client-focused motivational support package for smoking reduction (and quitting) and increasing (or otherwise using) physical activity (PA) can help smokers who do not wish to quit immediately to reduce the amount they smoke, and ultimately quit. This paper reports the study design and methods.

Methods and analysis

A pragmatic, multicentred, parallel, two group, randomised controlled superiority clinical trial, with embedded process evaluation and economics evaluation. Participants who wished to reduce smoking with no immediate plans to quit were randomised 1:1 to receive either (1) tailored individual health trainer face-to-face and/or telephone support to reduce smoking and increase PA as an aid to smoking reduction (intervention) or (2) brief written/electronic advice to reduce or quit smoking (control). Participants in both arms of the trial were also signposted to usual local support for smoking reduction and quitting. The primary outcome measure is 6-month carbon monoxide-confirmed floating prolonged abstinence following participant self-reported quitting on a mailed questionnaire at 3 and 9 months post-baseline. Participants confirmed as abstinent at 9 months will be followed up at 15 months.

Ethics and dissemination

Approved by SW Bristol National Health Service Research Committee (17/SW/0223). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals. Results will be disseminated to trial participants and healthcare providers.

Trial registration number

ISRCTN47776579; Pre-results.

Voicing Jordanian Adolescents’ Suicide

imageBackground Studies focusing on adolescent suicide in Arab countries are particularly scarce, with the few available undertaken from within an epidemiological paradigm. Objective This study aimed to understand Jordanian adolescents’ perceptions, beliefs, and attitudes toward suicide. Methods A qualitative design using 12 dual-moderator focus group discussions was conducted in public schools. Participants were selected from the three main regions of the country (rural southern, urban central, and suburban northern). Participants included Jordanian adolescent boys and girls, aged 14–17 years, who reported experiencing mild to moderate depressive symptoms. A relational content analysis approach was used for coding data, and a content analysis was used to identify salient thematic categories. Data were analyzed using NVivo software. Results Four themes emerged, including perceived risk factors, perceived protective factors, active and passive suicidal ideations, and e-games and Internet influences. Main risk factors were depression; anxiety; stigma, shame, and isolation; family issues; life pressures; and guilt. Conversely, religiosity, perceived positive family functioning, and availability of long-term goals seemed to confer resilience to adolescents’ suicidal ideation and behavior. Passive suicidality (having death wishes without any plans to complete suicide) was noticed most among participants who feared jeopardizing the family’s reputation if they committed suicide. Several boys with active suicidal ideations used the Blue Whale Challenge e-game to learn how to complete suicide and relinquish their problems. Discussion Suicide is a multifactorial problem requiring multimodal strategies. Evidence from this research suggests that those most passionate about the outcome of interest are encouraged to redouble efforts to reduce modifiable risk factors, enrich protective factors, target the underlying psychiatric illness that informs suicidal ideations and behavior, and research the effect of social media and Internet activity more deeply. Parents are advised to monitor the online activities of their children and familiarize themselves with the digital applications they use.

Impact of allergic rhinitis on the day-to-day lives of children: insights from an Australian cross-sectional study

Por: Bosnic-Anticevich · S. · Smith · P. · Abramson · M. · Hespe · C. M. · Johnson · M. · Stosic · R. · Price · D. B.
Study design and objective

Cross-sectional, observational survey to describe the impact of allergic rhinitis (AR) on Australian children (2 to 15 years).

Methods

Participants (n=1541), parents of children aged 2 to 15 years, provided information on behalf of themselves and one eligible child in their household using a custom-built online questionnaire. Children were allocated to case (AR) or control (No AR) analysis groups based on a validated screening questionnaire.

Statistical methods

The study sample was stratified on age: primary analysis population (6 to 15 years, n=1111; AR=797, No AR=314); exploratory population (2 to 5 years). The primary endpoint, parent-perceived burden, was quantified using a validated measure of health status and analysed via comparison of means.

Results

The majority of AR cases were treated (730/797; 90.3%) and classified as having moderate-severe, intermittent AR (549/797; 68.9%). Half reported adequate symptom control in the prior 2 weeks (389/797; 48.8%; OR=4.04; 95% CI (CI) 2.24 to 7.31). Having AR was associated with worse overall health status (7.4 vs 8.4, mean difference (least squares mean difference (LSMD))=–0.99; 95% CI –1.18 to –0.79), fewer days being happy (22.2 vs 25.9, LSMD=–3.68; 95% CI –4.82 to –2.54) and more days of poor physical (2.82 vs 0.78, LSMD=2.04; 95% CI 1.61 to 2.47) and emotional (2.14 vs 0.67, LSMD=1.47; 95% CI 1.02 to –1.92) health compared with not having AR. All of these outcomes were significantly (p

Conclusion

The parent-perceived burden of AR in Australian children is high and it impacts many areas of day-to-day living. Inadequate symptom control is a key driver of the extent of this impact. Opportunities to optimise the management of AR in children include the adoption of self-assessment tools to gauge and monitor adequacy of symptom control.

Information given by websites selling home self-sampling COVID-19 tests: an analysis of accuracy and completeness

Por: Taylor-Phillips · S. · Berhane · S. · Sitch · A. J. · Freeman · K. · Price · M. J. · Davenport · C. · Geppert · J. · Harris · I. M. · Osokogu · O. · Skrybant · M. · Deeks · J. J.
Objectives

To assess the accuracy and completeness of information provided by websites selling home self-sampling and testing kits for COVID-19.

Design

Cross-sectional observational study.

Setting

All websites (n=27) selling direct to user home self-sampling and testing kits for COVID-19 (41 tests) in the UK (39 tests) and USA (two tests) identified by a website search on 23 May 2020.

Main outcome measures

Thirteen predefined basic information items to communicate to a user, including who should be tested, when and how testing should be done, test accuracy, and interpretation of results.

Results

Many websites did not provide the name or manufacturer of the test (32/41; 78%), when to use the test (10/41; 24%), test accuracy (12/41; 29%), and how to interpret results (21/41; 51%). Sensitivity and specificity were the most commonly reported test accuracy measures (either reported for 27/41 [66%] tests): we could only link these figures to manufacturers’ documents or publications for four (10%) tests. Predictive values, most relevant to users, were rarely reported (five [12%] tests reported positive predictive values). For molecular virus tests, 9/23 (39%) websites explained that test positives should self-isolate, and 8/23 (35%) explained that test negatives may still have the disease. For antibody tests, 12/18 (67%) websites explained that testing positive does not necessarily infer immunity from future infection. Seven (39%) websites selling antibody tests claimed the test had a CE mark, when they were for a different intended use (venous blood rather than finger-prick samples).

Conclusions

At the point of online purchase of home self-sampling COVID-19 tests, users in the UK are provided with incomplete, and, in some cases, misleading information on test accuracy, intended use, and test interpretation. Best practice guidance for communication about tests to the public should be developed and enforced for online sales of COVID-19 tests.

A poststructural analysis: Current practices for suicide prevention by nurses in the emergency department and areas of improvement

Abstract

Aims and objectives

To use a poststructuralist framework to critique historical, social and institutional constructions of emergency nursing and examine conflicting discourses surrounding suicide prevention. The aim is to also demonstrate practical guidance for enhancing emergency nursing practice and research with regard to suicide prevention.

Background

Emergency departments have been historically constructed as places for treating life‐threatening physical crises, thereby constructing other "nonurgent" health needs as less of a priority. Physical needs take priority over psychological needs, such as suicide‐related thoughts and behaviours, negatively impacting the quality of care that certain groups of patients receive.

Design

A theoretical analysis of the published literature on the topic of emergency nursing and suicide prevention was conducted and analysed using a poststructuralist framework.

Methods

Relevant literature on the topic of emergency nursing related to suicide prevention was analysed for a poststructuralist construct of power, language, subjectivity and discourse. Implications to practice and research were identified, as well as expanding emergency nursing using a poststructuralist framework. SQUIRE guidelines were used (see Supporting Information).

Discussion

The emergency department is a critical point of intervention for patients with urgent and life‐threatening needs. However, the biomedical model and historical, social, and institutional expectations that influence emergency nurses' beliefs and values do not effectively respond to the needs of suicidal patients. One step to address this issue is to deconstruct the current understanding of emergency nursing as a treatment for only life‐threatening physical crises in order to become inclusive of psychological crises such as suicide‐related thoughts and behaviours.

Relevance to clinical practice

How a poststructural framework can be used to expand emergency care is discussed. Examples include empowering nurses to challenge the "taken‐for‐granted" emergency nursing and recognizing the health needs that fall outside of the dominant discourse of emergency care.

Willingness to participate in future HIV vaccine trials among men who have sex with men and female sex workers living in Nairobi, Kenya

by Elizabeth Mueni Mutisya, Gaudensia Mutua, Delvin Nyasani, Hannah Nduta, Rhoda W. Kabuti, Vincent Muturi-Kioi, Gloria Omosa-Manyonyi, Andrew Abaasa, Krysia Lindan, Matt A. Price, Joshua Kimani, Aggrey Omu Anzala

Objective

To evaluate factors associated with willingness to participate in future HIV vaccine trials among men who have sex with men and female sex workers living in Nairobi, Kenya.

Background

Working with ‘key populations’, those at elevated risk of HIV acquisition, is important to conduct efficient HIV prevention trials. In Nairobi Kenya, HIV infection is higher in men who have sex with men (MSM) and female sex workers (FSW) than in the general adult population, hence the need to establish if they would be willing to participate in future HIV vaccine trials.

Methods

We administered a structured questionnaire to MSM and FSW enrolled in a simulated vaccine efficacy trial (SiVET). The SiVET was an observational study designed to mimic the rigors of a clinical trial to assess HIV risk characteristics at baseline. After 12–15 months of follow-up, a structured questionnaire was administered to evaluate hypothetical willingness to participate in future HIV vaccine trials.

Results

Of 250 persons (80% MSM by design) enrolled in SiVET, 214 attended the final study visit and 174 (81%) of them expressed hypothetical willingness to participate in future HIV vaccine trials. These were 82% of MSM and 80% of FSW of those who attended the final study visit. Having a very good experience in the SiVET trial predicted willingness to participate in future HIV vaccine trials. Motivating factors for participation included a desire to receive education about HIV (59%) and to receive healthcare (57%).

Conclusions

Our data demonstrate high willingness among key populations in Kenya, to participate in future HIV vaccine trials after completing participation in a SiVET. The findings suggest that these groups might be a reliable target population for consideration in future HIV vaccine trials. Assessment of willingness to participate in these populations provides important information that may help to inform future education and recruitment efforts for vaccine trials. Improving the research experience for members of key populations could impact their willingness to participate in HIV vaccine trials.

Impact of COVID-19 pandemic on surgical neuro-oncology multi-disciplinary team decision making: a national survey (COVID-CNSMDT Study)

Por: Price · S. J. · Joannides · A. · Plaha · P. · Afshari · F. T. · Albanese · E. · Barua · N. U. · Chan · H. W. · Critchley · G. · Flannery · T. · Fountain · D. M. · Mathew · R. K. · Piper · R. J. · Poon · M. T. · Rajaraman · C. · Rominiyi · O. · Smith · S. · Solomou · G. · Solth · A. · Suras
Objectives

Pressures on healthcare systems due to COVID-19 has impacted patients without COVID-19 with surgery disproportionally affected. This study aims to understand the impact on the initial management of patients with brain tumours by measuring changes to normal multidisciplinary team (MDT) decision making.

Design

A prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020.

Setting

Regional neurosurgical units outside London (as the pandemic was more advanced at time of study).

Participants

Representatives from all units were invited to collect data on new patients discussed at their MDT meetings during the study period. Each unit decided if management decision for each patient had changed due to COVID-19.

Primary and secondary outcome measures

Primary outcome measures included number of patients where the decision to undergo surgery changed compared with standard management usually offered by that MDT. Secondary outcome measures included changes in surgical extent, numbers referred to MDT, number of patients denied surgery not receiving any treatment and reasons for any variation across the UK.

Results

18 units (75%) provided information from 80 MDT meetings that discussed 1221 patients. 10.7% of patients had their management changed—the majority (68%) did not undergo surgery and more than half of this group not undergoing surgery had no active treatment. There was marked variation across the UK (0%–28% change in management). Units that did not change management could maintain capacity with dedicated oncology lists. Low volume units were less affected.

Conclusion

COVID-19 has had an impact on patients requiring surgery for malignant brain tumours, with patients receiving different treatments—most commonly not receiving surgery or any treatment at all. The variations show dedicated cancer operating lists may mitigate these pressures.

Study registration

This study was registered with the Royal College of Surgeons of England’s COVID-19 Research Group (https://www.rcseng.ac.uk/coronavirus/rcs-covid-research-group/).

Meniscal Tear Outcome (METRO) review: a protocol for a systematic review summarising the clinical course and patient experiences of meniscal tears in the current literature

Por: Ahmed · I. · Khatri · C. · Parsons · N. · Hutchinson · C. E. · Staniszewska · S. · Price · A. J. · Metcalfe · A.
Introduction

Meniscal tears are a common knee injury with an incidence of 60 per 100 000. Management of meniscal tears can include either non-operative measures or operative procedures such as arthroscopic partial meniscectomy (APM). Despite substantial research evaluating the effectiveness of APM in the recent past, little is known about the clinical course or the experiences of patients with a meniscal tear.

Aim

To summarise the short to long-term patterns of variability in outcome in patients with a meniscal tear.

To summarise the evidence on patient experiences of meniscal tears. In particular, we will focus on patient experiences of treatment options, treatment pathways and their views of the outcomes used in meniscal tear research.

Methods and analysis

Two search strategies will be developed to identify citations from EMBASE, MEDLINE, AMED, CENTRAL, Web of Science and Sociofile. The date of our planned search is 14 August 2020. For the quantitative review we will identify studies reporting patient-reported outcome measures in patients after a meniscal tear. The standardised mean change will be used to assess the variation in size of response and summarise the overall response to each treatment option. All studies will undergo quality assessment using either the Cochrane risk of bias or the Newcastle-Ottawa tool.

A qualitative systematic review will be used to identify studies reporting views and experiences of patients with a meniscal tear. All studies will be assessed using the Critical Appraisal Skills Programme tool and if sufficient data are present a meta-synthesis will be performed to identify first, second and third-order constructs.

Ethics and dissemination

Given the nature of this study, no formal ethical approval will be sought. Results from the review will be disseminated at national conferences and will be submitted to a peer-reviewed journal for publication. Lay summaries will be freely available via the study Twitter page.

PROSPERO registration number

CRD42019122179.

The use of vascularised muscle flaps for treatment or prevention of wound complications following arterial surgery in the groin

Abstract

Wound complications following arterial surgery in the groin are relatively common and can result in significant morbidity and mortality. Vascularised muscle flaps (VMF) may be used as an adjunct to aid healing, either to manage complications or prophylactically. This series describes 46 patients who received sartorius or gracilis muscle flaps, of which 70% were performed as a salvage procedure to treat complications ranging from wound breakdown to vascular graft infection. The remaining 30% were performed at the time of the arterial surgery in patients with risk factors such as re‐do surgery or immunosuppression. The peri‐operative mortality rate was 9% and the major amputation rate was 26%, reflecting the complexity of patients that require intervention. Overall, 85% achieved successful healing in the groin without the need for further treatment following VMF. Only one case of flap necrosis occurred. Wound healing complications occurred more commonly after sartorius muscle flaps. The gracilis muscle offers a bulkier mass and greater mobility and so may be preferable, particularly for larger groin defects. This series has shown that VMF offer a safe and reliable option for selected cases to achieve wound healing in the groin in patients with often significant co‐morbidities.

Who gets referred for knee or hip replacement? A theoretical model of the potential impact of evidence-based referral thresholds using data from a retrospective review of clinic records from an English musculoskeletal referral hub

Por: Dakin · H. A. · Eibich · P. · Gray · A. · Smith · J. · Barker · K. L. · Beard · D. · Price · A. J. · on behalf of the ACHE Study team · Kang · Cook · Fitzpatrick · Murray · Arden · Carr · Smith · Harris · Middleton · Gibbons · Benedetto · Dawson · Sayers · Miller · Marques · Gooberma
Objectives

To estimate the relationship between patient characteristics and referral decisions made by musculoskeletal hubs, and to assess the possible impact of an evidence-based referral tool.

Design

Retrospective analysis of medical records and decision tree model evaluating policy changes using local and national data.

Setting

One musculoskeletal interface clinic (hub) in England.

Participants

922 adults aged ≥50 years referred by general practitioners with symptoms of knee or hip osteoarthritis.

Interventions

We assessed the current frequency and determinants of referrals from one hub and the change in referrals that would occur at this centre and nationally if evidence-based thresholds for referral (Oxford Knee and Hip Scores, OKS/OHS) were introduced.

Main outcome measure

OKS/OHS, referrals for surgical assessment, referrals for arthroplasty, costs and quality-adjusted life years.

Results

Of 110 patients with knee symptoms attending face-to-face hub consultations, 49 (45%) were referred for surgical assessment; the mean OKS for these 49 patients was 18 (range: 1–41). Of 101 hip patients, 36 (36%) were referred for surgical assessment (mean OHS: 21, range: 5–44). No patients referred for surgical assessment were above previously reported economic thresholds for OKS (43) or OHS (45). Setting thresholds of OKS ≤31 and OHS ≤35 might have resulted in an additional 22 knee referrals and 26 hip referrals in our cohort. Extrapolating hub results across England suggests a possible increase in referrals nationally, of around 13 000 additional knee replacements and 4500 additional hip replacements each year.

Conclusions

Musculoskeletal hubs currently consider OKS/OHS and other factors when making decisions about referral to secondary care for joint replacement. Those referred typically have low OHS/OKS, and introducing evidence-based OKS/OHS thresholds would prevent few inappropriate (high-functioning, low-pain) referrals. However, our findings suggest that some patients not currently referred could benefit from arthroplasty based on OKS/OHS. More research is required to explore other important patient characteristics currently influencing hub decisions.

Systemic evaluation and localization of resistin expression in normal human tissues by a newly developed monoclonal antibody

by Qing Lin, Shari A. Price, John T. Skinner, Bin Hu, Chunling Fan, Kazuyo Yamaji-Kegan, Roger A. Johns

Resistin and resistin-like molecules are pleiotropic cytokines that are involved in inflammatory diseases. Our previous work suggested that resistin has the potential to be used as a biomarker and therapeutic target for human pulmonary arterial hypertension. However, data are limited on the distribution of resistin in healthy human organs. In this study, we used our newly developed anti-human resistin (hResistin) antibody to immunohistochemically detect the expression, localization, and intracellular/extracellular compartmentalization of hResistin in a full human tissue panel from healthy individuals. The potential cross reactivity of this monoclonal anti-hResistin IgG1 with normal human tissues also was verified. Results showed that hResistin is broadly distributed and principally localized in the cytoplasmic granules of macrophages scattered in the interstitium of most human tissues. Bone marrow hematopoietic precursor cells also exhibited hResistin signals in their cytoplasmic granules. Additionally, hResistin labeling was observed in the cytoplasm of nervous system cells. Notably, the cytokine activity of hResistin was illustrated by positively stained extracellular material in most human tissues. These data indicate that our generated antibody binds to the secreted hResistin and support its potential use for immunotherapy to reduce circulating hResistin levels in human disease. Our findings comprehensively document the basal expression patterns of hResistin protein in normal human tissues, suggest a critical role of this cytokine in normal and pathophysiologic inflammatory processes, and offer key insights for using our antibody in future pharmacokinetic studies and immunotherapeutic strategies.

Rates of knee arthroplasty in patients with a history of arthroscopic chondroplasty: results from a retrospective cohort study utilising the National Hospital Episode Statistics for England

Por: Abram · S. G. F. · Palmer · A. J. R. · Judge · A. · Beard · D. J. · Price · A. J.
Objective

The purpose of this study was to analyse the rate of knee arthroplasty in the population of patients with a history of arthroscopic chondroplasty of the knee, in England, over 10 years, with comparison to general population data for patients without a history of chondroplasty.

Design

Retrospective cohort study.

Setting

English Hospital Episode Statistics (HES) data.

Participants and interventions

Patients undergoing arthroscopic chondroplasty in England between 2007/2008 and 2016/2017 were identified. Patients undergoing previous arthroscopic knee surgery or simultaneous cruciate ligament reconstruction or microfracture in the same knee were excluded.

Outcomes

Patients subsequently undergoing a knee arthroplasty in the same knee were identified and mortality-adjusted survival analysis was performed (survival without undergoing knee arthroplasty). A Cox proportional hazards model was used to identify factors associated with knee arthroplasty. Relative risk of knee arthroplasty (total or partial) in comparison to the general population was determined.

Results

Through 2007 to 2017, 157 730 eligible chondroplasty patients were identified. Within 1 year, 5.91% (7984/135 197; 95% CI 5.78 to 6.03) underwent knee arthroplasty and 14.22% (8145/57 267; 95% CI 13.94 to 14.51) within 5 years. Patients aged over 30 years with a history of chondroplasty were 17.32 times (risk ratio; 95% CI 16.81 to 17.84) more likely to undergo arthroplasty than the general population without a history of chondroplasty.

Conclusions

Patients with cartilage lesions of the knee, treated with arthroscopic chondroplasty, are at greater risk of subsequent knee arthroplasty than the general population and for a proportion of patients, there is insufficient benefit to prevent the need for knee arthroplasty within 1 to 5 years. These important new data will inform patients of the anticipated outcomes following this procedure. The risk in comparison to non-operative treatment remains unknown and there is an urgent need for a randomised clinical trial in this population.

Frequency and format of clinical trial results dissemination to patients: a survey of authors of trials indexed in PubMed

Por: Schroter · S. · Price · A. · Malicki · M. · Richards · T. · Clarke · M.
Objective

Dissemination of research findings is central to research integrity and promoting discussion of new knowledge and its potential for translation into practice and policy. We investigated the frequency and format of dissemination to trial participants and patient groups.

Design

Survey of authors of clinical trials indexed in PubMed in 2014–2015.

Results

Questionnaire emailed to 19 321 authors; 3127 responses received (16%). Of these 3127 trials, 2690 had human participants and 1818 enrolled individual patients. Among the 1818, 498 authors (27%) reported having disseminated results to participants, 238 (13%) planned to do so, 600 (33%) did not plan to, 176 (10%) were unsure and 306 (17%) indicated ‘other’ or did not answer. Of the 498 authors who had disseminated, 198 (40%) shared academic reports, 252 (51%) shared lay reports, 111 (22%) shared both and 164 (33%) provided individualised study results. Of the 1818 trials, 577 authors (32%) shared/planned to share results with patients outside their trial by direct contact with charities/patient groups, 401 (22%) via patient communities, 845 (46%) via presentations at conferences with patient representation, 494 (27%) via mainstream media and 708 (39%) by online lay summaries. Relatively few of the 1818 authors reported dissemination was suggested by institutional bodies: 314 (17%) of funders reportedly suggested dissemination to trial participants, 252 (14%) to patient groups; 333 (18%) of ethical review boards reportedly suggested dissemination to trial participants, 148 (8%) to patient groups. Authors described many barriers to dissemination.

Conclusion

Fewer than half the respondents had disseminated to participants (or planned to) and only half of those who had disseminated shared lay reports. Motivation to disseminate results to participants appears to arise within research teams rather than being incentivised by institutional bodies. Multiple factors need to be considered and various steps taken to facilitate wide dissemination of research to participants.

Determining responsiveness and meaningful changes for the Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways

Por: Price · A. J. · Ogollah · R. · Kang · S. · Hay · E. · Barker · K. L. · Benedetto · E. · Smith · S. · Smith · J. · Galloway · J. B. · Ellis · B. · Rees · J. · Glyn-Jones · S. · Beard · D. · Fitzpatrick · R. · Hill · J. C.
Objectives

We have previously developed and validated the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways, showing encouraging psychometric test results. The objective of this study was to determine the responsiveness of MSK-HQ following MSK treatments and to determine the minimally important change (MIC).

Setting

We collected data in four cohorts from community physiotherapy and secondary-care orthopaedic hip, knee and shoulder clinics.

Participants

592 individuals were recruited; 210 patients treated with physiotherapy for a range of MSK conditions in primary care; 150 patients undergoing hip replacement, 150 patients undergoing knee replacement and 82 undergoing shoulder surgery in secondary care.

Outcome measures

Preoperative data were collected including the MSK-HQ, European Quality of Life-5D (EQ-5D) and the OHS, OKS or OSS in each joint-specific group. The same scores, together with anchor questions, were collected postintervention at 3 months for the physiotherapy group and 6 months for all others. Following COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines, responsiveness was assessed using correlation between scores and the MIC was calculated for the entire cohort using receiver operating characteristic curve analysis.

Results

The MSK-HQ demonstrated strong correlation (R=0.73) with EQ-5D across the entire cohort and with each of the joint-specific Oxford scores (hip R=0.87, knee R=0.92 and shoulder R=0.77). Moderate correlation was seen between MSK-HQ and EQ-5D across each individual group (R value range 0.60–0.68), apart from the hip group where correlation was strong (R=0.77). The effect size with MSK-HQ was 0.93, in the entire cohort, double that measured with EQ-5D (0.43). In all subgroups, MSK-HQ measured a greater treatment effect compared with EQ-5D. The MIC is 5.5 (95% CI 2.7 to 8.3).

Conclusion

Our study demonstrates that the MSK-HQ questionnaire is responsive to change across a range of musculoskeletal conditions, supporting its use as a generic MSK measurement instrument.

Time from diagnosis to treatment of colorectal cancer in a South Australian clinical registry cohort: how it varies and relates to survival

Por: Roder · D. · Karapetis · C. S. · Olver · I. · Keefe · D. · Padbury · R. · Moore · J. · Joshi · R. · Wattchow · D. · Worthley · D. L. · Miller · C. L. · Holden · C. · Buckley · E. · Powell · K. · Buranyi-Trevarton · D. · Fusco · K. · Price · T.
Objectives

Some early studies indicated lower survival with longer time from diagnosis to cancer treatment, but others showed the reverse. We investigated time to treatment of colorectal cancer and associations with survival.

Setting and participants

Clinical registry data for colorectal cancer cases diagnosed in 2000–2010 at four major public hospitals in South Australia and treated by surgery (n=1675), radiotherapy (n=616) and/or systemic therapy (n=1556).

Design

A historic cohort design, with rank-order tests for ordinal clinical and sociodemographic predictors and multiple logistic regression for comparing time from diagnosis to treatment. Unadjusted Kaplan-Meier estimates and adjusted Cox proportional hazards regression were used to investigate disease-specific survival by time to treatment.

Outcome measures

Time to treatment and survival from diagnosis to death from colorectal cancer.

Results

Treatment (any type) commenced for 87% of surgical cases 60 days of diagnosis, with 80% having surgery within this period. Of those receiving radiotherapy, 59% began this treatment 60 days, and of those receiving systemic therapy, the corresponding proportion was 56%. Adjusted analyses showed treatment delay >60 days was more likely for rectal cancers, 2006–2010 diagnoses, residents of northern than other metropolitan regions and for surgery, younger ages 2 years from diagnosis for time to treatment >30 days. Survival in the 3–10 years postdiagnosis generally did not differ by time to treatment, except for lower survival for any treatment >90 days for surgical cases.

Conclusions

The lower survival 2 years from diagnosis for treatment 30 days of diagnosis is consistent with other studies attributed to preferencing more complicated cases for earlier care. Lower 3–10 years survival for surgical cases first treated >90 days from diagnosis is consistent with previously reported U-shaped relationships.

Cohort profile: the Canadian coordination and activity tracking in children (CATCH) longitudinal cohort

Por: Cairney · J. · Veldhuizen · S. · Rodriguez · M. C. · King-Dowling · S. · Kwan · M. Y. · Wade · T. · Price · D. · Missiuna · C. · Timmons · B.
Purpose

Developmental coordination disorder (DCD) is a prevalent, neurodevelopmental disorder affecting 2% to 5% of children, which is characterised by fine and gross motor problems. Children with DCD have been shown to be less fit and physically active than other children; however, the direction of causality is unknown as previous studies have typically been done in older children when the differences in fitness and physical activity are already present. The aim of the Coordination and Activity Tracking in Children (CATCH) study is to specifically address the issue of precedence by recruiting a large sample of children in early childhood.

Participants

CATCH comprises a community-based sample of parents and children 4 to 5 years of age divided into two groups: at risk for DCD (rDCD; n=287) and typically developing (TD; n=301). Inclusion in the rDCD group required a score at or below the 16th percentile on a standardised test of motor coordination and a score above 70 on a standardised test of intelligence.

Findings to date

Children in the rDCD group contained a higher proportion of males (67% vs 48%, 2=21.9, p2=7.4, p=0.004). According to parent report, rDCD children experienced more problems in self-care, school and leisure activities (p

Future plans

Children are being followed up annually for 3 years. At each follow-up, motor coordination testing is repeated, and data are collected on physical activity, fitness and social-emotional problems.

Understanding reliever overuse in patients purchasing over-the-counter short-acting beta2 agonists: an Australian community pharmacy-based survey

Por: Azzi · E. A. · Kritikos · V. · Peters · M. J. · Price · D. B. · Srour · P. · Cvetkovski · B. · Bosnic-Anticevich · S.
Objectives

Overuse of asthma relievers is associated with significant adverse consequences. This study aimed to better understand the population purchasing and using short-acting beta agonists (SABA) over the counter (OTC); and compare the demographic, clinical and behavioural characteristics of those who overuse SABA with those who do not.

Design and setting

Real-world cross-sectional observational study in community pharmacy.

Participants

Of 412 participants ≥16 years requesting SABA OTC, 289 were SABA overusers (used SABA more than twice per week in the past 4 weeks).

Main outcome measure

Reliever use, Global Initiative for Asthma-defined control, healthcare utilisation, patterns of preventer use.

Results

70.1% of participants were classified as SABA overusers, that is, reporting SABA use more than twice a week within the last 4 weeks, 73.6% reported not using a preventer daily and only 81.6% reported a doctor diagnosis of asthma. SABA overusers were more likely to have moderate-severe nasal symptoms (80.8% vs 63.0%, p

Conclusions

This study uncovers a hidden population of people who can only be identified in pharmacy with suboptimal asthma, coexisting rhinitis, poor preventer adherence and, in some cases, no asthma diagnosis.

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