Órlaith Burke

Single- or Two-stage Revision for Infected Total Hip Arthroplasty? A Systematic Review of the Literature

BackgroundThe best approach for surgical treatment of an infected THA remains controversial. Two-stage revision is believed to result in lower reinfection rates but may result in significant functional impairment. Some authors now suggest that single-stage revision may provide comparable results in terms of infection eradication while providing superior functional outcomes.Questions/purposesWe performed a systematic review to determine whether single- or two-stage revision for an infected THA provides lower reinfection rates and higher functional outcome scores.MethodsWe conducted a comprehensive search of PubMed and Embase, using the search string [Infection AND (“total hip replacement” OR “total hip arthroplasty”) AND revision]. All studies comparing reinfection rates or functional scores for single- and two-stage revision were retrieved and reviewed. A systematic review was performed according to the PRISMA checklist.ResultsThe initial search retrieved 1128 studies. Following strict exclusion criteria, we identified nine comparative studies comparing reinfection rates (all nine studies) or functional scores (four studies) between single- and two-stage revisions. The overall quality of studies was poor with no randomized studies being identified. Groups often varied in their baseline characteristics. There was no consensus among the studies regarding the relative incidence of reinfection between the two procedures. There was a trend toward better functional outcomes in single-stage surgery, but this reached significance in only one study.ConclusionsIn appropriate patients, single-stage revision appears to be associated with similar reinfection rates when compared with two-stage revision with superior functional outcomes. This concurs with earlier studies, but given the methodologic quality of the included studies, these findings should be treated with caution. High-quality randomized studies are needed to compare the two approaches to confirm these findings, and, if appropriate, to determine which patients are appropriate for single-stage revision.

Development of a core outcome set for disease modification trials in mild to moderate dementia: a systematic review, patient and public consultation and consensus recommendations.

BACKGROUND There is currently no disease-modifying treatment available to halt or delay the progression of the disease pathology in dementia. An agreed core set of the best-available and most appropriate outcomes for disease modification would facilitate the design of trials and ensure consistency across disease modification trials, as well as making results comparable and meta-analysable in future trials. OBJECTIVES To agree a set of core outcomes for disease modification trials for mild to moderate dementia with the UK dementia research community and patient and public involvement (PPI). DATA SOURCES We included disease modification trials with quantitative outcomes of efficacy from (1) references from related systematic reviews in workstream 1; (2) searches of the Cochrane Dementia and Cognitive Improvement Group study register, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Latin American and Caribbean Health Sciences Literature and PsycINFO on 11 December 2015, and clinical trial registries [International Standard Randomised Controlled Trial Number (ISRCTN) and clinicaltrials.gov] on 22 and 29 January 2016; and (3) hand-searches of reference lists of relevant systematic reviews from database searches. REVIEW METHODS The project consisted of four workstreams. (1) We obtained related core outcome sets and work from co-applicants. (2) We systematically reviewed published and ongoing disease modification trials to identify the outcomes used in different domains. We extracted outcomes used in each trial, recording how many used each outcome and with how many participants. We divided outcomes into the domains measured and searched for validation data. (3) We consulted with PPI participants about recommended outcomes. (4) We presented all the synthesised information at a conference attended by the wider body of National Institute for Health Research (NIHR) dementia researchers to reach consensus on a core set of outcomes. RESULTS We included 149 papers from the 22,918 papers screened, referring to 125 individual trials. Eighty-one outcomes were used across trials, including 72 scales [31 cognitive, 12 activities of daily living (ADLs), 10 global, 16 neuropsychiatric and three quality of life] and nine biological techniques. We consulted with 18 people for PPI. The conference decided that only cognition and biological markers are core measures of disease modification. Cognition should be measured by the Mini Mental State Examination (MMSE) or the Alzheimers Disease Assessment Scale - Cognitive subscale (ADAS-Cog), and brain changes through structural magnetic resonance imaging (MRI) in a subset of participants. All other domains are important but not core. We recommend using the Neuropsychiatric Inventory for neuropsychiatric symptoms: the Disability Assessment for Dementia for ADLs, the Dementia Quality of Life Measure for quality of life and the Clinical Dementia Rating scale to measure dementia globally. LIMITATIONS Most of the trials included participants with Alzheimers disease, so recommendations may not apply to other types of dementia. We did not conduct economic analyses. The PPI consultation was limited to members of the Alzheimers Society Research Network. CONCLUSIONS Cognitive outcomes and biological markers form the core outcome set for future disease modification trials, measured by the MMSE or ADAS-Cog, and structural MRI in a subset of participants. FUTURE WORK We envisage that the core set may be superseded in the future, particularly for other types of dementia. There is a need to develop an algorithm to compare scores on the MMSE and ADAS-Cog. STUDY REGISTRATION The project was registered with Core Outcome Measures in Effectiveness Trials [ www.comet-initiative.org/studies/details/819?result=true (accessed 7 April 2016)]. The systematic review protocol is registered as PROSPERO CRD42015027346. FUNDING The National Institute for Health Research Health Technology Assessment programme.

Extending the scope of pooled analyses of individual patient biomarker data from heterogeneous laboratory platforms and cohorts using merging algorithms

BACKGROUND A common challenge in medicine, exemplified in the analysis of biomarker data, is that large studies are needed for sufficient statistical power. Often, this may only be achievable by aggregating multiple cohorts. However, different studies may use disparate platforms for laboratory analysis, which can hinder merging. METHODS Using circulating placental growth factor (PlGF), a potential biomarker for hypertensive disorders of pregnancy (HDP) such as preeclampsia, as an example, we investigated how such issues can be overcome by inter-platform standardization and merging algorithms. We studied 16,462 pregnancies from 22 study cohorts. PlGF measurements (gestational age ⩾20 weeks) analyzed on one of four platforms: R&D Systems, AlereTriage, RocheElecsys or AbbottArchitect, were available for 13,429 women. Two merging algorithms, using Z-Score and Multiple of Median transformations, were applied. RESULTS Best reference curves (BRC), based on merged, transformed PlGF measurements in uncomplicated pregnancy across six gestational age groups, were estimated. Identification of HDP by these PlGF-BRCs was compared to that of platform-specific curves. CONCLUSIONS We demonstrate the feasibility of merging PlGF concentrations from different analytical platforms. Overall BRC identification of HDP performed at least as well as platform-specific curves. Our method can be extended to any set of biomarkers obtained from different laboratory platforms in any field. Merged biomarker data from multiple studies will improve statistical power and enlarge our understanding of the pathophysiology and management of medical syndromes.

The use of volunteer radon measurements for radon mapping purposes: an examination of sampling bias issues

National and regional radon surveys are used in many nations to produce maps detailing the spatial variation of indoor radon concentrations. National surveys which are designed to be representative use either a geographically-weighted or a population-weighted sampling scheme. Additionally, many countries collect a large number of data on indoor radon concentrations from volunteers who have chosen to have the indoor radon concentration measured in their own dwellings. This work examines the representativeness of volunteer-based samples in radon measurement and explores the effect of potential volunteer bias on radon mapping results. We also investigate the influence that media attention has on volunteer sampling of indoor radon concentrations. The result of our work indicates that volunteer measurements are biased due to over-sampling of high radon areas. Consequently such volunteer radon measurements should not be used for radon mapping purposes.

The influence of salt on handheld electrical moisture meters: can they be used to detect salt problems in porous stone?

ABSTRACT Salt contamination in heritage stone affects handheld moisture meter measurements on-site. This poses a problem when the readings indicate erroneously higher levels of moisture than actually present. For decision making with regards to moisture prevention treatment it is therefore crucial to distinguish between actual dampness and the hygroscopic action of salts. This study investigated the effect on moisture meter readings of both increased conductivity of pore water and the increased water retention caused by the presence of sodium chloride (NaCl) in artificially contaminated Portland limestone samples. The influence of NaCl contamination on selected handheld moisture meters was quantified. As a result, this article proposes that under certain circumstances moisture meters could be used to diagnose, reliably, both moisture and salt problems in heritage stone.

Catastrophic Limestone Decay at the Central Sanctuary of Iupiter Dolichenus at Dülük Baba Tepesi in Southern Turkey: Causes and Implications for Future Conservation

Dramatic deterioration of Hellenistic-Roman limestone remains recently excavated at Dülük Baba Tepesi (Southern Turkey) has been observed following the cold, wet winter of 2011/2012. A conceptual model is presented to explain the dramatic deterioration in which case hardening develops and initially strengthens the stone against deterioration, but then makes it more prone to exfoliation and blistering. Data collected using non-destructive techniques (Equotip surface hardness tester and Karsten tube for water uptake) on Fırat and Gaziantep formation limestone time series excavated in 2005, 2007, and 2013 demonstrates the progress of case hardening and deterioration after excavation. In combination with meteorological data from Gaziantep weather station the results are used to test and revise the model taking into account non-linear and threshold effects. Future excavation and conservation efforts should take into account the often-complex interactions between post-excavation case hardening and extreme winter conditions which can cause catastrophic deterioration.

Proceedings of Patient Reported Outcome Measure’s (PROMs) Conference Oxford 2017: Advances in Patient Reported Outcomes Research

Table of contentsS1 Using computerized adaptive testingTim CroudaceS2 Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policyJohn BrazierO1 “Am I going to get better?”—Using PROMs to inform patients about the likely benefit of surgeryNils Gutacker, Andrew StreetO2 Identifying Patient Reported Outcome Measures for an electronic Personal Health RecordDan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til WykesO3 Examining the change process over time qualitatively: transformative learning and response shiftNasrin Nasr, Pamela EnderbyO4 Developing a PROM to evaluate self-management in diabetes (HASMID): giving patients a voiceJill Carlton, Donna Rowen, Jackie Elliott, John Brazier, Katherine Stevens, Hasan Basarir, Alex LabeitO5 Development of the Primary Care Outcomes Questionnaire (PCOQ)Mairead Murphy, Sandra Hollinghurst, Chris SalisburyO6 Developing the PKEX score- a multimodal assessment tool for patients with shoulder problemsDominic Marley, James Wilson, Amy Barrat, Bibhas RoyO7 Applying multiple imputation to multi-item patient reported outcome measures: advantages and disadvantages of imputing at the item, sub-scale or score levelInes Rombach, Órlaith Burke, Crispin Jenkinson, Alastair Gray, Oliver Rivero-AriasO8 Integrating Patient Reported Outcome Measures (PROMs) into routine primary care for patients with multimorbidity: a feasibility studyIan Porter, Jaheeda Gangannagaripalli, Charlotte Bramwell, Jose M. ValderasO9 eRAPID: electronic self-report and management of adverse-events for pelvic radiotherapy (RT) patientsPatricia Holch, Susan Davidson, Jacki Routledge, Ann Henry, Kevin Franks, Alex Gilbert, Kate Absolom & Galina VelikovaO10 Patient reported outcomes (PROMs) based recommendation in clinical guidance for the management of chronic conditions in the United KingdomIan Porter, Jose M.ValderasO11 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 LifeJan R. BoehnkeO12 Patient-reported outcomes within health technology decision making: current status and implications for future policyAndrew Trigg, Ruth HowellsO13 Can social care needs and well-being be explained by the EQ-5D? Analysis of Health Survey for England datasetJeshika Singh, Subhash Pokhrel, Louise LongworthO14 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

Maternal circulating PlGF concentrations and placenta-related pregnancy complications: First results from the CoLab AngF Study

INTRODUCTION Circulating angiogenic factors are potential markers for preeclampsia, but heterogeneous studies have failed to identify precise predictive/diagnostic properties. The Global CoLaboratory is investigating how to merge published data of angiogenic factors for meta-analysis on an individual sample basis. OBJECTIVE To amalgamate pregnancy angiogenic factor studies, investigate diagnostic and predictive properties of these markers in preeclampsia and placenta-related pregnancy complications, and to test if measures from disparate platforms can be standardised. This is the first report using PlGF measures to diagnose preeclampsia. METHODS Data were derived from 15 cohorts, within and outside the CoLaboratory network. Women were classified as either case (confirmed diagnosis of preeclampsia at sampling) or non-case (no preeclampsia at sampling). Individual PlGF measurements from four different analytical platforms were used, along with transformations of the data (e.g. log-transformations, transformations to a baseline platform). Transformed measurements were standardised both for specific platforms and globally, stratifying on gestational age. Different statistical techniques were compared. RESULTS The database currently contains 1442 cases and 11,512 non-cases, which were used to define an algorithm to merge PlGF measurements from different platforms. Non-case distributions were used to standardise case results. Diagnostic PlGF measurements in relation to preeclampsia will be presented and confirm feasibility. CONCLUSIONS Future studies can extend this approach to other angiogenic factors, prediction as well as diagnosis and to other placenta-related disorders.