Academic Clinical Fellowship Research Articles

Contribution of ethnicity, area level deprivation and air pollution to paediatric intensive care unit admissions in the United Kingdom 2008–2021

There is emerging evidence on the impact of social and environmental determinants of health on paediatric intensive care unit (PICU) admissions and outcomes. We analysed UK paediatric intensive care data to explore disparities in the incidence of admission according to a child's ethnicity and the degree of deprivation and pollution in the child's residential area. Data were extracted on children <16 years admitted to UK PICUs between 1st January 2008 and 31st December 2021 from the Paediatric Intensive Care Audit Network (PICANet) database. Ethnicity was categorised as White, Asian, Black, Mixed or Other. Deprivation was quantified using the 'children in low-income families' measure and outdoor air pollution was characterised using mean annual PM2.5 level at local authority level, both divided into population-weighted quintiles. UK population estimates were used to calculate crude incidence of PICU admission. Incidence rate ratios were calculated using Poisson regression models. There were 245,099 admissions, of which 60.7% were unplanned. After adjusting for age and sex, Asian and Black children had higher relative incidence of unplanned PICU admission compared to White (IRR 1.29 [95% CI: 1.25-1.33] and 1.50 [95% CI: 1.44-1.56] respectively), but there was no evidence of increased incidence of planned admission. Children living in the most deprived quintile had 1.50 times the incidence of admission in the least deprived quintile (95% CI: 1.46-1.54). There were higher crude admission levels of children living in the most polluted quintile compared to the least (157.8 vs 113.6 admissions per 100,000 child years), but after adjustment for ethnicity, deprivation, age and sex there was no association between pollution and PICU admission (IRR 1.00 [95% CI: 1.00-1.00] per 1μg/m3 increase). Ethnicity and deprivation impact the incidence of PICU admission. When restricting to unplanned respiratory admissions and ventilated patients only, increasing pollution level was associated with increased incidence of PICU admission. It is essential to act to reduce these observed disparities, further work is needed to understand mechanisms behind these findings and how they relate to outcomes. There was no direct funding for this project. HM was funded by an NIHR Academic Clinical Fellowship (ACF-2022-18-017).

P045 Google Internet Searches Related to Inflammatory Arthritis: an Observational Study Using Google Trends Data

Abstract Background/Aims Inflammatory arthritis (IA) care involves a paradox. Rheumatologists focus on reducing disease activity through treat-to-target (T2T). But surveys/qualitative studies show patients’ main concern is pain. As these studies include a minority of patients, their findings may not be generalisable. The internet has transformed how patients access health information. Examining search engine data provides an alternative method to understand the health areas of most importance to people with IA. We examined publicly available Google search engine data, to determine the relative popularity of searches for different aspects of health made in conjunction with IA. Methods We used Google Trends data from 2011-2022 to determine the relative popularity of searches for “patient symptom” (pain; work; stiffness; fatigue; mood) and “T2T” (DMARDs; inflammation; synovitis; corticosteroids) domains made with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) in the UK/USA. Google Trends normalises a sample of search data by popularity over time and region, presenting it on a 0-100 scale at each time-point (100 represents the time-point with most searches). It allows comparisons of up to five search term combinations. We evaluated &amp;gt;100 search term combinations to ascertain the most popular “patient symptom” and “T2T” domains (comparing mean normalised scores across time-points). Results Patient Symptom Domains: in all IA forms in the UK/USA, pain was the most popular term. Its popularity increased over time. UK searches for pain gave mean scores of 58, 34, and 39 with RA, PsA, and AS. UK searches for other patient symptom domains gave mean scores ranging 2-7 with RA; no scores were generated with PsA/AS. In the USA, pain gave mean scores of 79, 51, and 63 with RA, PsA, and AS, compared to scores ranging 2-6 for other domains. T2T Domains: methotrexate was the most popular search term with RA and PsA in the UK (mean 28 and 21) and USA (mean 63 and 33); it was only slightly more popular than searches for synovitis and inflammation. For AS, in the UK and USA inflammation was most popular (mean 9 and 34). Most Popular Patient Symptom vs Most Popular T2T Domain: for RA, PsA, and AS, pain was substantially more popular in the UK (mean 58, 30, 52) and USA (mean 79, 54, 63) than methotrexate in RA and PsA in the UK (mean 16 and 14) and USA (mean 15 and 11) and inflammation in AS in the UK (mean 6) and USA (mean 8). Conclusion Pain is the most popular search term used with IA in Google searches in the UK/USA, supporting surveys/qualitative studies showing pain is the health aspect of most importance to people with IA. Routine pain assessments should be embedded within T2T strategies to ensure patient perspectives are considered. Disclosure M. Akthar: Grants/research support; ‘M.A. previously received funding by the National Institute for Health and Care Research (NIHR Academic Clinical Fellowship in Rheumatology)., The views expressed are those of the author and not necessarily those of the NIHR, NHS or the Department of Health and Social Care.’. K.J. Mason: Grants/research support; ‘K.J.M. is funded by the National Institute for Health and Care Research (NIHR; Grant Reference Number NIHR203281)., The views expressed are those of the author and not necessarily those of the NIHR, NHS, or the Department of Health and Social Care.’. I.C. Scott: Grants/research support; ‘I.C.S. is funded by the National Institute for Health and Care Research (NIHR Advanced Research Fellowship, NIHR300826)., The views expressed are those of the author and not necessarily those of the NIHR, NHS, or the Department of Health and Social Care.’

Adoption of routine surgical video recording: a nationwide freedom of information act request across England and Wales

Surgical video contains data with significant potential to improve surgical outcome assessment, quality assurance, education, and research. Current utilisation of surgical video recording is unknown and related policies/governance structures are unclear. A nationwide Freedom of Information (FOI) request concerning surgical video recording, technology, consent, access, and governance was sent to all acute National Health Service (NHS) trusts/boards in England/Wales between 20th February and 20th March2023. 140/144 (97.2%) trusts/boards in England/Wales responded to the FOI request. Surgical procedures were routinely recorded in 22 trusts/boards. The median estimate of consultant surgeons routinely recording their procedures was 20%. Surgical video was stored on internal systems (n=27), third-party products (n=29), and both (n=9). 32/140 (22.9%) trusts/boards ask for consent to record procedures as part of routine care. Consent for recording included non-clinical purposes in 55/140 (39.3%) trusts/boards. Policies for surgeon/patient access to surgical video were available in 48/140 (34.3%) and 32/140 (22.9%) trusts/boards, respectively. Surgical video was used for non-clinical purposes in 64/140 (45.7%) trusts/boards. Governance policies covering surgical video recording, use, and/or storage were available from 59/140 (42.1%) trusts/boards. There is significant heterogeneity in surgical video recording practices in England and Wales. A minority of trusts/boards routinely record surgical procedures, with large variation in recording/storage practices indicating scope for NHS-wide coordination. Revision of surgical video consent, accessibility, and governance policies should be prioritised by trusts/boards to protect key stakeholders. Increased availability of surgical video is essential for patients and surgeons to maximally benefit from the ongoing digital transformation of surgery. KL is supported by an NIHR Academic Clinical Fellowship and acknowledges infrastructure support for this research from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC).

Brain MRI changes in degenerative cervical myelopathy: a systematic review

Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction globally. Associated neurological symptoms and signs have historically been explained by pathobiology within the cervical spine. However, recent advances in imaging have shed light on numerous brain changes in patients with DCM, and it is hypothesised that these changes contribute to DCM pathogenesis. The aetiology, significance, and distribution of these supraspinal changes is currently unknown. The objective was therefore to synthesise all current evidence on brain changes in DCM. A systematic review was performed. Cross-sectional and longitudinal studies with magnetic resonance imaging on a cohort of patients with DCM were eligible. PRISMA guidelines were followed. MEDLINE and Embase were searched to 28th August 2023. Duplicate title/abstract screening, data extraction and risk of bias assessments were conducted. A qualitative synthesis of the literature is presented as per the Synthesis Without Meta-Analysis (SWiM) reporting guideline. The review was registered with PROSPERO (ID: CRD42022298538). Of the 2014 studies that were screened, 47 studies were identified that used MRI to investigate brain changes in DCM. In total, 1500 patients with DCM were included in the synthesis, with a mean age of 53 years. Brain alterations on MRI were associated with DCM both before and after surgery, particularly within the sensorimotor network, visual network, default mode network, thalamus and cerebellum. Associations were commonly reported between brain MRI alterations and clinical measures, particularly the Japanese orthopaedic association (JOA) score. Risk of bias of included studies was low to moderate. The rapidly expanding literature provides mounting evidence for brain changes in DCM. We have identified key structures and pathways that are altered, although there remains uncertainty regarding the directionality and clinical significance of these changes. Future studies with greater sample sizes, more detailed phenotyping and longer follow-up are now needed. ODM is supported by an Academic Clinical Fellowship at the University of Cambridge. BMD is supported by an NIHR Clinical Doctoral Fellowship at the University of Cambridge (NIHR300696). VFJN is supported by an NIHR Rosetrees Trust Advanced Fellowship (NIHR302544). This project was supported by an award from the Rosetrees Foundation with the Storygate Trust (A2844).

Experience of an NIHR Clinical Lectureship (medical/dental) and the determining factors for a clinical academic career post lectureship: a mixed-method evaluation

ObjectivesThe objective of this study is to investigate early-to-late postdoctoral clinical academic progression and the experiences of NIHR Clinical Lectureship (CL) fellows, considering enablers and barriers to success, and identifying...

How common is natural conception in women who have had a livebirth via assisted reproductive technology? Systematic review and meta-analysis

Abstract STUDY QUESTION What is the proportion of women who experience natural conception after a livebirth via assisted reproductive technology (ART)? SUMMARY ANSWER Current evidence suggests that natural conception pregnancy may occur in at least one in five women after having a baby via IVF or ICSI. WHAT IS KNOWN ALREADY It is widely known that some women having babies via ART go on to conceive naturally. This reproductive history is of media interest and often described as ‘miracle’ pregnancies. STUDY DESIGN, SIZE, DURATION A systematic review with meta-analysis was carried out. Ovid Medline, Embase, and PsycINFO were searched until 24 September 2021 for English language, human studies from 1980. Search terms were used for the concepts of natural conception pregnancy, assisted reproduction, and livebirth. PARTICIPANTS/MATERIALS, SETTING, METHODS The inclusion criterion was studies with an outcome measure of the proportion of women experiencing natural conception pregnancy after an ART livebirth. Quality of studies was assessed using the Critical Appraisal Skills Programme cohort study checklist or AXIS Appraisal tool for cross-sectional studies, and a risk of bias assessment was carried out. No studies were excluded based on quality. Random-effects meta-analyses were adopted to produce a pooled effect estimate of the proportion of natural conception pregnancy after ART livebirth. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1108 distinct studies were identified, resulting in 54 studies after screening by title and abstract. Eleven studies including 5180 women were selected for this review. The included studies were mostly of moderate quality with a maximum follow-up period ranging from 2 to 15 years. Four studies reported natural conception livebirths which were used as known underestimates of natural conception pregnancies. The pooled estimate for the proportion of women having natural conception pregnancies after ART livebirth was 0.20 (95% CI, 0.17–0.22). LIMITATIONS, REASONS FOR CAUTION The studies varied widely according to methodology, population, cause of subfertility, type and outcome of fertility treatment, and length of follow-up, leading to potential bias relating to confounding, selection bias, and missing data. WIDER IMPLICATIONS OF THE FINDINGS Current evidence suggests that contrary to widely held views, natural conception pregnancy after ART livebirth is far from rare. National, data-linked studies are needed to provide more accurate estimates of this incidence and analysis of associated factors and trends over time to facilitate tailored counselling of couples considering further ART. STUDY FUNDING/COMPETING INTEREST(S) This work was conducted as part of an academic clinical fellowship awarded to AT by the National Institute for Health Research (NIHR). NIHR has had no input into the study design, data collection, and analysis, nor the writing of this study. No authors have any conflicts of interest. REGISTRATION NUMBER PROSPERO (CRD42022322627).

ChatGPT: the future of discharge summaries?

ChatGPT: the future of discharge summaries?

Sleep EEG in young people with 22q11.2 deletion syndrome: A cross-sectional study of slow-waves, spindles and correlations with memory and neurodevelopmental symptoms.

Young people living with 22q11.2 Deletion Syndrome (22q11.2DS) are at increased risk of schizophrenia, intellectual disability, attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). In common with these conditions, 22q11.2DS is also associated with sleep problems. We investigated whether abnormal sleep or sleep-dependent network activity in 22q11.2DS reflects convergent, early signatures of neural circuit disruption also evident in associated neurodevelopmental conditions. In a cross-sectional design, we recorded high-density sleep EEG in young people (6-20 years) with 22q11.2DS (n=28) and their unaffected siblings (n=17), quantifying associations between sleep architecture, EEG oscillations (spindles and slow waves) and psychiatric symptoms. We also measured performance on a memory task before and after sleep. 22q11.2DS was associated with significant alterations in sleep architecture, including a greater proportion of N3 sleep and lower proportions of N1 and REM sleep than in siblings. During sleep, deletion carriers showed broadband increases in EEG power with increased slow-wave and spindle amplitudes, increased spindle frequency and density, and stronger coupling between spindles and slow-waves. Spindle and slow-wave amplitudes correlated positively with overnight memory in controls, but negatively in 22q11.2DS. Mediation analyses indicated that genotype effects on anxiety, ADHD and ASD were partially mediated by sleep EEG measures. This study provides a detailed description of sleep neurophysiology in 22q11.2DS, highlighting alterations in EEG signatures of sleep which have been previously linked to neurodevelopment, some of which were associated with psychiatric symptoms. Sleep EEG features may therefore reflect delayed or compromised neurodevelopmental processes in 22q11.2DS, which could inform our understanding of the neurobiology of this condition and be biomarkers for neuropsychiatric disorders. This research was funded by a Lilly Innovation Fellowship Award (UB), the National Institute of Mental Health (NIMH 5UO1MH101724; MvdB), a Wellcome Trust Institutional Strategic Support Fund (ISSF) award (MvdB), the Waterloo Foundation (918-1234; MvdB), the Baily Thomas Charitable Fund (2315/1; MvdB), MRC grant Intellectual Disability and Mental Health: Assessing Genomic Impact on Neurodevelopment (IMAGINE) (MR/L011166/1; JH, MvdB and MO), MRC grant Intellectual Disability and Mental Health: Assessing Genomic Impact on Neurodevelopment 2 (IMAGINE-2) (MR/T033045/1; MvdB, JH and MO); Wellcome Trust Strategic Award 'Defining Endophenotypes From Integrated Neurosciences' Wellcome Trust (100202/Z/12/Z MO, JH). NAD was supported by a National Institute for Health Research Academic Clinical Fellowship in Mental Health and MWJ by a Wellcome Trust Senior Research Fellowship in Basic Biomedical Science (202810/Z/16/Z). CE and HAM were supported by Medical Research Council Doctoral Training Grants (C.B.E. 1644194, H.A.M MR/K501347/1). HMM and UB were employed by Eli Lilly & Co during the study; HMM is currently an employee of Boehringer Ingelheim Pharma GmbH & Co KG. The views and opinions expressed are those of the author(s), and not necessarily those of the NHS, the NIHR or the Department of Health funders.

MP55-18 A NATIONAL COHORT STUDY OF CANCER OUTCOMES FOLLOWING HIGH-INTENSITY FOCUSED ULTRASOUND TREATMENT OF CLINICALLY LOCALISED PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP55-18 A NATIONAL COHORT STUDY OF CANCER OUTCOMES FOLLOWING HIGH-INTENSITY FOCUSED ULTRASOUND TREATMENT OF CLINICALLY LOCALISED PROSTATE CANCER Matthew Parry, Arunan Sujenthiran, Julie Nossiter, Melanie Morris, Brendan Berry, Ajay Aggarwal, Heather Payne, Jan van der Meulen, and Noel Clarke Matthew ParryMatthew Parry More articles by this author , Arunan SujenthiranArunan Sujenthiran More articles by this author , Julie NossiterJulie Nossiter More articles by this author , Melanie MorrisMelanie Morris More articles by this author , Brendan BerryBrendan Berry More articles by this author , Ajay AggarwalAjay Aggarwal More articles by this author , Heather PayneHeather Payne More articles by this author , Jan van der MeulenJan van der Meulen More articles by this author , and Noel ClarkeNoel Clarke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002634.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal high-intensity focused ultrasound (HIFU) has fewer treatment-related side effects compared to radical whole-gland therapy (i.e surgery and radiotherapy) but there are limited data on 5-year cancer control. We therefore aimed to report on 5-year prostate cancer control following HIFU. METHODS: This observational cohort study used linked national cancer registry data, radiotherapy data, administrative hospital data and mortality records of 1,381 men treated with HIFU for clinically localised prostate cancer in England. The primary outcome, failure-free survival (FFS), was defined as freedom from local salvage treatment and cancer-specific mortality. Secondary outcomes were freedom from repeat HIFU, freedom from skeletal-related events (SREs), prostate cancer-specific survival (CSS) and overall survival (OS). Cox regression was used to determine whether baseline characteristics, including age, treatment year, T-stage and cancer grade (in groups ranging from 1 [least aggressive] to 5 [most aggressive]) were associated with with FFS. RESULTS: The median follow-up was 37 months (IQR 20-62). The median age was 65 years (IQR 59-70) and 81% had a International Society of Urological Pathology (ISUP) grade group of 1 or 2. FFS was 96.5% (95% CI 95.4-97.4%) at 1 year, 86.0% (95% CI 83.7-87.9%) at 3 years and 77.5% (95% CI 74.4-80.3%) at 5 years. 5-year FFS for ISUP grade groups 1-5 were 82.9%, 76.6%, 72.2%, 52.3% and 30.8%, respectively (P <0.001). Freedom from repeat HIFU at 5 years was 79.1% (95% CI 75.7-82.1%). 172 (12.5%), 13 (0.9%) and three (0.2%) men required one, two and three repeat HIFU treatments during follow-up, respectively. Nine men experienced a SRE and there were 44 deaths, 13 of which were related to prostate cancer. CSS was 98.8% (95% CI 98-99%) and OS was 95.9% (95% CI 94.2-97.1%) at 5 years. CONCLUSIONS: These results suggest that about four in five men are free from local salvage treatment and cancer-specific mortality at 5 years. Treatment failure varied significantly according to ISUP grade group indicating patient selection remains key and patients should be appropriately informed with respect to salvage radical treatment. Source of Funding: M.G.P. was supported by the National Institute of Health Research (DRF-2018-11-ST2-036). T.E.C. was supported by the Medical Research Council (MR/S020470/1). B.B. was partly supported by the NHS National Institute for Health Research through an Academic Clinical Fellowship. H.P. was supported by the University College London Hospitals/University College London Comprehensive Biomedical Research Centre. J.v.d.M. was partly supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust. The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e945 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Parry More articles by this author Arunan Sujenthiran More articles by this author Julie Nossiter More articles by this author Melanie Morris More articles by this author Brendan Berry More articles by this author Ajay Aggarwal More articles by this author Heather Payne More articles by this author Jan van der Meulen More articles by this author Noel Clarke More articles by this author Expand All Advertisement PDF DownloadLoading ...

P215 In a treatment-naïve, early rheumatoid arthritis cohort, baseline ultrasound power Doppler synovitis and tenosynovitis are highly associated with remission when treated with first line etanercept + methotrexate (MTX) but not MTX alone

Abstract Background/Aims Clinical remission is the treatment target in rheumatoid arthritis (RA). In a treatment-naïve, early RA trial (VEDERA: ‘Very early Etanercept and Methotrexate versus Methotrexate with/without Delayed Etanercept in RA’), we previously reported the presence of ultrasound power Doppler synovitis (PDUS) at diagnosis that improved in the majority with treatment. For this study, we aimed to investigate specifically for an association of baseline PDUS and PD tenosynovitis (PDTS) with subsequent clinical remission (DAS28ESR ≤ 2.6) in VEDERA, also comparing the two treatment groups. Methods The ‘VEDERA’ trial randomised 120 treatment-naïve, new-onset RA patients to either first-line etanercept+methotrexate (ETN+MTX) or methotrexate treat-to-target (MTX-TT) regime with escalation to ETN+MTX if not in DAS28ESR remission at week 24. Clinically symptomatic and dominant hand (MCP 1-5, wrist, flexor tendons 1-5 and extensor carpii ulnaris tendon) ultrasound assessments were completed at baseline, weeks 12, 24 and 48. PDUS and PDTS were assessed semi-quantitatively and converted to dichotomous (absent = total score 0, present = total score ≥ 1) for this logistic regression analysis. Results At baseline, 68% (81/120) demonstrated PDUS and 68% also demonstrated PDTS overall. In the MTX-TT group, 63% (38/60) had PDUS and 62% (37/60) had PDTS at baseline. In ETN+MTX group, 72% (43/60) had PDUS and 75% (45/60) had PDTS at baseline. As per randomised trial, there were no differences in baseline demographics, DAS28ESR and HAQ between the groups. Overall, baseline PDUS was associated with week 24 remission and baseline PDTS was associated with week 24 and 48 remission (table 1). Baseline PDUS was particularly associated with week 24 remission in the ETN+MTX group, with a high OR (95% CI) of 6.83(1.2 - 38.91) compared to the MTX-TT group [1.75(0.5 - 6.14)]. Baseline PDTS was also associated with a high OR for week 48 remission in the ETN+MTX group (OR [95% CI] 9.13[1.77 - 47.02]) in contrast to an absence of association in the MTX-TT group. Conclusion Baseline PDUS and PDTS are associated with remission in early RA patients treated with TNF-inhibitor treatment. These measures may be useful to stratify patients early for TNF bDMARD to attain the target of clinical remission in RA. Disclosure R. Shukla: None. R. Hum: Other; R.H holds an Academic Clinical Fellowship funded by the National Institute for Health Research (NIHR) through the Integrated Academic Training (IAT) Programme. P. Ho: None. R.J. Wakefield: None. P. Emery: None. M.H. Buch: None.

Comparison of Vaccine Effectiveness Against the Omicron (B.1.1.529) Variant in Hemodialysis Patients

Comparison of Vaccine Effectiveness Against the Omicron (B.1.1.529) Variant in Hemodialysis Patients

Health-care provision for displaced populations arriving from Ukraine

Health-care provision for displaced populations arriving from Ukraine

Reply to: Correlation of Antidepressant Use and Symptom Time Period in Dream Enactment Behaviors.

Firstly, I would like to thank Sumi et al.1 for showing interest in my recently published study2 and providing the opportunity to expand the discussion on this fascinating topic, that has both clinical and theoretical relevance. Sumi et al. had concerns about possible confounding due to medication use. Although all participants in the Parkinson's Progression Markers Initiative (PPMI) database were untreated for Parkinson's disease (PD) at baseline, which is important to highlight, since dopaminergic medications have previously been associated with dream alterations3; I do nevertheless agree that given the frequent comorbidity of depression and REM sleep behavior disorder in people with PD, that the effects of antidepressants and clonazepam used to treat these, ought to be considered. In fact, a previous study identified that 41.2% of PD participants in PPMI reported using antidepressants during the course of the study and 14.2% reported having used clonazepam.4 However, Sumi et al.'s statement that neither PPMI nor the study evaluated the presence of depression, is not entirely correct. In the study, total number of depressive symptoms, assessed using the extensively validated Geriatric Depression Scale,5 was included as a covariate in one of the sensitivity analyses.2 Crucially, the inclusion of depressive symptoms as a covariate did not alter the association between aggressive dream content and either motor or cognitive decline.2 Nonetheless, to ensure that the results were not confounded by antidepressant use specifically, I have now conducted two further analyses. First, I repeated the primary analyses after adjusting for antidepressant use at any time from baseline to the most recent study visit. Second, I repeated the analyses after including self-reported past or present depression (obtained from item 10 of the REM sleep behavior disorder screening questionnaire), as an additional covariate. Neither antidepressant use nor a history of depression attenuated the association between dream content and motor or cognitive decline (P's < 0.05). Similarly, after adjusting for clonazepam use, the associations between aggressive dream content and both outcomes remained significant (P's < 0.05). Finally, with respect to Sumi et al.'s third concern regarding fluctuation of aggressive dreams over time, it is pertinent to emphasize that these participants were all newly diagnosed at baseline, with a mean duration of 6.3 months since diagnosis. As such, it is unlikely that sufficient time had passed for there to be a significant group for whom “aggressive dreams [had] disappeared” during the course of PD. In any case, if such a group were to exist, it could actually have led to an underestimation of the association, since individuals who once had aggressive dreams would have been included in the non-aggressive dream group. Therefore, whilst the insightful concerns raised by Sumi et al are important to consider, I do not believe they challenge the core conclusions of this study, namely, that people with newly diagnosed, untreated PD who report having frequent aggressive dreams, may be at higher risk of early motor and cognitive decline than those who do not report having them. Data used in the preparation of this article were obtained from the Parkinson's Progression Markers Initiative (PPMI) database (www.ppmi-info.org/data). For up-to-date information on the study, visit www.ppmi-info.org. Data were downloaded from the PPMI database on December 22, 2020. 1. Research Project: Conception, Organization, Execution; 2. Statistical Analysis: Design, Execution; 3. Manuscript Preparation AIO: 1,2,3. Each Parkinson's Progression Markers Initiative site received approval from a local ethical committee on human experimentation before commencement of the study. Written informed consent was obtained from all individuals who participated in the study. I confirm that I have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. No specific funding was received for this work. I declare that there are no conflicts of interest relevant to this work. The author is funded by a National Institute for Health Research academic clinical fellowship.

Consistency between the Eatwell Guide and nutrient profiling models in the UK: an observational study

BackgroundNutrient profile models (NPMs) are algorithms that classify or rank foods according to their nutritional composition. An NPM was developed in 2005 in the UK to regulate marketing of foods to children. The model uses a scoring system that balances points awarded for the protein, fibre, fruit, vegetable, and nut content of foods and drinks against points awarded for energy, saturated fats, sodium, and sugars. Foods that score above 4 and drinks that score above 1 face marketing restrictions. The NPM was revised in 2018, but this version has not been finalised. The Eatwell Guide, the UK's food-based dietary guidelines, provides healthy eating advice. The aim of this study was to evaluate the extent that the 2005 and the 2018 versions of the NPM are consistent with the Eatwell Guide. MethodsIn this observational study, we obtained individual-level data from years 9 to 11 (2016/17 to 2018/19) of the National Diet and Nutrition Survey (NDNS). The NDNS is an annual survey measuring food consumption in the UK from a representative sample of approximately 1000 people per year. We estimated the healthiness of individuals' diets according to an Eatwell Guide dietary index (ie, number of food-based and nutrient-based recommendations achieved) and an NPM dietary index (ie, a weighted average of the NPM score of all foods eaten). We compared the agreement between diet healthiness according to the Eatwell Guide and the NPM indices by calculating the Cohen's κ coefficient. No specific ethics approval or patient consent was required for this analysis of NDNS data. Findings3028 individual diets were assessed. Individuals with a higher (ie, healthier) Eatwell Guide index score consumed a diet with, on average, a lower (ie, healthier) NPM index score both for the 2005 and 2018 versions. Agreement between the Eatwell Guide and the NPM dietary index in classifying a diet as “healthy” was moderate for relatively healthier diets, irrespective of the NPM version (Cohen's κ 0·39 [p<0·0001] for the 2005 version and 0·46 [p<0·0001] for the 2018 version, using an NPM cutoff of 4). InterpretationThis study suggests that the Eatwell Guide and NPM dietary indices are broadly concordant when assessing the healthiness of UK diets. As NPMs and food-based dietary guidelines evolve it is crucial to improve alignment between dietary advice and NPM-based food policies to ensure consistent information is conveyed to the public. FundingNIHR Academic Clinical Fellowship, Nuffield Department of Population Health (University of Oxford), NIHR Oxford Biomedical Research Centre, and the British Heart Foundation.

PD08-06 TREATMENT-RELATED TOXICITY USING PROSTATE BED VERSUS PROSTATE BED AND PELVIC LYMPH NODE RADIATION THERAPY FOLLOWING RADICAL PROSTATECTOMY: A NATIONAL POPULATION-BASED STUDY

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (PD08)1 Sep 2021PD08-06 TREATMENT-RELATED TOXICITY USING PROSTATE BED VERSUS PROSTATE BED AND PELVIC LYMPH NODE RADIATION THERAPY FOLLOWING RADICAL PROSTATECTOMY: A NATIONAL POPULATION-BASED STUDY Matthew Parry, Arunan Sujenthiran, Julie Nossiter, Melanie Morris, Brendan Berry, Paul Cathcart, Noel Clarke, Heather Payne, Jan van der Meulen, and Ajay Aggarwal Matthew ParryMatthew Parry More articles by this author , Arunan SujenthiranArunan Sujenthiran More articles by this author , Julie NossiterJulie Nossiter More articles by this author , Melanie MorrisMelanie Morris More articles by this author , Brendan BerryBrendan Berry More articles by this author , Paul CathcartPaul Cathcart More articles by this author , Noel ClarkeNoel Clarke More articles by this author , Heather PayneHeather Payne More articles by this author , Jan van der MeulenJan van der Meulen More articles by this author , and Ajay AggarwalAjay Aggarwal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001976.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is debate about the effectiveness and toxicity of pelvic lymph node (PLN) irradiation when used for disease recurrence following radical prostatectomy. This study compared the toxicity of radiation therapy (RT) to the prostate bed and pelvic lymph nodes (PBPLN-RT) with prostate-bed only radiation therapy (PBO-RT). METHODS: Patients with prostate cancer who underwent post-prostatectomy RT in the English National Health Service between 2010-2016 were identified by using data from the Cancer Registry, the National Radiotherapy Dataset, and Hospital Episode Statistics, an administrative database of all hospital admissions. Follow-up was available up to December 31, 2018. Validated indicators were used to identify patients with ≥ Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicity according to the presence of both a procedure code and diagnostic code in patient Hospital Episode Statistics records. A competing risks regression analysis, with adjustment for patient and tumour characteristics, estimated subdistribution hazard ratios by comparing GI and GU toxicity for PBPLN-RT vs PBO-RT. RESULTS: 5-year cumulative incidences in the PBO-RT (n= 5,087) and PBPLN-RT (n= 593) groups was 18.2% and 15.9% for GI toxicity, respectively. For GU toxicity it was and 19.1% and 20.7%, respectively. There was no difference in GI or GU toxicity between PBO-RT and PBPLN-RT (GI: adjusted sHR, 0.90, 95% CI, 0.67 to 1.19; p= 0.45); (GU: adjusted sHR, 1.18, 95% CI, 0.98 to 1.44; p= 0.09). CONCLUSIONS: Including PLNs in the radiation field following radical prostatectomy is not associated with a significant increase in rates of ≥ Grade 2 GI or GU toxicity at 5 years. Source of Funding: M.G.P. was supported by the National Institute of Health Research (DRF-2018-11-ST2-036). T.E.C. was supported by the Medical Research Council (MR/S020470/1). B.B. was partly supported by the NHS National Institute for Health Research through an Academic Clinical Fellowship. H.P. was supported by the University College London Hospitals/University College London Comprehensive Biomedical Research Centre. J.v.d.M. was partly supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust. The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e115-e116 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Parry More articles by this author Arunan Sujenthiran More articles by this author Julie Nossiter More articles by this author Melanie Morris More articles by this author Brendan Berry More articles by this author Paul Cathcart More articles by this author Noel Clarke More articles by this author Heather Payne More articles by this author Jan van der Meulen More articles by this author Ajay Aggarwal More articles by this author Expand All Advertisement Loading ...

Reply: Functional cognitive disorder: dementia's blind spot.

H.A.B. is funded by a National Institute for Health Research (NIHR) Clinical Lectureship. R.B. is supported by a NIHR Academic Clinical Fellowship. D.J.B. is funded by Alzheimer's Research UK & Rosetrees. D.J.B., M.R. and A.V. acknowledge the support of the National Institute for Health Research Sheffield Biomedical Research Centre (Translational Neuroscience). M.J.E. is funded by NIHR and the Medical Research Council. S.M.F. is funded by the Wellcome Trust & the Royal Society. J.H. is funded by a Wellcome Clinical Research Career Development Fellowship. R.H., N.C.F., J.M.S. and M.N.R. acknowledge the support of the National Institute for Health Research University College London Hospitals Biomedical Research Centre. L.M. receives philanthropic funding from Baillie Gifford. T.R.N. is funded by an NIHR Clinician Scientist Award. C.P. is funded by the Innovative Medicines Initiative, BRACE, and the David Telling Charitable Trust. J.S. is supported by a National Research Scotland Career Researcher Fellowship. This publication presents independent research; the views expressed are those of the authors and not necessarily those of the specified funding bodies.

A Cross-Sectional Study of Potentially Modifiable Risk Factors for Dementia and Cognitive Function in India

Background: Dementia is rising globally, particularly in low-and-middle-income countries. India has almost four million people living with dementia, set to double by 2050. Targeting nine potentially modifiable risk factors (less education, hearing impairment, depression, physical inactivity, hypertension, obesity, smoking, diabetes, and social isolation) could possibly prevent or delay many dementias. We aimed for the first time to examine risk factors for dementia in India and their link with cognitive status and dementia, to inform prioritisation of public health interventions that could prevent or delay dementia. Methods: We conducted a cross-sectional analysis using three studies: 10/66 Dementia Study (n= 2,004), Longitudinal Aging Study of India (n= 386), and Study of Global Ageing (n= 2,441). Our exposures were the nine risk factors above. We calculated a cognitive z-score within each study and used dementia diagnosis in 10/66. We adjusted for socioeconomic factors, age, and sex using multivariable linear for cognition and logistic regression for dementia. Findings: Less education, hearing impairment, depression, and physical inactivity were associated with lower z-scores and increased odds of dementia. Obesity was associated with higher z-score and lower odds of dementia. Social isolation was associated with lower z-scores and decreased odds of dementia. Results for smoking, diabetes, and hypertension were inconsistent. Interpretation: Our risk estimates were larger for less education, hearing impairment and physical inactivity compared to global estimates and should be intervention priorities. This study highlights the need for longitudinal studies to clarify the relationship between these potentially modifiable risk factors and dementia in India. Funding Information: CBR is supported by a National Institutes of Health Research (NIHR) Academic Clinical Fellowship, NM by an Alzheimer’s Society Senior Fellowship, GL by North Thames NIHR ARC and an NIHR senior investigator award. GL and NM are supported by the NIHR Biomedical Research Centre. Declaration of Interests: The authors have no interests to disclose. Ethics Approval Statement: This was a secondary analysis of existing data. Ethics committee approval was sought by each individual study. We received agreement to use this data on 3rd October 2019 and downloaded the data dictionary, questionnaires and assessment tools.

Assessing the Effectiveness of BNT162b2 and ChAdOx1nCoV-19 COVID-19 Vaccination in Prevention of Hospitalisations in Elderly and Frail Adults: A Single Centre Test Negative Case-Control Study

Background: On 8th December 2020, deployment of the first vaccine against SARS-CoV-2 authorised for UK use, the mRNA-based vaccine BNT162b2, began, followed by the adenoviral vector vaccine ChAdOx1nCoV-19 on 4th January 2021. Initially care home-residents and staff, frontline healthcare workers and adults from age 80 were targeted. In phase 3 trials, BNT162b2 and ChAdOx1nCoV-19 demonstrated 95% and 70% efficacy, respectively, after two doses against symptomatic SARS-CoV-2 infection. However, few data exist regarding the effectiveness of these vaccines in elderly frail people. Evaluation following implementation to determine the effectiveness of one dose in reducing hospitalisations due to SARS-CoV-2 infection in elderly adults is urgent.Methods: A prospective single-centre test-negative design case-control study of adults aged ≥80 years hospitalised with COVID-19 disease or other acute respiratory disease. We conducted logistic regression controlling for time (week), gender, index of multiple deprivations (IMD), and care residency status (CRS), and sensitivity analyses matched for time and gender using a conditional logistic model adjusting for IMD and CRS.Findings: First dose vaccine effectiveness of BNT162b2 was 71.4% (95% confidence interval [CI] 46.5-90.6). ChAdOx1nCoV-19 first dose vaccine effectiveness was 80.4% (95% CI 36.4-94.5). When effectiveness analysis for BNT162b2 was restricted to the period covered by ChAdOx1nCoV-19, the estimate was 79.3% (95% CI 47.0-92.5).Interpretation: A single dose of either BNT162b2 or ChAdOx1nCoV-19 vaccine resulted in substantial reductions in the risk of COVID-19-related hospitalisation in elderly, frail patients with extensive co-morbid disease.Funding: The AvonCAP study is an investigator-led project funded under a collaborative agreement by Pfizer.Conflict of Interest: CH is Principal Investigator of the Avon CAP study which is an investigator-led University of Bristol study funded by Pfizer and has previously received support from the NIHR in an Academic Clinical Fellowship. JO is a Co-Investigator on the Avon CAP Study. AF is a member of the Joint Committee on Vaccination and Immunization (JCVI) and chair of the World Health Organization European Technical Advisory Group of Experts on Immunization (ETAGE) committee. In addition to receiving funding from Pfizer as Chief Investigator of this study, he leads another project investigating transmission of respiratory bacteria in families jointly funded by Pfizer and the Gates Foundation. The other authors have no relevant conflicts of interest to declare.Ethical Approval: The study was approved by the Health Research Authority Research Ethics Committee (East of England, Essex), REC 20/EE/0157, including data collection under Section 251 of the 2006 NHS Act authorised by the Confidentiality Advisory Group.

Visual Acuity Deficits in Otherwise Normally Developing Zika Virus Exposed Children

Background: The Zika virus (ZIKV) targets neural stem cells in the developing brain. It remains unclear whether ZIKV-Exposed Children (ZEC) with no apparent neurological manifestations at birth were protected from ZIKV neurotropism during gestation or harbor subtle pathology that might disrupt neurodevelopment. In this prospective study, we tracked a cohort of normocephalic ZIKV-exposed children (NZEC) in parallel with normocephalic unexposed controls (UC) from birth to 30 months of age to determine whether NZEC show higher rates of neurodevelopmental delays relative to UC. Methods: A total of 384 pregnant women were recruited from public health centers in Grenada, West Indies and enrolled between April 2016 and March 2017, which was a period of active ZIKV transmission. Serum samples were collected from mothers during the prenatal and postnatal period and assessed for ZIKV antibodies using a plasmonic-gold platform. Infants were classified as NZEC if their mothers tested positive for ZIKV infection during pregnancy and they were normocephalic, as defined by World Health Organization Child Growth Standards. Children were classified as UC if their mothers tested negative for ZIKV infection during and following pregnancy. Outcome measures included the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, which were administered and scored by research staff blinded to participants’ exposure status. Findings: A total of 68 NZEC and 63 UC completed outcome measures between 22 to 30 months of age. There were no group differences in socio-demographics. Visual acuity deficits were apparent in NZEC in the absence of any other cognitive, motor, language, or behavioral delays. Interpretation: The presence of visual acuity deficits in NZEC suggests that the visual system may be selectively vulnerable in otherwise normally developing children. Continued neurocognitive surveillance of this cohort will address whether early vision problems place NZEC at risk for future deficits in visuo-spatial functions and learning disorders. Funding Statement: TWINDREF GSP-SRGI-18009 (KB); USAID AID-OAA-A-14-00028 (ADL), NIH R21HD093551-01 (RW, BL, MF), Stanford Maternal Child Health Research Institute (ADL). MF is supported by an Academic Clinical Fellowship in Paediatrics from the National Institute for Health Research, UK, to the University of Southampton. Declaration of Interests: None of the authors have any conflicts of interest to disclose. Ethics Approval Statement: Institutional Review Board approval was obtained at St George’s University (IRB#16061) and Stanford University (IRB#45242). Informed consent was obtained from all mothers who participated in this study. There was no financial compensation.

MP53-17 PATIENT-REPORTED OUTCOMES AFTER PROSTATE ONLY VS PROSTATE AND PELVIC LYMPH NODE RADIATION THERAPY

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (MP53)1 Apr 2020MP53-17 PATIENT-REPORTED OUTCOMES AFTER PROSTATE ONLY VS PROSTATE AND PELVIC LYMPH NODE RADIATION THERAPY Matthew Parry*, Julie Nossiter, Thomas Cowling, Arunan Sujenthiran, Brendan Berry, Paul Cathcart, Noel Clarke, Heather Payne, Jan van der Meulen, and Ajay Aggarwal Matthew Parry*Matthew Parry* More articles by this author , Julie NossiterJulie Nossiter More articles by this author , Thomas CowlingThomas Cowling More articles by this author , Arunan SujenthiranArunan Sujenthiran More articles by this author , Brendan BerryBrendan Berry More articles by this author , Paul CathcartPaul Cathcart More articles by this author , Noel ClarkeNoel Clarke More articles by this author , Heather PayneHeather Payne More articles by this author , Jan van der MeulenJan van der Meulen More articles by this author , and Ajay AggarwalAjay Aggarwal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000915.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known about the toxicity of pelvic lymph node (PLN) irradiation following intensity-modulated radiation therapy (IMRT) for the treatment of men with high-risk prostate cancer. We aimed to compare patient-reported outcomes of IMRT to the prostate and the pelvic lymph nodes (PPLN-IMRT) compared to prostate only IMRT (PO-IMRT). METHODS: Patients diagnosed with high-risk or locally advanced prostate cancer in the English National Health Service, between April 2014 and September 2016, and treated with IMRT were identified from the National Prostate Cancer Audit. Men were mailed a questionnaire 18 months after diagnosis. Patient-reported sexual, urinary, bowel and hormonal function domains using the EPIC-26, and generic health-related quality of life (HRQoL) using EQ-5D-5L, were collected from patient surveys. Comparator groups (PPLN-IMRT versus PO-IMRT) were compared using linear regression, adjusting for baseline patient, tumour and treatment characteristics. RESULTS: Of the 5468 men (78%) who responded to the patient survey, 4196 (77%) received PO-IMRT and 1272 (23%) received PPLN-IMRT. Adjusted mean scores for urinary, bowel, and hormonal EPIC-26 domains, and HRQoL were similar irrespective of the treatment region. Patients receiving PPLN-IMRT reported worse sexual function than those receiving PO-IMRT (-2.26 adjusted mean difference on a 0-100 scale; 95% CI: -3.66 to -0.86, P =0.002) but this was not a clinically meaningful difference. CONCLUSIONS: PPLN-IMRT is not associated with clinically important differences in patient-reported toxicity for men with high-risk or locally advanced prostate cancer. Results from ongoing trials will provide further insight into the anti-cancer effectiveness of PLN irradiation. Source of Funding: M.G.P. was supported by a Doctoral Research Fellowship from the NHS National Institute for Health Research (DRF-2018-11-ST2-036). T.E.C. was supported by the Medical Research Council (MR/S020470/1). B.B. was partly supported by the NHS National Institute for Health Research through an Academic Clinical Fellowship. H.P. was supported by the University College London Hospitals/University College London Comprehensive Biomedical Research Centre. J.v.d.M. was partly supported by the NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust. The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e789-e789 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Parry* More articles by this author Julie Nossiter More articles by this author Thomas Cowling More articles by this author Arunan Sujenthiran More articles by this author Brendan Berry More articles by this author Paul Cathcart More articles by this author Noel Clarke More articles by this author Heather Payne More articles by this author Jan van der Meulen More articles by this author Ajay Aggarwal More articles by this author Expand All Advertisement PDF downloadLoading ...