• Adding abiraterone or docetaxel to long-term hormone therapy for prostate cancer: directly randomised data from the STAMPEDE multi-arm, multi-stage platform protocol.

      Sydes, Matthew R; Spears, Melissa R; Mason, Malcolm D; Clarke, Noel W; Dearnaley, David P; de Bono, Johann S; Attard, Gert; Chowdhury, Simon; Cross, Bill; Gillessen, Silke; et al. (Oxford University Press, 2018-02-26)
      Adding abiraterone acetate with prednisolone (AAP) or docetaxel with prednisolone (DocP) to standard-of-care (SOC) each improved survival in STAMPEDE: a multi-arm multi-stage platform randomised controlled protocol recruiting patients with high-risk locally advanced or metastatic PCa starting long-term androgen deprivation therapy (ADT). The protocol provides the only direct, randomised comparative data of SOC+AAP vs SOC+DocP.
    • Cardiorespiratory fitness and activity explains the obesity-deprivation relationship in children

      Nevill, Alan M.; Duncan, Michael J; Lahart, Ian M; Sandercock, Gavin (Oxford University Press, 2017-01-06)
      This study examined the association between obesity and deprivation in English children and whether cardiorespiratory fitness or physical activity (PA) can explain this association. Obesity was assessed using IOTF criteria in 8,398 10-16 year olds. Social deprivation was measured using the Index of Multiple Deprivation (IMD) (subdivided into 3 groups; high, mid and low deprivation). Obesity was analysed using binary logistic regression with stature, age and sex incorporated as confounding variables. Children's fitness levels were assessed using predicted VO2 max (20-metre shuttle run test) and PA was estimated using the PA Questionnaire for Adolescents or Children (PAQ). A strong association was found between obesity and deprivation. When fitness and PA were added to the logistic regression models, increasing levels in both were found to reduce the odds of obesity, although it was only by including fitness into the model that the association between obesity and deprivation disappeared. Including estimated PA into the model was found to be curvilinear. Initial increases in PA increase the odds of obesity. Only by increasing PA to exceed the 71(st) percentile (PAQ = 3.22) did the odds of being obese start to decline. In order to reduce deprivation inequalities in children's weight-status, health practitioners should focus on increasing cardiorespiratory fitness via physical activity levels in areas of greater deprivation.
    • Hypertension in rheumatoid arthritis

      Panoulas, Vasileios F.; Metsios, Giorgos S.; Pace, A.V.; John, H.; Treharne, G.J.; Banks, M.J.; Kitas, George D. (Oxford University Press, 2008)
      RA associates with an increased burden of cardiovascular disease, which is at least partially attributed to classical risk factors such as hypertension (HT) and dyslipidaemia. HT is highly prevalent, and seems to be under-diagnosed and under-treated among patients with RA. In this review, we discuss the mechanisms that may lead to increased blood pressure in such patients, paying particular attention to commonly used drugs for the treatment of RA. We also suggest screening strategies and management algorithms for HT, specific to the RA population, although it is clear that these need to be formally assessed in prospective randomized controlled trials designed specifically for the purpose, which, unfortunately, are currently lacking.
    • Long-term exposure to medium-dose glucocorticoid therapy associates with hypertension in patients with rheumatoid arthritis

      Panoulas, Vasileios F.; Douglas, Karen M. J.; Milionis, Haralampos J.; Metsios, Giorgos S.; Stavropoulos-Kalinoglou, Antonios; Nightingale, Peter; Kita, Marina D.; Elisaf, Moses S.; Kitas, George D. (Oxford University Press, 2008)
      OBJECTIVE: Rheumatoid arthritis (RA) associates with increased cardiovascular morbidity and mortality that is due to both traditional and novel cardiovascular risk factors. Hypertension (HT), one of the most common risk factors for cardiovascular disease, is highly prevalent in RA. The effects of long-term glucocorticoid (GC) therapy on blood pressure have not been established yet. This study examined whether GC exposure associates with HT in patients with RA. METHODS: Four hundred consecutive RA patients with detailed clinical and laboratory assessments were categorized into three groups according to GC exposure: no or limited exposure (N/L-E); a low-dose (< 7.5 mg) long-term exposure (LD/LT-E); and medium-dose (> or = 7.5 mg) long-term exposure (MD/LT-E). The association of GC exposure with HT was evaluated using logistic regression analysis. RESULTS: HT was more prevalent in the MD/LT-E group (84.7%) than the LD/LT-E or N/L-E groups (70.7 and 67.3%, respectively, P = 0.028). Logistic regression revealed increased odds for HT when comparing MD/LT-E with N/L-E, after adjustment for HT risk factors [odds ratio (OR) = 2.57, 95% CI 1.01-6.56, P = 0.049] and RA disease characteristics (OR = 3.64, 95% CI: 1.36-9.77, P = 0.01). CONCLUSIONS: MD/LT GC exposure associates with a very high prevalence of HT. This appears to be independent of other risk factors for HT or of channelling bias due to disease severity, even though the latter cannot be excluded given the cross-sectional nature of our study. RA patients in this GC exposure group should be particularly targeted for early identification and aggressive management of HT.
    • Neutrality and Workplace Restrictions on Headscarves and Religious Dress: Lessons from Achbita and Bougnaoui

      Hambler, Andrew; University of Wolverhampton (Oxford University Press, 2018-03-15)
      Bans on the wearing of religious symbols, and particularly the Islamic headscarf, in the European public square have been controversial and have been challenged on several occasions on human rights grounds (primarily under Article 9 (Freedom of thought, conscience and religion) of the European Convention on Human Rights (ECHR)).1 However, restrictions on religious dress in the workplace have been fully considered only recently, most significantly before the European Court of Human Rights (ECtHR) in Eweida and Ors v United Kingdom.2 In its judgment, the Court concluded that the right to manifest religion through dress could be restricted,3 in situations where there was a health and safety concern but not in situations where customer image was the justification for any restrictions—regarding the latter, the religious right carried more weight than the employer’s desire for uniformity....
    • New resting energy expenditure prediction equations for patients with rheumatoid arthritis

      Metsios, Giorgos S.; Stavropoulos-Kalinoglou, Antonios; Panoulas, Vasileios F.; Koutedakis, Yiannis; Nevill, Alan M.; Douglas, Karen M. J.; Kita, Marina D.; Kitas, George D. (Oxford University Press, 2008)
      OBJECTIVES: Resting energy expenditure (REE), one of the main components of total energy expenditure, can be measured via indirect calorimetry and/or predicted from equations. The latter may be misleading in RA, as they do not take into account the metabolic alterations occurring in RA. The objectives of this study are to evaluate the accuracy of widely used REE-predictive equations in RA patients against measured REE and to develop RA-specific equations. METHODS: We assessed REE (via indirect calorimetry and several predictive equations), fat-free mass (FFM; via bioelectrical impedance) and disease activity (CRP) in RA patients and healthy controls. Data from 60 RA patients (experimental group) were used to assess the accuracy of existing REE equations and to develop new equations. The new equations were validated in an independent cross-validation group of 22 RA patients. These two groups were merged and two final equations were developed. RESULTS: All equations significantly under-predicted measured REE (from 15% to 18.2%, all at P < 0.001) in the RA experimental group, but not in the control group. After both equations demonstrated a high validity in the cross-validation group, the new final REE prediction equations developed from the total RA sample (n = 82) were: Model 1: REE (kcal/day) = 126.1 x FFM(0.638) x CRP(0.045) (R(2) = 0.70) and Model 2: REE (kcal/day) = 598.8 x weight(0.47) x age(-0.29) x CRP(0.066) (R(2) = 0.62). CONCLUSION: The new equations provide an accurate prediction of REE in RA patients and could be used for clinical monitoring of resting metabolism of these patients without the requirement for specialized personnel.
    • Physical activity and awareness in breast screening attendees in Black Country, UK

      Lahart, I. M.; Reichl, C.; Metsios, G. S.; Nevill, Alan M.; Carmichael, A. R. (Oxford University Press, 2014-07-10)
      This study aimed to determine the physical activity levels and awareness of the influence of physical activity and overweight/obesity on breast cancer risk among NHS breast screening programme (NHSBSP) attendees. One hundred and eighty-eight (white British = 95%; post-menopausal = 80%) attendees completed a demographic and anthropometric data questionnaire, International Physical Activity Questionnaire (IPAQ) and awareness of breast cancer risk factors questionnaire. IPAQ data were reported as continuous measures (MET-min·week−1) and as categorical variables (low, moderate and high activities). The highest median physical activity levels were reported in the domestic physical activity domain (756 MET-min·week−1). Most participants were categorized as ‘moderately active’ (45%), while 30% were classified in the ‘high activity’ and 25% as ‘low activity’ categories. Almost a third of participants (30%) reported no leisure-time physical activity and 83% reported no vigorous physical activity. There was high awareness of the effects of physical activity (75%) and obesity (80%) on breast cancer risk. No significant differences were found between physical activity categories and awareness that physical activity can reduce breast cancer risk (p > 0.05). However, compared with moderate and high activity categories, participants in the ‘low activity’ category were significantly more likely to respond that they thought they achieved recommended physical activity levels (p < 0.05). Participants who are unaware of their inadequate physical activity levels may have a less positive intention to increase physical activity levels. Practical strategies aimed to increase knowledge of the recommended physical activity guidelines and facilitate the achievement of these guidelines may be required for NHSBSP attendees.
    • Physical employment standards for UK fire and rescue service personnel

      Blacker, S D; Rayson, M P; Wilkinson, D M; Carter, J M; Nevill, Alan M.; Richmond, V L (Oxford University Press, 2015-10-01)
      Evidence-based physical employment standards are vital for recruiting, training and maintaining the operational effectiveness of personnel in physically demanding occupations.
    • Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis.

      Panoulas, Vasileios F.; Douglas, Karen M. J.; Milionis, Haralampos J.; Stavropoulos-Kalinoglou, Antonios; Nightingale, Peter; Kita, Marina D.; Tselios, Andreas L.; Metsios, Giorgos S.; Elisaf, Moses S.; Kitas, George D. (Oxford University Press, 2007)
      OBJECTIVES: Rheumatoid arthritis (RA) associates with excessive cardiovascular morbidity and mortality. Hypertension (HT) contributes significantly to the development of cardiovascular disease (CVD). Little is known about the factors that influence blood pressure (BP) in patients with RA. In this study, we assessed the prevalence of HT in a secondary care cohort of RA patients, and aimed to identify factors associated with its presence and inadequate control. METHODS: A total of 400 consecutive RA patients were studied. HT was defined as systolic BP >/=140 mmHg and/or diastolic BP >/=90 mmHg or current use of antihypertensive drugs. The association of HT with several demographic and RA-related factors, comorbidities and drugs was evaluated using logistic regression. RESULTS: HT was present in 282 (70.5%) patients. Of those, 171 (60.6%) received anti-hypertensive therapy, but 111 (39.4%) remained undiagnosed. Of those treated, only 37/171 (21.8%) were optimally controlled. Multivariable logistic regression revealed age (OR = 1.054, CI: 1.02 to 1.07, P = 0.001), body mass index [BMI (OR = 1.06, CI: 1.003-1.121, P = 0.038)] and prednisolone use (OR = 2.39, CI: 1.02-5.6, P = 0.045) to be independently associated with the presence of HT. BMI (OR = 1.11, CI: 1.02-1.21, P = 0.002) and the presence of CVD (OR = 4.01, CI: 1.27-12.69, P = 0.018) associated with uncontrolled HT. CONCLUSIONS: HT is highly prevalent in RA, under-diagnosed particularly in the young, and under-treated particularly in old RA patients with CVD. RA patients receiving steroids should be specifically targeted for screening and treatment; those with any cardiovascular comorbidity may require particularly aggressive monitoring and treatment strategies.
    • Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial

      Luckraz, Heyman; Giri, Ramesh; Wrigley, Benjamin; Nagarajan, Kumaresan; Senanayake, Eshan; Sharman, Emma; Beare, Lawrence; Nevill, Alan (Oxford University Press, 2020-11-25)
      OBJECTIVES Our goal was to investigate the efficacy of balanced forced diuresis in reducing the rate of acute kidney injury (AKI) in cardiac surgical patients requiring cardiopulmonary bypass (CPB), using the RenalGuard® (RG) system. METHODS Patients at risk of developing AKI (history of diabetes and/or anaemia; estimated glomerular filtration rate 20–60 ml/min/1.73 m2; anticipated CPB time >120 min; log EuroSCORE > 5) were randomized to the RG system group (n = 110) or managed according to current practice (control = 110). The primary end point was the development of AKI within the first 3 postoperative days as defined by the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) criteria. RESULTS There were no significant differences in preoperative and intraoperative characteristics between the 2 groups. Postoperative AKI rates were significantly lower in the RG system group compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025]. This effect persisted even after controlling for a number of potential confounders (odds ratio 2.82, 95% confidence interval 1.20–6.60; P = 0.017) when assessed by binary logistic regression analysis. The mean volumes of urine produced during surgery and within the first 24 h postoperatively were significantly higher in the RG system group (P < 0.001). There were no significant differences in the incidence of blood transfusions, atrial fibrillation and infections and in the median duration of intensive care unit stays between the groups. The number needed to treat with the RG system to prevent AKI was 9 patients (95% confidence interval 6.0–19.2). CONCLUSIONS In patients at risk for AKI who had cardiac surgery with CPB, the RS RG system significantly reduced the incidence of AKI and can be used safely and reproducibly. Larger studies are required to confirm cost benefits.
    • Significant reduction in ventilator-associated pneumonia with the Venner-PneuX System in high-risk patients undergoing cardiac surgery: the Low Ventilator-Associated-Pneumonia study

      Gopal, Shameer; Luckraz, Heyman; Giri, Ramesh; Nevill, Alan M.; Muhammed, Israr; Reid, Matthew; Bickerton, Shelagh; Jenkins, Donna (Oxford University Press, 2014-12-26)
      This study assessed whether the Venner-PneuX endotracheal tube (ET) system, which has sub-glottic suction as well as irrigation ports and continuous cuff-pressure monitoring, is associated with a reduction in ventilator-associated pneumonia (VAP) when compared with the standard ET in high-risk patients undergoing cardiac surgery. METHODS: This was a single-institution, prospective, randomized control trial. Patients were categorized as either Group A (Venner-PneuX ET tube, n = 120) or Group B (Standard ET tube, n = 120). Inclusion criteria included patients over the age of 70 years and/or impaired left ventricular function (LVEF <50%) undergoing cardiac surgery. Patients were monitored for VAP for up to 48 h post extubation and the diagnosis of VAP was according to the centres for disease control definition. RESULTS: There were no significant differences in the patients' demographics. The mean (SD) ages for the two groups were 72.4 (8.2) and 72.1 (7.4) years (P = 0.6), respectively. The mean EuroSCORE was 6.39 (2.2) for Group A and 6.48 (2.6) for Group B (P = 0.9). The median intubation times were 14.7 (7.3, 2927.2) h and 13 (2.5, 528.7) h, respectively. VAP incidence was significantly lower in the Venner-PneuX ET group, being 10.8% when compared with 21% in the standard ET group (P = 0.03). There was no significant difference between the two groups in terms of intensive care unit stay (P = 0.2) and in-hospital mortality (P = 0.2). A binary logistic regression analysis (type of ET tube, age, LVEF, history of lung disease, smoking history, surgical procedure, EuroSCORE, cardiopulmonary bypass time, blood transfusion, intubation duration among others) confirmed that the Venner-PneuX ET tube was associated with significant VAP reduction (Odds ratio 0.45, P = 0.03). CONCLUSIONS: The Venner-PneuX VAP prevention system is associated with a significant reduction in VAP. This can potentially lead to significant cost reductions and should be implemented as part of the VAP reduction bundle.
    • The use of YouTube for the self-management of arthritis and joint pain: a patient and public involvement study

      Bond, Carol; Ahmed, Osman; Peters, Sophie L; Lee, Hopin; Merolli, Mark; Lawson, Jem (Oxford University Press, 2019-04-12)