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4. Risk of Early Versus Later Rebleeding From Dural Arteriovenous Fistulas With Cortical Venous Drainage

Author

Durnford, Andrew J, Akarca, Danyal, Culliford, David, Millar, John, Guniganti, Ridhima, Giordan, Enrico, Brinjikji, Waleed, Chen, Ching-Jen, Abecassis, Isaac Josh, Levitt, Michael, Polifka, Adam J, Derdeyn, Colin P, Samaniego, Edgar A, Kwasnicki, Amanda, Alaraj, Ali, Potgieser, Adriaan RE, Chen, Stephanie, Tada, Yoshiteru, Phelps, Ryan, Abla, Adib, Satomi, Junichiro, Starke, Robert M, van Dijk, J Marc C, Amin-Hanjani, Sepideh, Hayakawa, Minako, Gross, Bradley, Fox, W Christopher, Kim, Louis, Sheehan, Jason, Lanzino, Giuseppe, Kansagra, Akash P, Du, Rose, Lai, Rosalind, Zipfel, Gregory J, Bulters, Diederik O, Piccirillo, Jay F, Raman, Hari, Lipsey, , Kim, Vine, Roanna, Cloft, Harry J, Kallmes, David F, Pollock, Bruce E, Link, Michael J, Patibandla, Mohana Rao, Ding, Dale, Buell, Thomas, Paisan, Gabriella, Meyer, R Michael, Kelly, , Cory, Duffill, Jonathan, Ditchfield, Adam, Macdonald, Jason, Laurent, Dimitri, Hoh, Brian, Smith, Jessica, Lockerman, Ashley, Lunsford, L Dade, Jankowitz, Brian T, Gutierrez, Santiago Ortega, Hasan, David, Roa, Jorge A, Rossen, James, Guerrero, Waldo, McGruder, Allen, Charbel, Fady T, Aletich, Victor A, Rose-Finnell, Linda, Peterson, Eric C, Yavagal, Dileep R, Sur, Samir, Kanematsu, Yasuhisa, Yamamoto, Nobuaki, Kinouchi, Tomoya, Korai, Masaaki, Yamaguchi, Izumi, Yamamoto, Yuki, Winkler, Ethan, Lawton, Michael, Rutkowski, Martin, Sultan, M Ali Aziz, Patel, Nirav, and Frerichs, Kai U

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Kidney Disease, Central Nervous System Vascular Malformations, Cerebral Angiography, Drainage, Embolization, Therapeutic, Humans, Outcome Assessment, Health Care, drainage, fistula, hemorrhage, incidence, natural history, CONDOR Investigators, Cardiorespiratory Medicine and Haematology, Neurosciences, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

BackgroundCranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage.MethodsPatients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference.ResultsOf 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2-14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3-5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7-12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4-37.7; P, 0.026).ConclusionsThe risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.

Published
2022

18. COVID-19: experiences of lockdown and support needs in children and young adults with kidney conditions

Author

Tse, Yincent, Darlington, Anne-Sophie E., Tyerman, Kay, Wallace, Dean, Pankhurst, Tanya, Chantziara, Sofia, and Culliford, David

Subjects
Young adults -- Psychological aspects -- Health aspects -- Social aspects -- Surveys, Children -- Diseases -- Psychological aspects -- Social aspects -- Surveys, Epidemics -- Social aspects -- Demographic aspects -- United Kingdom, Parents -- Surveys, Kidney diseases -- Demographic aspects -- Psychological aspects, Health
Abstract

Background During the initial COVID-19 pandemic, young United Kingdom (UK) kidney patients underwent lockdown and those with increased vulnerabilities socially isolated or 'shielded' at home. The experiences, information needs, decision-making and support needs of children and young adult (CYA) patients or their parents during this period is not well known. Methods A UK-wide online survey co-produced with patients was conducted in May 2020 amongst CYA aged 12-30, or parents of children aged < 18 years with any long-term kidney condition. Participants answered qualitative open text alongside quantitative closed questions. Thematic content analysis using a three-stage coding process was conducted. Results One-hundred and eighteen CYA (median age 21) and 197 parents of children (median age 10) responded. Predominant concerns from CYA were heightened vigilance about viral (68%) and kidney symptoms (77%) and detrimental impact on education or work opportunities (70%). Parents feared the virus more than CYA (71% vs. 40%), and had concerns that their child would catch the virus from them (64%) and would have an adverse impact on other children at home (65%). CYA thematic analysis revealed strong belief of becoming seriously ill if they contracted COVID-19; lost educational opportunities, socialisation and career development; and frustration with the public for not following social distancing rules. Positive outcomes included improved family relationships and community cohesion. Only a minority (14-21% CYA and 20-31% parents, merged questions) desired more support. Subgroup analysis identified greater negative psychological impact in the shielded group. Conclusions This survey demonstrates substantial concern and need for accurate tailored advice for CYA based on individualised risks to improve shared decision making. Graphical abstract, Author(s): Yincent Tse [sup.1] , Anne-Sophie E. Darlington [sup.2] , Kay Tyerman [sup.3] , Dean Wallace [sup.4] , Tanya Pankhurst [sup.5] , Sofia Chantziara [sup.2] , David Culliford [sup.6] , [...]

Published
2021
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27. The past, present and future of total hip and knee arthroplasty in the UK : a population-based statistical analysis

Author

Culliford, David John and Walker-Bone, Karen

Subjects
617.5
Abstract

The total replacement of the hip and knee joint has become one of the most successful surgical procedures of the late 20th century, yet in the United Kingdom little attention has been given to describing trends and exploring risk factors at a population level, with even less consideration given to future levels of activity. This thesis has used nationally representative primary care data from the Clinical Practice Research Datalink to describe past trends, estimate the lifetime risk, explore risk factors and project future levels of total hip and knee replacement for the UK as a whole. The data comprised over 100,000 surgical procedures spanning a twenty year period, and was accompanied by demographic and clinical details for patients undergoing these procedures. Temporal trends for hip and knee replacement between 1991 and 2006 were described by age and gender, and incidence rates were found to have increased considerably over the period. The lifetime risk of hip and knee replacement was estimated at between 5 and 10 percent for a 50-year old in the United Kingdom, which is much less than the lifetime risk of osteoarthritis, the disease for which the vast majority of these operations are performed. The time to failure of primary hip and knee replacements was found to have a small but significant association with body mass index. Finally, projections of the future rate of these replacement operations were presented, suggesting that changes in the distribution of body mass index in the UK may increase future levels of knee replacement more than hip replacement. This thesis has presented and discussed four published articles which build upon each other to add to the descriptive epidemiological literature on the past trends, current risks and future needs of hip and knee replacement in the UK. Over the coming decades, it is important that researchers continue to analyse population-level data on hip and knee replacement in order to report on changes in risk factors, to monitor changes in the characteristics of those undergoing joint surgery and to inform policymakers and healthcare providers.

Published
2016

30. Opioid use, postoperative complications, and implant survival after unicompartmental versus total knee replacement: a population-based network study

Author

Burn, Edward, Weaver, James, Morales, Daniel, Prats-Uribe, Albert, Delmestri, Antonella, Strauss, Victoria Y, He, Ying, Robinson, Danielle E, Pinedo-Villanueva, Rafael, Kolovos, Spyros, Duarte-Salles, Talita, Sproviero, William, Yu, Dahai, Van Speybroeck, Michel, Williams, Ross, John, Luis H, Hughes, Nigel, Sena, Anthony G, Costello, Ruth, Birlie, Belay, Culliford, David, O'Leary, Caroline, Morgan, Henry, Burkard, Theresa, Prieto-Alhambra, Daniel, and Ryan, Patrick

Published
2019
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45. Impact of the COVID-19 pandemic on prescription refills for immune-mediated inflammatory disorders: a time series analysis (Jan 2019 to Jan 2021) using the English Prescribing Dataset

Author

Barrett, Ravina, Barrett, Robert, Lin, Sharon Xiaowen, Culliford, David, Fraser, Simon, and Edwards, Christopher

Abstract

Objective To investigate monthly prescription refills for common immunosuppressive/immunomodulatory therapy (sulfasalazine, hydroxychloroquine, azathioprine, methotrexate, leflunomide) prescriptions in England during the complete first wave of the COVID-19 pandemic. Secondary analysis examined unit cost analysis and regional use.Design and setting A national cohort of community-based, primary care patients who anonymously contribute data to the English Prescribing Dataset, dispensed in the community in England, were included. Descriptive statistics and interrupted time series analysis over 25 months (14 months before, 11 months after first lockdown) were evaluated (January 2019 to January 2021, with March 2020 as the cut-off point).Outcome measures Prescription reimbursement variance in period before the pandemic as compared with after the first lockdown.Results Fluctuation in monthly medicines use is noted in March 2020: a jump is observed for hydroxychloroquine (Mann-Whitney, SE 14.652, standardised test statistic 1.911, p value=0.059) over the study period. After the first lockdown, medicines use fluctuated, with wide confidence intervals. Unit-cost prices changed substantially: sulfasalazine 33% increase, hydroxychloroquine 98% increase, azathioprine 41% increase, methotrexate 41% increase, leflunomide 20% decrease. London showed the least quantity variance, suggesting more homogeneous prescribing and patient access compared with Midlands and East of England, suggesting that some patients may have received medication over/under requirement, representing potential resource misallocation and a proxy for adherence rates. Changepoint detection revealed four out of the five medicines’ use patterns changed with a strong signal only for sulfasalazine in March/April 2020.Conclusions Findings potentially present lower rates of adherence because of the pandemic, suggesting barriers to care access. Unit price increases are likely to have severe budget impacts in the UK and potentially globally. Timely prescription refills for patients taking immunosuppressive/immunomodulatory therapies are recommended. Healthcare professionals should identify patients on these medicines and assess their prescription-day coverage, with planned actions to flag and follow-up adherence concerns in patients.

Published
2022

49. Quality of Survival and Growth in Children and Young Adults in the PNET4 European Controlled Trial of Hyperfractionated Versus Conventional Radiation Therapy for Standard-Risk Medulloblastoma

Author

Kennedy, Colin, Bull, Kim, Chevignard, Mathilde, Culliford, David, Dörr, Helmuth G., Doz, François, Kortmann, Rolf-Dieter, Lannering, Birgitta, Massimino, Maura, Navajas Gutiérrez, Aurora, Rutkowski, Stefan, Spoudeas, Helen A., and Calaminus, Gabriele

Published
2014
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