34 research outputs found
Study protocol for the COPE study: COVID-19 in Older People : the influence of frailty and multimorbidity on survival. A multi-centre, European observational study
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.Peer reviewedPublisher PD
CENP-F expression is associated with poor prognosis and chromosomal instability in patients with primary breast cancer
DNA microarrays have the potential to classify tumors according to their transcriptome. Tissue microarrays (TMAs) facilitate the validation of biomarkers by offering a high-throughput approach to sample analysis. We reanalyzed a high profile breast cancer DNA microarray dataset containing 96 tumor samples using a powerful statistical approach, between group analyses. Among the genes we identified was centromere protein-F (CENP-F), a gene associated with poor prognosis. In a published follow-up breast cancer DNA microarray study, comprising 295 tumour samples, we found that CENP-F upregulation was significantly associated with worse overall survival (p < 0.001) and reduced metastasis-free survival (p < 0.001). To validate and expand upon these findings, we used 2 independent breast cancer patient cohorts represented on TMAs. CENP-F protein expression was evaluated by immunohistochemistry in 91 primary breast cancer samples from cohort I and 289 samples from cohort II. CENP-F correlated with markers of aggressive tumor behavior including ER negativity and high tumor grade. In cohort I, CENP-F was significantly associated with markers of CIN including cyclin E, increased telomerase activity, c-Myc amplification and aneuploidy. In cohort II, CENP-F correlated with VEGFR2, phosphorylated Ets-2 and Ki67, and in multivariate analysis, was an independent predictor of worse breast cancer-specific survival (p = 0.036) and overall survival (p = 0.040). In conclusion, we identified CENP-F as a biomarker associated with poor outcome in breast cancer and showed several novel associations of biological significance
The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study
Background
The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed to establish the prevalence of frailty in patients with COVID-19 who were admitted to hospital and investigate its association with mortality and duration of hospital stay.
Methods
This was an observational cohort study conducted at ten hospitals in the UK and one in Italy. All adults (â„18 years) admitted to participating hospitals with COVID-19 were included. Patients with incomplete hospital records were excluded. The study analysed routinely generated hospital data for patients with COVID-19. Frailty was assessed by specialist COVID-19 teams using the clinical frailty scale (CFS) and patients were grouped according to their score (1â2=fit; 3â4=vulnerable, but not frail; 5â6=initial signs of frailty but with some degree of independence; and 7â9=severe or very severe frailty). The primary outcome was in-hospital mortality (time from hospital admission to mortality and day-7 mortality).
Findings
Between Feb 27, and April 28, 2020, we enrolled 1564 patients with COVID-19. The median age was 74 years (IQR 61â83); 903 (57·7%) were men and 661 (42·3%) were women; 425 (27·2%) had died at data cutoff (April 28, 2020). 772 (49·4%) were classed as frail (CFS 5â8) and 27 (1·7%) were classed as terminally ill (CFS 9). Compared with CFS 1â2, the adjusted hazard ratios for time from hospital admission to death were 1·55 (95% CI 1·00â2·41) for CFS 3â4, 1·83 (1·15â2·91) for CFS 5â6, and 2·39 (1·50â3·81) for CFS 7â9, and adjusted odds ratios for day-7 mortality were 1·22 (95% CI 0·63â2·38) for CFS 3â4, 1·62 (0·81â3·26) for CFS 5â6, and 3·12 (1·56â6·24) for CFS 7â9.
Interpretation
In a large population of patients admitted to hospital with COVID-19, disease outcomes were better predicted by frailty than either age or comorbidity. Our results support the use of CFS to inform decision making about medical care in adult patients admitted to hospital with COVID-19
Using visual methodology: Social work student's perceptions of practice and the impact on practice educators.
This is an Accepted Manuscript of an article published by Taylor & Francis in Practice: Social Work in Action on 21-6-18, available online: https://doi.org/10.1080/09503153.2018.1476477Practice learning within social work education plays a significant part in studentsâ educational journey. Little is understood about the emotional climate of placements. This paper presents a small scale qualitative study of 13 social work studentsâ perceptions of their relationship with a practice educator (PE) and 6 PEâs perceptions of these emotional experiences. Visual methodology was employed over a two-phased research project, first social work students were asked to draw an image of what they thought practice education looked like, phase two used photo eliciation, PEs were then asked to explore the meaning of these images. Results demonstrated that social work students focused on their own professional discourse, the identity of PEs, power relationship and dynamics between themselves and PEs, the disjointed journey and practice education in its entirity. Whilst the PEs shared their personal views of practice education and reflected on this, both groups had a shared understanding of practice education including its values and frustrations. Keywords: social work placements, visual methodology, practice educator
Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation
Background: Reducing avoidable harm in maternity services is a priority globally. As well as learning from mistakes, it is important to produce rigorous descriptions of âwhat good looks likeâ. Objective: We aimed to characterise features of safety in maternity units and to generate a plain language framework that could be used to guide learning and improvement. Methods: We conducted a multisite ethnography involving 401 hours of non-participant observations 33 semistructured interviews with staff across six maternity units, and a stakeholder consultation involving 65 semistructured telephone interviews and one focus group. Results: We identified seven features of safety in maternity units and summarised them into a framework, named For Us (For Unit Safety). The features include: (1) commitment to safety and improvement at all levels, with everyone involved; (2) technical competence, supported by formal training and informal learning; (3) teamwork, cooperation and positive working relationships; (4) constant reinforcing of safe, ethical and respectful behaviours; (5) multiple problem-sensing systems, used as basis of action; (6) systems and processes designed for safety, and regularly reviewed and optimised; (7) effective coordination and ability to mobilise quickly. These features appear to have a synergistic character, such that each feature is necessary but not sufficient on its own: the features operate in concert through multiple forms of feedback and amplification. Conclusions: This large qualitative study has enabled the generation of a new plain language frameworkâFor Usâthat identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units
Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study
Background:
The reduced renal function has prognostic significance in COVID-19 and it has been linked to mortality in the general population. Reduced renal function is prevalent in older age and thus we set out to better understand its effect on mortality.
Methods:
Patient clinical and demographic data was taken from the COVID-19 in Older People (COPE) study during two periods (FebruaryâJune 2020 and October 2020âMarch 2021, respectively). Kidney function on admission was measured using estimated glomerular filtration rate (eGFR). The primary outcomes were time to mortality and 28-day mortality. Secondary outcome was length of hospital stay. Data were analysed with multilevel Cox proportional hazards regression, and multilevel logistic regression and adjusted for individual patient clinical and demographic characteristics.
Results:
One thousand eight hundred two patients (55.0% male; median [IQR] 80 [73â86] years) were included in the study. 28-day mortality was 42.3% (n =â742). 48% (n =â801) had evidence of renal impairment on admission. Using a time-to-event analysis, reduced renal function was associated with increased in-hospital mortality (compared to eGFR â„ 60 [Stage 1&2]): eGFR 45â59 [Stage 3a] aHRâ=â1.26 (95%CI 1.02â1.55); eGFR 30â44 [Stage 3b] aHRâ=â1.41 (95%CI 1.14â1.73); eGFR 1â29 [Stage 4&5] aHRâ=â1.42 (95%CI 1.13â1.80). In the co-primary outcome of 28-day mortality, mortality was associated with: Stage 3a adjusted odds ratio (aOR)â=â1.18 (95%CI 0.88â1.58), Stage 3b aORâ=â1.40 (95%CI 1.03â1.89); and Stage 4&5 aORâ=â1.65 (95%CI 1.16â2.35).
Conclusion:
eGFR on admission is a good independent predictor of mortality in hospitalised older patients with COVID-19 population. We found evidence of a dose-response between reduced renal function and increased mortality