Anna Wilkinson

Bio: Anna Wilkinson is an academic researcher from University of Sheffield. The author has contributed to research in topics: Ezetimibe & Surrogate endpoint. The author has an hindex of 13, co-authored 18 publications receiving 991 citations. Previous affiliations of Anna Wilkinson include Sheffield Hallam University.

Effects of cigarette smoking upon clinical outcomes of assisted reproduction: a meta-analysis

Abstract: background: The aim of this meta-analysis was to investigate whether any difference exists in success rate of clinical outcomes of assisted reproductive technologies (ART) between women who actively smoke cigarettes at the time of treatment and those who do not. methods: An intensive computerized search was conducted on published literature from eight databases, using search terms related to smoking, assisted reproduction and outcome measures. Eligible studies compared outcomes of ART between cigarette smoking patients and a control group of non-smoking patients and reported on live birth rate per cycle, clinical pregnancy rate per cycle, ectopic pregnancy rate per pregnancy or spontaneous miscarriage rate per pregnancy, and 21 studies were included in the meta-analyses. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for the data, and statistical heterogeneity was tested for using x 2 and I 2 values. A systematic review examined the effect of smoking upon fertilization rates across 17 studies. results: Smoking patients demonstrated significantly lower odds of live birth per cycle (OR 0.54, 95% CI 0.30 -0.99), significantly lower odds of clinical pregnancy per cycle (OR 0.56, 95% CI 0.43- 0.73), significantly higher odds of spontaneous miscarriage (OR 2.65, 95% CI 1.33 -5.30) and significantly higher odds of ectopic pregnancy (OR 15.69, 95% CI 2.87 -85.76). A systematic literature review revealed that fertilization rates were not significantly different between smoking and non-smoking groups in most studies. conclusions: This meta-analysis provides compelling evidence for a significant negative effect of cigarette smoking upon clinical out- comes of ART and should be presented to infertility patients who smoke cigarettes in order to optimize success rates.

Taxanes for the adjuvant treatment of early breast cancer: systematic review and economic evaluation.

Abstract: Objectives To estimate the clinical effectiveness and cost-effectiveness of docetaxel and paclitaxel compared with non-taxane, anthracycline-containing chemotherapy regimens, for the adjuvant treatment of women with early-stage breast cancer. Data sources Major electronic databases were searched between October 2005 and February 2006. Review methods A systematic review of the literature on adjuvant taxane versus anthracycline non-taxane chemotherapy for women with early breast cancer was undertaken. A mathematical model was developed to synthesise the available data on costs, disease-free survival and health-related quality of life (HRQoL) of patients receiving taxane-containing chemotherapy versus non-taxane-containing chemotherapy. Results Eight of the 11 selected trials (six docetaxel and five paclitaxel) reported a significant improvement in disease-free survival (DFS) or time to recurrence (TTR) for taxanes over comparator regimens. Docetaxel was associated with more adverse events than paclitaxel, most notably febrile neutropenia. Taxanes produced cardiotoxicity, although this was not reported to be greater than for anthracycline comparator arms in all trials. Treatment-related deaths were uncommon. Where reported, all chemotherapy regimens caused HRQoL to deteriorate during treatment. Following treatment, there were no clinically significant differences between taxane and comparator treatment groups. There were few data available comparing licensed regimens of taxanes with chemotherapy regimens commonly used in the UK. The three trials selected as the basis for the economic analysis were those that used the taxanes in accordance with current UK marketing authorisation and had also reported in full. The estimated incremental cost-effectiveness ratio for docetaxel compared to FAC6, based on the BCIRG 001 study, is 12,000 pounds (7000-39,000 pounds) and for paclitaxel compared with Adriamycin/cyclophosphamide, based on the NSABP B28 and CALGB 9344 studies, is 43,000 pounds (16,000 pounds-dominated) and 39,000 pounds (12,000 pounds-dominated), respectively. However, the comparators used in these trials restrict the generalisability of the results, as they do not conform to current standard care in the UK, typically FEC6 and E4-CMF4. An exploratory indirect comparison shows that the benefits of taxane containing regimens compared to regimens in current use in the UK is subject to large uncertainty due to the lack of direct trial comparisons between these interventions. Assumptions regarding the benefits in the taxane arm after the trial follow-up period and the annual rate of recurrence in this period have the most significant influence on the ICER. Conclusions There is a large degree of heterogeneity in the evidence base for the effectiveness of taxane- compared with non-taxane-containing regimens in terms of the interventions, comparators and populations. Eight of the 11 trials providing effectiveness data reported a significant improvement in DFS or TTR for taxanes over comparator regimens. The remaining three trials found no significant differences between the groups in DFS/TTR. The cost-effectiveness results suggest that the cost per quality-adjusted life-year for taxane- compared with non-taxane-containing chemotherapy varies between 12,000 pounds and 43,000 pounds, depending on the taxane under consideration and the specific trial used as the basis of the analysis. However, the comparators used in these trials do not conform to current standard care in the UK. More research is needed, comparing taxanes used in line with their current UK marketing authorisation and with anthracycline-containing regimens commonly used in the UK. The on-going TACT trial is expected to provide useful data. There are currently few data on the effectiveness of taxanes for the over-70s. Further research is required into the long-term outcomes of taxane therapy, such as whether there are any long-term adverse events that significantly impact on overall survival or quality of life and whether the increases in DFS will translate into increases in overall survival.

Ezetimibe monotherapy for cholesterol lowering in 2,722 people: systematic review and meta-analysis of randomized controlled trials.

Abstract: . Objectives. To study the evidence on the efficacy and safety of ezetimibe monotherapy for the treatment of primary (heterozygous familial and non-familial) hypercholesterolaemia. Design. Systematic review and meta-analysis of randomized controlled trials (RCTs). Methods. Eleven electronic bibliographic databases covering the biomedical, scientific and grey literature were searched from inception and supplemented by contact with experts in the field. Two reviewers independently determined the eligibility of RCTs, with a minimum treatment duration of 12 weeks, which compared ezetimibe monotherapy (10 mg per day) with placebo. Results. In the absence of data from clinical outcome trials, surrogate endpoints such as changes in lipid concentrations were used as indicators of clinical outcomes. A meta-analysis of eight randomized, double-blind, placebo-controlled trials (all 12 weeks) showed that ezetimibe monotherapy was associated with a statistically significant mean reduction in LDL cholesterol (from baseline to endpoint) of −18.58%, (95% CI: −19.67 to −17.48, P < 0.00001) compared with placebo. Significant (P < 0.00001) changes were also found in total cholesterol (−13.46%, 95% CI: −14.22 to −12.70), HDL cholesterol (3.00%, 95% CI: 2.06–3.94) and triglyceride levels (−8.06%, 95% CI: −10.92 to −5.20). Ezetimibe monotherapy appeared to be well tolerated with a safety profile similar to placebo. Conclusions. In a meta-analysis restricted to short-term trials in hypercholesterolaemia, significant potentially favourable changes in lipid and lipoprotein levels relative to baseline occurred with ezetimibe monotherapy. Further long-term studies with cardiovascular and other clinical outcome data are needed to assess the efficacy and safety of ezetimibe more fully.

Motivating mobility: designing for lived motivation in stroke rehabilitation

Abstract: How to motivate and support behaviour change through design is becoming of increasing interest to the CHI community. In this paper, we present our experiences of building systems that motivate people to engage in upper limb rehabilitation exercise after stroke. We report on participatory design work with four stroke survivors to develop a holistic understanding of their motivation and rehabilitation needs, and to construct and deploy engaging interactive systems that satisfy these. We reflect on the limits of motivational theories in trying to design for the lived experience of motivation and highlight lessons learnt around: helping people articulate what motivates them; balancing work, duty, fun; supporting motivation over time; and understanding the wider social context. From these we identify design guidelines that can inform a toolkit approach to support both scalability and personalisability.

The role of education and training in achieving change in care homes: a literature review

Abstract: Care homes play a vital role in the provision of support for the frailest members of our society, and given the demographic trends their role will continue for the foreseeable future. However, there remain enduring concerns about the quality of care such homes provide. Training and education for staff are often seen as the key to raising standards and as such are widely promoted. This paper presents a conceptual review and synthesis of the literature on the role of education and training in initiating and supporting change in care homes. A systematic method to the identification of sources was adopted, and a rigorous three-stage approach to analysis applied. The review identifies the barriers and facilitators to change and concludes that education is a necessary but not a sufficient condition for success. Rather it is argued that the role and status of care homes needs to be raised, and that a relationship-centred approach to care adopted, which acknowledges the importance of attending to the need...