Publications by year
In Press
Merriel S (In Press). A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for Active Surveillance. BMC Urology
Merriel S, Hamilton W, Ball S, Hyde C (In Press). A prospective evaluation of the fourth be Clear on Cancer ‘Blood in Pee’ campaign in England. European Journal of Cancer Care
Bailey S, Green H, Merriel S, Oram R, Thirlwell C, Ruth K, Tyrrell J, Weedon M (In Press). Applying a genetic risk score for prostate cancer to men with lower urinary tract symptoms in primary care to predict prostate cancer diagnosis: a cohort study in the UK Biobank. British Journal of Cancer
Merriel SWD (In Press). Comparison of multiparametric magnetic resonance imaging and targeted biopsy with systematic biopsy alone for the diagnosis of prostate cancer. JAMA Network Open
Merriel S, Hamilton W (In Press). Experiences of ‘traditional’ and ‘one-stop’ MRI-based prostate cancer diagnostic pathways in England: a qualitative study with patients and GPs. BMJ Open
Merriel S, Martins T, Bailey S (In Press). Exploring the causes of death among patients with metastatic prostate cancer: a changing landscape. Jama Network Open
Merriel S, Hamilton W (In Press). Improving early cancer diagnosis in primary care. Prescriber
Merriel S (In Press). Lymphoma for GPs across the cancer continuum. InnovAiT
Merriel SWD, Gnanapragasam V (In Press). Prostate cancer treatment choices: the GP’s role in shared decision-making. British Journal of General Practice
Merriel SWD, Tsukagoshi S, Caesar S, Weaver R (In Press). Qualified GPs planning to work overseas: Go, enjoy yourself, and come back’. British Journal of General Practice
Merriel S (In Press). Retrospective cohort study evaluating clinical, biochemical and pharmacological prognostic factors for prostate cancer progression using primary care data. BMJ Open
Merriel SWD, Pocock L, Gilbert E, Creavin S, Walter FM, Spencer A, Hamilton W (In Press). Systematic Review & Meta-Analysis of the Diagnostic Accuracy of Prostate Specific Antigen (PSA) for the Detection of Prostate Cancer in Symptomatic Patients.
Abstract:
Systematic Review & Meta-Analysis of the Diagnostic Accuracy of Prostate Specific Antigen (PSA) for the Detection of Prostate Cancer in Symptomatic Patients
Abstract
. BackgroundProstate Specific Antigen (PSA) is a commonly used test to detect prostate cancer. Attention has mostly focused on the use of PSA in screening asymptomatic patients, but the diagnostic accuracy of PSA for prostate cancer in patients with symptoms is less well understood.MethodsA systematic database search was conducted of Medline, EMBASE, Web of Science, and the Cochrane library. Studies reporting the diagnostic accuracy of PSA for prostate cancer in patients with symptoms were included. Two investigators independently assessed the titles and abstracts of all database search hits and full texts of potentially relevant studies against the inclusion criteria, and data extracted into a proforma. Study quality was assessed using the QUADAS-2 tool by two investigators independently. Summary estimates of diagnostic accuracy were calculated with meta-analysis using bivariate mixed effects regression.Results563 search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. 19 studies met the inclusion criteria, 18 of which were conducted in secondary care settings (one from a screening study cohort). All studies used histology obtained by Transrectal Ultrasound guided biopsy (TRUS) as a reference test, usually only for patients with elevated PSA or abnormal prostate examination. Pooled data from 14,489 patients found estimated sensitivity of PSA for prostate cancer was 0.93 (95% CI 0.88, 0.96) and specificity was 0.20 (95% CI 0.12, 0.33). The area under the receiving-operator characteristic curve was 0.72 (95% CI 0.68, 0.76). All studies were assessed as having a high risk of bias in at least one QUADAS-2 domain.ConclusionsCurrently available evidence suggests PSA is highly sensitive but poorly specific for prostate cancer detection. However, significant limitations in study design and reference test reduces the certainty of this estimate. There is very limited evidence for the performance of PSA in primary care, the healthcare setting where most PSA testing is performed.
Abstract.
Merriel S, Hamilton W (In Press). Systemic anticancer therapies and the role of primary care. Prescriber
Merriel S (In Press). Why test study protocol: a UK-wide audit using the Primary Care Academic Collaborative to explore the reasons for primary care testing. British Journal of General Practice
2022
Green H, Merriel SWD, Oram R, Ruth K, Tyrrell J, Jones S, Thirlwell C, Gillings M, Weedon M, Bailey SER, et al (2022). Applying a genetic risk score for prostate cancer to men with lower urinary tract symptoms in primary care to predict prostate cancer diagnosis: a cohort study in the UK Biobank.
Abstract:
Applying a genetic risk score for prostate cancer to men with lower urinary tract symptoms in primary care to predict prostate cancer diagnosis: a cohort study in the UK Biobank
Objectives to assess how accurately a genetic risk score (GRS) can identify incident prostate cancer in men seeing their general practitioner with lower urinary tract symptoms. Design Cohort study. Setting UK Biobank data linked to primary care records. Participants Men registered with the UK Biobank, eligible for the primary care data linkage, with a record showing that they consulted their general practitioner with lower urinary tract symptoms (LUTS) that could indicate possible undiagnosed prostate cancer. Main outcome measures a diagnosis of prostate cancer within two years of the patient’s first consultation with their general practitioner for LUTS. Results a GRS is associated with prostate cancer in men with symptoms (OR=2.54 [2.16 to 2.99] p=5e-29). An integrated risk model including age and GRS applied to symptomatic men predicted prostate cancer with an AUC of 0.768 (0.739 to 0.796). Men aged 40 years and under in the bottom four GRS quintiles, aged 50 years and under in the bottom two GRS quintiles, and aged 50 to 60 years in the bottom GRS quintile had a two-year prostate cancer incidence below 1%, despite the presence of symptoms. The negative predictive value of the combined model exceeded 99%. Conclusions This study is the first to apply a genetic risk score in a clinical setting to improve the triage of men with symptoms of prostate cancer. It demonstrates the added benefit of incorporating an estimate of genetic risk of prostate cancer into the clinical assessment of symptomatic men in primary care. Assessment of prostate cancer risk in men with LUTS is currently based on presenting clinical features alone. Men with the lowest genetic risk of developing prostate cancer could safely avoid invasive investigation, with adequate safety netting, whilst those identified with the greatest risk could be fast-tracked for further investigation.
Abstract.
Merriel S (2022). Magnetic Resonance Imaging (MRI) for prostate cancer diagnosis in primary care.
Abstract:
Magnetic Resonance Imaging (MRI) for prostate cancer diagnosis in primary care
Background
Detection of prostate cancer in primary care relies on Digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA), both of which have significant limitations. Magnetic Resonance Imaging (MRI) has emerged as a diagnostic test for prostate cancer that is more accurate than existing tests but is currently only used in secondary care. This PhD aimed to examine the potential impact of prostate MRI on the diagnosis of prostate cancer in primary care.
Methods
I performed systematic reviews with narrative syntheses to examine the evidence on patient centred outcomes (PCOs) from diagnostic tests for prostate cancer, including MRI, and the cost-effectiveness of prostate cancer diagnostic pathways that incorporate pre-biopsy MRI. I undertook a qualitative study employing one-to-one interviews of patients who had undergone prostate MRI and GPs who had recently referred men with suspected prostate cancer for diagnostic testing to explore the acceptability of prostate MRI as a diagnostic test and experiences of the prostate cancer diagnostic pathway. I completed an early economic evaluation of primary care prostate cancer diagnostic pathways incorporating prostate MRI using decision analytic modelling informed by a linked data approach.
Results
Prostate MRI and MRI-guided biopsy have more favourable PCOs compared to standard prostate biopsy techniques. Prostate MRI met most key constructs of acceptability for patients, whilst GPs had a spectrum of knowledge and understanding of prostate MRI as a diagnostic test for prostate cancer. Published evidence suggests MRI-based prostate cancer diagnostic pathways are cost-effective, although no studies incorporated primary care data. Modelling suggests implementing prostate MRI in primary care could reduce costs involved with prostate cancer diagnosis, without a significant utility detriment for patients.
Conclusion
Incorporating MRI into primary care as a diagnostic test for prostate cancer could reduce costs for the NHS and is acceptable to patients. Prior to implementation in primary care, feasibility, comparable diagnostic accuracy, GPs’ clinical knowledge, and improved outcomes for patients must be demonstrated.
Abstract.
Hardy V, Yue A, Archer S, Merriel SWD, Thompson M, Emery J, Usher-Smith J, Walter FM (2022). Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review.
BMJ Open,
12(1), e053732-e053732.
Abstract:
Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review
BackgroundMissed opportunities for diagnosing cancer cause patients harm and have been attributed to suboptimal use of tests and referral pathways in primary care. Primary care physician (PCP) factors have been suggested to affect decisions to investigate cancer, but their influence is poorly understood.ObjectiveTo synthesise evidence evaluating the influence of PCP factors on decisions to investigate symptoms of possible cancer.MethodsWe searched MEDLINE, Embase, Scopus, CINAHL and PsycINFO between January 1990 and March 2021 for relevant citations. Studies examining the effect or perceptions and experiences of PCP factors on use of tests and referrals for symptomatic patients with any cancer were included. PCP factors comprised personal characteristics and attributes of physicians in clinical practice.Data extraction and synthesisCritical appraisal and data extraction were undertaken independently by two authors. Due to study heterogeneity, data could not be statistically pooled. We, therefore, performed a narrative synthesis.Results29 studies were included. Most studies were conducted in European countries. A total of 11 PCP factors were identified comprising modifiable and non-modifiable factors. Clinical judgement of symptoms as suspicious or 'alarm' prompted more investigations than non-alarm symptoms. ‘Gut feeling’ predicted a subsequent cancer diagnosis and was perceived to facilitate decisions to investigate non-specific symptoms as PCP experience increased. Female PCPs investigated cancer more than male PCPs. The effect of PCP age and years of experience on testing and referral decisions was inconclusive.ConclusionsPCP interpretation of symptoms as higher risk facilitated testing and referral decisions for possible cancer. However, in the absence of 'alarm' symptoms or ‘gut feeling’, PCPs may not investigate cancer. PCPs require strategies for identifying patients with non-alarm and non-specific symptoms who need testing or referral.PROSPERO registration numberCRD420191560515.
Abstract.
Merriel SWD, Pocock L, Gilbert E, Creavin S, Walter FM, Spencer A, Hamilton W (2022). Systematic review and meta-analysis of the diagnostic accuracy of prostate-specific antigen (PSA) for the detection of prostate cancer in symptomatic patients.
BMC Medicine,
20(1).
Abstract:
Systematic review and meta-analysis of the diagnostic accuracy of prostate-specific antigen (PSA) for the detection of prostate cancer in symptomatic patients
Abstract
. Background
. Prostate-specific antigen (PSA) is a commonly used test to detect prostate cancer. Attention has mostly focused on the use of PSA in screening asymptomatic patients, but the diagnostic accuracy of PSA for prostate cancer in patients with symptoms is less well understood.
.
. Methods
. A systematic database search was conducted of Medline, EMBASE, Web of Science, and the Cochrane library. Studies reporting the diagnostic accuracy of PSA for prostate cancer in patients with symptoms were included. Two investigators independently assessed the titles and abstracts of all database search hits and full texts of potentially relevant studies against the inclusion criteria, and data extracted into a proforma. Study quality was assessed using the QUADAS-2 tool by two investigators independently. Summary estimates of diagnostic accuracy were calculated with meta-analysis using bivariate mixed effects regression.
.
. Results
. Five hundred sixty-three search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. Nineteen studies met the inclusion criteria, 18 of which were conducted in secondary care settings with one from a screening study cohort. All studies used histology obtained by transrectal ultrasound-guided biopsy (TRUS) as a reference test; usually only for patients with elevated PSA or abnormal prostate examination. Pooled data from 14,489 patients found estimated sensitivity of PSA for prostate cancer was 0.93 (95% CI 0.88, 0.96) and specificity was 0.20 (95% CI 0.12, 0.33). The area under the hierarchical summary receiver operator characteristic curve was 0.72 (95% CI 0.68, 0.76). All studies were assessed as having a high risk of bias in at least one QUADAS-2 domain.
.
. Conclusions
. Currently available evidence suggests PSA is highly sensitive but poorly specific for prostate cancer detection in symptomatic patients. However, significant limitations in study design and reference test reduces the certainty of this estimate. There is very limited evidence for the performance of PSA in primary care, the healthcare setting where most PSA testing is performed.
.
Abstract.
2021
Merriel SW, Lee L, Neal R (2021). Community diagnostic centres: bringing diagnostics closer to home.
Br J Gen Pract,
71(713), 534-535.
Author URL.
2020
Duncan P, Payne RA, Merriel S (2020). A new collaborative model of primary care research: could it provide trainees and clinicians with more opportunities to get involved?. British Journal of General Practice, 70(698), 430-431.
Merriel S, Moon D, Dundee P, Corcoran N, Carroll P, Partin A, Smith J, Hamdy F, Moore C, Ost P, et al (2020). Active Surveillance in 2020: a modified Delphi study to develop a practical guide for selecting patients with prostate cancer for Active Surveillance.
Merriel SWD (2020). Active surveillance for prostate cancer: an update. Trends in Urology and Men’s Health
Merriel SWD, Hardy V, Thompson MJ, Walter FM, Hamilton W (2020). Patient-Centered Outcomes from Multiparametric MRI and MRI-Guided Biopsy for Prostate Cancer: a Systematic Review.
J Am Coll Radiol,
17(4), 486-495.
Abstract:
Patient-Centered Outcomes from Multiparametric MRI and MRI-Guided Biopsy for Prostate Cancer: a Systematic Review.
OBJECTIVE: to identify and characterize patient-centered outcomes (PCOs) relating to multiparametric MRI (mpMRI) and MRI-guided biopsy as diagnostic tests for possible prostate cancer. METHODS: Medline via OVID, EMBASE, PsycInfo, and the Cochrane Central register of Controlled Trials (CENTRAL) were searched for relevant articles. Hand searching of reference lists and snowballing techniques were performed. Studies of mpMRI and MRI-guided biopsy that measured any PCO were included. There were no restrictions placed on year of publication, language, or country for study inclusion. All database search hits were screened independently by two reviewers, and data were extracted using a standardized form. RESULTS: Overall, 2,762 database search hits were screened based on title and abstract. of these, 222 full-text articles were assessed, and 10 studies met the inclusion criteria. There were 2,192 participants featured in the included studies, all of which were conducted in high-income countries. Nineteen different PCOs were measured, with a median of four PCOs per study (range 1-11). Urethral bleeding, pain, and urinary tract infection were the most common outcomes measured. In the four studies that compared mpMRI or MRI-guided biopsy to transrectal ultrasound biopsy, most adverse outcomes occurred less frequently in MRI-related tests. These four studies were assessed as having a low risk of bias. DISCUSSION: PCOs measured in studies of mpMRI or MRI-guided biopsy thus far have mostly been physical outcomes, with some evidence that MRI tests are associated with less frequent adverse outcomes compared with transrectal ultrasound biopsy. There was very little evidence for the effect of mpMRI and MRI-guided biopsy on emotional, cognitive, social, or behavioral outcomes.
Abstract.
Author URL.
Martins T, Merriel SWD, Hamilton W (2020). Routes to diagnosis of symptomatic cancer in sub-Saharan Africa: systematic review.
BMJ Open,
10(11), e038605-e038605.
Abstract:
Routes to diagnosis of symptomatic cancer in sub-Saharan Africa: systematic review
BackgroundMost cancers in sub-Saharan Africa (SSA) are diagnosed at advanced stages, with limited treatment options and poor outcomes. Part of this may be linked to various events occurring in patients’ journey to diagnosis. Using the model of pathways to treatment, we examined the evidence regarding the routes to cancer diagnosis in SSA.Design and settingsA systematic review of available literature was performed.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Between 30 September and 30 November 2019, seven electronic databases were searched using terms relating to SSA countries, cancer and routes to diagnosis comprising the population, exposure and outcomes, respectively. Citation lists of included studies were manually searched to identify relevant studies. Furthermore, ProQuest Dissertations & Theses Global was searched to identify appropriate grey literature on the subject.Results18 of 5083 references identified met the inclusion criteria: eight focused on breast cancer; three focused on cervical cancer; two each focused on lymphoma, Kaposi’s sarcoma and childhood cancers; and one focused on colorectal cancer. With the exception of Kaposi’s sarcoma, definitive diagnoses were made in tertiary healthcare centres, including teaching and regional hospitals. The majority of participants initially consulted within primary care, although a considerable proportion first used complementary medicine before seeking conventional medical help. The quality of included studies was a major concern, but their findings provided important insight into the pathways to cancer diagnosis in the region.ConclusionThe proportion of patients who initially use complementary medicine in their cancer journey may explain a fraction of advanced-stage diagnosis and poor survival of cancer in SSA. However, further research would be necessary to fully understand the exact role (or activities) of primary care and alternative care providers in patient cancer journeys.
Abstract.
2019
Merriel SWD, Hetherington L, Seggie A, Castle JT, Cross W, Roobol MJ, Gnanapragasam V, Moore CM, Prostate Cancer UK Expert Reference Group on Active Surveillance (2019). Best practice in active surveillance for men with prostate cancer: a Prostate Cancer UK consensus statement.
BJU Int,
124(1), 47-54.
Abstract:
Best practice in active surveillance for men with prostate cancer: a Prostate Cancer UK consensus statement.
OBJECTIVES: to develop a consensus statement on current best practice of active surveillance (AS) in the UK, informed by patients and clinical experts. SUBJECTS AND METHODS: a consensus statement was drafted on the basis of three sources of data: systematic literature search of national and international guidelines; data arising from a Freedom of Information Act request to UK urology departments regarding their current practice of AS; and survey and interview responses from men with localized prostate cancer regarding their experiences and views of AS. The Prostate Cancer UK Expert Reference Group (ERG) on AS was then convened to discuss and refine the statement. RESULTS: Guidelines and protocols for AS varied significantly in terms of risk stratification, criteria for offering AS, and protocols for AS between and within countries. Patients and healthcare professionals identified clinical, emotional and process needs for AS to be effective. Men with prostate cancer wanted more information and psychological support at the time of discussing AS with the treating team and in the first 2 years of AS, and a named healthcare professional to discuss any questions or concerns they had. The ERG agreed 30 consensus statements regarding best practice for AS. Statements were grouped under headings: 'Inclusion/Exclusion Criteria'; 'AS follow-up protocol' and 'When to stop AS'. CONCLUSION: Significant variation currently exists in the practice of AS in the UK and internationally. Men have clear views on the level of involvement in treatment decisions and support from their treating professionals when receiving AS. The Prostate Cancer UK AS ERG has developed a set of consensus statements for best practice in AS. Evidence for best practice in AS, and the use of multiparametric magnetic resonance imaging in AS, is still evolving, and further studies are needed to determine how to optimize AS outcomes.
Abstract.
Author URL.
Elwenspoek MMC, Sheppard AL, McInnes MDF, Merriel SWD, Rowe EWJ, Bryant RJ, Donovan JL, Whiting P (2019). Comparison of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy with Systematic Biopsy Alone for the Diagnosis of Prostate Cancer: a Systematic Review and Meta-analysis.
JAMA Netw Open,
2(8).
Abstract:
Comparison of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy with Systematic Biopsy Alone for the Diagnosis of Prostate Cancer: a Systematic Review and Meta-analysis.
Importance: the current diagnostic pathway for patients with suspected prostate cancer (PCa) includes prostate biopsy. A large proportion of individuals who undergo biopsy have either no PCa or low-risk disease that does not require treatment. Unnecessary biopsies may potentially be avoided with prebiopsy imaging. Objective: to compare the performance of systematic transrectal ultrasonography-guided prostate biopsy vs prebiopsy biparametric or multiparametric magnetic resonance imaging (MRI) followed by targeted biopsy with or without systematic biopsy. Data Sources: MEDLINE, Embase, Cochrane, Web of Science, clinical trial registries, and reference lists of recent reviews were searched through December 2018 for randomized clinical trials using the terms "prostate cancer" and "MRI." Study Selection: Randomized clinical trials comparing diagnostic pathways including prebiopsy MRI vs systematic transrectal ultrasonography-guided biopsy in biopsy-naive men with a clinical suspicion of PCa. Data Extraction and Synthesis: Data were pooled using random-effects meta-analysis. Risk of bias was assessed using the revised Cochrane tool. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. All review stages were conducted by 2 reviewers. Main Outcomes and Measures: Detection rate of clinically significant and insignificant PCa, number of biopsy procedures, number of biopsy cores taken, and complications. Results: Seven high-quality trials (2582 patients) were included. Compared with systematic transrectal ultrasonography-guided biopsy alone, MRI with or without targeted biopsy was associated with a 57% (95% CI, 2%-141%) improvement in the detection of clinically significant PCa, a 33% (95% CI, 23%-45%) potential reduction in the number of biopsy procedures, and a 77% (95% CI, 60%-93%) reduction in the number of cores taken per procedure. One trial showed reduced pain and bleeding adverse effects. Systematic sampling of the prostate in addition to the acquisition of targeted cores did not significantly improve the detection of clinically significant PCa compared with systematic biopsy alone. Conclusions and Relevance: in this meta-analysis, prebiopsy MRI combined with targeted biopsy vs systematic transrectal ultrasonography-guided biopsy alone was associated with improved detection of clinically significant PCa, despite substantial heterogeneity among trials. Prebiopsy MRI was associated with a reduced number of individual biopsy cores taken per procedure and with reduced adverse effects, and it potentially prevented unnecessary biopsies in some individuals. This evidence supports implementation of prebiopsy MRI into diagnostic pathways for suspected PCa.
Abstract.
Author URL.
Kesten JM, Flannagan C, Ruane-McAteer E, Merriel SWD, Nadarzynski T, Shapiro G, Rosberger Z, Prue G (2019). Mixed-methods study in England and Northern Ireland to understand young men who have sex with men's knowledge and attitudes towards human papillomavirus vaccination.
BMJ Open,
9(5).
Abstract:
Mixed-methods study in England and Northern Ireland to understand young men who have sex with men's knowledge and attitudes towards human papillomavirus vaccination.
OBJECTIVES: Men who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when received prior to sexual debut, at genitourinary medicine clinics in the UK. In September 2019, the national HPV vaccination programme will be extended to boys. This study aimed to understand young MSM's (YMSM) knowledge and attitudes towards HPV vaccination. DESIGN: Questionnaires assessed YMSM demographics, sexual behaviour, culture, knowledge and attitudes towards HPV vaccination and stage of vaccine decision-making using the precaution adoption process model. Focus groups explored sexual health information sources, attitudes, barriers and facilitators to vaccination and strategies to support vaccination uptake. Questionnaire data were analysed using descriptive statistics and focus group data were analysed thematically. SETTING: Questionnaires were completed online or on paper. Focus groups were conducted within Lesbian Gay Bisexual Transgender Queer organisational settings and a university student's union in England and Northern Ireland. PARTICIPANTS: Seventeen YMSM (M=20.5 years) participated in four focus groups and 51 (M=21.1 years) completed questionnaires. RESULTS: over half of YMSM were aware of HPV (54.9%), yet few (21.6%) had previously discussed vaccination with a healthcare professional (HCP). Thematic analyses found YMSM were willing to receive the HPV vaccine. Vaccination programmes requiring YMSM to request the vaccine, particularly prior to sexual orientation disclosure to family and friends, were viewed as unfeasible. Educational campaigns explaining vaccine benefits were indicated as a way to encourage uptake. CONCLUSIONS: This study suggests that to effectively implement HPV vaccination for YMSM, this population requires clearer information and greater discussion with their HCP. In support of the decision made by the Joint Committee on Vaccination and Immunisation, universal vaccination is the most feasible and equitable option. However, the absence of a catch-up programme will leave a significant number of YMSM at risk of HPV infection.
Abstract.
Author URL.
2018
Prue GE, Flannagan C, Ruane-McAteer E, Merriel SWD, Nadarzynski T, Shapiro GK, Rosberger Z, Kesten JM (2018). "The only way round it is if every male child is vaccinated"; exploring the views of young men-who-have-sex-with-men towards HPV vaccination: a qualitative study.
Author URL.
Merriel SW, Nadarzynski T, Kesten JM, Flannagan C, Prue G (2018). 'Jabs for the boys': time to deliver on HPV vaccination recommendations.
Br J Gen Pract,
68(674), 406-407.
Author URL.
Merriel SWD, Flannagan C, Kesten JM, Shapiro GK, Nadarzynski T, Prue G (2018). Knowledge and Attitudes of General Practitioners and Sexual Health Care Professionals Regarding Human Papillomavirus Vaccination for Young Men Who Have Sex with Men.
Int J Environ Res Public Health,
15(1).
Abstract:
Knowledge and Attitudes of General Practitioners and Sexual Health Care Professionals Regarding Human Papillomavirus Vaccination for Young Men Who Have Sex with Men.
Men who have sex with men (MSM) may be at higher risk for human papillomavirus (HPV)-associated cancers. Healthcare professionals' recommendations can affect HPV vaccination uptake. Since 2016, MSM up to 45 years have been offered HPV vaccination at genitourinary medicine (GUM) clinics in a pilot programme, and primary care was recommended as a setting for opportunistic vaccination. Vaccination prior to potential exposure to the virus (i.e. sexual debut) is likely to be most efficacious, therefore a focus on young MSM (YMSM) is important. This study aimed to explore and compare the knowledge and attitudes of UK General Practitioners (GPs) and sexual healthcare professionals (SHCPs) regarding HPV vaccination for YMSM (age 16-24). A cross-sectional study using an online questionnaire examined 38 GPs and 49 SHCPs, including 59 (67.82%) females with a mean age of 40.71 years. Twenty-two participants (20 SHCPs, p < 0.001) had vaccinated a YMSM patient against HPV. GPs lack of time (25/38, 65.79%) and SHCP staff availability (27/49, 55.10%) were the main reported factors preventing YMSM HPV vaccination. GPs were less likely than SHCPs to believe there was sufficient evidence for vaccinating YMSM (OR = 0.02, 95% CI = 0.01, 0.47); less likely to have skills to identify YMSM who may benefit from vaccination (OR = 0.03, 95% CI = 0.01, 0.15); and less confident recommending YMSM vaccination (OR = 0.01, 95% CI = 0.00, 0.01). GPs appear to have different knowledge, attitudes, and skills regarding YMSM HPV vaccination when compared to SHCPs.
Abstract.
Author URL.
Nicholson BD, Shinkins B, Price S, Verbakel JY, Merriel S (2018). National cancer control plans. The Lancet Oncology, 19(12).
Romero Y, Trapani D, Johnson S, Tittenbrun Z, Given L, Hohman K, Stevens L, Torode JS, Boniol M, Ilbawi AM, et al (2018). National cancer control plans: a global analysis. The Lancet Oncology, 19(10), e546-e555.
Merriel SWD, May MT, Martin RM (2018). Predicting prostate cancer progression: protocol for a retrospective cohort study to identify prognostic factors for prostate cancer outcomes using routine primary care data.
BMJ Open,
8(1).
Abstract:
Predicting prostate cancer progression: protocol for a retrospective cohort study to identify prognostic factors for prostate cancer outcomes using routine primary care data.
INTRODUCTION: Prostate cancer is the most common cancer in men in the UK, with nearly 40 000 diagnosed in 2014; and it is the second most common cause of male cancer-related mortality. The clinical conundrum is that most men live with prostate cancer rather than die from it, while existing treatments have significant associated morbidity. Recent studies have shown very low mortality rates (1% after a median of 10-year follow-up) and no treatment-related reductions in mortality, in men with localised prostate cancer. This study will identify prognostic factors associated with prostate cancer progression to help differentiate aggressive from more indolent tumours in men with localised disease at diagnosis, and so inform the decision to adopt conservative (active surveillance) or radical (surgery or radiotherapy) management strategies. METHODS AND ANALYSIS: the Clinical Practice Research Datalink (CPRD) contains 57 318 men who were diagnosed with prostate cancer between 1 January 1987 and 31 December 2016. These men will be linked to the Office for National Statistics (ONS) and the National Cancer Registration and Analysis Service registry databases for mortality, TNM stage, Gleason grade and treatment data. Men with a diagnosis date prior to 1 January 1987 and men with lymph node or distant metastases at diagnosis will be excluded. A priori determined prognostic factors potentially associated with prostate cancer mortality, the end point of cancer progression, will be measured at baseline, and the participants followed through to development of cancer progression, death or the end of the follow-up period (31 December 2016). Cox proportional hazards regression will be used to estimate crude and mutually adjusted HRs. Mortality risk will be predicted using flexible parametric survival models that can accurately fit the shape of the hazard function. ETHICS AND DISSEMINATION: This study protocol has approval from the Independent Scientific Advisory Committee for the UK Medicines and Healthcare products Regulatory Agency Database Research (protocol 17_041). The findings will be presented in peer-reviewed journals and local CPRD researcher meetings.
Abstract.
Author URL.
Merriel SWD, Funston G, Hamilton W (2018). Prostate Cancer in Primary Care.
Adv Ther,
35(9), 1285-1294.
Abstract:
Prostate Cancer in Primary Care.
Prostate cancer is a common malignancy seen worldwide. The incidence has risen in recent decades, mainly fuelled by more widespread use of prostate-specific antigen (PSA) testing, although prostate cancer mortality rates have remained relatively static over that time period. A man's risk of prostate cancer is affected by his age and family history of the disease. Men with prostate cancer generally present symptomatically in primary care settings, although some diagnoses are made in asymptomatic men undergoing opportunistic PSA screening. Symptoms traditionally thought to correlate with prostate cancer include lower urinary tract symptoms (LUTS), such as nocturia and poor urinary stream, erectile dysfunction and visible haematuria. However, there is significant crossover in symptoms between prostate cancer and benign conditions affecting the prostate such as benign prostatic hypertrophy (BPH) and prostatitis, making it very challenging to distinguish between them on the basis of symptoms. The evidence for the performance of PSA in asymptomatic and symptomatic men for the diagnosis of prostate cancer is equivocal. PSA is subject to false positive and false negative results, affecting its clinical utility as a standalone test. Clinicians need to counsel men about the risks and benefits of PSA testing to inform their decision-making. Digital rectal examination (DRE) by primary care clinicians has some evidence to show discrimination between benign and malignant conditions affecting the prostate. Patients referred to secondary care for diagnostic testing for prostate cancer will typically undergo a transrectal or transperineal biopsy, where a number of samples are taken and sent for histological examination. These biopsies are invasive procedures with side effects and a risk of infection and sepsis, and alternative tests such as multiparametric magnetic resonance imaging (mpMRI) are currently being trialled for their accuracy and safety in diagnosing clinically significant prostate cancer.
Abstract.
Author URL.
2017
(2017). Abstracts of the 2017 World Congress of Psycho-Oncology, 14-18 August 2017, Berlin, Germany.
Psychooncology,
26 Suppl 3, 3-167.
Author URL.
Merriel SWD, Turner EL, Walsh E, Young GJ, Metcalfe C, Hounsome L, Tudge I, Donovan J, Hamdy F, Neal D, et al (2017). Cross-sectional study evaluating data quality of the National Cancer Registration and Analysis Service (NCRAS) prostate cancer registry data using the Cluster randomised trial of PSA testing for Prostate cancer (CAP).
BMJ Open,
7(11).
Abstract:
Cross-sectional study evaluating data quality of the National Cancer Registration and Analysis Service (NCRAS) prostate cancer registry data using the Cluster randomised trial of PSA testing for Prostate cancer (CAP).
OBJECTIVES: to compare the completeness and agreement of prostate cancer data recorded by the National Cancer Registration and Analysis Service (NCRAS) with research-level data specifically abstracted from medical records from the Cluster randomised triAl of prostate specific antigen (PSA) testing for Prostate cancer (CAP) trial. DESIGN: Cross-sectional comparison study. PARTICIPANTS: We included 1356 men from the CAP trial cohort who were linked to the NCRAS registry. PRIMARY AND SECONDARY OUTCOME MEASURES: Completeness of prostate cancer data in NCRAS and CAP and agreement for tumour, node, metastases (TNM) stage (T1/T2; T3; T4/N1/M1) and Gleason grade (4-6; 7; 8-10), measured by differences in proportions and Cohen's kappa statistic. Data were also stratified by year and pre-2010 versus post-2010, when NCRAS reporting standards changed. RESULTS: Compared with CAP, completeness was lower in NCRAS for Gleason grade (41.2% vs 76.7%, difference 35.5, 95% CI 32.1 to 39.0) and TNM stage (29.9% vs 67.6%, difference 37.6, 95% CI 34.1 to 41.1). NCRAS completeness for Gleason grade (pre-2010 vs post-2010 31.69% vs 64%; difference 32.31, 95% CI 26.76 to 37.87) and TNM stage (19.31% vs 55.50%; difference 36.19, 95% CI 30.72 to 41.67) improved over time. Agreement for Gleason grade was high (Cohen's kappa, κ=0.90, 95% CI 0.88 to 0.93), but lower for TNM stage (κ=0.41, 95% CI 0.37 to 0.51) overall. There was a trend towards improved agreement on Gleason grade, but not TNM stage, when comparing pre-2010 and post-2010 data. CONCLUSION: NCRAS case identification was very high; however, data on prostate cancer grade was less complete than CAP, and agreement for TNM stage was modest. Although the completeness of NCRAS data has improved since 2010, the higher completeness rate in CAP demonstrates that gains could potentially be achieved in routine registry data. This study's findings highlight a need for improved recording of stage and grade data in the source medical records.
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Fildes A, Aicken C, Merriel SWD, Llewellyn C (2017). Developing a communication toolbox for primary care practitioners to raise the issue of weight with parents of preschool children: a qualitative study.
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Lim RS, Evans L, George AP, de Alwis N, Stimpson P, Merriel S, Giddings CEB, Billah B, Smith JA, Safdar A, et al (2017). Do demographics and tumour-related factors affect nodal yield at neck dissection? a retrospective cohort study.
J Laryngol Otol,
131(S1), S36-S40.
Abstract:
Do demographics and tumour-related factors affect nodal yield at neck dissection? a retrospective cohort study.
BACKGROUND: Nodal metastasis is an important prognostic factor in head and neck squamous cell carcinoma. This study aimed to determine the average nodal basin yield per level of neck dissection, and to investigate if age, gender, body mass index, tumour size, depth of tumour invasion and p16 status influence nodal yield. METHOD: a retrospective review of 185 patients with head and neck squamous cell carcinoma generated 240 neck dissection specimens. RESULTS: the respective mean nodal yields for levels I, II, III, IV and V were 5.27, 9.43, 8.49, 7.43 and 9.02 in non-cutaneous squamous cell carcinoma patients, and 4.2, 7.57, 9.65, 4.33 and 12.29 in cutaneous squamous cell carcinoma patients. Multiple regression analysis revealed that p16-positive patients with mucosal squamous cell carcinoma yielded, on average, 2.4 more nodes than their p16-negative peers (p = 0.04, 95 per cent confidence interval = 0.116 to 4.693). This figure was 3.84 (p = 0.008, 95 per cent confidence interval = 1.070 to 6.605) for p16-positive patients with oral cavity squamous cell carcinoma. CONCLUSION: in mucosal squamous cell carcinoma, p16-positive status significantly influenced nodal yield, with the impact being more pronounced in oral cavity squamous cell carcinoma patients.
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Prue G, Flannagan C, Kesten J, Merriel S, Shapiro G, Rosberger Z (2017). Exploring views regarding targeted HPV vaccination in young men who have sex with men and their healthcare professionals.
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Merriel A, Murove BT, Merriel SWD, Sibanda T, Moyo S, Crofts J (2017). Implementation of a modified obstetric early warning system to improve the quality of obstetric care in Zimbabwe.
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS,
136(2), 175-179.
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Merriel SWD (2017). Management of angina in primary care.
Nurse Prescribing,
15(10), 492-497.
Abstract:
Management of angina in primary care
Angina pectoris is chest pain due to insufficient coronary artery blood flow and/or increased myocardial oxygen demand. In 2012, angina affected 3.05% of men and 1.79% of women in the UK. Stable angina is a chronic disease that can progress to unstable angina or myocardial infarction. Lifestyle modification, medications, and cardiac intervention/cardiothoracic surgery all play a part in its management. Patients with angina are mostly managed in primary care, where the focus of care is on maintaining quality of life and preventing disease progression.
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2016
Merriel SWD, Carroll R, Hamilton F, Hamilton W (2016). Association between unexplained hypoalbuminaemia and new cancer diagnoses in UK primary care patients.
Fam Pract,
33(5), 449-452.
Abstract:
Association between unexplained hypoalbuminaemia and new cancer diagnoses in UK primary care patients.
BACKGROUND: the association between hypoalbuminaemia and a new diagnosis of cancer is as yet unknown. OBJECTIVE: This study aimed to assess whether unexplained hypoalbuminaemia was associated with an increased risk of subsequent new cancer diagnosis within the next 12 months. METHODS: a cohort study was performed using a large UK database of adult primary care patients. Patients with a serum albumin test, either low or normal, were followed for 12 months for a new diagnosis of non-skin cancer. Logistic regression was used to assess for relationships between hypoalbuminaemia and cancer diagnoses. RESULTS: a total of 100 122 participants had at least one albumin test result. of these, 5753 (5.75%) had a result
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Merriel A, van der Nelson H, Merriel S, Bennett J, Donald F, Draycott T, Siassakos D (2016). Identifying Deteriorating Patients Through Multidisciplinary Team Training.
Am J Med Qual,
31(6), 589-595.
Abstract:
Identifying Deteriorating Patients Through Multidisciplinary Team Training.
Multidisciplinary training has improved maternity outcomes when the training has been well attended, regular, in house, used high-fidelity simulators, and integrated teamwork training. If these principles were used in other settings, better clinical care may result. This before-after study sought to establish whether a short multidisciplinary training intervention can improve recognition of the deteriorating patient using an aggregated physiological parameter scoring system (Early Warning Score [EWS]). Nursing, medical, and allied nursing staff participated in an hour-long training session, using real-life scenarios with simple tools and structured debriefing. After training, staff were more likely to calculate EWS scores correctly (68.02% vs 55.12%; risk ratio [RR] = 1.24, 95% confidence interval [CI] = 1.07-1.44), and observations were more likely to be performed at the correct frequency (78.57% vs 68.09%; RR = 1.20, 95% CI = 1.09-1.32). Multidisciplinary training, according to core principles, can lead to more accurate identification of deteriorating patients, with implications for subsequent care and outcome.
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Merriel SWD, Turner EL, Walsh E, Young G, Metcalfe C, Hounsome L, Tudge I, Donovan J, Hamdy F, Neal D, et al (2016). Validation of the National Cancer Registration and Analysis Service prostate cancer registry with data from the CAP study.
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2015
Merriel S (2015). Critically appraising the evidence.
InnovAiT: Education and inspiration for general practice,
8(9), 562-568.
Abstract:
Critically appraising the evidence
the ability to understand and analyse a research paper and decide whether it should change your clinical practice is a key skill in providing evidence-based medicine. As GPs, we need to stay abreast of the latest developments in medical research across all disciplines by appraising evidence that is presented to us in a critical and efficient manner. This article aims to refresh your knowledge of statistics and study design, explain the process of critical appraisal, and present resources that can assist you in analysing research articles.
Abstract.
Merriel SWD, Salisbury C, Metcalfe C, Ridd M (2015). Depth of the patient-doctor relationship and content of general practice consultations: cross-sectional study.
BRITISH JOURNAL OF GENERAL PRACTICE,
65(637), E545-E551.
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2014
Merriel SWD, Andrews V, Salisbury C (2014). Telehealth interventions for primary prevention of cardiovascular disease: a systematic review and meta-analysis.
PREVENTIVE MEDICINE,
64, 88-95.
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Merriel SWD, Andrews V, Salisbury C (2014). Telehealth interventions for primary prevention of cardiovascular disease: a systematic review and meta-analysis (vol 64, pg 88, 2014).
PREVENTIVE MEDICINE,
67, 343-343.
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