Christopher Palmer PhD

Chris Palmer


Publications:
2013
  The Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders
Fritz, Z, Malyon, A, Frankau, JM, Parker, RA, Cohn, S, Laroche, CM, Palmer, CR & Fuld, JP 2013, 'The Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: a mixed methods evaluation of the effects on clinical practice and patient care' PLoS One, vol 8, no. 9, pp. e70977. DOI: 10.1371/journal.pone.0070977

AIMS: To determine whether the introduction of the Universal Form of Treatment Options (the UFTO), as an alternative approach to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders, reduces harms in patients in whom a decision not to attempt cardiopulmonary resuscitation (CPR) was made, and to understand the mechanism for any observed change.

METHODS: A mixed-methods before-and-after study with contemporaneous case controls was conducted in an acute hospital. We examined DNACPR (103 patients with DNACPR orders in 530 admissions) and UFTO (118 decisions not to attempt resuscitation in 560 admissions) practice. The Global Trigger Tool was used to quantify harms. Qualitative interviews and observations were used to understand mechanisms and effects.

RESULTS: RATE OF HARMS IN PATIENTS FOR WHOM THERE WAS A DOCUMENTED DECISION NOT TO ATTEMPT CPR WAS REDUCED: Rate difference per 1000 patient-days was 12.9 (95% CI: 2.6-23.2, p-value=0.01). There was a difference in the proportion of harms contributing to patient death in the two periods (23/71 in the DNACPR period to 4/44 in the UFTO period (95% CI 7.8-36.1, p-value=0.006). Significant differences were maintained after adjustment for known confounders. No significant change was seen on contemporaneous case control wards. Interviews with clinicians and observation of ward practice revealed the UFTO helped provide clarity of goals of care and reduced negative associations with resuscitation decisions.

CONCLUSIONS: Introducing the UFTO was associated with a significant reduction in harmful events in patients in whom a decision not to attempt CPR had been made. Coupled with supportive qualitative evidence, this indicates the UFTO improved care for this vulnerable group.

TRIAL REGISTRATION: Controlled-Trials.com ISRCTN85474986 UK Comprehensive Research Network Portfolio 7932.


General Information
Organisations: Neuroinformatics DTC.
Authors: Fritz, Zoë, Malyon, Alexandra, Frankau, Jude M, Parker, Richard A, Cohn, Simon, Laroche, Clare M, Palmer, Chris R & Fuld, Jonathan P.
Keywords: (Cardiopulmonary Resuscitation, Decision Making, Humans, Resuscitation Orders. )
Pages: e70977
Publication Date: 2013
Publication Information
Category: Article
Journal: PLoS One
Volume: 8
Issue number: 9
ISSN: 1932-6203
Original Language: English
DOIs: 10.1371/journal.pone.0070977
2012
  A gene variant near ATM is significantly associated with metformin treatment response in type 2 diabetes
van Leeuwen, N, Nijpels, G, Becker, ML, Deshmukh, H, Zhou, K, Stricker, BHC, Uitterlinden, AG, Hofman, A, van 't Riet, E, Palmer, CNA, Guigas, B, Slagboom, PE, Durrington, P, Calle, RA, Neil, A, Hitman, G, Livingstone, SJ, Colhoun, H, Holman, RR, McCarthy, MI, Dekker, JM, 't Hart, LM & Pearson, ER 2012, 'A gene variant near ATM is significantly associated with metformin treatment response in type 2 diabetes: a replication and meta-analysis of five cohorts' Diabetologia, vol 55, no. 7, pp. 1971-7. DOI: 10.1007/s00125-012-2537-x

AIMS/HYPOTHESIS: In this study we aimed to replicate the previously reported association between the glycaemic response to metformin and the SNP rs11212617 at a locus that includes the ataxia telangiectasia mutated (ATM) gene in multiple additional populations.

METHODS: Incident users of metformin selected from the Diabetes Care System West-Friesland (DCS, n = 929) and the Rotterdam Study (n = 182) from the Netherlands, and the CARDS Trial (n = 254) from the UK were genotyped for rs11212617 and tested for an association with both HbA(1c) reduction and treatment success, defined as the ability to reach the treatment target of an HbA(1c) ? 7 % (53 mmol/mol). Finally, a meta-analysis including data from literature was performed.

RESULTS: In the DCS cohort, we observed an association between rs11212617 genotype and treatment success on metformin (OR 1.27, 95% CI 1.03, 1.58, p = 0.028); in the smaller Rotterdam Study cohort, a numerically similar but non-significant trend was observed (OR 1.45, 95% CI 0.87, 2.39, p = 0.15); while in the CARDS cohort there was no significant association. In meta-analyses of these three cohorts separately or combined with the previously published cohorts, rs11212617 genotype is associated with metformin treatment success (OR 1.24, 95% CI 1.04, 1.49, p = 0.016 and OR 1.25, 95% CI 1.33, 1.38, p = 7.8 × 10(-6), respectively).

CONCLUSIONS/INTERPRETATION: A gene variant near ATM is significantly associated with metformin treatment response in type 2 diabetic patients from the Netherlands and the UK. This is the first robustly replicated common susceptibility locus found to be associated with metformin treatment response.


General Information
Organisations: MRC Human Genetics Unit.
Authors: van Leeuwen, N, Nijpels, G, Becker, M L, Deshmukh, H, Zhou, K, Stricker, B H C, Uitterlinden, A G, Hofman, A, van 't Riet, E, Palmer, C N A, Guigas, B, Slagboom, P E, Durrington, P, Calle, R A, Neil, A, Hitman, G, Livingstone, S J, Colhoun, H, Holman, R R, McCarthy, M I, Dekker, J M, 't Hart, L M & Pearson, E R.
Keywords: (Aged, Cohort Studies, DNA Replication, Diabetes Mellitus, Type 2, Dose-Response Relationship, Drug, Female, Genome-Wide Association Study, Hemoglobin A, Glycosylated, Humans, Hypoglycemic Agents, Male, Metformin, Middle Aged, Netherlands, Polymorphism, Single Nucleotide, Prospective Studies, Treatment Outcome. )
Number of pages: 7
Pages: 1971-7
Publication Date: Jul 2012
Publication Information
Category: Article
Journal: Diabetologia
Volume: 55
Issue number: 7
ISSN: 0012-186X
Original Language: English
DOIs: 10.1007/s00125-012-2537-x
2011
  Common nonsynonymous substitutions in SLCO1B1 predispose to statin intolerance in routinely treated individuals with type 2 diabetes
Donnelly, LA, Doney, ASF, Tavendale, R, Lang, CC, Pearson, ER, Colhoun, HM, McCarthy, MI, Hattersley, AT, Morris, AD & Palmer, CNA 2011, 'Common nonsynonymous substitutions in SLCO1B1 predispose to statin intolerance in routinely treated individuals with type 2 diabetes' Clinical pharmacology and therapeutics, vol 89, no. 2, pp. 210-216. DOI: 10.1038/clpt.2010.255

SLCO1B1 gene variants are associated with severe statin-induced myopathy. We examined whether these variants are also associated with general statin intolerance in a large population of patients with type 2 diabetes receiving statins as part of routine clinical care. A total of 4,196 individuals were genotyped for rs4149056 (Val174Ala) and rs2306283 (Asp130Asn). Intolerance was defined by serum biochemistry and also by discontinuation, switching, or reduction in dose of the prescribed statin drug. Ala174 was associated with higher intolerance (odds ratio = 2.05, P = 0.043), whereas Asp130 was associated with lower intolerance (odds ratio = 0.71, P = 0.026). Ala174 was associated with a lower low-density lipoprotein cholesterol (LDLc) response to statins (P = 0.01) whereas 130D was associated with a greater LDLc response to statins (P = 0.048), as previously reported; however, this association was no longer present when data for statin-intolerant individuals were removed from the analysis. This study suggests that common genetic variants selected for an extreme phenotype of statin-induced myopathy also predispose to more common milder statin intolerance and may, for this reason, impact lipid-lowering efficacy.


General Information
Organisations: MRC Human Genetics Unit.
Authors: Donnelly, L. A., Doney, A. S. F., Tavendale, R., Lang, C. C., Pearson, E. R., Colhoun, H. M., McCarthy, M. I., Hattersley, A. T., Morris, A. D. & Palmer, C. N. A..
Keywords: (Single nucleotide polymorphisms OATP-C Functional analysis Adherence Variants Myopathy Efficacy Safety SLCO1B1-ASTERISK-5 Simvastatin. )
Number of pages: 7
Pages: 210-216
Publication Date: 2011
Publication Information
Category: Article
Journal: Clinical pharmacology and therapeutics
Volume: 89
Issue number: 2
ISSN: 0009-9236
Original Language: English
DOIs: 10.1038/clpt.2010.255
2007
  Topographic and laminar organization of spatial frequency and orientation in a developmental model of V1 using natural images
Palmer, CM & Bednar, JA 2007, 'Topographic and laminar organization of spatial frequency and orientation in a developmental model of V1 using natural images' Society for Neuroscience Annual Meeting, 2007, San Diego, California, United States, 3/11/07 - 7/11/07, .
General Information
Organisations: Neuroinformatics DTC.
Authors: Palmer, C. M. & Bednar, J. A..
Publication Date: Nov 2007
Publication Information
Category: Poster
Original Language: English
  Modeling the development of topographic and laminar organization for orientation and spatial frequency in the primary visual cortex
Palmer, C & Bednar, JA 2007, 'Modeling the development of topographic and laminar organization for orientation and spatial frequency in the primary visual cortex' Society for Neuroscience Annual Meeting, 2007, San Diego, California, United States, 3/11/07 - 7/11/07, .
General Information
Organisations: Neuroinformatics DTC.
Authors: Palmer, Chris & Bednar, James A..
Publication Date: 2007
Publication Information
Category: Poster
Original Language: English
  Self organising cortical maps in V1 layer 4C with realistic LGN spatiotemporal receptive fields
Palmer, C & Bednar, JA 2007, 'Self organising cortical maps in V1 layer 4C with realistic LGN spatiotemporal receptive fields'.
General Information
Organisations: Neuroinformatics DTC.
Authors: Palmer, Chris & Bednar, James A..
Publication Date: 2007
Publication Information
Category: Poster
Original Language: English
2001
  Introduction
O'Gorman, FJ, Birch, D & Palmer, C (ed.) 2001, 'Introduction: Landscape, writing, community' Worldviews: Environment, Culture, Religion, vol 5, no. 1, pp. 1-3. DOI: 10.1163/156853501750191544
General Information
Organisations: Neuroinformatics DTC.
Authors: O'Gorman, FJ & Birch, D.
Number of pages: 3
Pages: 1-3
Publication Date: 2001
Publication Information
Category: Article
Journal: Worldviews: Environment, Culture, Religion
Volume: 5
Issue number: 1
ISSN: 1363-5247
Original Language: English
DOIs: 10.1163/156853501750191544

Projects:
Self organising cortical maps in V1 layer 4C, with realistic LGN spatiotemporal receptive fields (PhD)