835 results found
El-Osta A, Hennessey C, Pilot C, et al., 2021, A digital solution to streamline access to smoking cessation interventions in England; findings from a primary care pilot (STOPNOW study), Public Health in Practice, Vol: 2, ISSN: 2666-5352
Objectives:Despite the proven efficacy of several smoking cessation medications that have been shown to improve long-term abstinence rates, approximately two-thirds of smokers report not having used medication in their most recent quit attempt. A main barrier could be delayed access to pharmacological interventions. This study investigated the utility of a primary care linked online portal to streamline timely access to pharmacological support to patients who want to quit smoking by making an asynchronous request for treatment to their general practitioner.Study design:Prospective cohort study.Methods:An online portal with added functionality was developed, which allowed patients with a unique link to make an asynchronous request for treatment. Two GP practices identified a total of 4337 eligible patients who received an SMS or email invite to engage with an online portal including an electronic survey to capture information about smoking behaviours and to request treatment. Portal informatics and patient level data were analysed to measure the efficacy of the online system in reducing the time between making a formal request to treatment and access to pharmacological support. The primary outcome measure was the time between making a formal request for treatment and access to pharmacological support from a designated community pharmacy.Results:323 patients (7.4%) initiated the survey, but only 56 patients completed the survey and made a formal request for treatment. 94% of participants did not return to use the portal to make a second or follow-up request for treatment. Only 3 participants completed the 12-week pathway. A total of 75 medication items were prescribed and collected by 56 patients. The time difference between the formal request to treatment and GP review ranged between 20 h and 1 week. The time difference between approval of prescription by the GP and access to medication was 5 days ± 2.1 days (range = 1.9–7.0 days).Conclusion:The widespre
Deal A, Hayward SE, Huda M, et al., 2021, Strategies and action points to ensure equitable uptake of COVID-19 vaccinations: A national qualitative interview study to explore the views of undocumented migrants, asylum seekers, and refugees, Journal of Migration and Health, Vol: 4, ISSN: 2666-6235
Introduction: Early evidence confirms lower COVID-19 vaccine uptake in established ethnic minority populations, yet there has been little focus on understanding vaccine hesitancy and barriers to vaccination in migrants. Growing populations of precarious migrants (including undocumented migrants, asylum seekers and refugees) in the UK and Europe are considered to be under-immunised groups and may be excluded from health systems, yet little is known about their views on COVID-19 vaccines specifically, which are essential to identify key solutions and action points to strengthen vaccine roll-out. Methods: We did an in-depth semi-structured qualitative interview study of recently arrived migrants (foreign-born, >18 years old; <10 years in the UK) to the UK with precarious immigration status between September 2020 and March 2021, seeking their input into strategies to strengthen COVID-19 vaccine delivery and uptake. We used the 'Three Cs' model (confidence, complacency and convenience) to explore COVID-19 vaccine hesitancy, barriers and access. Data were analysed using a thematic framework approach. Data collection continued until data saturation was reached, and no novel concepts were arising. The study was approved by the University of London ethics committee (REC 2020.00630). Results: We approached 20 migrant support groups nationwide, recruiting 32 migrants (mean age 37.1 years; 21 [66%] female; mean time in the UK 5.6 years [SD 3.7 years]), including refugees (n = 3), asylum seekers (n = 19), undocumented migrants (n = 8) and migrants with limited leave to remain (n = 2) from 15 different countries (5 WHO regions). 23 (72%) of 32 migrants reported being hesitant about accepting a COVID-19 vaccine and two (6%) would definitely not accept a vaccine. Participants communicated concerns over vaccine content, side-effects, lack of accessible information in an appropriate language, lack of trust in the health system and low per
Majeed A, Hodes S, Marks S, 2021, Consent for covid-19 vaccination in children., BMJ, Vol: 374, Pages: 1-2, ISSN: 1759-2151
Palladino R, Chataway J, Majeed A, et al., 2021, Interface of multiple sclerosis, depression, vascular disease, and mortality a population-based matched cohort study, Neurology, Vol: 97, Pages: E1322-E1333, ISSN: 0028-3878
Background and Objectives To assess whether the association among depression, vascular disease, and mortality differs in people with multiple sclerosis (MS) compared with age-, sex-, and general practice–matched controls.Methods We conducted a population-based retrospective matched cohort study between January 1, 1987, and September 30, 2018, that included people with MS and matched controls without MS from England, stratified by depression status. We used time-varying Cox proportional hazard regression models to test the association among MS, depression, and time to incident vascular disease and mortality. Analyses were also stratified by sex.Results We identified 12,251 people with MS and 72,572 matched controls. At baseline, 21% of people with MS and 9% of controls had depression. Compared with matched controls without depression, people with MS had an increased risk of incident vascular disease regardless of whether they had comorbid depression. The 10-year hazard of all-cause mortality was 1.75-fold greater in controls with depression (95% confidence interval [CI] 1.59–1.91), 3.88-fold greater in people with MS without depression (95% CI 3.66–4.10), and 5.43-fold greater in people with MS and depression (95% CI 4.88–5.96). Overall, the interaction between MS status and depression was synergistic, with 14% of the observed effect attributable to the interaction. Sex-stratified analyses confirmed differences in hazard ratios.Discussion Depression is associated with increased risks of incident vascular disease and mortality in people with MS, and the effects of depression and MS on all-cause mortality are synergistic. Further studies should evaluate whether effectively treating depression is associated with a reduced risk of vascular disease and mortality.
Greenfield G, Shmueli L, Harvey A, et al., 2021, Patient-initiated second medical consultations: patient characteristics and motivating factors, impact on care and satisfaction: A systematic review, BMJ Open, Vol: 11, Pages: 1-7, ISSN: 2044-6055
Objectives: To review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction, and cost-effectiveness. Data sources: Embase, Medline, PsycINFO and HMIC databases.Study design: A systematic literature search was performed for terms related to second opinion and patient characteristics. Study quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data collection / Extraction methods: We included articles focused on patient-initiated second opinions, which provided quantitative data on their impact on diagnosis, treatment, prognosis or patient satisfaction, described the characteristics or motivating factors of patients who initiated a second opinion, or the cost-effectiveness of patient-initiated second opinions. Principal findings: Thirty-one articles were included in the review. 27 studies considered patient characteristics, 18 patient motivating factors, 10 patient satisfaction, and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reporting on the cost-effectiveness of patient initiated second opinions.Conclusions: Seeking a second opinion was more common in women, middle-age patients, and more educated patients, and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain m
Paulson KR, Kamath AM, Alam T, et al., 2021, Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019, The Lancet, Vol: 398, Pages: 870-905, ISSN: 0140-6736
BackgroundSustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.MethodsWe completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.FindingsGlobal U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019.
Webb J, Peerbux S, Ang A, et al., 2021, Long-Term Effectiveness of a Digital Therapeutic Intervention for Smoking Cessation: A Randomized Controlled Trial, MedRxIV
<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>The present study evaluated the long-term effectiveness of Quit Genius (QG), an extended digital smoking cessation intervention.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Participants were adult smokers (N=556) recruited between January and November of 2019 via social media and referrals from primary care practices who were given nicotine replacement therapy and randomly assigned to Quit Genius (QG) (n=277), a cognitive behavioral therapy (CBT) based digital intervention or Very Brief Advice (VBA) (n=279), a face-to-face control intervention. Primary analyses (N=530), by intention-to-treat, compared QG and VBA on biochemically verified continuous 7-day abstinence at 4, 26, and 52 weeks post-quit date. Secondary outcomes included sustained abstinence, quit attempts, self-efficacy and mental well-being.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Seven-day point prevalence abstinence from weeks 4 through 52 ranged from 27% to nearly 45% among those who received QG, and from 13% to 29% for those in VBA. Continuous 7-day abstinence at 26 and 52 weeks occurred in 27.2% and 22.6% of QG participants, respectively, relative to 16.6% and 13.2% of VBA participants; QG participants were more likely to remain abstinent than those in VBA (Relative Risk [RR]= 1.71, 95% CI 1.17-2.50; <jats:italic>p</jats:italic>=0.005).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This study provides evidence for the long-term effectiveness of an extended digital therapeutic intervention.</jats:p></jats:sec><jats:sec><jats:title>Implications</jats:title><jats:p>The long-term effectiveness of digital smoking cessation interventions has not been
Ebrahimi H, Aryan Z, Moghaddam SS, et al., 2021, Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019 a systematic analysis for the Global Burden of Disease Study 2019, LANCET RESPIRATORY MEDICINE, Vol: 9, Pages: 1030-1049, ISSN: 2213-2600
Hayhoe B, 2021, Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: a choice experiment, PLoS Medicine, Vol: 18, Pages: 1-20, ISSN: 1549-1277
Delayed (or ‘back-up’) antibiotic prescription, where the patient is given a prescription but advised todelay initiating antibiotics, has been shown to be effective in reducing antibiotic use in primary care.However, this strategy is not widely used in the UK. This study aimed to identify factors influencingpreferences among the UK public for delayed prescription, and understand their relative importance,to help increase appropriate use of this prescribing option.Methods and FindingsWe conducted an online choice experiment in two UK general population samples: adults, and parentsof children under 18 years. Respondents were presented with twelve scenarios in which they, or theirchild, might need antibiotics for a respiratory tract infection, and asked to choose either an immediateor a delayed prescription. Scenarios were described by seven attributes. Data were collected betweenNovember 2018 and February 2019. Respondent preferences were modelled using mixed-effectslogistic regression.The survey was completed by 802 adults and 801 parents (75% of those who opened the survey). Thesamples reflected the UK population in age, sex, ethnicity and country of residence. The mostimportant determinant of respondent choice was symptom severity, especially for cough-relatedsymptoms. In the adult sample the probability of choosing delayed prescription was 0.53 (95% CI 0.50-0.56, p<.001) for a chesty cough and runny nose, compared to 0.30 (0.28-0.33, p<.001) for a chestycough with fever, 0.47 (0.44-0.50, p<.001) for sore throat with swollen glands and 0.37 (0.34-0.39,p<.001) for sore throat, swollen glands and fever. Respondents were less likely to choose delayedprescription with increasing duration of illness (odds ratio 0.94 (0.92-0.96, p<0.001)). Probabilities ofchoosing delayed prescription were similar for parents considering treatment for a child (44% ofchoices vs. 42% for adults, p=0.04). However, parents differed from the adult sample in showing
Neves AL, Li E, Serafini A, et al., 2021, Evaluating the impact of COVID-19 on the adoption of virtual care in general practice in 20 countries (inSIGHT): rationale and study protocol, Journal of Medical Internet Research, Vol: 10, ISSN: 1438-8871
Background: In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. This study aims to explore the perspectives of General Practitioners (GPs) / Family Doctors on a.) use of virtual care during the COVID-19 pandemic; b.) perceived impact on quality and safety of care; c.) essential factors for high-quality and sustainable use of virtual care in the future. Methods: Online cross-sectional questionnaire of GPs, distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. General Practitioners were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care, and participants’ characteristics, may be explored. Qualitative data (free-text responses) will be analysed using framework analysis. Results: Data collection took place from June to September 2020. As of this manuscript’s submission, a total of 1,605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. Discussion: The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care and essential factors for high-quality future use. In addition, a description of the under
Majeed F, Wingfield D, Taghavi Azar Sharabiani M, et al., 2021, Risk of Covid-19 in shielded and nursing care home patients: cohort study in general practice, British Journal of General Practice Open, ISSN: 2398-3795
Background: Covid-19 cases were first detected in the UK in January 2020 and vulnerable patients were asked to shield from March to reduce their risk of Covid-19 infection.Aim: To determine the risk and determinants of Covid-19 diagnosis in shielded vs. non-shielded groups adjusted for key comorbidities not explained by shielding. Design: Retrospective cohort study of adults with COVID-19 infection between 1/2/20-15/5/20 in West London. Method: Individuals diagnosed with Covid-19 were identified in SystmOne records using clinical codes. Infection risks were adjusted for socio-demographic factors, nursing home status and comorbidities. Results: Of 57,713 adults, 573 (1%) individuals were identified as shielded and 1,074 adults had documented Covid-19 infections (1.9%). Covid-19 infection rate in the shielded group individuals compared with non-shielded adult individuals was 6.5 % (37/573) vs. 1.8 % (1,037/57, 140), p<0.0001. A multivariable fully adjusted Cox proportional hazards regression identified that Covid-19 infection was increased with aHR (95% CI): shielding status 1.52 (1.00-2.30), p=0.048. Other determinants of Covid-19 infection included nursing home residency 7.05 (4.22-11.77) p<0.001, Black African, 2.52 (1.99-3.18) p<0.001, Other 1.74 (1.42-2.13) p<0.001, Non-stated 1.70 (1.02-2.84) p=0.04, or South Asian ethnicity 1.46 (1.10-1.93) p=0.01, history of respiratory disease 1.51 (1.06-2.16), p=0.02, deprivation (3rd vs. least deprived IMD quintile) 1.25 (1.01-1.56) p=0.045, obesity (BMI>30kg/m2) 1.39 (1.18-1.63) p<0.001, and age 1.02 (1.01-1.02) p<0.001. Male gender was associated with lower risk of Covid-19 infection: 0.71 (0.62-0.82) p<0.001.Conclusion: Shielded individuals had a higher Covid-19 infection rate compared with non-shielded individuals, after adjusting for socio-demographic factors, nursing home status, and comorbidities.
Salman D, Beaney T, Robb C, et al., 2021, The impact of social restrictions during the COVID-19 pandemic on the physical activity levels of adults aged 50-92 years: a baseline survey of the CHARIOT COVID-19 Rapid Response prospective cohort study, BMJ Open, Vol: 11, Pages: 1-12, ISSN: 2044-6055
Objectives: Physical inactivity is more common in older adults, is associated with social isolation and loneliness, and contributes to increased morbidity and mortality. We examined the effect of social restrictions to reduce COVID-19 transmission in the UK (lockdown), on physical activity (PA) levels of older adults, and the social predictors of any change.Design: Baseline analysis of a survey-based prospective cohort study Setting: Adults enrolled in the Cognitive Health in Ageing Register for Investigational and Observational Trials (CHARIOT) cohort from General Practitioner (GP) practices in North West London were invited to participate from April to July 2020.Participants: 6,219 cognitively healthy adults aged 50 to 92 years completed the survey.Main outcome measures: Self-reported PA before and after the introduction of lockdown, as measured by Metabolic Equivalent of Task (MET) minutes. Associations of PA with demographic, lifestyle and social factors, mood and frailty.Results: Mean PA was significantly lower following the introduction of lockdown, from 3,519 MET minutes/week to 3,185 MET minutes/week (p<0.001). After adjustment for confounders and pre-lockdown PA, lower levels of PA after the introduction of lockdown were found in those who were over 85 years old (640 [95% CI: 246 to 1034] MET minutes/week less); were divorced or single (240 [95% CI: 120 to 360] MET minutes/week less); living alone (277 [95% CI: 152 to 402] MET minutes/week less); reported feeling lonely often (306 [95% CI: 60 to 552] MET minutes/week less); and showed symptoms of depression (1007 [95% CI: 1401 to 612] MET minutes/week less) compared to those aged 50-64 years, married, co-habiting, and not reporting loneliness or depression, respectively. Conclusions and Implications: Markers of social isolation, loneliness and depression were associated with lower PA following the introduction of lockdown in the UK. Targeted interventions to increase PA in these groups should be consid
Greenfield G, Okoli O, Quezada Yamamoto H, et al., 2021, Characteristics of frequently attending children in hospital emergency departments: a systematic review, BMJ Open, ISSN: 2044-6055
Objective: To summarise the literature on frequent attendances to hospital emergency departments and describe sociodemographic and clinical characteristics of children who attend EDs frequently.Setting: Hospital emergency departments.Participants: Children <21 years, attending hospital emergency departments frequently.Primary outcome measures: Outcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year.Results: We included 21 studies representing 6,513,627 children. Between 0.3% to 75% of all paediatric ED users were frequent users. Most studies defined 4 or more visits per year as a “frequent ED” usage. Children who were frequent ED users were more likely to be less than 5 years old. In the US, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis.Conclusions: The review included a wide range of information across various health systems, however children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary-care oriented conditions.
Majeed A, 2021, Longitudinal data on covid-19 immunity could be collected from medical records, BMJ: British Medical Journal, Vol: 374, Pages: 1-1, ISSN: 0959-535X
Aliabadi S, Anyanwu P, Beech E, et al., 2021, Effect of antibiotic stewardship interventions in primary care on antimicrobial resistance of Escherichia coli bacteraemia in England (2013-18): a quasi-experimental, ecological, data linkage study, Lancet Infectious Diseases, ISSN: 1473-3099
BACKGROUND: Antimicrobial resistance is a major global health concern, driven by overuse of antibiotics. We aimed to assess the effectiveness of a national antimicrobial stewardship intervention, the National Health Service (NHS) England Quality Premium implemented in 2015-16, on broad-spectrum antibiotic prescribing and Escherichia coli bacteraemia resistance to broad-spectrum antibiotics in England. METHODS: In this quasi-experimental, ecological, data linkage study, we used longitudinal data on bacteraemia for patients registered with a general practitioner in the English National Health Service and patients with E coli bacteraemia notified to the national mandatory surveillance programme between Jan 1, 2013, and Dec 31, 2018. We linked these data to data on antimicrobial susceptibility testing of E coli from Public Health England's Second-Generation Surveillance System. We did an ecological analysis using interrupted time-series analyses and generalised estimating equations to estimate the change in broad-spectrum antibiotics prescribing over time and the change in the proportion of E coli bacteraemia cases for which the causative bacteria were resistant to each antibiotic individually or to at least one of five broad-spectrum antibiotics (co-amoxiclav, ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin), after implementation of the NHS England Quality Premium intervention in April, 2015. FINDINGS: Before implementation of the Quality Premium, the rate of antibiotic prescribing for all five broad-spectrum antibiotics was increasing at rate of 0·2% per month (incidence rate ratio [IRR] 1·002 [95% CI 1·000-1·004], p=0·046). After implementation of the Quality Premium, an immediate reduction in total broad-spectrum antibiotic prescribing rate was observed (IRR 0·867 [95% CI 0·837-0·898], p<0·0001). This effect was sustained until the end of the study period; a 57% reduction in rate of antibiotic pr
El-Osta A, Webber I, Alaa A, et al., 2021, What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study, BMJ Open, ISSN: 2044-6055
Ngaosuwan K, Johnston DG, Godsland IF, et al., 2021, Mortality risk in patients with adrenal insufficiency using prednisolone or hydrocortisone: a retrospective cohort study, Journal of Clinical Endocrinology and Metabolism, Vol: 106, Pages: 2242-2251, ISSN: 0021-972X
CONTEXT: Prednisolone has been recommended rather than hydrocortisone for glucocorticoid replacement in adrenal insufficiency due its longer duration of action and lower cost. OBJECTIVE: To determine mortality rates with prednisolone versus hydrocortisone. DESIGN: Observational study. SETTING: A UK primary care database (Clinical Practice Research Datalink). PARTICIPANTS: Patients with primary and secondary adrenal insufficiency, treated with either prednisolone or hydrocortisone, and controls individually matched for age, sex, period and place of follow-up. INTERVENTIONS: Nil. OUTCOMES: Mortality relative to individually matched controls. RESULTS: As expected, mortality in adrenal insufficiency irrespective of cause was increased, based on 5478 patients (4228 on hydrocortisone; 1250 on prednisolone) and 54314 controls (41934 and 12380, respectively). Overall, the adjusted hazard ratio (HR) was similar with the two treatments (prednisolone, 1.76 [95% CI, 1.54-2.01] vs. hydrocortisone 1.69 [1.57-1.82]; p=0.65). This was also the case for secondary adrenal insufficiency. In primary disease (1405 on hydrocortisone vs. 137 on prednisolone:13965 and 1347 controls, respectively), prednisolone-users were older, more likely to have another autoimmune disease and malignancy, and less likely to have mineralocorticoid replacement. Nevertheless, after adjustment, the HR for prednisolone-treated patients remained higher than for those taking hydrocortisone (2.92 [2.19-3.91] vs. 1.90 [1.66-2.16]; p=0.0020). CONCLUSIONS: In primary but not in secondary adrenal insufficiency mortality was higher with prednisolone. The study was large, but the number of prednisolone-treated patients was small, and they had greater risk factors. Nonetheless the increased mortality associated with prednisolone persisted despite statistical adjustment. Further evidence is needed regarding the long-term safety of prednisolone as routine replacement.
Tilney M, Majeed A, Vallejo-Vaz AJ, 2021, Disparities by gender among adults with heterozygous familial hypercholesterolaemia in the maltese FH registry, EAS 2021, Publisher: Elsevier, Pages: e187-e187, ISSN: 0021-9150
Nugawela MD, Gurudas S, Prevost AT, et al., 2021, Ethnic disparities in the development of sight-threatening diabetic retinopathy in a uk multi-ethnic population with diabetes: an observational cohort study, Journal of Personalized Medicine, Vol: 11, ISSN: 2075-4426
There is little data on ethnic differences in incidence of DR and sight threatening DR (STDR) in the United Kingdom. We aimed to determine ethnic differences in the development of DR and STDR and to identify risk factors of DR and STDR in people with incident or prevalent type II diabetes (T2DM). We used electronic primary care medical records of people registered with 134 general practices in East London during the period from January 2007–January 2017. There were 58,216 people with T2DM eligible to be included in the study. Among people with newly diagnosed T2DM, Indian, Pakistani and African ethnic groups showed an increased risk of DR with Africans having highest risk of STDR compared to White ethnic groups (HR: 1.36 95% CI 1.02–1.83). Among those with prevalent T2DM, Indian, Pakistani, Bangladeshi and Caribbean ethnic groups showed increased risk of DR and STDR with Indian having the highest risk of any DR (HR: 1.24 95% CI 1.16–1.32) and STDR (HR: 1.38 95% CI 1.17–1.63) compared with Whites after adjusting for all covariates considered. It is important to optimise prevention, screening and treatment options in these ethnic minority groups to avoid health inequalities in diabetes eye care.
Tudor Car L, Myint Kyaw B, Nannan Panday RS, et al., 2021, Digital health training programs for medical students: a scoping review, Journal of Medical Internet Research, Vol: 7, Pages: 1-11, ISSN: 1438-8871
Background: Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. This review collated and analyzed the literature evaluating digital health education for medical students to inform development of future courses and identify areas where curricula may need to be strengthened.Methods: We carried out a scoping review following the Joanna Briggs Institute’s guidance and reported in line with PRISMA-ScR guidelines. We searched six major bibliographic databases and grey literature sources for the articles published from January 2000 to November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussion between the authors. The findings were analyzed using thematic analysis and presented narratively.Results: A total of 34 studies focusing on different digital courses were included in this review. Most (n=22) were published from 2010 to 2019 and originated from the US (n=20). The reported digital health courses were mostly elective (n=20), integrated into the existing curriculum (n=24) and focused mainly on medical informatics (n=17). Most of the courses targeted medical students from first to third year (n=17) and the duration of the courses ranged from an hour to three academic years. Most (n=22) reported the use of blended education. Six of 34 delivered courses entirely digitally using online modules, offline learning, Massive Open Online Courses, and virtual patient simulations. The reported courses used various assessment approaches such as paper-based assessments, in person observations and/or online-based assessment. Thirty studies evaluated courses mostly using uncontrolled before and after design and generally reported improvements in students’ learning outcomes. ConclusionsDigital health courses reported in the literature were mostly elective, focused on a single area of digital health and lac
Cecil E, Dewa L, Ma R, et al., 2021, General practitioner and nurse practitioner attitudes towards electronic reminders in primary care: A qualitative analysis, BMJ Open, Vol: 11, ISSN: 2044-6055
Objectives Reminders in primary care administrative systems aim to help clinicians provide evidence-based care, prescribe safely and save money. However, increased use of reminders can lead to alert fatigue. Our study aimed to assess general practitioners’ (GPs) and nurse practitioners’ (NPs) views on electronic reminders in primary care.Design A qualitative analysis using semistructured interviews.Setting and participants Fifteen GPs and NP based in general practices located in North-West London and Yorkshire, England.Methods We collected data on participants’ views on: (1) perceptions of the value of information provided; (2) reminder-related behaviours and (3) how to improve reminders. We carried out a thematic analysis.Results Participants were familiar with reminders in their clinical systems and felt many were important to support their clinical work. However, participants reported, on average, 70% of reminders were ignored. Four major themes emerged: (1) reaction to a reminder, which was mixed and varied by situation. (2) Factors influencing the decision to act on reminders, often related to experience, consultation styles and interests of participants. Time constraints, alert design, inappropriate presentation and litigation were also factors. (3) Negative consequences of using reminders were increased workload or costs and compromising GP and NPs behaviour. (4) Factors relating to improving users’ engagement with reminders were prevention of unnecessary reminders through data linkage across healthcare administrative systems or the development of more intelligent algorithms. Participants felt training was vital to effectively manage reminders.Conclusions GPs and NPs believe reminders are useful in supporting the provision of good quality patient care. Improving GPs and NPs’ engagement with reminders centres on further developing their relevance to their clinical practice, which is personalised, considers cognitive workflow and s
Majeed A, Papaluca M, Molokhia M, 2021, Assessing the long-term safety and efficacy of COVID-19 vaccines, Journal of the Royal Society of Medicine, Vol: 114, Pages: 337-340, ISSN: 0141-0768
Tudor Car L, Kyaw BM, Nannan Panday RS, et al., 2021, Digital Health Training Programs for Medical Students: Scoping Review (Preprint), DH
<sec> <title>BACKGROUND</title> <p>Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. The COVID-19 pandemic has contributed to this swift and widespread transition to digital health and education. However, the need for digital health competencies goes beyond the COVID-19 pandemic because they are becoming essential for the delivery of effective, efficient, and safe care.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This review aims to collate and analyze studies evaluating digital health education for medical students to inform the development of future courses and identify areas where curricula may need to be strengthened.</p> </sec> <sec> <title>METHODS</title> <p>We carried out a scoping review by following the guidance of the Joanna Briggs Institute, and the results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We searched 6 major bibliographic databases and gray literature sources for articles published between January 2000 and November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussions between the authors. The findings were analyzed using thematic analysis and presented narratively.</p> </sec> <sec> <title>RESULTS</title> <p>A total of 34 studies focusing on different digital courses were included in this review. Most of the studies (22/34, 65%) wer
Gurudas S, Nugawela M, Prevost AT, et al., 2021, Development and validation of resource-driven risk prediction models for incident chronic kidney disease in type 2 diabetes, Scientific Reports, Vol: 11, Pages: 1-11, ISSN: 2045-2322
Prediction models for population-based screening need, for global usage, to be resource-driven, involving predictors that are affordably resourced. Here, we report the development and validation of three resource-driven risk models to identify people with type 2 diabetes (T2DM) at risk of stage 3 CKD defined by a decline in estimated glomerular filtration rate (eGFR) to below 60 mL/min/1.73m2. The observational study cohort used for model development consisted of data from a primary care dataset of 20,510 multi-ethnic individuals with T2DM from London, UK (2007–2018). Discrimination and calibration of the resulting prediction models developed using cox regression were assessed using the c-statistic and calibration slope, respectively. Models were internally validated using tenfold cross-validation and externally validated on 13,346 primary care individuals from Wales, UK. The simplest model was simplified into a risk score to enable implementation in community-based medicine. The derived full model included demographic, laboratory parameters, medication-use, cardiovascular disease history (CVD) and sight threatening retinopathy status (STDR). Two less resource-intense models were developed by excluding CVD and STDR in the second model and HbA1c and HDL in the third model. All three 5-year risk models had good internal discrimination and calibration (optimism adjusted C-statistics were each 0.85 and calibration slopes 0.999–1.002). In Wales, models achieved excellent discrimination(c-statistics ranged 0.82–0.83). Calibration slopes at 5-years suggested models over-predicted risks, however were successfully updated to accommodate reduced incidence of stage 3 CKD in Wales, which improved their alignment with the observed rates in Wales (E/O ratios near to 1). The risk score demonstrated similar model performance compared to direct evaluation of the cox model. These resource-driven risk prediction models may enable universal screening for Stage 3 CKD t
Sekhon Inderjit Singh HK, Lal N, Majeed A, et al., 2021, Ethnic disparities in the uptake of colorectal cancer screening: An analysis of the West London population, Colorectal Disease, Vol: 23, Pages: 1804-1813, ISSN: 1462-8910
BACKGROUND: Colorectal cancer (CRC) screening reduces mortality but variation exists in uptake with poorer uptake in ethnic minority groups. We aim to evaluate the relationship between ethnicity and CRC screening uptake in West London. METHODS: CRC screening results from the Central London, West London, Hammersmith and Fulham, Hounslow and Ealing Clinical commissioning group collaborative between 2012-2017 were retrospectively analysed. These five clinical commissioning groups (CCGs) are located in West London. Compliance with screening according to ethnic groups was evaluated compared to the White British control. RESULTS: 155,038 individuals were screened. White British individuals had the highest compliance (52.6%). A maximal difference of 8.2% compliance was seen between CCGs. The odds of being less likely to participate was significant (p<0.05) in all ethnic minorities except for Asian Chinese on univariate and multivariate analysis (adjusted OR:1.091 p=0.88). CONCLUSION: This is the largest retrospective study focusing on the role of ethnicity in the uptake of CRC screening in England. Poor uptake of screening in all ethnic minorities in West London with the exception of Asian Chinese individuals, in particular, is a novel finding. A mandate to routinely collect ethnicity data, the use of a single more diverse census and further intervention is needed to understand this disparity and improve health inequity. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: We clarify the independent role of ethnic minority as a risk factor for poor colorectal screening uptake in West London. Only Chinese individuals are an exception. This is an important avenue to address to increase screening uptake and decrease cancer mortality overall but to also improve health inequity.
Ngaosuwan K, Johnston DG, Godsland IF, et al., 2021, Increased mortality risk in patients with primary and secondary adrenal insufficiency, Journal of Clinical Endocrinology and Metabolism, Vol: 106, Pages: e2759-e2768, ISSN: 0021-972X
CONTEXT: Mortality data in patients with adrenal insufficiency are inconsistent, possibly due to temporal and geographical differences between patients and their reference populations. OBJECTIVE: To compare mortality risk and causes of death in adrenal insufficiency with an individually-matched reference population. DESIGN: Retrospective cohort study. SETTING: UK general practitioner database (CPRD). PARTICIPANTS: 6821 patients with adrenal insufficiency (primary, 2052; secondary, 3948) and 67564 individually-matched controls (primary, 20366; secondary, 39134). MAIN OUTCOME MEASURES: All-cause and cause-specific mortality; hospital admission from adrenal crisis. RESULTS: With follow-up of 40799 and 406899 person-years for patients and controls respectively, the hazard ratio (HR; [95%CI]) for all-cause mortality was 1.68 [1.58 - 1.77]. HRs were greater in primary (1.83 [1.66 - 2.02]) than in secondary (1.52 [1.40 - 1.64]) disease; (HR; primary versus secondary disease, 1.16 [1.03 - 1.30]). The leading cause of death was cardiovascular disease (HR 1.54 [1.32-1.80]), along with malignant neoplasms and respiratory disease. Deaths from infection were also relatively high (HR 4.00 [2.15 - 7.46]). Adrenal crisis contributed to 10% of all deaths. In the first two years following diagnosis, the patients' mortality rate and hospitalisation from adrenal crisis were higher than in later years. CONCLUSION: Mortality was increased in adrenal insufficiency, especially primary, even with individual matching and was observed early in the disease course. Cardiovascular disease was the major cause but mortality from infection was also high. Adrenal crisis was a common contributor. Early education for prompt treatment of infections and avoidance of adrenal crisis hold potential to reduce mortality.
Kendrick PJ, Reitsma MB, Abbasi-Kangevari M, et al., 2021, Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019, The Lancet Public Health, Vol: 6, Pages: e482-e499, ISSN: 2468-2667
BackgroundChewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control.MethodsWe estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period.FindingsIn 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15–19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: –1·21% [–1·26 to –1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant
Udeh-Momoh CT, Watermeyer T, Price G, et al., 2021, Protocol of the cognitive health in ageing register: investigational, observational and trial studies in dementia research (CHARIOT): prospective readiness cOhort (PRO) SubStudy., BMJ Open, Vol: 11, Pages: 1-12, ISSN: 2044-6055
INTRODUCTION: The Cognitive Health in Ageing Register: Investigational, Observational and Trial Studies in Dementia Research (CHARIOT): Prospective Readiness cOhort (PRO) SubStudy (CPSS), sponsored by Janssen Pharmaceutical Research & Development LLC, is an Alzheimer's disease (AD) biomarker enriched observational study that began 3 July 2015 CPSS aims to identify and validate determinants of AD, alongside cognitive, functional and biological changes in older adults with or without detectable evidence of AD pathology at baseline. METHODS AND ANALYSIS: CPSS is a dual-site longitudinal cohort (3.5 years) assessed quarterly. Cognitively normal participants (60-85 years) were recruited across Greater London and Edinburgh. Participants are classified as high, medium (amnestic or non-amnestic) or low risk for developing mild cognitive impairment-Alzheimer's disease based on their Repeatable Battery for the Assessment of Neuropsychological Status performance at screening. Additional AD-related assessments include: a novel cognitive composite, the Global Preclinical Alzheimer's Cognitive Composite, brain MRI and positron emission tomography and cerebrospinal fluid analysis. Lifestyle, other cognitive and functional data, as well as biosamples (blood, urine, and saliva) are collected. Primarily, study analyses will evaluate longitudinal change in cognitive and functional outcomes. Annual interim analyses for descriptive data occur throughout the course of the study, although inferential statistics are conducted as required. ETHICS AND DISSEMINATION: CPSS received ethical approvals from the London-Central Research Ethics Committee (15/LO/0711) and the Administration of Radioactive Substances Advisory Committee (RPC 630/3764/33110) The study is at the forefront of global AD prevention efforts, with frequent and robust sampling of the well-characterised cohort, allowing for detection of incipient pathophysiological, cognitive and functional changes that could inform therape
Cecil E, Bottle A, Majeed A, et al., 2021, Factors associated with potentially missed acute deterioration in primary care, British Journal of General Practice, Vol: 24/6/21, Pages: e547-e554, ISSN: 0960-1643
BACKGROUND: In the UK, the majority of primary care contacts are uncomplicated. However, safety incidents resulting in patient harm occur, such as failure to recognise a patient's deterioration in health. AIM: We aimed to determine patient and healthcare factors associated with potentially missed deterioration. DESIGN AND SETTING: A cohort of patients registered with English CPRD general practices between 01-04-2014 and 31-12-2017 with linked hospital data. METHODS: We defined a potentially missed deterioration as a patient, seen in primary care by a GP in the three days before hospitalisation, having a self-referred admission. We used generalised estimating equations to investigate factors associated with odds of a self-referred admission. We investigated all diagnoses and subsets of commonly reported missed conditions. RESULTS: There were 116,097 patients who contacted a GP three days prior to an emergency admission. Patients with sepsis or urinary tract infections were more likely to self-refer, adjusted odds ratio 1.10 95%CI(1.02-1.19) and 1.09 (1.04-1.14) respectively. GP appointment durations were associated with self-referral. On average, a 5-minute increase resulted in 10% decrease in odds of self-referred admissions, 0.90 (0.89-0.91). Patients having a telephone (compared with face-to-face) consultation 1.13 (1.09-1.16), previous health service use and health status were also associated with self-referred admission. CONCLUSIONS: Differentiating deterioration from self-limiting conditions can be difficult for clinicians, particularly in patients with sepsis, UTI or with long-term conditions. Our findings supports the call for longer GP consultations and cautions reliance on telephone consultations in primary care; however, research is needed to understand the underlying mechanisms.
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