680 results found
Hayhoe B, Kim D, Aylin PP, et al., 2019, Adherence to guidelines in management of symptoms suggestive of heart failure in primary care., Heart, Vol: 105, Pages: 678-685
OBJECTIVE: Clinical guidelines on heart failure (HF) suggest timings for investigation and referral in primary care. We calculated the time for patients to achieve key elements in the recommended pathway to diagnosis of HF. METHODS: In this observational study, we used linked primary and secondary care data (Clinical Practice Research Datalink, a database of anonymised electronic records from UK general practices) between 2010 and 2013. Records were examined for presenting symptoms (breathlessness, fatigue, ankle swelling) and key elements of the National Institute for Health and Care Excellence-recommended pathway to diagnosis (serum natriuretic peptide (NP) test, echocardiography, specialist referral). RESULTS: 42 403 patients were diagnosed with HF, of whom 16 597 presented in primary care with suggestive symptoms. 6464 (39%) had recorded NP or echocardiography, and 6043 (36%) specialist referral. Median time from recorded symptom(s) to investigation (NP or echocardiography) was 292 days (IQR 34-844) and to referral 236 days (IQR 42-721). Median time from symptom(s) to diagnosis was 972 days (IQR 337-1468) and to treatment with HF-relevant medication 803 days (IQR 230-1364). Factors significantly affecting timing of referral, treatment and diagnosis included patients' sex (p=0.001), age (p<0.001), deprivation score (p=0.001), comorbidities (p<0.001) and presenting symptom type (p<0.001). CONCLUSIONS: Median times to investigation or referral of patients presenting in primary care with symptoms suggestive of HF considerably exceeded recommendations. There is a need to support clinicians in the diagnosis of HF in primary care, with improved access to investigation and specialist assessment to support timely management.
Beghi E, Giussani G, Abd-Allah F, et al., 2019, Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, LANCET NEUROLOGY, Vol: 18, Pages: 357-375, ISSN: 1474-4422
Sripa P, Hayhoe B, Garg P, et al., 2019, Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review., Br J Gen Pract
BACKGROUND: GPs often act as gatekeepers, authorising patients' access to specialty care. Gatekeeping is frequently perceived as lowering health service use and health expenditure. However, there is little evidence suggesting that gatekeeping is more beneficial than direct access in terms of patient- and health-related outcomes. AIM: To establish the impact of GP gatekeeping on quality of care, health use and expenditure, and health outcomes and patient satisfaction. DESIGN AND SETTING: A systematic review. METHOD: The databases MEDLINE, PreMEDLINE, Embase, and the Cochrane Library were searched for relevant articles using a search strategy. Two authors independently screened search results and assessed the quality of studies. RESULTS: Electronic searches identified 4899 studies (after removing duplicates), of which 25 met the inclusion criteria. Gatekeeping was associated with better quality of care and appropriate referral for further hospital visits and investigation. However, one study reported unfavourable outcomes for patients with cancer under gatekeeping, and some concerns were raised about the accuracy of diagnoses made by gatekeepers. Gatekeeping resulted in fewer hospitalisations and use of specialist care, but inevitably was associated with more primary care visits. Patients were less satisfied with gatekeeping than direct-access systems. CONCLUSION: Gatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction. Survival rate of patients with cancer in gatekeeping schemes was significantly lower than those in direct access, although primary care gatekeeping was not otherwise associated with delayed patient referral. The long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies.
Huckvale K, Wang CJ, Majeed A, et al., 2019, Digital health at fifteen: more human (more needed), BMC MEDICINE, Vol: 17, ISSN: 1741-7015
Fadahunsi KP, Akinlua JT, O'Connor S, et al., 2019, Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth., BMJ Open, Vol: 9
INTRODUCTION: Electronic health (eHealth) applications have become a very large repository of health information which informs critical decisions relating to the diagnosis, treatment and prognosis of patients. Poor information quality (IQ) within eHealth may compromise patient safety. Evaluation of IQ in eHealth is therefore necessary to promote patient safety. An IQ framework specifies what aspects of information to assess and how to conduct the assessment. This systematic review aims to identify dimensions within existing IQ frameworks in eHealth and develop a new IQ framework for the assessment of eHealth. METHOD AND ANALYSIS: We will search Embase, Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, PsycINFO (American Psychological Association), Global Health, Scopus, ProQuest Dissertations and Theses Global, Health Management Information Consortium and reference lists of relevant publications for articles published in English until November 2018. Studies will be selected by two independent reviewers based on prespecified eligibility criteria. Two reviewers will independently extract data in each eligible study using a prepiloted Microsoft Excel data extraction form. Thematic synthesis will be employed to define IQ dimensions and develop a new IQ framework for eHealth. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review as primary data will not be collected. The result of the review will be disseminated through publication in an academic journal and scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42018097142.
Foley K, Alturkistani A, Carter A, et al., 2019, Massive Open Online Courses (MOOC) Evaluation Methods: Protocol for a Systematic Review, JMIR RESEARCH PROTOCOLS, Vol: 8, ISSN: 1929-0748
Car J, Carlstedt-Duke J, Car LT, et al., 2019, Digital Education in Health Professions: The Need for Overarching Evidence Synthesis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 21, ISSN: 1438-8871
Meinert E, Alturkistani A, Osama T, et al., 2019, Digital Technology in Somatic and Gene Therapy Trials of Pediatric Patients With Ocular Diseases: Protocol for a Scoping Review, JMIR RESEARCH PROTOCOLS, Vol: 8, Pages: 241-247, ISSN: 1929-0748
Meinert E, Alturkistani A, Foley KA, et al., 2019, Blockchain Implementation in Health Care: Protocol for a Systematic Review, JMIR RESEARCH PROTOCOLS, Vol: 8, Pages: 153-159, ISSN: 1929-0748
Hayhoe B, Greenfield G, Majeed A, 2019, Is it getting easier to obtain antibiotics in the UK?, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 69, Pages: 54-55, ISSN: 0960-1643
Bottle A, Kim D, Hayhoe B, et al., 2019, Frailty and comorbidity predict first hospitalisation after heart failure diagnosis in primary care: population-based observational study in England., Age Ageing
Background: frailty has only recently been recognised as important in patients with heart failure (HF), but little has been done to predict the first hospitalisation after diagnosis in unselected primary care populations. Objectives: to predict the first unplanned HF or all-cause admission after diagnosis, comparing the effects of comorbidity and frailty, the latter measured by the recently validated electronic frailty index (eFI). Design: observational study. Setting: primary care in England. Subjects: all adult patients diagnosed with HF in primary care between 2010 and 2013. Methods: we used electronic health records of patients registered with primary care practices sending records to the Clinical Practice Research Datalink (CPRD) in England with linkage to national hospital admissions and death data. Competing-risk time-to-event analyses identified predictors of first unplanned hospitalisation for HF or for any condition after diagnosis. Results: of 6,360 patients, 9% had an emergency hospitalisation for their HF, and 39% had one for any cause within a year of diagnosis; 578 (9.1%) died within a year without having any emergency admission. The main predictors of HF admission were older age, elevated serum creatinine and not being on a beta-blocker. The main predictors of all-cause admission were age, comorbidity, frailty, prior admission, not being on a beta-blocker, low haematocrit and living alone. Frailty effects were largest in patients aged under 85. Conclusions: this study suggests that frailty has predictive power beyond its comorbidity components. HF patients in the community should be assessed for frailty, which should be reflected in future HF guidelines.
Chang KC-M, Vamos EP, Palladino R, et al., 2019, Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis, JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, Vol: 73, Pages: 11-18, ISSN: 0143-005X
James SL, Theadom A, Ellenbogen RG, et al., 2019, Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, LANCET NEUROLOGY, Vol: 18, Pages: 56-87, ISSN: 1474-4422
Feigin VL, Nguyen G, Cercy K, et al., 2018, Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016, New England Journal of Medicine, Vol: 379, Pages: 2429-2437, ISSN: 0028-4793
BackgroundThe lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.MethodsWe used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.ResultsThe estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle–SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calcul
Foley K, Alturkistani A, Carter A, et al., MOOC evaluation methods: a systematic review protocol, JMIR Research Protocols, ISSN: 1929-0748
Massive open online courses (MOOCs) have increased in popularity in recent years. They target a wide variety of learners and use novel teaching approaches, yet often exhibit low completion rates (10%). It is important to evaluate MOOCs to determine their impact and effectiveness, but little is known at this point about the methodologies that should be used for evaluation.
Hayhoe B, Cowling TE, Pillutla V, et al., 2018, Integrating a nationally scaled workforce of community health workers in primary care: a modelling study, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 111, Pages: 453-461, ISSN: 0141-0768
Ahmad A, Laverty AA, Alexakis C, et al., 2018, Changing nationwide trends in endoscopic, medical and surgical admissions for inflammatory bowel disease: 2003-2013, BMJ OPEN GASTROENTEROLOGY, Vol: 5, ISSN: 2054-4774
Zunt JR, Kassebaum NJ, Blake N, et al., 2018, Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, Lancet Neurology, Vol: 17, Pages: 1061-1082, ISSN: 1474-4422
BackgroundAcute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education.FindingsGlobal meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval [UI] 319 426–458 514) to 318 400 (265 218–408 705). Incident cases globally increased from 2·50 million (95% UI 2·19–2·91) in 1990 to 2·82 million (2·46–3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates an
Roth GA, Collaborotors GBDCD, Abate D, et al., 2018, Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1736-1788, ISSN: 0140-6736
Kyu HH, Abate D, Abate KH, et al., 2018, Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1859-1922, ISSN: 0140-6736
James SLG, Abate D, Abate KH, et al., 2018, Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1789-1858, ISSN: 0140-6736
Dicker D, Nguyen G, Abate D, et al., 2018, Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1684-1735, ISSN: 0140-6736
Lozano R, Fullman N, Abate D, et al., 2018, Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 2091-2138, ISSN: 0140-6736
Stanaway JD, Afshin A, Gakidou E, et al., 2018, Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1923-1994, ISSN: 0140-6736
Murray CJL, Callender CSKH, Kulikoff XR, et al., 2018, Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1995-2051, ISSN: 0140-6736
Steel N, Ford JA, Newton JN, et al., 2018, Changes in health in the countries of the UK and 150 English Local Authority areas 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, LANCET, Vol: 392, Pages: 1647-1661, ISSN: 0140-6736
Fitzmaurice C, Akinyemiju TF, Al Lami FH, et al., 2018, Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016 A Systematic Analysis for the Global Burden of Disease Study, JAMA ONCOLOGY, Vol: 4, Pages: 1553-1568, ISSN: 2374-2437
Shather Z, Laverty AA, Bottle A, et al., 2018, Sustained Socioeconomic Inequalities in Hospital Admissions for Cardiovascular Events Among People with Diabetes in England, AMERICAN JOURNAL OF MEDICINE, Vol: 131, Pages: 1340-1348, ISSN: 0002-9343
Alexakis C, Saxena S, Chhaya V, et al., 2018, Smoking Status at Diagnosis and Subsequent Smoking Cessation: Associations With Corticosteroid Use and Intestinal Resection in Crohn's Disease, AMERICAN JOURNAL OF GASTROENTEROLOGY, Vol: 113, Pages: 1689-1700, ISSN: 0002-9270
Elmontsri M, Banarsee R, Majeed A, 2018, Improving patient safety in developing countries - moving towards an integrated approach., JRSM Open, Vol: 9, ISSN: 2054-2704
Patient safety is a major public health issue. It has also been recognised as an area for improvement. The purpose of this article is to discuss the need for developing an integrated approach to patient safety improvement in developing countries. Relevant literature to identify the common themes and patterns associated with patient safety improvement was conducted through a search of the online databases (MEDLINE, EMBASE, PUBMED and Google Scholar) for the years 2000 to 2017. Lessons and interventions from developed countries have been taken into consideration to identify the themes needed for patient safety improvement in developing countries. This review provides an integrated approach based on best practice which can be used to guide the development of a national strategy for improving patient safety. Policy makers need to focus on developing a holistic and comprehensive approach to patient safety improvement that takes into account the themes discussed in this article.
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