139 results found
Lovell B, Dhillon R, Khader A, et al., 2019, Delivering and evaluating a scalable training model for strengthening family medicine in resource-limited environments: the Gaza experience, BJGP Open, ISSN: 2398-3795
Background: Since 2007 Gaza Palestine has been subject to blockade affecting over 1.9 million people. This denies health professionals’ access to Continuing Professional Development (CPD). In Gaza, family physicians are scarce, and their level of training does not meet the needs of UNRWA’s Family Health Team model for better population health. Aim: This study sought to develop a postgraduate training programme for Gazan doctors via a Diploma in Family Medicine and evaluate its impact on physicians and patients.Design and setting: A mixed-methods evaluation of a postgraduate Diploma Methods: The programme was delivered over one year, to 15 primary care doctors. The impact was evaluated through focus group discussions and patient feedback questionnaire survey comparing FM PG Diploma graduate doctors and doctors without the FM PG Diploma. Results: All participating doctors graduated successfully and found the experience extremely positive. Trainees felt that the Diploma helped them take more individualised approach to patients; have a better understanding of psychosocial elements affecting patient health; feel more inclined towards team-working and collaborative approaches to healthcare; and more insight into non-verbal communication such as active listening and tactile gestures. Statistical analysis of patients feedback showed significantly improved patient-reported outcomes and satisfaction when treated by course diplomates compared to non-diplomates. Conclusion: Where there are limited training opportunities, investment in a structured Postgraduate Diploma training programme can improve quality of health service delivery. UNRWA’s experience in Gaza demonstrates the value of a scalable model in resource-limited settings.
Su B, Newson R, Soljak H, et al., 2018, Associations between postoperative rehabilitation of hip fracture and outcomes: national database analysis (vol 19, 211, 2018), BMC MUSCULOSKELETAL DISORDERS, Vol: 19, ISSN: 1471-2474
Zhang S, Tomata Y, Newson RB, et al., 2018, Combined healthy lifestyle behaviours and incident disability in an elderly population: the Ohsaki Cohort 2006 Study, JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, Vol: 72, Pages: 679-684, ISSN: 0143-005X
Su B, Newson R, Soljak H, et al., 2018, Associations between post-operative rehabilitation of hip fracture and outcomes: national database analysis (90 characters), BMC Musculoskeletal Disorders, Vol: 19, ISSN: 1471-2474
Rehabilitation programmes are used to improve hip fracture outcomes. There is little published trial clinical trial or population-based data on the effects of the type or provider of rehabilitation treatments on hip fracture outcomes. We evaluated the associations of rehabilitation interventions with post-operative hip fracture outcomes.
Razak Y, Newson R, Collins R, et al., 2018, Key treatment target achievement in diabetes care uncorrelated to deprivation scores: A case study in West London, Diabetes UK Professional Conference 2018, Publisher: Wiley, Pages: 5-5, ISSN: 0742-3071
BACKGROUND: Change in the prevalence of asthma-like symptoms in populations of ageing adults is likely to be influenced by smoking, asthma treatment and atopy. METHODS: The European Community Respiratory Health Survey collected information on prevalent asthma-like symptoms from representative samples of adults aged 20-44 years (29 centres in 13 European countries and Australia) at baseline and 10 and 20 years later (n=7844). Net changes in symptom prevalence were determined using generalised estimating equations (accounting for non-response through inverse probability weighting), followed by meta-analysis of centre level estimates. FINDINGS: Over 20 years the prevalence of 'wheeze' and 'wheeze in the absence of a cold' decreased (-2.4%, 95% CI -3.5 to -1.3%; -1.5%, 95% CI -2.4 to -0.6%, respectively) but the prevalence of asthma attacks, use of asthma medication and hay fever/nasal allergies increased (0.6%, 95% CI 0.1 to 1.11; 3.6%, 95% CI 3.0 to 4.2; 2.7%, 95% CI 1.7 to 3.7). Changes were similar in the first 10 years compared with the second 10 years, except for hay fever/nasal allergies (increase seen in the first 10 years only). Decreases in these wheeze-related symptoms were largely seen in the group who gave up smoking, and were seen in those who reported hay fever/nasal allergies at baseline. INTERPRETATION: European adults born between 1946 and 1970 have, over the last 20 years, experienced less wheeze, although they were more likely to report asthma attacks, use of asthma medication and hay fever. Decrease in wheeze is largely attributable to smoking cessation, rather than improved treatment of asthma. It may also be influenced by reductions in atopy with ageing.
Moore E, Newson R, Joshi M, et al., 2017, Effects of pulmonary rehabilitation on exacerbation number and severity in people with COPD: An historical cohort study using electronic health records, Chest, Vol: 152, Pages: 1188-1202, ISSN: 1931-3543
BackgroundIn previous systematic reviews, predominantly of randomised controlled trials, pulmonary rehabilitation (PR) has been shown to reduce hospital admissions for acute exacerbations of COPD (AECOPD). However, findings have been less consistent for cohort studies. We aimed to compare rates of hospitalized and general practice (GP) treated AECOPD before and after PR.MethodsUsing anonymised data from the Clinical Practice Research Datalink and Hospital Episode Statistics, hospital admissions and GP visits for AECOPD were compared one year before and after PR in patients referred for PR. Exacerbation rates were also compared between individuals eligible and referred for PR with those eligible and not referred.Results69,089 (64%) of the COPD patients in the cohort were eligible for PR. Of these, only 6,436 (9.3%) were recorded as having been referred for rehabilitation. 62, 019 (89.8%) were not referred and 634 (0.98%) declined referral. When combining GP and hospital exacerbations, people who were eligible and were referred for PR had a slightly higher but not statistically significant exacerbation rate (2.83 exacerbations/patient-year 95% CI: 2.66, 3.00) than those who were eligible but not referred (2.17 exacerbations/patient-year 95% CI: 2.11, 2.24).ConclusionsThis study found that less than 10% of patients who were eligible for PR were actually referred. Patients who were eligible and referred for (but not necessarily completed) PR did not have fewer GP visits and hospitalizations for AECOPD in the year after PR compared to those not referred or compared to the year before PR.
Newson RB, 2017, Stata tip 127: Use capture noisily groups, Stata Journal, Vol: 17, Pages: 511-514, ISSN: 1536-867X
Moore E, Palmer T, Newson R, et al., 2016, Pulmonary rehabilitation for acute exacerbations of chronic obstructive pulmonary disease (COPD): A systematic review, European Respiratory Society Congress 2016, Publisher: European Respiratory Society, Pages: PA3771-PA3771, ISSN: 0903-1936
Background: Acute exacerbations of COPD (AECOPD) have a significant impact on healthcare utilisation, including physician visits and hospitalisations. The effect of pulmonary rehabilitation (PR) on hospitalisations for AECOPD is inconclusive.Methods: Medical databases were searched to assess the impact of PR on emergency hospitalisations for AECOPD. Cohort studies and randomised controlled trials (RCTs) reporting hospitalisations for AECOPD as an outcome were included. Meta-analyses compared exacerbation rates between eligible PR recipients and non-recipients before and after PR.Results: 18 studies were included in the meta-analysis. Admission rates per person-year were lower in the year following completion of PR. Results from 10 RCTs showed that the control groups had a higher overall rate of exacerbations than the PR groups (0.967, 95% confidence intervals (CIs) 0.669, 1.399 for control versus 0.615 95% CI 0.328, 1.155 for PR). Five studies compared admission numbers in the 12 months before and after PR, finding a significantly higher admission rate before (1.243, 95% CIs 0.661, 2.336) compared to after PR (0.472, 95% CIs 0.280, 0.794). The pooled result of three cohort studies found the reference group had a lower admission rate compared to the PR group (0.184, 95% CI 0.106, 0.317 for reference versus 0.282 95% CI 0.246, 0.323 for PR).Conclusions: Although results from RCTs suggested that PR reduces subsequent exacerbations, pooled results from the cohort studies did not favour PR, likely reflecting the heterogeneous nature of individuals included in observational research and the varying standards of PR programmes.
Moore E, Newson R, Rothnie KJ, et al., 2016, Effects of pulmonary rehabilitation on exacerbation number and severity in people with Chronic Obstructive Pulmonary Disease (COPD), European Respiratory Society 2016, Publisher: European Respiratory Society, Pages: PA3775-PA3775, ISSN: 0903-1936
Background: Acute exacerbations of COPD are a major cause of morbidity and mortality and have a heavy burden on healthcare resources. Pulmonary rehabilitation (PR) has been shown to reduce hospital admissions and improve quality of life, but few studies have investigated the effect of PR on exacerbation rate using routinely collected health records.Methods: Primary care data from the Clinical Practice Research Datalink and Hospital Episode Statistics (HES) on acute exacerbations were combined to determine the effects of PR on acute exacerbations of COPD one year before and after PR in patients who received PR compared to patients who did not.Findings: 108,042 patients were included in the analysis between 1st January 2004 and 31st March 2014. Of those, 38,952 (36%) were not eligible for PR. Of the 69,090 eligible; 6,436 (9.3%) were recorded a having received PR, 62,019 (89.8%) were not referred and 634 (0.9%) were referred but declined. When combining primary care events with HES events, people who received PR had a higher incidence rate (IR) of acute exacerbations (IR = 3.18 95% CI: 3.02, 3.35) compared to people who did not receive PR (IR = 3.04 95% CI: 2.88, 3.20).Conclusions: This study highlights that a high proportion of COPD patients eligible for PR in the UK are not being referred. In addition, poorer outcomes (defined as acute exacerbations) following PR suggest that either higher risk patients are being referred for PR, or PR as currently delivered is ineffective. Higher quality, standardised PR programmes should be encouraged to ensure outcomes from randomised controlled trials can be replicated in real life.
Moore EA, Palmer T, Newson R, et al., 2016, Pulmonary rehabilitation as a mechanism to reduce hospitalizations for acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis, Chest, Vol: 150, Pages: 837-859, ISSN: 1931-3543
BackgroundAcute exacerbation of COPD (AECOPD) has a significant impact on health-care use, including physician visits and hospitalizations. Previous studies and reviews have shown that pulmonary rehabilitation (PR) has many benefits, but the effect on hospitalizations for AECOPD is inconclusive.MethodsA literature search was carried out to find studies that might help determine, using a meta-analysis, the impact of PR on AECOPD, defined as unscheduled or emergency hospitalizations and ED visits. Cohort studies and randomized controlled trials (RCTs) reporting hospitalizations for AECOPD as an outcome were included. Meta-analyses compared hospitalization rates between eligible PR recipients and nonrecipients before and after rehabilitation.ResultsEighteen studies were included in the meta-analysis. Results from 10 RCTs showed that the control groups had a higher overall rate of hospitalization than did the PR groups (control groups: 0.97 hospitalizations/patient-year; 95% CI, 0.67-1.40; PR groups: 0.62 hospitalizations/patient-year; 95% CI, 0.33-1.16). Five studies compared admission numbers in the 12 months before and after rehabilitation, finding a significantly higher admission rate before compared with after (before: 1.24 hospitalizations/patient-year; 95% CI, 0.66-2.34; after: 0.47 hospitalizations/patient-year; 95% CI, 0.28-0.79). The pooled result of three cohort studies found that the reference group had a lower admission rate compared with the PR group (0.18 hospitalizations/patient-year; 95% CI, 0.11-0.32 for reference group vs 0.28 hospitalizations/patient-year; 95% CI, 0.25-0.32 for the PR group).ConclusionsAlthough results from RCTs suggested that PR reduces subsequent admissions, pooled results from the cohort studies did not, likely reflecting the heterogeneous nature of individuals included in observational research and the varying standard of PR programs.
McKay AJ, Newson R, Soljak M, et al., 2015, Are primary care factors associated with hospital episodes for adverse drug reactions? A national observational study., BMJ Open, Vol: 5, ISSN: 2044-6055
Objective Identification of primary care factors associated with hospital admissions for adverse drug reactions (ADRs).Design and setting Cross-sectional analysis of 2010–2012 data from all National Health Service hospitals and 7664 of 8358 general practices in England.Method We identified all hospital episodes with an International Classification of Diseases (ICD) 10 code indicative of an ADR, in the 2010–2012 English Hospital Episode Statistics (HES) admissions database. These episodes were linked to contemporary data describing the associated general practice, including general practitioner (GP) and patient demographics, an estimate of overall patient population morbidity, measures of primary care supply, and Quality and Outcomes Framework (QOF) quality scores. Poisson regression models were used to examine associations between primary care factors and ADR-related episode rates.Results 212 813 ADR-related HES episodes were identified. Rates of episodes were relatively high among the very young, older and female subgroups. In fully adjusted models, the following primary care factors were associated with increased likelihood of episode: higher deprivation scores (population attributable fraction (PAF)=0.084, 95% CI 0.067 to 0.100) and relatively poor glycated haemoglobin (HbA1c) control among patients with diabetes (PAF=0.372; 0.218 to 0.496). The following were associated with reduced episode likelihood: lower GP supply (PAF=−0.016; −0.026 to −0.005), a lower proportion of GPs with UK qualifications (PAF=−0.035; −0.058 to −0.012), lower total QOF achievement rates (PAF=−0.021; −0.042 to 0.000) and relatively poor blood pressure control among patients with diabetes (PAF=−0.144; −0.280 to −0.022).Conclusions Various aspects of primary care are associated with ADR-related hospital episodes, including achievement of particular QOF indicators. Further investigation with individual level data
Amaral AFS, Newson RB, Abramson MJ, et al., 2015, Changes in IgE sensitization and total IgE levels over 20 years of follow-up, Journal of Allergy and Clinical Immunology, Vol: 137, Pages: 1788-1795.e9, ISSN: 1097-6825
Background: Cross-sectional studies have reported a lower prevalence of sensitisation in older adults, but few longitudinal studies have examined whether this is an aging or a year-of birth cohort effect. Objective: To assess changes in sensitisation and total IgE in a cohort of European adults as they aged over a 20-year period.Methods: Serum specific IgE to common aeroallergens (house dust mite, cat, grass) and total IgE were measured in 3206 adults, from 25 centres in the European Community Respiratory Health Survey, on three occasions over 20 years. Changes in sensitisation and total IgE were analysed by regression analysis, corrected for potential differences in laboratory equipment, and using inverse sampling-probability weights to account for non-response.Results: Over the 20-year follow-up, the prevalence of sensitisation to at least one of the three allergens fell from 29.4% to 24.8% (-4.6%, 95%CI: -7.0% to -2.1%). The prevalence of sensitisation to house dust mite (-4.3%, 95%CI: -6.0% to -2.6%) and cat (-2.1%, 95%CI: - 3.6% to -0.7%) fell more than sensitisation to grass (-0.6%, 95%CI: -2.5% to 1.3%). Age specific prevalence of sensitisation to house dust mite and cat did not differ between year-of birth cohorts, but sensitisation to grass was most prevalent in the most recent ones. Overall, total IgE fell significantly (geometric mean ratio: 0.63, 95%CI 0.58 to 0.68), at all ages, in all year-of-birth cohorts.Conclusion: Aging was associated with lower levels of sensitisation, especially to house dust mite and cat, after the age of 20.
Greenfield G, Ramzan FA, Newson RB, et al., 2015, Frequent attendances to National Health Service general practitioner-led urgent care centres in London: an observational study, Publisher: ELSEVIER SCIENCE INC, Pages: S40-S40, ISSN: 0140-6736
Amaral AFS, Newson RB, Anto JM, et al., 2015, Change in prevalence of IgE sensitization over 20 years in the European community respiratory health survey cohort, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Burney PGJ, Patel J, Newson R, et al., 2015, Global and regional trends in COPD mortality, 1990-2010, EUROPEAN RESPIRATORY JOURNAL, Vol: 45, Pages: 1239-1247, ISSN: 0903-1936
Sepanlou SG, Newson RB, Poustchi H, et al., 2015, Cardiovascular Disease Mortality and Years of Life Lost Attributable to Non-optimal Systolic Blood Pressure and Hypertension in Northeastern Iran, ARCHIVES OF IRANIAN MEDICINE, Vol: 18, Pages: 144-152, ISSN: 1029-2977
Garcia-Larsen V, Jones M, Potts JF, et al., 2014, Low grade systemic inflammation and lung function outcomes in European adults from the global asthma and allergy network of excellence (GA(2)LEN) follow-up survey, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Patel J, Burney PGJ, Newson RB, et al., 2014, Global and regional trends in mortality from chronic obstructive pulmonary disease: Their relation to poverty, smoking and population change, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Newson RB, van Ree R, Forsberg B, et al., 2014, Geographical variation in the prevalence of sensitization to common aeroallergens in adults: the GA(2)LEN survey, ALLERGY, Vol: 69, Pages: 643-651, ISSN: 0105-4538
Newson RB, Jones M, Forsberg B, et al., 2014, The association of asthma, nasal allergies, and positive skin prick tests with obesity, leptin, and adiponectin, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 44, Pages: 250-260, ISSN: 0954-7894
Brown C, Lacharme-Lora L, Mukonoweshuro B, et al., 2013, Consequences of exposure to peri-articular injections of micro- and nano-particulate cobalt-Chromium alloy, BIOMATERIALS, Vol: 34, Pages: 8564-8580, ISSN: 0142-9612
Tomassen P, Jarvis D, Newson R, et al., 2013, Staphylococcus aureus enterotoxin-specific IgE is associated with asthma in the general population: a GA(2)LEN study, ALLERGY, Vol: 68, Pages: 1289-1297, ISSN: 0105-4538
Jarvis D, Newson R, Burney P, 2013, Change in respiratory symptoms in young adults as they age: European community respiratory health survey 3 (ECRHS 3), EUROPEAN RESPIRATORY JOURNAL, Vol: 42, ISSN: 0903-1936
Gnatiuc L, Kato B, Matheson MC, et al., 2013, The association of asthma with BMI and menarche in the 1958 British Birth Cohort., Journal of Asthma
Newson RB, 2013, Attributable and unattributable risks and fractions and other scenario comparisons, STATA JOURNAL, Vol: 13, Pages: 672-698, ISSN: 1536-867X
Newson RB, 2013, Bonferroni and Holm approximations for Sidak and Holland-Copenhaver q-values, STATA JOURNAL, Vol: 13, Pages: 379-381, ISSN: 1536-867X
Jarvis D, Newson R, Lotvall J, et al., 2012, Asthma in adults and its association with chronic rhinosinusitis: The GA2LEN survey in Europe, ALLERGY, Vol: 67, Pages: 91-98, ISSN: 0105-4538
Newson RB, 2012, Sensible parameters for univariate and multivariate splines, STATA JOURNAL, Vol: 12, Pages: 479-504, ISSN: 1536-867X
Newson RB, 2012, From resultssets to resultstables in Stata, STATA JOURNAL, Vol: 12, Pages: 191-213, ISSN: 1536-867X
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