Publications
283 results found
Cecil E, Saxena S, Aylin P, 2018, Children and Young People's Contacts in Primary Care within 3 Days of an Admission to Hospital with Meningitis, Publisher: OXFORD UNIV PRESS, Pages: 7-8, ISSN: 1353-4505
Ahmad A, Laverty AA, Cowling TE, 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
Background and study aims In the last decade, there have been major advances in inflammatory bowel disease (IBD) management but their impact on hospital admissions requires evaluation. We aim to investigate nationwide trends in IBD surgical/medical elective and emergency admissions, including endoscopy and cytokine inhibitor infusions, between 2003 and 2013.Patients and methods We used Hospital Episode Statistics and population data from the UK Office for National Statistics.Results Age-sex standardised admission rates increased from 76.5 to 202.9/100 000 (p<0.001) and from 69.5 to 149.5/100 000 (p<0.001) for Crohn’s disease (CD) and ulcerative colitis (UC) between 2003–2004 and 2012–2013, respectively. Mean length of stay (days) fell significantly for elective (from 2.6 to 0.7 and from 2.0 to 0.7 for CD and UC, respectively) and emergency admissions (from 9.2 to 6.8 and from 10.8 to 7.6 for CD and UC, respectively). Elective lower gastrointestinal (GI) endoscopy rates decreased from 6.3% to 3.7% (p<0.001) and from 18.4% to 17.6% (p=0.002) for CD and UC, respectively. Elective major abdominal surgery rates decreased from 2.8% to 1.0% (p<0.001) and from 4.9 to 2.4 (p=0.010) for CD and UC, respectively, with emergency rates also decreasing significantly for CD. Between 2006-2007 and 2012-2013, elective admission rates for cytokine-inhibitor infusions increased from 11.1 to 57.2/100 000 and from 1.4 to 12.1/100 000 for CD and UC, respectively.Conclusions Rising IBD hospital admission rates in the past decade have been driven by an increase in the incidence and prevalence of IBD. Lower GI endoscopy and surgery rates have fallen, while cytokine inhibitor infusion rates have risen. There has been a concurrent shift from emergency care to shorter elective hospital stays. These trends indicate a move towards more elective medical management and may reflect improvements in disease control.
Blackwell J, Alexakis C, Cecil E, et al., 2018, Smoking in UC is associated with decreased thiopurine use but not steroid dependency or colectomy, Publisher: OXFORD UNIV PRESS, Pages: S528-S530, ISSN: 1873-9946
Viner RM, Kinra S, Nicholls D, et al., 2018, Burden of child and adolescent obesity on health services in England, Arch Dis Child, Vol: 103, Pages: 247-254, ISSN: 0003-9888
OBJECTIVE: To assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England. DESIGN: Pathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data. SETTING: Data on CYP aged 2-18 years from the Health Survey for England 2006 to 2013. MAIN OUTCOME MEASURES: Clinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI >/=99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function). RESULTS: 11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13-18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management. CONCLUSIONS: There is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden.
Saxena S, 2017, Success and failure of the National Childhood Measurement Programme in England, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
White B, Hsia Y, Kinra S, et al., 2017, Survey of anti-obesity drug prescribing for obese children and young people in UK primary care., BMJ Paediatrics Open, Vol: 1, ISSN: 2399-9772
Objectives Antiobesity drug (AOD) prescribing in childrenand young people (CYP) in primary care is rising with highrates of discontinuation. Little is known about prescribingin this group in terms of patient demographics andcomorbidities, reasons for initiation and discontinuation, oradherence to national guidelines.Design Questionnaire survey to general practitioners(GPs) identified using a nationally representative primarycare database covering 6% of UK population.Setting UK-wide primary care.Participants Patients were eligible if prescribed anAOD aged ≤18 years between 2010 and 2012. A total of151 patients from 108 unique practices were identifiedvia national prescribing database, with responses for 119patients (79%) from 84 practices; 94 of 119 (79%) wereeligible for inclusion.Primary and secondary outcomes Survey of GPprescribing habits of AODs to CYP. We audited orlistatusage against the National Institute for Health and CareExcellence (NICE) guidance.Results 47% were prescribed metformin, 59% orlistatand 5% both drugs. Orlistat was largely prescribed by GPsindependently (49/55 prescriptions, 89%) and metforminby GPs on specialist recommendation (12/44, 27%).Orlistat was largely prescribed in those over 16 yearsof age without physical comorbidities. Metformin wasinitiated for treatment of polycystic ovarian syndrome(70%), insulin resistance (25%) and impaired glucosecontrol (9%). Median supply of metformin was 10.5months (IQR 4–18.5 months) and 2.0 months (1.0–4.0) fororlistat (p≤0.001). Drug terminations were largely due tofamilies not requesting repeat prescriptions. NICE guidanceadherence was low; 17% of orlistat prescriptions wereinitiated by specialists, and 56% had evidence of obesityrelatedcomorbidity. GPs reported lower confidence inprescribing AOD to CYP compared with adults (10-pointLikert score median 3 vs 8, p<0.001).Conclusions Prescribing of AOD in primary care ischallenging with low adherence to NICE guidance. Furtherwork is
Rann O, Sharland M, Long P, et al., 2017, Did the accuracy of oral amoxicillin dosing of children improve after British National Formulary dose revisions in 2014?: national cross sectional survey in England, BMJ Open, Vol: 7, ISSN: 2044-6055
Objectives Inaccurate antibiotic dosing can lead to treatment failure, fuel antimicrobial resistance and increase side effects. The British National Formulary for Children (BNFC) guidance recommends oral antibiotic dosing according to age bands as a proxy for weight. Recommended doses of amoxicillin for children were increased in 2014 ‘after widespread concerns of under dosing’. However, the impact of dose changes on British children of different weights is unknown, particularly given the rising prevalence of childhood obesity in the UK. We aimed to estimate the accuracy of oral amoxicillin dosing in British children before and after the revised BNFC guidance in 2014.Setting and participants We used data on age and weights for 1556 British children (aged 2–18 years) from a nationally representative cross-sectional survey, the Health Survey for England 2013.Interventions We calculated the doses each child would receive using the BNFC age band guidance, before and after the 2014 changes, against the ‘gold standard’ weight-based dose of amoxicillin, as per its summary of product characteristics.Primary outcome measure Assuming children of different weights were equally likely to receive antibiotics, we calculated the percentage of the children who would be at risk of misdosing by the BNFC age bands.Results Before 2014, 54.6% of children receiving oral amoxicillin would have been underdosed and no child would have received more than the recommended dose. After the BNFC guidance changed in 2014, the number of children estimated as underdosed dropped to 5.8%, but 0.5% of the children would have received too high a dose.Conclusions Changes to the BNFC age-banded amoxicillin doses in 2014 have significantly reduced the proportion of children who are likely to be underdosed, with only a minimal rise in the number of those above the recommended range.
Wang H, Abajobir A, Abate KH, et al., 2017, Global, regional, and national under-5 mortality, adultmortality, age-specific mortality, and life expectancy,1970–2016: a systematic analysis for the Global Burden ofDisease Study 2016, The Lancet, Vol: 390, Pages: 1084-1150, ISSN: 0140-6736
BackgroundDetailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.MethodsWe have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15–60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to
Gakidou E, Afshin A, Abajobir AA, et al., 2017, Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, Lancet, Vol: 390, Pages: 1345-1422, ISSN: 0140-6736
BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.MethodsWe used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.FindingsSince 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smok
Hay SI, Abajobir AA, Abate KH, et al., 2017, Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, Lancet, Vol: 390, Pages: 1260-1344, ISSN: 0140-6736
BackgroundMeasurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).MethodsWe used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.FindingsThe highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9–78·6) for females and 72·0 years (68·8–75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0–49·5]) and for males was in Lesotho (41·5 years [39·0–44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97–6·48) for both sexes combined. Global HALE increased by 6·04 years (
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators, 2017, Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016., Lancet, Vol: 390, Pages: 1211-1259, ISSN: 0140-6736
BACKGROUND: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. METHODS: We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS: Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs
Fullman N, Barbar RM, Abajobir AA, et al., 2017, Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016, The Lancet, Vol: 390, Pages: 1423-1459, ISSN: 0140-6736
BackgroundThe UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030.MethodsWe used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0–100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment.FindingsGlobally, the median health-related SDG index was 56·7 (IQR 31·9–66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6–88·9), Iceland (86·0, 84·1–87·6), and Sweden (85·6, 81·8–87·8) having the h
Alexakis C, Kumar S, Saxena S, et al., 2017, Editorial: depression in the setting of inflammatory bowel disease means we have failed to provide early, effective, psychosocial care-authors' reply, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 46, Pages: 554-555, ISSN: 0269-2813
Pollok RCG, Saxena S, Alexakis C, et al., 2017, Letter to Editor Regarding Narula et al, IBD 2017, Budenoside Use Is a Key Quality Marker in the Management of IBD, Inflammatory Bowel Diseases, Vol: 23, Pages: E41-E41, ISSN: 1078-0998
Ahmad A, Laverty A, Alexakis C, et al., 2017, Changing nationwide patterns in UK admissions for medical therapy, surgery, lower gi endoscopy and anti-tnf infusions for inflammatory bowel disease between 2003-2013, Annual General Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ Publishing Group, Pages: A158-A158, ISSN: 0017-5749
Alexakis C, Kumar S, Saxena S, et al., 2017, Systematic review with meta-analysis: the impact of a depressive state on disease course in adult inflammatory bowel disease, Alimentary Pharmacology and Therapeutics, Vol: 46, Pages: 225-235, ISSN: 0269-2813
BackgroundDespite a higher prevalence of psychosocial morbidity in Inflammatory Bowel Disease (IBD), the association between depressive state and disease course in IBD is poorly understood.AimTo investigate the impact of depressive state on disease course in IBD.MethodsWe conducted a systematic review in MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and PsychINFO for prospective studies evaluating the impact of baseline depressive state on subsequent disease course in adult IBD.ResultsEleven studies matched our entry criteria, representing 3194 patients with IBD. Three reported on patients with ulcerative colitis (UC), four included patients with Crohn's disease (CD) exclusively, and four studies included both UC and CD. Five studies reported an association between depressive state and disease course. None of the UC-specific studies found any association. In three of four CD-specific studies, a relationship between depressive state and worsening disease course was found. In four of five studies including patients in remission at baseline, no association between depressive state and disease course was found. Pooled analysis of IBD studies with patients in clinical remission at baseline identified no association between depressive state and disease course (HR 1.04, 95%CI: 0.97-1.12).ConclusionThere is limited evidence to support an association between depressive state and subsequent deterioration in disease course in IBD, but what data that exist are more supportive of an association with CD than UC. Baseline disease activity may be an important factor in this relationship. Further studies are needed to understand the relationship between mental health and outcomes in IBD.
Ma R, Cecil E, Saxena S, 2017, TRENDS IN RECORDED ABORTIONS IN UK GENERAL PRACTICE - COHORT STUDY USING CLINICAL PRACTICE RESEARCH DATALINK (CPRD), Publisher: BMJ PUBLISHING GROUP, Pages: A36-A36, ISSN: 1368-4973
Ma RMMN, Saxena S, Cecil E, 2017, Can Clinical Practice Research Datalink (CPRD) be used to study trends in recorded abortions in UK general practice?, Faculty of Sexual and Reproductive Healthcare Annual Scientific Conference
Alexakis C, Saxena S, Chhaya V, et al., 2017, Do Thiopurines Reduce the Risk of Surgery in Elderly Onset Inflammatory Bowel Disease? A 20-Year National Population-Based Cohort Study., Inflamm Bowel Dis, Vol: 23, Pages: 672-680
BACKGROUND: Evidence that thiopurines impact on the risk of surgery in elderly onset inflammatory bowel disease (EO-IBD) is lacking. We aimed to compare the rates of surgery in EO-IBD (>60 years at diagnosis) with adult-onset IBD (18-59 yrs), and examine the impact of thiopurines on surgical risk in EO-IBD. METHODS: Using a U.K. database between 1990 and 2010, we compared rates of surgery between adult-onset IBD and EO-IBD using survival analysis. Ulcerative colitis (UC) and Crohn's disease (CD) were analyzed separately. Cox proportional hazard modeling was used to determine the adjusted relative risk of surgery. We further assessed the impact of duration of thiopurine treatment on risk of surgery. RESULTS: We identified 2758 of 9515 patients with UC and 1349 of 6490 patients with CD, with EO-IBD. Cumulative 1, 5, and 10 years risk of colectomy was similar in EO-UC (2.2, 4.5, and 5.8%, respectively) and AO-UC (2.2, 5.0, and 7.3%, respectively; P = 0.15). Cumulative 1, 5, and 10 years risk of first intestinal surgery was lower in EO-CD (9.5, 14.6, and 17.9%, respectively) than AO-CD (12.2, 19.0, and 24.4%, respectively; P < 0.001). Early steroid use, steroid dependency, and thiopurine use was associated with higher risk of colectomy in EO-UC. Among EO-UC receiving thiopurines for >12 months, there was a 70% reduction in risk of colectomy (hazard ratio. 0.30; 95% confidence interval, 0.15-0.58). Thiopurines were not associated with a reduced risk of surgery in EO-CD. CONCLUSIONS: Risk of colectomy in EO-UC does not differ from AO-UC, but the risk of surgery in EO-CD is significantly lower than in AO-CD. Sustained thiopurine use of 12 months or more duration in EO-UC reduces the risk colectomy, but does not impact on the risk of surgery in EO-CD. These findings are important given the greater risk of thiopurine-associated lymphoma in the elderly.
Hay SI, Jayaraman SP, Truelsen T, et al., 2017, GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 (vol 388, pg 1545, 2016), LANCET, Vol: 389, Pages: E1-E1, ISSN: 0140-6736
Mainous AG, Baker R, Majeed A, et al., 2016, English language skills and diabetes and hypertension among foreign-born South Asian adults in England, PUBLIC HEALTH REPORTS, Vol: 121, Pages: 331-336, ISSN: 0033-3549
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Chhaya V, Saxena S, Cecil E, et al., 2016, Emerging trends and risk factors for perianal surgery in Crohn's disease: a 20-year national population-based cohort study, European Journal of Gastroenterology & Hepatology, Vol: 28, Pages: 890-895, ISSN: 0954-691X
Background: Little is known about the rates of perianal surgery (PAS) in Crohn’s disease (CD). Our aim was to determine trends in PAS, the timing of surgery relative to the diagnosis of CD and to identify subgroups at risk of PAS.Materials and methods: We identified 9391 incident cases of CD between 1989 and 2009. We defined three eras: era 1 (1989–1995), era 2 (1996–2002) and era 3 (2003–2009), and determined trends in procedure type and the time to first PAS relative to the date of diagnosis. We used Kaplan–Meier analysis to calculate the rate of first PAS and performed Cox regression to determine subgroups at risk of PAS.Results: Among the 9391 incident cases of CD, 405 (4.3%) underwent PAS. The overall rate of PAS was 5.5% [95% confidence interval (CI): 4.9–6.2%] 10 years after diagnosis. 34% (n=137) of all patients undergoing PAS had surgery in the 5 years before CD diagnosis. Abscess drainage increased from 34 to 58%, whereas proctectomy decreased from 16 to 6% between eras 1 and 3, respectively. Men [hazard rate (HR) 1.51, 95% CI: 1.24–1.84], those aged 17–40 years (HR 1.69, 95% CI: 1.09–2.02 vs. those aged >40 years) and those with a history of previous intestinal resection (HR 28.5, 95% CI: 22.2–36.5) were more likely to have PAS.Conclusion: Around one-third of patients have a PAS in the 5 years preceding their diagnosis of CD. Surgical practice has changed over 20 years, with a decrease in proctectomy and a concurrent increase in abscess drainage that is likely to reflect improvements in therapeutic practice.
Chhaya V, Saxena S, Cecil E, et al., 2016, Steroid dependency and trends in prescribing for inflammatory bowel disease - a 20-year national population-based study., Alimentary Pharmacology and Therapeutics, Vol: 44, Pages: 482-494, ISSN: 0269-2813
BACKGROUND: It is unclear whether adherence to prescribing standards has been achieved in inflammatory bowel disease (IBD). AIM: To determine how prescribing of 5-aminosalicylates (5-ASAs), steroids and thiopurines has changed in response to emerging evidence. METHODS: We examined trends in oral and topical therapies in 23 509 incident IBD cases (6997 with Crohn's disease and 16 512 with ulcerative colitis) using a nationally representative sample between 1990 and 2010. We created five eras according to the year of diagnosis: era 1 (1990-1993), era 2 (1994-1997), era 3 (1998-2001), era 4 (2002-2005) and era 5 (2006-2010). We calculated the proportion of patients treated with prolonged 5-ASAs (>12 months) and steroid dependency, defined as prolonged steroids (>3 months) or recurrent (restarting within 3 months) steroid exposure. We calculated the cumulative probability of receiving each medication using survival analysis. RESULTS: Half of the Crohn's disease patients were prescribed prolonged oral 5-ASAs during the study, although this decreased between era 3 and 5 from 61.8% to 56.4% (P = 0.002). Thiopurine use increased from 14.0% to 47.1% (P < 0.001) between era 1 and 5. This coincided with a decrease in steroid dependency from 36.5% to 26.8% (P < 0.001) between era 1 and 2 and era 4 and 5 respectively. In ulcerative colitis, 49% of patients were maintained on prolonged oral 5-ASAs. Despite increasing thiopurine use, repeated steroid exposure increased from 15.3% to 17.8% (P = 0.02) between era 1 and 2 and era 4 and 5 respectively. CONCLUSIONS: Prescribing in clinical practice insufficiently mirrors the evidence base. Physicians should direct management towards reducing steroid dependency and optimising 5-ASA use in patients with IBD.
Gnani S, Morton S, Ramzan F, et al., 2016, Healthcare use among preschool children attending GP-led urgent care centres: a descriptive, observational study, BMJ Open, Vol: 6, ISSN: 2044-6055
Objective: Urgent Care Centres (UCCs) hours were developed with the aim of reducing inappropriate Emergency Department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care in two General Practitioner (GP)-led UCCs with extended opening times. Design: Retrospective observational epidemiological study using routinely collected data.Setting: Two GP-led UCCs in London, co-located with a hospital ED.Participants: All children aged under 5 years attending two GP-led UCCs over a 3 year period. Outcomes: Outcomes of care for the children including; primary diagnosis; registration status with a GP; destination following review within the UCC and any medication prescribed. Comparison between GP-led UCC visit rates and routine general practices was also made.Results: 3% (n=7,747/282,947) of all attenders at the GP-led UCCs were children aged under 5 years. The most common reason for attendance was a respiratory illness (27%), followed by infectious illness (17%). 18% (n=1428) were either upper respiratory tract infections or viral infections. The majority (91%) of children attending were registered with a GP and over two thirds of attendances were ‘out of hours’. Overall 79% were seen and discharged home. Preschool children were more likely to attend their GP (47.0 per 100) than a GP-led UCC (9.4 per 100; 95% confidence interval: 8.9-10.0).Conclusions: Two thirds of preschool children attending GP-led UCCs do so out of hours, despite the majority being registered with a GP. The case mix is comparable to those presenting to an ED setting, with the majority managed exclusively by the GPs in the UCC before discharge home. Further work is required to understand the benefits of a GP-led urgent system in influencing future use of services especially emergency care.
Alexakis C, Oliver C, Hockney E, et al., 2016, MONITORING IBD MEDICATIONS IN PRIMARY CARE: AUDIT OF PRACTICE IN SOUTH WEST LONDON, Publisher: BMJ PUBLISHING GROUP, Pages: A142-A142, ISSN: 0017-5749
Majeed F, Hansell A, Saxena S, et al., 2016, How would a decision to leave the European Union affect medical research and health in the United Kingdom?, Journal of the Royal Society of Medicine, Vol: 109, Pages: 216-218, ISSN: 1758-1095
Kononowicz AA, Woodham L, Georg C, et al., 2016, Virtual patient simulations for health professional education, Cochrane Database of Systematic Reviews, Vol: 5, ISSN: 1469-493X
This is the protocol for a review and there is no abstract. The objectives are as follows:The objective of this review is to evaluate the effectiveness of virtual patient simulation as an educational intervention versus traditional learning, other types of e-Learning interventions and other forms of virtual patient simulation interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on learners’ knowledge, skills and attitudes. Our secondary objective is to assess the cost-effectiveness of these interventions.
Paul P, Toon E, Hadadgar A, et al., 2016, Online- and local area network (LAN)-based eLearning interventions for medical doctors' education, Cochrane Database of Systematic Reviews, Vol: 2016, ISSN: 1465-1858
This is the protocol for a review and there is no abstract. The objectives are as follows: This review will evaluate the effectiveness of internet- and LAN-based eLearning for ongoing training of medical doctors, specifically looking at the impact of the learning on the learners' knowledge, skills, attitude, and satisfaction. This review will also assess any change in clinical practices or behaviours in response to these interventions, and the economic impact (cost and cost-effectiveness) of internet- and LAN-based educational interventions.
Cecil E, Bottle A, Cowling TE, et al., 2016, Primary Care Access, Emergency Department Visits, and Unplanned Short Hospitalizations in the UK, PEDIATRICS, Vol: 137, ISSN: 0031-4005
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Giuliani S, Cecil EV, Apelt N, et al., 2016, Pediatric Emergency Appendectomy and 30-Day Postoperative Outcomes in District General Hospitals and Specialist Pediatric Surgical Centers in England, April 2001 to March 2012 Retrospective Cohort Study, Annals of Surgery, Vol: 263, Pages: 184-190, ISSN: 1528-1140
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