Compliance with NICE guidelines when commissioning varicose vein procedures

Background

Varicose veins impair quality of life and can lead to chronic leg ulcers. National Institute for Health and Care Excellence (NICE) guidelines (CG168) set out evidence-based standards for patient management. In England, Clinical Commissioning Groups (CCGs) fund NHS care within their locality. The objective of this study was to evaluate CCGs' commissioning policies and compare them with CG168.

Methods

Searches were made for the published policies of all 206 English CCGs. They were reviewed for compliance with NICE guidelines and the associated quality standard. Areas of disagreement were analysed for themes.

Results

Some 203 CCGs (98·5 per cent) had a published policy and 190 (93·6 per cent) of these were published after publication of CG168. Only 73 of the policies (36·0 per cent) were compliant with CG168. Treatment was restricted on the basis of clinical disease severity in 119 CCGs (58·6 per cent); 29 (14·3 per cent) stipulated delay of treatment using a 'trial' of conservative treatment; 22 (10·8 per cent) used lifestyle-related factors such as BMI and smoking status to ration treatment. Treatment was commissioned for uncomplicated symptomatic varicose veins in 87 CCGs (42·9 per cent), but some applied additional rationing mechanisms; 109 CCGs (53·7 per cent) would treat oedema, 183 (90·1 per cent) would treat skin and soft tissue damage, 202 (99·5 per cent) healed ulceration, and all would allow active ulcers to be treated.

Discussion

The majority of CCGs in England have commissioning policies that contradict NICE guidelines. Rationing strategies include disease severity, delay and patient lifestyle-related factors, creating unwarranted geographical variation for varicose vein treatment, disregarding the NHS Constitution for England, and perhaps leading to an increase in costly treatment of chronic complications in the long term.

Resveratrol increases serum adiponectin level and decreases leptin and insulin level in an experimental model of hypercholesterolemia

Serum adiponectin concentration is inversely associated with leptin and insulin concentration. There is little paucity of information in the literature on the adipokine levels and regulation by resveratrol in cholesterol diet-fed animals. Thirty rabbits were randomly divided into six groups, each of five animals: Group 1 = control (C), Group 2 = cholesterol diet (CD) only, Group 3 = resveratrol 200 mg/kg (R200), Group 4 = resveratrol 400 mg/kg (R400), Group 5 = CD + R200, Group 6 = CD + R400. The preparations were administered for 8th weeks of the treatment protocol. weight and blood glucose level were measured on week zero and the 8th week of the treatment. At the end of the study period, the rabbits were placed under light anaesthesia. Blood samples were evaluated for serum concentrations of metabolites assays (adiponectin, leptin and insulin). Serum adiponectin significantly (P < 0.05) increased in resveratrol + CD groups, compared to CD group only. Leptin and insulin significantly (P <0.05) decreased in CD groups co-administered with resveratrol, compared with CD group only. In conclusion, the increase in adiponectin level and decrease in leptin and insulin level following resveratrol administration elucidated the therapeutic potential of resveratrol, despite cholesterol diet consumption.

Effects of Clove and Fermented Ginger on Blood Glucose, Leptin, Insulin and Insulin Receptor Levels in High Fat DietInduced Type 2 Diabetic Rabbits

The aimed of this research is to evaluate the effects of clove and fermented ginger supplements on blood glucose,serum insulin, insulin receptor and Leptin levels of high fat diet-induced type 2 diabetes mellitus in rabbits. Clove and gingerare spices with records of medicinal value over decades. Thirty males rabbits weighing, 1-1.5kg were used for the research.Type 2 diabetes was induced by feeding the animals with a high fat diet for a period of eight weeks. Blood glucose levelswere determined after the induction period and rabbits having 140 mg/dL and above were selected for the study. The animalswere grouped into six groups with five (n=5) rabbits in each group: Group 1 (Normoglycemic control group.) received normalfeed and distilled water ad libitum for six weeks; Group 2 (Diabetic negative control group.) received normal feed anddistilled water ad libitum for six weeks; Groups 3 (Diabetic positive control.) received cholestran 0.26g/kg and normal feedfor a period of six weeks; Group 4 and 5 (diabetic rabbits) were fed on 12.5%, clove and 12.5% fermented gingerrespectively for a period of six weeks; while Group 6 were co-fed on 12.5% clove and 12.5% fermented ginger for a periodof six weeks. Fasting blood glucose levels were determined at weekly interval during the treatment period. At the end of theexperiment, the rabbits were euthanized by cervical dislocation and blood samples were collected for the determination ofinsulin, insulin receptor and leptin levels. A significantly (P<0.05) decrease in blood glucose levels was recorded in thesupplements treated groups compared to diabetic control group. Clove supplement been most effective and sustaining inantihyperglycemic activity, also appears with a significant decreasing effect on leptin levels compared to diabetic controlgroup. A significant increase in insulin levels was also noted in the fermented ginger treated group along with higher levelsof Leptin compared as compared to control group. In conclusion the result of the study show that clove and fermented gingersupplementation possesses anti-diabetic properties and may help in the control of hyperleptinaemia in type 2 diabetes.

Cardiac Troponin T and creatine kinase MB fraction levels among patients with acute ischemic stroke in Nigeria

BACKGROUND

Stroke has been a global burden, with increasing morbidity and mortality. Serum cardiac troponin t (cTnT) and creatine kinase (CK-MB) fraction are reported to be elevated in patients admitted with acute ischaemic stroke and high level of these biomarkers indicated more severe stroke and neurologic deficit in some of the patients.

OBJECTIVE

To evaluate the serum levels cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in patients with acute ischaemic stroke and relate the analytes to severity of stroke.

METHOD

Patients with clinical diagnosis of ischaemic stroke diagnosed, confirmed by brain Computerized Tomography scan and equal number of apparently healthy age and sex-matched were recruited. Serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) were analysed using ELISA method and Stroke severity was determined using National Institute of Health Stroke Score (NIHSS).

RESULTS

Mean serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in stroke patients were found to be higher than age sex matched control (p<0.05). NIHS Score of 12.2 ± 5.43 and 9.78 ± 3.97 were observed in Patients with elevated and normal cTnT respectively (p=0.009) while NIHS Score were similar in patients with elevated and normal CK-MB (p = 0.772).

CONCLUSION

The mean values of serum cTnT and CK-MB were higher in acute ischaemic stroke patients compared to controls. Serum cardiac Troponin t level may be a significant biomarker of the severity of stroke.

The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine

Using telecommunications technology it would be possible to link a patient and paramedic to a Doctor in the Emergency Department (ED) at the point of first patient contact. A questionnaire-based study on telemedicine in the pre-hospital environment involving patients, paramedics, doctors and nurses in the ED, was performed to assess if they would want and accept telemedicine in pre-hospital emergency care. When asked 98.5% (55) of patients, 89% (11) of doctors, 76% (14) of nurses and 91% (42) of ambulance personnel saw the potential of an audio-visual link from the pre-hospital environment to the ED. The potential benefits were felt to be in diagnosis of time-dependent illnesses, time management, increased hospital preparedness for incoming patients and increased triage efficiency. Stakeholder enthusiasm for pre-hospital telemedicine must be met with the technological requirements to provide such a service. As noted by one patient a pre-hospital audio-visual link to the ED could be “potentially a life saving service”.

Predictors of male condom utilization in Plateau State, Nigeria

BACKGROUND

Nigerian men play major roles in the reproductive decision-making process, including issues concerning fertility. Despite efforts made by the government to reduce the incidence of HIV by using condom as a means of dual protection, the utilization of male condom is still relatively low in Nigeria. This study aimed to assess the condom utilization and predictors of condom use among male respondents in Plateau State.

METHODOLOGY

An analysis of secondary data of the 2013 Nigeria Demographic Health Survey dataset was done. Data were collected through a cross-sectional study using multistage cluster sampling technique from 393 consenting males aged 15-49 years in Plateau State using a semistructured, closed-ended questionnaire. Survey data quality was ascertained using field check tables during data entry. The dataset was analyzed using SPSS version 21.0 software (SPSS, IBM Corp, Armonk, NY, USA). Condom utilization prevalence rate was calculated for the 393 males, while predictors were determined by logistic regression. P ≤ 0.05 was considered statistically significant.

RESULTS

Mean age of the respondents was 31.05 ± 9.395 years. Most (90.3%) of the respondents were aware of at least one of the various family planning methods. The prevalence of condom use among them was 15.5% with the 20-29 years' age group having the highest proportion (28.8%). Significant associations were found between condom use and age, level of wealth, level of education, marital status, knowledge of contraception, occupation, and religion. Predictors of condom use include level of wealth (middle class), not being married, and primary level education.

CONCLUSIONS

The prevalence of male condom use is low in Plateau State. The predictors of condom use are level of wealth, being unmarried, and primary level of education. Having only a primary level of education and been in the middle class reduces the likelihood of using condoms while being unmarried increases it.

Association between Adiponectin, Serum Lipids and Obesity in a University Setting in Nigeria

Obesity is an energy imbalance condition, which is accompanied by metabolic and cardiovascular complications.Adiponectin, produced by adipocytes, is an important adipokine involved in carbohydrate and lipid metabolism. Adiponectinlevel is altered in obesity in various populations. In Nigeria, very few studies regarding adiponectin exist, and none, to thebest of our knowledge, investigated the relationship between adiponectin and lipid profile and obesity. Therefore, this studyaims to evaluate changes in adiponectin level and serum lipids with body mass index, and investigate the relationship betweenadiponectin, serum lipids and obesity in Nigerian adults. Anthropometric parameters and blood pressure were measured, and blood samples were collected for biochemical assessment after 12 hours fasting, in a total of 280 subjects, comprising of 186males and 94 females. Serum adiponectin level was evaluated by ELISA, while serum lipid profile was determined byenzymatic endpoint method. Quantitative data were analyzed for significant difference using ANOVA, and Pearson'scorrelation was used to evaluate relationships. Serum adiponectin level was significantly (P ˂ 0.05) highest within overweightmale subjects (1.6 ± 0.06 µg/ml), and lowest within normal male subjects (1.4 ± 0.03 µg/ml). The values for adiponectin concentrations were not significantly different in the female subjects. There was no association in serum lipids andadiponectin in both male (r = -0.035, P >0.05; r = -0.011, P >0.05; r = -0.053, P >0.05; r = -0.084, P >0.05) and female (r=0.061, P >0.05; r = 0.018, P>0.05; r = 0.057, P>0.05; r = -0.021, P >0.05) for LDL, HDL, TC and TRIG respectively. Lipidprofile was not different across BMI classes. There was no relationship between adiponectin and serum lipids in individualsin the study population of adult Nigerians.

Mobile phone-based interactive voice response as a tool for improving access to healthcare in remote areas in Ghana - an evaluation of user experiences

OBJECTIVES

To investigate and determine the factors that enhanced or constituted barriers to the acceptance of an mHealth system which was piloted in Asante-Akim North District of Ghana to support healthcare of children.

METHODS

Four semi-structured focus group discussions were conducted with a total of 37 mothers. Participants were selected from a study population of mothers who subscribed to a pilot mHealth system which used an interactive voice response (IVR) for its operations. Data were evaluated using qualitative content analysis methods. In addition, a short quantitative questionnaire assessed system's usability (SUS).

RESULTS

Results revealed 10 categories of factors that facilitated user acceptance of the IVR system including quality-of-care experience, health education and empowerment of women. The eight categories of factors identified as barriers to user acceptance included the lack of human interaction, lack of update and training on the electronic advices provided and lack of social integration of the system into the community. The usability (SUS median: 79.3; range: 65-97.5) of the system was rated acceptable.

CONCLUSIONS

The principles of the tested mHealth system could be of interest during infectious disease outbreaks, such as Ebola or Lassa fever, when there might be a special need for disease-specific health information within populations.

Effects of Selenium Yeast on Blood Glucose and Antioxidant Biomarkers in Cholesterol Fed Diet Induced Type 2 Diabetes Mellitus in Wistar Rats

Selenium is an antioxidant that prevents oxygen radical from damaging cells from chronic diseases that can develop from cell injury and inflammation such as diabetes mellitus. The aim of the study is to investigate the possible protective effect of selenium yeast on cholesterol diet induced type-2 diabetes mellitus and oxidative stress in rats. Twenty male wistar rats were divided in to four groups of five animals each: Group 1: (Negative control) received standard animal feed only, Group 2:  received cholesterol diet (CD) only, Group 3: received CD and 0.1 mg/kg selenium yeast orally, Group 4: Received CD and 0.2 mg/kg selenium yeast orally for six weeks. At the end of the study period, the animals were sacrificed and the serum samples were collected and evaluated for estimation of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). The results showed a significant decrease in blood glucose level in the groups  co-administered CD and selenium yeast when compared to CD group only. Antioxidant enzymes status recorded significant decrease in SOD, CAT and GPx activities in CD and selenium yeast administered when compared to CD group only. In Conclusion, Selenium yeast administrations prevent free radical formations which are potent inducer of diabetes mellitus.

Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery

BACKGROUND

Increasing numbers of older patients are undergoing vascular surgery. Inadequate preoperative assessment and optimization may contribute to increased postoperative morbidity and mortality.

METHODS

Patients aged at least 65 years scheduled for elective aortic aneurysm repair or lower-limb arterial surgery were enrolled in an RCT of standard preoperative assessment or preoperative comprehensive geriatric assessment and optimization. Randomization was stratified by sex and surgical site (aorta/lower limb). Primary outcome was length of hospital stay. Secondary outcome measures included new medical co-morbidities, postoperative medical or surgical complications, discharge to a higher level of dependency and 30-day readmission rate.

RESULTS

A total of 176 patients were included in the final analysis (control 91, intervention 85). Geometric mean length of stay was 5·53 days in the control group and 3·32 days in the intervention group (ratio of geometric means 0·60, 95 per cent c.i. 0·46 to 0·79; P < 0·001). There was a lower incidence of delirium (11 versus 24 per cent; P = 0·018), cardiac complications (8 versus 27 per cent; P = 0·001) and bladder/bowel complications (33 versus 55 per cent; P = 0·003) in the intervention group compared with the control group. Patients in the intervention group were less likely to require discharge to a higher level of dependency (4 of 85 versus 12 of 91; P = 0·051).

CONCLUSION

In this study of patients aged 65 years or older undergoing vascular surgery, preoperative comprehensive geriatric assessment was associated with a shorter length of hospital stay. Patients undergoing assessment and optimization had a lower incidence of complications and were less likely to be discharged to a higher level of dependency. Registration number: ISRCTN23142588 (http://www.controlled-trials.com).