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Steflik HJ, Charlton J, Briley M, Selewski DT, Gist KM, Hanna M, Askenazi DJ, Griffin R. Neoatal nephrotoxic medication exposure and early acute kidney injury: Results from the AWAKEN study. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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D'Souza N, Charlton J, Grayson J, Kobayashi S, Hutchison L, Hunt M, Simic M. Are biomechanics during gait associated with the structural disease onset and progression of lower limb osteoarthritis? A systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:381-394. [PMID: 34757028 DOI: 10.1016/j.joca.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/12/2021] [Accepted: 10/23/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate if gait biomechanics are associated with increased risk of structurally diagnosed disease onset or progression of lower limb osteoarthritis (OA). METHOD A systematic review of Medline and Embase was conducted from inception to July 2021. Two reviewers independently screened records, extracted data and assessed risk of bias. Included studies reported gait biomechanics at baseline, and either structural imaging or joint replacement occurrence in the lower limb at follow-up. The primary outcome was the Odds Ratio (OR) (95% confidence interval (CI)) of the association between biomechanics and structural OA outcomes with data pooled for meta-analysis. RESULTS Twenty-three studies reporting 25 different biomechanical metrics and 11 OA imaging outcomes were included (quality scores ranged 12-20/21). Twenty studies investigated knee OA progression; three studies investigated knee OA onset. Two studies investigated hip OA progression. 91% of studies reported a significant association between at least one biomechanical variable and OA onset or progression. There was an association between frontal plane biomechanics with medial tibiofemoral and hip OA progression and sagittal plane biomechanics with patellofemoral OA progression. Meta-analyses demonstrated increased odds of medial tibiofemoral OA progression with greater baseline peak knee adduction moment (KAM) (OR: 1.88 [95%CI: 1.08, 3.29]) and varus thrust presence (OR: 1.97 [95%CI: 1.32, 2.96]). CONCLUSION Evidence suggests that certain gait biomechanics are associated with an increased odds of OA onset and progression in the knee, and progression in the hip. REGISTRATION NUMBER PROSPERO CRD42019133920.
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Affiliation(s)
- N D'Souza
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - J Charlton
- Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Canada.
| | - J Grayson
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - S Kobayashi
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - L Hutchison
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - M Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Canada.
| | - M Simic
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
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Rapoport M, Wood J, Dow J, O'Neill D, Charlton J, Koppel S. An International Review of Motor Vehicle Collision Risk with Medical Conditions in Older Adults. Innov Aging 2021. [PMCID: PMC8681638 DOI: 10.1093/geroni/igab046.3176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective was to examine the impact of seven categories of medical illness on risk of Motor Vehicle Collisions (MVC) in older adults. In late 2019, a systematic review of the MVC risk associated with alcohol use disorders, psychiatric disorders, epilepsy, diabetes, hearing loss, vision disorders and sleep disorders was conducted. A total of 64,720 titles were screened, and 138 articles were included. Of these, only thirteen pertained to older adults, only six showed increased MVC risk in at least one condition, and only seven were rated of “Good” quality. Hearing impairment was associated with MVC only if associated with visual acuity or contrast sensitivity impairments (RR 1.52, 95% CI 1.01-2.3 and RR 2.41, 95% CI 1.62-3.57, respectively). A high depression score was associated with increased MVC (RR 1.5, 95% CI 1.1-2.1) in one study, but a similar relationship was not found in two other studies. Glaucoma increased at-fault MVC risk (RR 1.65, 95% CI 1.20-2.28) in one study, but no relationship was found in another. Visual field loss increased MVC risk in three of four studies (RR or HR ranging from 1.31 to 2.32). One negative study each were identified for alcohol use disorders, age-related macular degeneration, any eye disease, or any psychiatric disorder, and four negative studies were identified for reduced visual acuity. No studies of older adults were found for epilepsy or sleep disorders. Interpretation of MVC risk in older drivers with medical illness is rendered challenging by the paucity and quality of studies.
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Affiliation(s)
| | - Joanne Wood
- Queensland University of Technology, Brisbane City, Queensland, Australia
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Gulliford MC, Charlton J, Boiko O, Winter JR, Rezel-Potts E, Sun X, Burgess C, McDermott L, Bunce C, Shearer J, Curcin V, Fox R, Hay AD, Little P, Moore MV, Ashworth M. Safety of reducing antibiotic prescribing in primary care: a mixed-methods study. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background
The threat of antimicrobial resistance has led to intensified efforts to reduce antibiotic utilisation, but serious bacterial infections are increasing in frequency.
Objectives
To estimate the risks of serious bacterial infections in association with lower antibiotic prescribing and understand stakeholder views with respect to safe antibiotic reduction.
Design
Mixed-methods research was undertaken, including a qualitative interview study of patient and prescriber views that informed a cohort study and a decision-analytic model, using primary care electronic health records. These three work packages were used to design an application (app) for primary care prescribers.
Data sources
The Clinical Practice Research Datalink.
Setting
This took place in UK general practices.
Participants
A total of 706 general practices with 66.2 million person-years of follow-up from 2002 to 2017 and antibiotic utilisation evaluated for 671,830 registered patients. The qualitative study included 31 patients and 30 health-care professionals from primary care.
Main outcome measures
Sepsis and localised bacterial infections.
Results
Patients were concerned about antimicrobial resistance and the side effects, as well as the benefits, of antibiotic treatment. Prescribers viewed the onset of sepsis as the most concerning potential outcome of reduced antibiotic prescribing. More than 40% of antibiotic prescriptions in primary care had no coded indication recorded across both Vision® and EMIS® practice systems. Antibiotic prescribing rates varied widely between general practices, but there was no evidence that serious bacterial infections were less frequent at higher prescribing practices (adjusted rate ratio for 20% increase in prescribing 1.03, 95% confidence interval 1.00 to 1.06; p = 0.074). The probability of sepsis was lower if an antibiotic was prescribed at an infection consultation, and the number of antibiotic prescriptions required to prevent one episode of sepsis (i.e. the number needed to treat) decreased with age. For those aged 0–4 years, the number needed to treat was 29,773 (95% uncertainty interval 18,458 to 71,091) in boys and 27,014 (95% uncertainty interval 16,739 to 65,709) in girls. For those aged > 85 years, the number needed to treat was 262 (95% uncertainty interval 236 to 293) in men and 385 (95% uncertainty interval 352 to 421) in women. Frailty was associated with a greater risk of sepsis and a smaller number needed to treat. For severely frail patients aged 55–64 years, the number needed to treat was 247 (95% uncertainty interval 156 to 459) for men and 343 (95% uncertainty interval 234 to 556) for women. At all ages, the probability of sepsis was greatest for urinary tract infection, followed by skin infection and respiratory tract infection. The numbers needed to treat were generally smaller for the period 2014–17, when sepsis was diagnosed more frequently. The results are available using an app that we developed to provide primary care prescribers with stratified risk estimates during infection consultations.
Limitations
Analyses were based on non-randomised comparisons. Infection episodes and antibiotic prescribing are poorly documented in primary care.
Conclusions
Antibiotic treatment is generally associated with lower risks, but the most serious bacterial infections remain infrequent even without antibiotic treatment. This research identifies risk strata in which antibiotic prescribing can be more safely reduced.
Future work
The software developed from this research may be further developed and investigated for antimicrobial stewardship effect.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin C Gulliford
- School of Population Health and Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Judith Charlton
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Olga Boiko
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Joanne R Winter
- School of Population Health and Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Emma Rezel-Potts
- School of Population Health and Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Xiaohui Sun
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Caroline Burgess
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Lisa McDermott
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Catey Bunce
- School of Population Health and Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - James Shearer
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Vasa Curcin
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Robin Fox
- Bicester Health Centre, Bicester, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Michael V Moore
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King’s College London, London, UK
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Gelinas I, Mazer B, Chen YT, Vrkljan B, Marshall S, Charlton J, Koppel S. Evaluating Older Drivers in Their Everyday Driving Environments. Innov Aging 2020. [PMCID: PMC7743774 DOI: 10.1093/geroni/igaa057.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Developing tools that accurately detect at-risk driving behaviors is a public-health priority. There is a need for a measure that accurately assesses older drivers’ level of competence on familiar roadways. The objective of this presentation is to describe the development of the procedures and scoring of a new approach, the Electronic Driving Observation Schedule (eDOS), to observe everyday driving in the community. The eDOS was used to record and compare the driving environment and performance of older drivers and low-risk younger drivers during their everyday driving. Older (n=160, >74y) and younger (n=60, 35-64y) drivers completed a 20-30-minute drive from their home to destinations of their choice. Older drivers drove on simpler routes with fewer intersections and lane changes. Both groups made few driving errors, which were mostly low-risk. Younger drivers tended to demonstrate poor driving habits (not signaling, speeding, poor lane position) and compliance with road rules. Part of a symposium sponsored by Transportation and Aging Interest Group.
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Affiliation(s)
| | - Barbara Mazer
- McGill University School of Physical and Occupational Therapy, Montreal, Quebec, Canada
| | | | | | | | - Judith Charlton
- Monash University Accident Research Centre, Clayton, Victoria, Australia
| | - Sjaanie Koppel
- Monash University Accident Research Centre, Clayton, Victoria, Australia
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Gulliford MC, Juszczyk D, Prevost AT, Soames J, McDermott L, Sultana K, Wright M, Fox R, Hay AD, Little P, Moore M, Yardley L, Ashworth M, Charlton J. Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study. Health Technol Assess 2020; 23:1-70. [PMID: 30900550 DOI: 10.3310/hta23110] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Unnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance. OBJECTIVES To develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory infections (RTIs). INTERVENTIONS A multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing. DESIGN A parallel-group, cluster randomised controlled trial. SETTING The trial was conducted in 79 general practices in the UK Clinical Practice Research Datalink (CPRD). PARTICIPANTS All registered patients were included. MAIN OUTCOME MEASURES The primary outcome was the rate of antibiotic prescriptions for self-limiting RTIs over the 12-month intervention period. COHORT STUDY A separate population-based cohort study was conducted in 610 CPRD general practices that were not exposed to the trial interventions. Data were analysed to evaluate safety outcomes for registered patients with 45.5 million person-years of follow-up from 2005 to 2014. RESULTS There were 41 intervention trial arm practices (323,155 patient-years) and 38 control trial arm practices (259,520 patient-years). There were 98.7 antibiotic prescriptions for RTIs per 1000 patient-years in the intervention trial arm (31,907 antibiotic prescriptions) and 107.6 per 1000 patient-years in the control arm (27,923 antibiotic prescriptions) [adjusted antibiotic-prescribing rate ratio (RR) 0.88, 95% confidence interval (CI) 0.78 to 0.99; p = 0.040]. There was no evidence of effect in children aged < 15 years (RR 0.96, 95% CI 0.82 to 1.12) or adults aged ≥ 85 years (RR 0.97, 95% CI 0.79 to 1.18). Antibiotic prescribing was reduced in adults aged between 15 and 84 years (RR 0.84, 95% CI 0.75 to 0.95), that is, one antibiotic prescription was avoided for every 62 patients (95% CI 40 to 200 patients) aged 15-84 years per year. Analysis of trial data for 12 safety outcomes, including pneumonia and peritonsillar abscess, showed no evidence that these outcomes might be increased as a result of the intervention. The analysis of data from non-trial practices showed that if a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then 1.1 (95% CI 0.6 to 1.5) more cases of pneumonia per year and 0.9 (95% CI 0.5 to 1.3) more cases of peritonsillar abscesses per decade may be observed. There was no evidence that mastoiditis, empyema, meningitis, intracranial abscess or Lemierre syndrome were more frequent at low-prescribing practices. LIMITATIONS The research was based on electronic health records that may not always provide complete data. The number of practices included in the trial was smaller than initially intended. CONCLUSIONS This study found evidence that, overall, general practice antibiotic prescribing for RTIs was reduced by this electronically delivered intervention. Antibiotic prescribing rates were reduced for adults aged 15-84 years, but not for children or the senior elderly. FUTURE WORK Strategies for antimicrobial stewardship should employ stratified interventions that are tailored to specific age groups. Further research into the safety of reduced antibiotic prescribing is also needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN95232781. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dorota Juszczyk
- School of Population Health and Environmental Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Toby Prevost
- School of Population Health and Environmental Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Public Health, Imperial College London, London, UK
| | - Jamie Soames
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Lisa McDermott
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kirin Sultana
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Mark Wright
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | | | - Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Michael Moore
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Judith Charlton
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Winter JR, Charlton J, Ashworth M, Bunce C, Gulliford MC. Peritonsillar Abscess and Antibiotic Prescribing for Respiratory Infection in Primary Care: A Population-Based Cohort Study and Decision-Analytic Model. Ann Fam Med 2020; 18:390-396. [PMID: 32928754 PMCID: PMC7489966 DOI: 10.1370/afm.2570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To quantify the risk of peritonsillar abscess (PTA) following consultation for respiratory tract infection (RTI) in primary care. METHOD A cohort study was conducted in the UK Clinical Practice Research Datalink including 718 general practices with 65,681,293 patient years of follow-up and 11,007 patients with a first episode of PTA. From a decision tree, Bayes theorem was employed to estimate both the probability of PTA following an RTI consultation if antibiotics were prescribed or not, and the number of patients needed to be treated with antibiotics to prevent 1 PTA. RESULTS There were 11,007 patients with PTA with age-standardized incidence of new episodes of PTA of 17.2 per 100,000 patient years for men and 16.1 for women; 6,996 (64%) consulted their practitioner in the 30 days preceding PTA diagnosis, including 4,243 (39%) consulting for RTI. The probability of PTA following an RTI consultation was greatest in men aged 15 to 24 years with 1 PTA in 565 (95% uncertainty interval 527 to 605) RTI consultations without antibiotics prescribed but 1 in 1,139 consultations (1,044 to 1,242) if antibiotics were prescribed. One PTA might be avoided for every 1,121 (975 to 1,310) additional antibiotic prescriptions for men aged 15 to 24 years and 926 (814 to 1,063) for men aged 25 to 34 years. The risk of PTA following RTI consultation was smaller and the number needed to treat higher at other ages and risks were lower in women than men. CONCLUSIONS The risk of PTA may be lower if antibiotics are prescribed for RTI but even in young men nearly 1,000 antibiotic prescriptions may be required to prevent 1 PTA case. We caution that lack of randomization and data standardization may bias estimates.
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Affiliation(s)
- Joanne R Winter
- King's College London, School of Population Health and Environmental Sciences, London, United Kingdom
| | - Judith Charlton
- King's College London, School of Population Health and Environmental Sciences, London, United Kingdom
| | - Mark Ashworth
- King's College London, School of Population Health and Environmental Sciences, London, United Kingdom
| | - Catey Bunce
- King's College London, School of Population Health and Environmental Sciences, London, United Kingdom.,NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, London, United Kingdom
| | - Martin C Gulliford
- King's College London, School of Population Health and Environmental Sciences, London, United Kingdom .,NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, London, United Kingdom
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Gulliford MC, Charlton J, Winter JR, Sun X, Rezel-Potts E, Bunce C, Fox R, Little P, Hay AD, Moore MV, Ashworth M. Probability of sepsis after infection consultations in primary care in the United Kingdom in 2002-2017: Population-based cohort study and decision analytic model. PLoS Med 2020; 17:e1003202. [PMID: 32702001 PMCID: PMC7377386 DOI: 10.1371/journal.pmed.1003202] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Efforts to reduce unnecessary antibiotic prescribing have coincided with increasing awareness of sepsis. We aimed to estimate the probability of sepsis following infection consultations in primary care when antibiotics were or were not prescribed. METHODS AND FINDINGS We conducted a cohort study including all registered patients at 706 general practices in the United Kingdom Clinical Practice Research Datalink, with 66.2 million person-years of follow-up from 2002 to 2017. There were 35,244 first episodes of sepsis (17,886, 51%, female; median age 71 years, interquartile range 57-82 years). Consultations for respiratory tract infection (RTI), skin or urinary tract infection (UTI), and antibiotic prescriptions were exposures. A Bayesian decision tree was used to estimate the probability (95% uncertainty intervals [UIs]) of sepsis following an infection consultation. Age, gender, and frailty were evaluated as association modifiers. The probability of sepsis was lower if an antibiotic was prescribed, but the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat [NNT]) decreased with age. At 0-4 years old, the NNT was 29,773 (95% UI 18,458-71,091) in boys and 27,014 (16,739-65,709) in girls; over 85 years old, NNT was 262 (236-293) in men and 385 (352-421) in women. Frailty was associated with greater risk of sepsis and lower NNT. For severely frail patients aged 55-64 years, the NNT was 247 (156-459) in men and 343 (234-556) in women. At all ages, the probability of sepsis was greatest for UTI, followed by skin infection, followed by RTI. At 65-74 years, the NNT following RTI was 1,257 (1,112-1,434) in men and 2,278 (1,966-2,686) in women; the NNT following skin infection was 503 (398-646) in men and 784 (602-1,051) in women; following UTI, the NNT was 121 (102-145) in men and 284 (241-342) in women. NNT values were generally smaller for the period from 2014 to 2017, when sepsis was diagnosed more frequently. Lack of random allocation to antibiotic therapy might have biased estimates; patients may sometimes experience sepsis or receive antibiotic prescriptions without these being recorded in primary care; recording of sepsis has increased over the study period. CONCLUSIONS These stratified estimates of risk help to identify groups in which antibiotic prescribing may be more safely reduced. Risks of sepsis and benefits of antibiotics are more substantial among older adults, persons with more advanced frailty, or following UTIs.
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Affiliation(s)
- Martin C. Gulliford
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals London, London, United Kingdom
| | - Judith Charlton
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Joanne R. Winter
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Xiaohui Sun
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Emma Rezel-Potts
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals London, London, United Kingdom
| | - Catey Bunce
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals London, London, United Kingdom
| | - Robin Fox
- The Health Centre, Bicester, United Kingdom
| | - Paul Little
- Primary Care Research Group, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom
| | - Alastair D. Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Michael V. Moore
- Primary Care Research Group, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
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Gulliford MC, Sun X, Charlton J, Winter JR, Bunce C, Boiko O, Fox R, Little P, Moore M, Hay AD, Ashworth M. Serious bacterial infections and antibiotic prescribing in primary care: cohort study using electronic health records in the UK. BMJ Open 2020; 10:e036975. [PMID: 32114481 PMCID: PMC7050314 DOI: 10.1136/bmjopen-2020-036975] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates. DESIGN Cohort study. SETTING 706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017. PARTICIPANTS 10.1 million registered patients with 69.3 million patient-years' follow-up. EXPOSURES All antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications. MAIN OUTCOME MEASURES First episodes of serious bacterial infections. Poisson models were fitted adjusting for age group, gender, comorbidity, deprivation, region and calendar year, with random intercepts representing family practice-specific estimates. RESULTS The age-standardised antibiotic prescribing rate per 1000 patient-years increased from 2002 (male 423; female 621) to 2012 (male 530; female 842) before declining to 2017 (male 449; female 753). The median family practice had an antibiotic prescribing rate of 648 per 1000 patient-years with 95% range for different practices of 430-1038 antibiotic prescriptions per 1000 patient-years. Specific coded indications were recorded for 58% of antibiotic prescriptions at the median family practice, the 95% range at different family practices was from 10% to 75%. There were 139 759 first episodes of serious bacterial infection. After adjusting for covariates and the proportion of coded consultations, there was no evidence that serious bacterial infections were lower at family practices with higher total antibiotic prescribing. The adjusted rate ratio for 20% higher total antibiotic prescribing was 1.03, (95% CI 1.00 to 1.06, p=0.074). CONCLUSIONS We did not find population-level evidence that family practices with lower total antibiotic prescribing might have more frequent occurrence of serious bacterial infections overall. Improving the recording of infection episodes has potential to inform better antimicrobial stewardship in primary care.
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Affiliation(s)
- Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, GreatMaze Pond, London, UK
| | - Xiaohui Sun
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Judith Charlton
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Joanne R Winter
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Catey Bunce
- School of Population Health and Environmental Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, GreatMaze Pond, London, UK
| | - Olga Boiko
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Robin Fox
- The Health Centre, Coker Close, Bicester, UK
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Michael Moore
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Gafoor R, Charlton J, Ravindrarajah R, Gulliford MC. Importance of Frailty for Association of Antipsychotic Drug Use With Risk of Fracture: Cohort Study Using Electronic Health Records. J Am Med Dir Assoc 2019; 20:1495-1501.e1. [DOI: 10.1016/j.jamda.2019.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/09/2019] [Accepted: 05/11/2019] [Indexed: 12/01/2022]
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Louis RMS, Charlton J, Koppel S, Molnar LJ, Stefano MD, Darzins P, Bédard M, Marshall S. THE RELATIONSHIP BETWEEN OLDER DRIVERS’ RESILIENCE AND SELF-REPORTED DRIVING MEASURES OVER 5 YEARS. Innov Aging 2019. [PMCID: PMC6840545 DOI: 10.1093/geroni/igz038.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As people age into older adulthood, they are more likely to experience events that impact their driving, such as age-related cognitive and functional declines, serious illness, or disability. The ability to demonstrate resilience following such adversity may influence one’s decisions and feelings about driving. This study investigated whether resilience of older drivers changes over time, and if relationships between resilience, gender, and self-reported driving-related abilities, perceptions and practices remain stable or change. Participants were from the Candrive/Ozcandrive study, a prospective cohort study of older drivers from Canada, Australia and New Zealand. Analyses are presented from a subset of Ozcandrive participants (n=125) from Australia who completed a resilience scale at two time points approximately five years apart, as well as measures of driving comfort during the day and night, perceived driving abilities, and driving frequency. Participants were primarily male (67.2%) with a mean age of 81.6 years (SD=3.3, Range=76.0-90.0) at Time 1. Resilience increased significantly from Time 1 to Time 2 (Median=82.0/84.00, z=-2.9, p<.01). Although females had significantly higher resilience than males at both Time 1 (Median=84.0/81.0, U=2.3, p=.02) and Time 2 (Median=86.5/82.0, U=2.1, p=.03), there was a statistically significant increase in resilience of males over five years (p<.01) and no statistical change for females. Results show small but significant positive correlations, and increasingly stronger relationships over time between older drivers’ resilience and driving comfort as well as perceived driving abilities. Future research will use modelling to examine the association of various factors on the change in resilience and driving-related measures.
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Affiliation(s)
- Renée M St Louis
- Monash University Accident Research Centre, Clayton, Victoria, Australia
| | - Judith Charlton
- Monash University Accident Research Centre, Clayton, Victoria, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Clayton, Victoria, Australia
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, United States
| | | | - Peteris Darzins
- Eastern Health Clinical School, Monash University, Forest Hill, Victoria, Australia
| | | | - Shawn Marshall
- University of Ottawa/ Ottawa Hospital, Ottawa, Ontario, Canada
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12
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Abstract
Objective: The objective of this study was to address the uptake of safer vehicles and in-vehicle technologies among older adults through a better understanding of extent and use of safer vehicles and awareness/acceptance of new vehicle technologies.Methods: Data were collected from a sample of 501 active older drivers (those who drove at least once a week) through telephone surveys.Results: The sample included experienced and active drivers aged between 65 and 92 years (median 73 years). Though two-thirds indicated that safety was a priority in their vehicle choice, other factors such as reliability and vehicle make were more important. There was low awareness of driver assist safety features, particularly among the oldest drivers. Only one-quarter of drivers were receptive to paying extra for safety features, and there was no interest in paying more for driverless vehicles.Conclusions: The findings showed an overall low awareness and acceptance of in-vehicle safety features; however, where there was some awareness, there was greater interest in purchasing vehicles with safety features. More effort should be undertaken to develop and prioritize a set of recommendations to increase use of safe vehicles by older drivers.
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Affiliation(s)
- Jennifer Oxley
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - Judith Charlton
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - David Logan
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - Steve O'Hern
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - Lynn Meuleners
- School of Population and Global Public Health, University of Western Australia, Perth, Australia
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Hall AB, Ho C, Albanese B, Keay L, Hunter K, Charlton J, Hayen A, Bilston LE, Brown J. User-driven design of child restraint information to reduce errors in use: a pilot randomised controlled trial. Inj Prev 2019; 26:432-438. [PMID: 31530570 DOI: 10.1136/injuryprev-2019-043380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Incorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of child restraints. The relationship between comprehension and errors in use was also explored. METHODS We used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same restraint. Participants installed the restraint in a vehicle buck, secured an appropriately sized mannequin in the restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial. RESULTS There was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, p<0.001). The mean error percentage in the control group was 23% (95% CI 16% to 31%) compared with 14% in the intervention group (95% CI 8% to 20%, p=0.056). For every one point increase in comprehension, there was an almost 2% (95% CI -2.7% to -1.0%) reduction in errors (y=45.5-1.87x, p value for slope <0.001). CONCLUSIONS Consumer-driven design of informational materials can increase the correct use of child restraints. Targeting improved comprehension of informational materials may be an effective mechanism for reducing child restraint misuse.
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Affiliation(s)
- Alexandra B Hall
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Ho
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Bianca Albanese
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Keay
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Hunter
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Judith Charlton
- Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | - Andrew Hayen
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Julie Brown
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia .,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Polce S, Jung M, Charlton J, Wernicke A, Potters L, Parashar B. Neck Dissection plus Neck Radiation is not better than Neck Radiation Alone in N0 Patients with Head and Neck Cancers. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Puckett L, Saba S, Henry S, Rosen S, Rooney E, Eacobacci K, Kapyur A, Laxer A, Pappas K, Gilbo P, Robeny J, Filosa S, Musial S, Chaudhry A, Chaudhry R, Lesser M, Riegel A, Ramoutarpersaud S, Charlton J, Lee L. Screening for Late Effects of Radiation: Coronary Artery Calcification in a Cohort of Long-Term Breast Cancer Survivors in The CAROLE (CArdiac Related Oncologic Late Effects) Study. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gulliford MC, Prevost AT, Charlton J, Juszczyk D, Soames J, McDermott L, Sultana K, Wright M, Fox R, Hay AD, Little P, Moore MV, Yardley L, Ashworth M. Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial. BMJ 2019; 364:l236. [PMID: 30755451 PMCID: PMC6371944 DOI: 10.1136/bmj.l236] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections. DESIGN Open label, two arm, cluster randomised controlled trial. SETTING UK general practices in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017. PARTICIPANTS 79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care. INTERVENTIONS AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice champion nominated for the trial. MAIN OUTCOME MEASURES Primary outcome was the rate of antibiotic prescriptions for respiratory tract infections from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Prespecified subgroup analyses by age group were reported. RESULTS The trial included 41 AMS practices (323 155 patient years) and 38 usual care practices (259 520 patient years). Unadjusted and adjusted rate ratios for antibiotic prescribing were 0.89 (95% confidence interval 0.68 to 1.16) and 0.88 (0.78 to 0.99, P=0.04), respectively, with prescribing rates of 98.7 per 1000 patient years for AMS (31 907 prescriptions) and 107.6 per 1000 patient years for usual care (27 923 prescriptions). Antibiotic prescribing was reduced most in adults aged 15-84 years (adjusted rate ratio 0.84, 95% confidence interval 0.75 to 0.95), with one antibiotic prescription per year avoided for every 62 patients (95% confidence interval 40 to 200). There was no evidence of effect for children younger than 15 years (adjusted rate ratio 0.96, 95% confidence interval 0.82 to 1.12) or people aged 85 years and older (0.97, 0.79 to 1.18); there was also no evidence of an increase in serious bacterial complications (0.92, 0.74 to 1.13). CONCLUSIONS Electronically delivered interventions, integrated into practice workflow, result in moderate reductions of antibiotic prescribing for respiratory tract infections in adults, which are likely to be of importance for public health. Antibiotic prescribing to very young or old patients requires further evaluation. TRIAL REGISTRATION ISRCTN95232781.
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Affiliation(s)
- Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, London, UK
| | - A Toby Prevost
- School of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Judith Charlton
- School of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK
| | - Dorota Juszczyk
- School of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, London, UK
| | - Jamie Soames
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Lisa McDermott
- School of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK
| | - Kirin Sultana
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Mark Wright
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Robin Fox
- The Health Centre, Bicester, Oxfordshire, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Michael V Moore
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK
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Young K, Osborne R, Koppel S, Charlton J, Grzebieta R, Williamson A, Haworth N, Woolley J, Senserrick T. What are Australian drivers doing behind the wheel? An overview of secondary task data from the Australian Naturalistic Driving Study. ACTA ACUST UNITED AC 2019. [DOI: 10.33492/jacrs-d-18-00085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using data from the Australian Naturalistic Driving Study (ANDS), this study examined patterns of secondary task engagement (e.g., mobile phone use, manipulating centre stack controls) during everyday driving trips to determine the type and duration of secondary task engaged in. Safety-related incidents associated with secondary task engagement were also examined. Results revealed that driver engagement in secondary tasks was frequent, with drivers engaging in one or more secondary tasks every 96 seconds, on average. However, drivers were more likely to initiate engagement in secondary tasks when the vehicle was stationary, suggesting that drivers do self-regulate the timing of task engagement to a certain degree. There was also evidence that drivers modified their engagement in a way suggestive of limiting their exposure to risk by engaging in some secondary tasks for shorter periods when the vehicle was moving compared to when it was stationary. Despite this, almost six percent of secondary tasks events were associated with a safety-related incident. The findings will be useful in targeting distraction countermeasures and policies and determining the effectiveness of these in managing driver distraction.
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Affiliation(s)
- Kristie Young
- Monash University Accident Research Centre, Monash University, Australia
| | - Rachel Osborne
- Monash University Accident Research Centre, Monash University, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Monash University, Australia
| | - Judith Charlton
- Monash University Accident Research Centre, Monash University, Australia
| | - Raphael Grzebieta
- Transport and Road Safety (TARS) Research Centre, University of New South Wales, Australia
| | - Ann Williamson
- Transport and Road Safety (TARS) Research Centre, University of New South Wales, Australia
| | - Narelle Haworth
- Centre for Accident Research and Road Safety – Queensland (CARRSQ), Queensland University of Technology, Australia
| | - Jeremy Woolley
- Centre for Automotive Safety Research (CASR), University of Adelaide, Australia
| | - Teresa Senserrick
- Transport and Road Safety (TARS) Research Centre, University of New South Wales, Australia
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Dregan A, Ravindrarajah R, Charlton J, Ashworth M, Molokhia M. Long-term trends in antithrombotic drug prescriptions among adults aged 80 years and over from primary care: a temporal trends analysis using electronic health records. Ann Epidemiol 2018; 28:440-446. [PMID: 29609872 DOI: 10.1016/j.annepidem.2018.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE This study aimed to estimate trends in antithrombotic prescriptions from 2001 to 2015 among people aged 80 years and over within clinical indications. METHODS A prospective cohort study with 215,559 participants registered with the UK Clinical Practice Research Datalink from 2001 to 2015 was included in the analyses. The prevalence and incidence of antiplatelet and anticoagulant drugs were estimated for each year and by five clinical indications. RESULTS The prevalence rate of antithrombotic prescriptions among patients aged over 80 years and diagnosed with atrial fibrillation increased from 53% in 2001 to 77% in 2015 (Ptrend <.001). Anticoagulant prescriptions rates also increased five-fold in older adults with atrial fibrillation from around 10% in 2001 to 46% in 2015 (Ptrend <.001). Clopidogrel-prescribing rates in patients aged over 80 years and with venous thrombosis increased from 0.4% in 2001 to 10% in 2015 (Ptrend <.001). Warfarin-prescribing rates in older patients with venous thrombosis increased from 13% in 2001 to 21% in 2015 (Ptrend <.001). CONCLUSIONS The use of antithrombotic drugs increased from 2001 to 2015 in people aged 80 years and over across multiple clinical indications. Assessing the benefits and harms of antithrombotic drugs across different clinical indications in older people is a priority.
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Affiliation(s)
- A Dregan
- King's College London, Population Health and Environmental Sciences, London, UK; NIHR, Biomedical Research Centre at Guy's and St Thomas NHS Foundation Trust, London, UK.
| | - R Ravindrarajah
- King's College London, Population Health and Environmental Sciences, London, UK
| | - J Charlton
- King's College London, Population Health and Environmental Sciences, London, UK
| | - M Ashworth
- King's College London, Population Health and Environmental Sciences, London, UK
| | - M Molokhia
- King's College London, Population Health and Environmental Sciences, London, UK
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Koppel S, Bugeja L, Smith D, Lamb A, Dwyer J, Fitzharris M, Newstead S, D'Elia A, Charlton J. Understanding fatal older road user crash circumstances and risk factors. Traffic Inj Prev 2018; 19:S181-S183. [PMID: 29584508 DOI: 10.1080/15389588.2018.1426911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. METHODS The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013-2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. RESULTS The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0-10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5-4.6). There was a significant relationship between age group and deceased road user type (χ2(15, N = 226) = 3.56, p < 0.001). The proportion of deceased drivers decreased with age, whereas the proportion of deceased pedestrians increased with age. The majority of fatal ORU crashes involved a counterpart (another vehicle: 59.4%; fixed/stationary object: 25.4%), and occurred "on road" (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have "misjudged" (40.9%) or "failed to yield" (37.9%). CONCLUSIONS Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.
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Affiliation(s)
- Sjaan Koppel
- a Monash University Accident Research Centre, Monash University , Melbourne , Australia
| | - Lyndal Bugeja
- b Coroners Court of Victoria , Melbourne , Australia
| | - Daisy Smith
- a Monash University Accident Research Centre, Monash University , Melbourne , Australia
| | - Ashne Lamb
- b Coroners Court of Victoria , Melbourne , Australia
| | - Jeremy Dwyer
- b Coroners Court of Victoria , Melbourne , Australia
| | - Michael Fitzharris
- a Monash University Accident Research Centre, Monash University , Melbourne , Australia
| | - Stuart Newstead
- a Monash University Accident Research Centre, Monash University , Melbourne , Australia
| | - Angelo D'Elia
- a Monash University Accident Research Centre, Monash University , Melbourne , Australia
| | - Judith Charlton
- a Monash University Accident Research Centre, Monash University , Melbourne , Australia
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Koppel S, Bugeja L, Smith D, Lamb A, Dwyer J, Fitzharris M, Newstead S, D'Elia A, Charlton J. Using medico-legal data to investigate fatal older road user crash circumstances and risk factors. Traffic Inj Prev 2018; 19:133-140. [PMID: 28758801 DOI: 10.1080/15389588.2017.1360492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study used medico-legal data to investigate fatal older road user (ORU, aged 65 years and older) crash circumstances and risk factors relating to 4 key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. METHOD The Coroners' Court of Victoria's (CCOV) Surveillance Database was searched to identify and describe the frequency and rate per 100,000 population of fatal ORU crashes in the Australian state of Victoria for 2013-2014. Information relating to the deceased ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. RESULTS One hundred and thirty-eight unintentional fatal ORU crashes were identified in the CCOV Surveillance Database. Of these fatal ORU crashes, most involved older drivers (44%), followed by older pedestrians (32%), older passengers (17%), older pedal cyclists (4%), older motorcyclists (1%), and older mobility scooter users (1%). The average annual rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI], 6.0-10.2). In terms of the crash characteristics and circumstances, most fatal ORU crashes involved a counterpart (98%), of which the majority were passenger cars (50%) or fixed/stationary objects (25%), including trees (46%) or embankments (23%). In addition, most fatal ORU crashes occurred close to home (73%), on-road (87%), on roads that were paved (94%), on roads with light traffic volume (37%), and during low-risk conditions: between 12 p.m. and 6 p.m. (44%), on weekdays (80%), during daylight (75%), and under dry/clear conditions (81%). Road user (RU) error was identified by the police and/or the coroner for the majority of fatal crashes (55%), with a significant proportion of deceased ORUs deemed to have failed to yield (54%) or misjudged (41%). CONCLUSIONS RU error was the most significant factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the road system to fully accommodate RU errors. Initiatives related to safer roads and roadsides, vehicles, speed zones, as well as behavioral approaches are key areas of priority for targeted activity to prevent fatal ORU crashes in the future.
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Affiliation(s)
- Sjaan Koppel
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Lyndal Bugeja
- b Coroners Court of Victoria , Melbourne , Australia
- c Department of Forensic Medicine , Monash University , Melbourne , Victoria , Australia
| | - Daisy Smith
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Ashne Lamb
- b Coroners Court of Victoria , Melbourne , Australia
| | - Jeremy Dwyer
- b Coroners Court of Victoria , Melbourne , Australia
| | - Michael Fitzharris
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Stuart Newstead
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Angelo D'Elia
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Judith Charlton
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
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Ravindrarajah R, Hazra NC, Charlton J, Jackson SHD, Dregan A, Gulliford MC. Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records. BMJ Open 2018; 8:e018836. [PMID: 29358434 PMCID: PMC5781050 DOI: 10.1136/bmjopen-2017-018836] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study aimed to estimate the association of frailty with incidence and mortality of fractures at different sites in people aged over 80 years. DESIGN Cohort study. SETTING UK family practices from 2001 to 2014. PARTICIPANTS 265 195 registered participants aged 80 years and older. MEASUREMENTS Frailty status classified into 'fit', 'mild', 'moderate' and 'severe' frailty. Fractures, classified into non-fragility and fragility, including fractures of femur, pelvis, shoulder and upper arm, and forearm/wrist. Incidence of fracture, and mortality within 90 days and 1 year, were estimated. RESULTS There were 28 643 fractures including: non-fragility fractures, 9101; femur, 12 501; pelvis, 2172; shoulder and upper arm, 4965; and forearm/wrist, 6315. The incidence of each fracture type was higher in women and increased with frailty category (femur, severe frailty compared with 'fit', incidence rate ratio (IRR) 2.4, 95% CI 2.3 to 2.6). Fractures of the femur (95-99 years compared with 80-84 years, IRR 2.7, 95% CI 2.6 to 2.9) and pelvis (IRR 2.9, 95% CI 2.5 to 3.3) were strongly associated with age but non-fragility and forearm fractures were not. Mortality within 90 days was greatest for femur fracture (adjusted HR, compared with forearm fracture 4.3, 95% CI 3.7 to 5.1). Mortality was higher in men and increased with age (HR 5.3, 95% CI 4.3 to 6.5 in those over 100 years compared with 80-84 years) but was less strongly associated with frailty category. Similar associations with fractures were seen at 1-year mortality. CONCLUSIONS The incidence of fractures at all sites was higher in women and strongly associated with advancing frailty status, while the risk of mortality after a fracture was greater in men and was associated with age rather than frailty category.
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Affiliation(s)
- Rathi Ravindrarajah
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Nisha C Hazra
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Stephen H D Jackson
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health Service Foundation Trust, Kings’ College London, London, UK
| | - Alex Dregan
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health Service Foundation Trust, Kings’ College London, London, UK
- Department of Clinical Gerontology, King’s College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health Service Foundation Trust, Kings’ College London, London, UK
- Department of Clinical Gerontology, King’s College London, London, UK
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Loeb H, Kim J, Arbogast K, Kuo J, Koppel S, Cross S, Charlton J. Automated recognition of rear seat occupants' head position using Kinect™ 3D point cloud. J Safety Res 2017; 63:135-143. [PMID: 29203011 DOI: 10.1016/j.jsr.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Child occupant safety in motor-vehicle crashes is evaluated using Anthropomorphic Test Devices (ATD) seated in optimal positions. However, child occupants often assume suboptimal positions during real-world driving trips. Head impact to the seat back has been identified as one important injury causation scenario for seat belt restrained, head-injured children (Bohman et al., 2011). There is therefore a need to understand the interaction of children with the Child Restraint System to optimize protection. METHOD Naturalistic driving studies (NDS) will improve understanding of out-of-position (OOP) trends. To quantify OOP positions, an NDS was conducted. Families used a study vehicle for two weeks during their everyday driving trips. The positions of rear-seated child occupants, representing 22 families, were evaluated. The study vehicle - instrumented with data acquisition systems, including Microsoft Kinect™ V1 - recorded rear seat occupants in 1120 driving 26 trips. Three novel analytical methods were used to analyze data. To assess skeletal tracking accuracy, analysts recorded occurrences where Kinect™ exhibited invalid head recognition among a randomly-selected subset (81 trips). Errors included incorrect target detection (e.g., vehicle headrest) or environmental interference (e.g., sunlight). When head data was present, Kinect™ was correct 41% of the time; two other algorithms - filtering for extreme motion, and background subtraction/head-based depth detection are described in this paper and preliminary results are presented. Accuracy estimates were not possible because of their experimental nature and the difficulty to use a ground truth for this large database. This NDS tested methods to quantify the frequency and magnitude of head positions for rear-seated child occupants utilizing Kinect™ motion-tracking. RESULTS This study's results informed recent ATD sled tests that replicated observed positions (most common and most extreme), and assessed the validity of child occupant protection on these typical CRS uses. SUMMARY Optimal protection in vehicles requires an understanding of how child occupants use the rear seat space. This study explored the feasibility of using Kinect™ to log positions of rear seated child occupants. Initial analysis used the Kinect™ system's skeleton recognition and two novel analytical algorithms to log head location. PRACTICAL APPLICATIONS This research will lead to further analysis leveraging Kinect™ raw data - and other NDS data - to quantify the frequency/magnitude of OOP situations, ATD sled tests that replicate observed positions, and advances in the design and testing of child occupant protection technology.
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Affiliation(s)
- Helen Loeb
- Center for Injury Research and Prevention at the Children's Hospital of Philadelphia, 3535 Market Street, Suite 1150, Philadelphia, PA, 19104, United States.
| | - Jinyong Kim
- Center for Injury Research and Prevention at the Children's Hospital of Philadelphia, 3535 Market Street, Suite 1150, Philadelphia, PA, 19104, United States
| | - Kristy Arbogast
- Center for Injury Research and Prevention at the Children's Hospital of Philadelphia, 3535 Market Street, Suite 1150, Philadelphia, PA, 19104, United States
| | - Jonny Kuo
- Monash University Accident Research Centre, 21 Alliance Lane, Clayton VIC 3800, Melbourne, Australia.
| | - Sjaan Koppel
- Monash University Accident Research Centre, 21 Alliance Lane, Clayton VIC 3800, Melbourne, Australia.
| | - Suzanne Cross
- Monash University Accident Research Centre, 21 Alliance Lane, Clayton VIC 3800, Melbourne, Australia.
| | - Judith Charlton
- Monash University Accident Research Centre, 21 Alliance Lane, Clayton VIC 3800, Melbourne, Australia.
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Gulliford M, Ravindrarajah R, Hamada S, Jackson S, Charlton J. Inception and deprescribing of statins in people aged over 80 years: cohort study. Age Ageing 2017; 46:1001-1005. [PMID: 29088364 DOI: 10.1093/ageing/afx100] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/08/2017] [Indexed: 11/13/2022] Open
Abstract
Objective statin use over the age of 80 years is weakly evidence-based. This study aimed to estimate rates of statin inception and deprescribing by frailty level in people aged 80 years or older. Methods a cohort of 212,566 participants aged ≥80 years was sampled from the UK Clinical Practice Research Datalink. Statin inception was defined as a first-ever prescription in a non-statin user; deprescribing was defined as a last ever statin prescription more than 6 months before the end of participant records. Rates were estimated in a time-to-event framework allowing for mortality as a competing risk. Co-variates were age, gender, frailty category and prevention type. Results prevalent statin use increased from 2001-5 (9.9%) to 2011-15 (49.3%). Inception of statins in never-users was low overall at 2.4% per year (95% confidence interval (CI) 2.2-2.6%) and declined with age. Deprescribing of statins in current users occurred at a rate of 5.6% (95% CI 5.4-5.9%) per year overall and increased with age, reaching 17.8% per year (95% CI 6.7-28.9%) among centenarians. Deprescribing was slightly higher for primary prevention (6.5% per year) than secondary prevention (5.2% per year) indications (P < 0.001). Deprescribing increased with frailty level being 5.0% per year in 'fit' participants and 7.1% in 'severe' frailty (P < 0.001). Conclusions statin use has increased in the over 80s but deprescribing is common and increases with age and frailty level. These paradoxical findings highlight a need for better evidence to inform statin use and discontinuation for people aged ≥80 years.
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Affiliation(s)
- Martin Gulliford
- King's College London, Department of Primary Care and Public Health Sciences, London, UK
- National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas’ National Health Service Foundation Trust, London, UK
| | - Rathi Ravindrarajah
- King's College London, Department of Primary Care and Public Health Sciences, London, UK
| | - Shota Hamada
- King's College London, Department of Primary Care and Public Health Sciences, London, UK
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Stephen Jackson
- King's College London, Department of Clinical Gerontology, London, UK
| | - Judith Charlton
- King's College London, Department of Primary Care and Public Health Sciences, London, UK
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Charlton J, Ravindrarajah R, Hamada S, Jackson SH, Gulliford MC. Trajectory of Total Cholesterol in the Last Years of Life Over Age 80 Years: Cohort Study of 99,758 Participants. J Gerontol A Biol Sci Med Sci 2017; 73:1083-1089. [DOI: 10.1093/gerona/glx184] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/26/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- Judith Charlton
- Department of Primary Care and Public Health Sciences, King’s College London, UK
| | - Rathi Ravindrarajah
- Department of Primary Care and Public Health Sciences, King’s College London, UK
| | - Shota Hamada
- Department of Primary Care and Public Health Sciences, King’s College London, UK
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | | | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, UK
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK
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25
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Gulliford MC, Booth HP, Reddy M, Charlton J, Fildes A, Prevost AT, Khan O. Effect of Contemporary Bariatric Surgical Procedures on Type 2 Diabetes Remission. A Population-Based Matched Cohort Study. Obes Surg 2017; 26:2308-15. [PMID: 26922184 PMCID: PMC5018032 DOI: 10.1007/s11695-016-2103-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of the study is to evaluate the effect of gastric banding, gastric bypass and sleeve gastrectomy on medium to long-term diabetes control in obese participants with type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS Matched cohort study using primary care electronic health records from the UK Clinical Practice Research Datalink. Obese participants with type 2 diabetes who received bariatric surgery from 2002 to 2014 were compared with matched control participants who did not receive BS. Remission was defined for each year of follow-up as HbA1c <6.5 % and no antidiabetic drugs prescribed. RESULTS There were 826 obese participants with T2DM who received bariatric surgery including adjustable gastric banding (LAGB) 220; gastric bypass (GBP) 449; or sleeve gastrectomy (SG) 153; with four procedures undefined. Mean HbA1c declined from 8.0 % before BS to 6.5 % in the second postoperative year; proportion with HbA1c <6.5 % (<48 mmol/mol) increased from 17 to 47 %. The proportion of patients in remission was 30 % in the second year, being 20 % for LAGB, 34 % for GBP and 38 % for SG. The adjusted relative rate of remission over the first six postoperative years was 5.97 (4.86 to 7.33, P < 0.001) overall; for LAGB 3.32 (2.27 to 4.86); GBP 7.16 (5.64 to 9.08); and SG 6.82 (5.05 to 9.19). Rates of remission were maintained into the sixth year of follow-up. CONCLUSIONS Remission of diabetes may continue for up to 6 years after bariatric surgical procedures. Diabetes outcomes are generally more favourable after gastric bypass or sleeve gastrectomy than LAGB.
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Affiliation(s)
- Martin C Gulliford
- King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | - A Toby Prevost
- King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
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Charlton J, Koppel S, Darzins P, Di Stefano M, Macdonald W, Odell M, D’Elia A, Porter M. CHANGES IN DRIVING PATTERNS OF OLDER AUSTRALIANS: FINDINGS FROM THE CANDRIVE/OZCANDRIVE COHORT STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J. Charlton
- Monash University Accident Research Centre, Monash University, Victoria, Australia,
| | - S. Koppel
- Monash University Accident Research Centre, Monash University, Victoria, Australia,
| | - P. Darzins
- Eastern Health, Burwood, Victoria, Australia,
| | | | | | - M. Odell
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia,
| | - A. D’Elia
- Monash University Accident Research Centre, Monash University, Victoria, Australia,
| | - M.M. Porter
- University of Manitoba, Winnipeg, Manitoba, Canada
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Ravindrarajah R, Hazra NC, Hamada S, Charlton J, Jackson SHD, Dregan A, Gulliford MC. Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality >80 Years of Age: Cohort Study Using Electronic Health Records. Circulation 2017; 135:2357-2368. [PMID: 28432148 DOI: 10.1161/circulationaha.116.026687] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials show benefit from lowering systolic blood pressure (SBP) in people ≥80 years of age, but nonrandomized epidemiological studies suggest lower SBP may be associated with higher mortality. This study aimed to evaluate associations of SBP with all-cause mortality by frailty category >80 years of age and to evaluate SBP trajectories before death. METHODS A population-based cohort study was conducted using electronic health records of 144 403 participants ≥80 years of age registered with family practices in the United Kingdom from 2001 to 2014. Participants were followed for ≤5 years. Clinical records of SBP were analyzed. Frailty status was classified using the e-Frailty Index into the categories of fit, mild, moderate, and severe. All-cause mortality was evaluated by frailty status and mean SBP in Cox proportional-hazards models. SBP trajectories were evaluated using person months as observations, with mean SBP and antihypertensive treatment status estimated for each person month. Fractional polynomial models were used to estimate SBP trajectories over 5 years before death. RESULTS During follow-up, 51 808 deaths occurred. Mortality rates increased with frailty level and were greatest at SBP <110 mm Hg. In fit women, mortality was 7.7 per 100 person years at SBP 120 to 139 mm Hg, 15.2 at SBP 110 to 119 mm Hg, and 22.7 at SBP <110 mm Hg. For women with severe frailty, rates were 16.8, 25.2, and 39.6, respectively. SBP trajectories showed an accelerated decline in the last 2 years of life. The relative odds of SBP <120 mm Hg were higher in the last 3 months of life than 5 years previously in both treated (odds ratio, 6.06; 95% confidence interval, 5.40-6.81) and untreated (odds ratio, 6.31; 95% confidence interval, 5.30-7.52) patients. There was no evidence of intensification of antihypertensive therapy in the final 2 years of life. CONCLUSIONS A terminal decline of SBP in the final 2 years of life suggests that nonrandomized epidemiological associations of low SBP with higher mortality may be accounted for by reverse causation if participants with lower blood pressure values are closer, on average, to the end of life.
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Affiliation(s)
- Rathi Ravindrarajah
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.).
| | - Nisha C Hazra
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Shota Hamada
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Judith Charlton
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Stephen H D Jackson
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Alex Dregan
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Martin C Gulliford
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
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Affiliation(s)
- Pamela E. Ross
- Occupational Therapy Department, Epworth HealthCare, Melbourne, Australia
| | - Marilyn Di Stefano
- School of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Judith Charlton
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - Gershon Spitz
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jennie L. Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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Gulliford MC, Charlton J, Prevost T, Booth H, Fildes A, Ashworth M, Littlejohns P, Reddy M, Khan O, Rudisill C. Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records. Value Health 2017; 20:85-92. [PMID: 28212974 PMCID: PMC5338873 DOI: 10.1016/j.jval.2016.08.734] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/06/2016] [Accepted: 08/27/2016] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. METHODS A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. RESULTS In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. CONCLUSIONS Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals.
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Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK; National Institutes for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Toby Prevost
- Department of Primary Care and Public Health Sciences, King's College London, London, UK; National Institutes for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Helen Booth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Alison Fildes
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Marcus Reddy
- Department of Surgery, St George's University Hospital National Health Service Foundation Trust, London, UK
| | - Omar Khan
- Department of Surgery, St George's University Hospital National Health Service Foundation Trust, London, UK
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Hall A, Ho C, Keay L, McCaffery K, Hunter K, Charlton J, Bilston L, Hayen A, Brown J. 537 Consensus driven design of child restraint product information to reduce misuse. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Emanuel G, Charlton J, Ashworth M, Gulliford MC, Dregan A. Cardiovascular risk assessment and treatment in chronic inflammatory disorders in primary care. Heart 2016; 102:1957-1962. [PMID: 27534979 PMCID: PMC5256394 DOI: 10.1136/heartjnl-2016-310111] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 12/12/2022] Open
Abstract
Objective To compare differences in cardiovascular (CV) risk factors assessment and management among patients with rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) with that of matched controls. Methods A matched cohort study was conducted using primary care electronic health records for one London borough. All patients diagnosed with RA or IBD, and matched controls registered with local general practices on 12th of January 2014 were identified. The study compared assessment and treatment of CV risk factors (blood pressure, body mass index, cholesterol and smoking) in the year before, the year after, and 5 years after RA and IBD diagnosis. Results A total of 1121 patients with RA and 1875 patients with IBD were identified and matched with 4282 and, respectively, 7803 controls. Patients with RA were 25% (incidence rate ratio, 1.25, 95% CI 1.12 to 1.35) more likely to have a CV risk factor measured compared with matched controls. The difference declined to 8% (1.08, 1.04 to 1.14) over 5 years of follow-up. The corresponding figures for IBD were 26% (1.26, 1.16 to 1.38) and 10% (1.10, 1.05 to 1.15). Patients with RA showed higher antihypertensive prescription rates during 5 years of follow-up (OR, 1.37, 95% CI 1.14 to 1.65) and patients with IBD showed higher statin prescription rates in the year preceding diagnosis (2.30, 1.20 to 4.42). Incomplete CV risk assessment meant that QRISK scores could be calculated for less than a fifth (17%) and clinical recording of CV disease (CVD) risk scores among patients with RA and IBD was 11% and 6%, respectively. Conclusions The assessment and treatment of vascular risk in patients with RA and IBD in primary care is suboptimal, particularly with reference to CVD risk score calculation.
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Affiliation(s)
- G Emanuel
- Department of Primary Care and Public Health, King's College London, London, UK
| | - J Charlton
- Department of Primary Care and Public Health, King's College London, London, UK
| | - M Ashworth
- Department of Primary Care and Public Health, King's College London, London, UK
| | - M C Gulliford
- Department of Primary Care and Public Health, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, Kings' College London, London UK
| | - A Dregan
- Department of Primary Care and Public Health, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, Kings' College London, London UK
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Juszczyk D, Charlton J, McDermott L, Soames J, Sultana K, Ashworth M, Fox R, Hay AD, Little P, Moore MV, Yardley L, Prevost AT, Gulliford MC. Electronically delivered, multicomponent intervention to reduce unnecessary antibiotic prescribing for respiratory infections in primary care: a cluster randomised trial using electronic health records-REDUCE Trial study original protocol. BMJ Open 2016; 6:e010892. [PMID: 27491663 PMCID: PMC4985802 DOI: 10.1136/bmjopen-2015-010892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Respiratory tract infections (RTIs) account for about 60% of antibiotics prescribed in primary care. This study aims to test the effectiveness, in a cluster randomised controlled trial, of electronically delivered, multicomponent interventions to reduce unnecessary antibiotic prescribing when patients consult for RTIs in primary care. The research will specifically evaluate the effectiveness of feeding back electronic health records (EHRs) data to general practices. METHODS AND ANALYSIS 2-arm cluster randomised trial using the EHRs of the Clinical Practice Research Datalink (CPRD). General practices in England, Scotland, Wales and Northern Ireland are being recruited and the general population of all ages represents the target population. Control trial arm practices will continue with usual care. Practices in the intervention arm will receive complex multicomponent interventions, delivered remotely to information systems, including (1) feedback of each practice's antibiotic prescribing through monthly antibiotic prescribing reports estimated from CPRD data; (2) delivery of educational and decision support tools; (3) a webinar to explain and promote effective usage of the intervention. The intervention will continue for 12 months. Outcomes will be evaluated from CPRD EHRs. The primary outcome will be the number of antibiotic prescriptions for RTIs per 1000 patient years. Secondary outcomes will be: the RTI consultation rate; the proportion of consultations for RTI with an antibiotic prescribed; subgroups of age; different categories of RTI and quartiles of intervention usage. There will be more than 80% power to detect an absolute reduction in antibiotic prescription for RTI of 12 per 1000 registered patient years. Total healthcare usage will be estimated from CPRD data and compared between trial arms. ETHICS AND DISSEMINATION Trial protocol was approved by the National Research Ethics Service Committee (14/LO/1730). The pragmatic design of the trial will enable subsequent translation of effective interventions at scale in order to achieve population impact. TRIAL REGISTRATION NUMBER ISRCTN95232781; Pre-results.
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Affiliation(s)
- Dorota Juszczyk
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Lisa McDermott
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Jamie Soames
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Kirin Sultana
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Robin Fox
- Bicester Health Centre, Bicester, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Michael V Moore
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - A Toby Prevost
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Booth HP, Khan O, Fildes A, Prevost AT, Reddy M, Charlton J, Gulliford MC. Changing Epidemiology of Bariatric Surgery in the UK: Cohort Study Using Primary Care Electronic Health Records. Obes Surg 2016; 26:1900-5. [PMID: 26757921 PMCID: PMC4951499 DOI: 10.1007/s11695-015-2032-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to use primary care electronic health records to evaluate the epidemiology of bariatric surgery in the UK. METHODS A cohort comprising all obese patients with a bariatric surgical procedure was drawn from the Clinical Practice Research Datalink (CPRD). Rates of bariatric surgery were estimated using the registered CPRD population as denominator. RESULTS There were 3039 adult obese patients with first bariatric surgery procedures between 2002 and 2014, including laparoscopic adjustable gastric banding (LAGB), 1297; gastric bypass (GBP), 1265; and sleeve gastrectomy (SG), 477. Annual procedures increased from one in 2002 to a maximum of 525 in 2010. Intervention rates were greatest among those aged 35-54, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. The mean age and body mass index of participants increased, as did the proportion of men and proportion with diabetes. Between 2002 and 2006, LAGB accounted for >90 % of procedures; in 2014, GBP accounted for 52 % and SG 26 %. Among patients initially receiving LAGB, the rate of band removal was 1.6 (95 % confidence interval 1.3-2.0) per 100 patient years; the rate of a second procedure of a different type was 1.2 (0.9-1.5) per 100 patient years. CONCLUSIONS Numbers of bariatric surgical procedures have increased with increasing use of GBP and SG. Rates of bariatric surgery per 100,000 population remain low and provide evidence of limited access to bariatric surgical procedures in relation to need.
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Affiliation(s)
- Helen P. Booth
- Department of Primary Care and Public Health Sciences, King’s College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD UK
- Department of Surgery, St George’s Hospital, Blackshaw Rd, London, SW17 0QT UK
| | - Omar Khan
- Department of Surgery, St George’s Hospital, Blackshaw Rd, London, SW17 0QT UK
| | - Alison Fildes
- Department of Primary Care and Public Health Sciences, King’s College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD UK
| | - A. Toby Prevost
- Department of Primary Care and Public Health Sciences, King’s College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, SE1 9RT UK
| | - Marcus Reddy
- Department of Surgery, St George’s Hospital, Blackshaw Rd, London, SW17 0QT UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King’s College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD UK
| | - Martin C. Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, SE1 9RT UK
| | - for the King’s Bariatric Surgery Study Group
- Department of Primary Care and Public Health Sciences, King’s College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD UK
- Department of Surgery, St George’s Hospital, Blackshaw Rd, London, SW17 0QT UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, SE1 9RT UK
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Gulliford MC, Moore MV, Little P, Hay AD, Fox R, Prevost AT, Juszczyk D, Charlton J, Ashworth M. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ 2016; 354:i3410. [PMID: 27378578 PMCID: PMC4933936 DOI: 10.1136/bmj.i3410] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs). DESIGN Cohort study. SETTING 610 UK general practices from the UK Clinical Practice Research Datalink. PARTICIPANTS Registered patients with 45.5 million person years of follow-up from 2005 to 2014. EXPOSURES Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients. MAIN OUTCOME MEASURES Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice. RESULTS From 2005 to 2014 the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women. From 2005 to 2014, new episodes of meningitis, mastoiditis, and peritonsillar abscess decreased annually by 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%. Age and sex standardised incidences for pneumonia and peritonsillar abscess were higher for practices in the lowest fourth of antibiotic prescribing compared with the highest fourth. The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% (95% confidence interval 7.8% to 17.5%, P<0.001) for pneumonia and 9.9% (5.6% to 14.0%, P<0.001) for peritonsillar abscess. If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade. Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome were similar in frequency at low prescribing and high prescribing practices. CONCLUSIONS General practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre's syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.
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Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Michael V Moore
- Academic Unit for Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Academic Unit for Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Robin Fox
- The Health Centre, Bicester, Oxford, UK
| | - A Toby Prevost
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Dorota Juszczyk
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
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Rudisill C, Charlton J, Booth HP, Gulliford MC. Are healthcare costs from obesity associated with body mass index, comorbidity or depression? Cohort study using electronic health records. Clin Obes 2016; 6:225-31. [PMID: 27097821 PMCID: PMC5074251 DOI: 10.1111/cob.12144] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/11/2016] [Accepted: 03/20/2016] [Indexed: 01/20/2023]
Abstract
The objective of this study was to evaluate the association between body mass index (BMI) and healthcare costs in relation to obesity-related comorbidity and depression. A population-based cohort study was undertaken in the UK Clinical Practice Research Datalink (CPRD). A stratified random sample was taken of participants registered with general practices in England in 2008 and 2013. Person time was classified by BMI category and morbidity status using first diagnosis of diabetes (T2DM), coronary heart disease (CHD), stroke or malignant neoplasms. Participants were classified annually as depressed or not depressed. Costs of healthcare utilization were calculated from primary care records with linked hospital episode statistics. A two-part model estimated predicted mean annual costs by age, gender and morbidity status. Linear regression was used to estimate the effects of BMI category, comorbidity and depression on healthcare costs. The analysis included 873 809 person-years (62% female) from 250 046 participants. Annual healthcare costs increased with BMI, to a mean of £456 (95% CI 344-568) higher for BMI ≥40 kg m(-2) than for normal weight based on a general linear model. After adjusting for BMI, the additional cost of comorbidity was £1366 (£1269-£1463) and depression £1044 (£973-£1115). There was evidence of interaction so that as the BMI category increased, additional costs of comorbidity (£199, £74-£325) or depression (£116, £16-£216) were greater. High healthcare costs in obesity may be driven by the presence of comorbidity and depression. Prioritizing primary prevention of cardiovascular disease and diabetes in the obese population may contribute to reducing obesity-related healthcare costs.
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Affiliation(s)
- C Rudisill
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - J Charlton
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - H P Booth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - M C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
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Gulliford MC, Charlton J, Booth HP, Fildes A, Khan O, Reddy M, Ashworth M, Littlejohns P, Prevost AT, Rudisill C. Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records. Health Serv Deliv Res 2016. [DOI: 10.3310/hsdr04170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundBariatric surgery is known to be an effective treatment for extreme obesity but access to these procedures is currently limited.ObjectiveThis study aimed to evaluate the costs and outcomes of increasing access to bariatric surgery for severe and morbid obesity.Design and methodsPrimary care electronic health records from the UK Clinical Practice Research Datalink were analysed for 3045 participants who received bariatric surgery and 247,537 general population controls. The cost-effectiveness of bariatric surgery was evaluated in severe and morbid obesity through a probabilistic Markov model populated with empirical data from electronic health records.ResultsIn participants who did not undergo bariatric surgery, the probability of participants with morbid obesity attaining normal body weight was 1 in 1290 annually for men and 1 in 677 for women. Costs of health-care utilisation increased with body mass index category but obesity-related physical and psychological comorbidities were the main drivers of health-care costs. In a cohort of 3045 adult obese patients with first bariatric surgery procedures between 2002 and 2014, bariatric surgery procedure rates were greatest among those aged 35–54 years, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. During 7 years of follow-up, the incidence of diabetes diagnosis was 28.2 [95% confidence interval (CI) 24.4 to 32.7] per 1000 person-years in controls and 5.7 (95% CI 4.2 to 7.8) per 1000 person-years in bariatric surgery patients (adjusted hazard ratio was 0.20, 95% CI 0.13 to 0.30;p < 0.0001). In 826 obese participants with type 2 diabetes mellitus who received bariatric surgery, the relative rate of diabetes remission, compared with controls, was 5.97 (95% CI 4.86 to 7.33;p < 0.001). There was a slight reduction in depression in the first 3 years following bariatric surgery that was not maintained. Incremental lifetime costs associated with bariatric surgery were £15,258 (95% CI £15,184 to £15,330), including costs associated with bariatric surgical procedures of £9164 per participant. Incremental quality-adjusted life-years (QALYs) were 2.142 (95% CI 2.031 to 2.256) per participant. The estimated cost per QALY gained was £7129 (95% CI £6775 to £7506). Estimates were similar across gender, age and deprivation subgroups.LimitationsIntervention effects were derived from a randomised trial with generally short follow-up and non-randomised studies of longer duration.ConclusionsBariatric surgery is associated with increased immediate and long-term health-care costs but these are exceeded by expected health benefits to obese individuals with reduced onset of new diabetes, remission of existing diabetes and lower mortality. Diverse obese individuals have clear capacity to benefit from bariatric surgery at acceptable cost.Future workFuture research should evaluate longer-term outcomes of currently used procedures, and ways of delivering these more efficiently and safely.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme. Martin C Gulliford and A Toby Prevost were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals. Peter Littlejohns was supported by the South London Collaboration for Leadership in Applied Health Research and Care. The funders did not engage in the design, conduct or reporting of the research.
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Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Helen P Booth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Alison Fildes
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Omar Khan
- Department of Surgery, St George’s University Hospital NHS Foundation Trust, London, UK
| | - Marcus Reddy
- Department of Surgery, St George’s University Hospital NHS Foundation Trust, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - A Toby Prevost
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Sukhawathanakul P, Tuokko H, Rhodes RE, Marshall SC, Charlton J, Koppel S, Gélinas I, Naglie G, Mazer B, Vrkljan B, Myers A, Man-Son-Hing M, Bédard M, Rapoport M, Korner-Bitensky N, Porter MM. Measuring Driving-Related Attitudes Among Older Adults: Psychometric Evidence for the Decisional Balance Scale Across Time and Gender. GERONT 2015; 55:1068-78. [DOI: 10.1093/geront/gnv077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/14/2015] [Indexed: 01/22/2023] Open
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Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost T, Gulliford MC. Fildes et al. Respond. Am J Public Health 2015; 105:e3-4. [DOI: 10.2105/ajph.2015.302853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alison Fildes
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Judith Charlton
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Caroline Rudisill
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Peter Littlejohns
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Toby Prevost
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Martin C. Gulliford
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
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Charlton J, Alcaide-German M, Chagtai T, Popov S, Sebire N, Gessler M, Graf N, Pritchard-Jones K, Williams R. 256 Integrated analysis of DNA methylation, copy number and expression data in Wilms Tumour identifies subtype-specific molecular signatures. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ross P, Ponsford JL, Di Stefano M, Charlton J, Spitz G. On the road again after traumatic brain injury: driver safety and behaviour following on-road assessment and rehabilitation. Disabil Rehabil 2015; 38:994-1005. [DOI: 10.3109/09638288.2015.1074293] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hazra N, Dregan A, Charlton J, Gulliford MC, D'Cruz DP. Incidence and mortality of relapsing polychondritis in the UK: a population-based cohort study. Rheumatology (Oxford) 2015; 54:2181-7. [PMID: 26187053 DOI: 10.1093/rheumatology/kev240] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Relapsing polychondritis is a rare disease characterized by cartilage inflammation. Our aim was to estimate the incidence, prevalence and mortality of relapsing polychondritis and describe the clinical features of relapsing polychondritis in a large population. METHODS All participants diagnosed with relapsing polychondritis were sampled from the Clinical Practice Research Datalink. Prevalence and incidence rates for 1990-2012 were estimated. Relative mortality rates were estimated in a time-to-event framework using reference UK life tables. A questionnaire validation study assessed diagnostic accuracy. RESULTS There were 117 participants with relapsing polychondritis ever recorded. Fifty (82%) of 61 cases were validated by a physician and unconfirmed cases were excluded. The analysis included 106 participants (42 men, 64 women) diagnosed with relapsing polychondritis. The mean age (range) at diagnosis in men was 55 (range 17-81) years and in women 51 (range 11-79) years. The median interval from first symptom to diagnosis was 1.9 years. The incidence of relapsing polychondritis between 1990 and 2012 was 0.71 (95% CI 0.55, 0.91) per million population per year. There were 19 deaths from any cause. There were 16 observed deaths eligible for survival analysis and 7.4 deaths expected for the UK population of the same age, sex and period. The standardized mortality ratio was 2.16 (95% CI 1.24, 3.51), P < 0.01. Respiratory disease, cardiac conditions and cancer were the most frequent causes of death. CONCLUSION The incidence of relapsing polychondritis may be lower than previously estimated, and diagnostic misclassification and delay are common. Mortality in relapsing polychondritis is more than twice that of the general population.
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Affiliation(s)
- Nisha Hazra
- Division of Primary Care and Public Health Research, King's College London
| | - Alex Dregan
- Division of Primary Care and Public Health Research, King's College London, NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, and
| | - Judith Charlton
- Division of Primary Care and Public Health Research, King's College London
| | - Martin C Gulliford
- Division of Primary Care and Public Health Research, King's College London, NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, and
| | - David P D'Cruz
- Louise Coote Lupus Unit, Gassiot House, St Thomas' Hospital, London, UK david.d'
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Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health 2015; 105:e54-9. [PMID: 26180980 DOI: 10.2105/ajph.2015.302773] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES We examined the probability of an obese person attaining normal body weight. METHODS We drew a sample of individuals aged 20 years and older from the United Kingdom's Clinical Practice Research Datalink from 2004 to 2014. We analyzed data for 76,704 obese men and 99,791 obese women. We excluded participants who received bariatric surgery. We estimated the probability of attaining normal weight or 5% reduction in body weight. RESULTS During a maximum of 9 years' follow-up, 1283 men and 2245 women attained normal body weight. In simple obesity (body mass index = 30.0-34.9 kg/m(2)), the annual probability of attaining normal weight was 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1290 for men and 1 in 677 for women with morbid obesity (body mass index = 40.0-44.9 kg/m(2)). The annual probability of achieving a 5% weight reduction was 1 in 8 for men and 1 in 7 for women with morbid obesity. CONCLUSIONS The probability of attaining normal weight or maintaining weight loss is low. Obesity treatment frameworks grounded in community-based weight management programs may be ineffective.
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Affiliation(s)
- Alison Fildes
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Judith Charlton
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Caroline Rudisill
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Peter Littlejohns
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - A Toby Prevost
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Martin C Gulliford
- Alison Fildes, Judith Charlton, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King's College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
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Gulliford M, Charlton J, Bhattarai N, Rudisill C. Reply to comment on "impact and cost-effectiveness of a universal strategy to promote physical activity in primary care". Eur J Health Econ 2015; 16:453. [PMID: 25752459 DOI: 10.1007/s10198-015-0678-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Martin Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK,
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Fildes A, Rudisill C, Charlton J, Gulliford M. Comment on 'Bariatric Surgery Can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model'. Obes Surg 2015; 25:1254-5. [PMID: 25920615 DOI: 10.1007/s11695-015-1694-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alison Fildes
- Department of Primary Care and Public Health Sciences, King's College London, 6th Floor, Capital House, 42 Weston Street, London, SE1 3QD, UK,
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Charlton J, Mackay L, McKnight JA. A pilot study comparing a type 1 nurse-led diabetes clinic with a conventional doctor-led diabetes clinic. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Booth H, Khan O, Prevost T, Reddy M, Dregan A, Charlton J, Ashworth M, Rudisill C, Littlejohns P, Gulliford MC. Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study. Lancet Diabetes Endocrinol 2014; 2:963-8. [PMID: 25466723 DOI: 10.1016/s2213-8587(14)70214-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The effect of currently used bariatric surgical procedures on the development of diabetes in obese people is not well defined. We aimed to assess the effect of bariatric surgery on development of type 2 diabetes in a large population of obese individuals. METHODS We did a matched cohort study of adults (age 20–100 years) identified from a UK-wide database of family practices, who were obese (BMI ≥30 kg/m2) and did not have diabetes. We enrolled 2167 patients who had undergone bariatric surgery between Jan 1, 2002, and April 30, 2014, and matched them--according to BMI, age, sex, index year, and HbA1c--with 2167 controls who had not had surgery. Procedures included laparoscopic gastric banding (n=1053), gastric bypass (795), and sleeve gastrectomy (317), with two procedures undefined. The primary outcome was development of clinical diabetes, which we extracted from electronic health records. Analyses were adjusted for matching variables, comorbidity, cardiovascular risk factors, and use of antihypertensive and lipid-lowering drugs. FINDINGS During a maximum of 7 years of follow-up (median 2·8 years [IQR 1·3–4·5]), 38 new diagnoses of diabetes were made in bariatric surgery patients and 177 were made in controls. By the end of 7 years of follow-up, 4·3% (95% CI 2·9–6·5) of bariatric surgery patients and 16·2% (13·3–19·6) of matched controls had developed diabetes. The incidence of diabetes diagnosis was 28·2 (95% CI 24·4–32·7) per 1000 person-years in controls and 5·7 (4·2–7·8) per 1000 person-years in bariatric surgery patients; the adjusted hazard ratio was 0·20 (95% CI 0·13–0·30, p<0·0001). This estimate was robust after varying the comparison group in sensitivity analyses, excluding gestational diabetes, or allowing for competing mortality risk. INTERPRETATION Bariatric surgery is associated with reduced incidence of clinical diabetes in obese participants without diabetes at baseline for up to 7 years after the procedure. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Helen Booth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
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Gulliford MC, Dregan A, Moore MV, Ashworth M, van Staa T, McCann G, Charlton J, Yardley L, Little P, McDermott L. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open 2014; 4:e006245. [PMID: 25348424 PMCID: PMC4212213 DOI: 10.1136/bmjopen-2014-006245] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/18/2014] [Accepted: 10/07/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Overutilisation of antibiotics may contribute to the emergence of antimicrobial drug resistance, a growing international concern. This study aimed to analyse the performance of UK general practices with respect to antibiotic prescribing for respiratory tract infections (RTIs) among young and middle-aged adults. SETTING Data are reported for 568 UK general practices contributing to the Clinical Practice Research Datalink. PARTICIPANTS Participants were adults aged 18-59 years. Consultations were identified for acute upper RTIs including colds, cough, otitis-media, rhino-sinusitis and sore throat. PRIMARY AND SECONDARY OUTCOME MEASURES For each consultation, we identified whether an antibiotic was prescribed. The proportion of RTI consultations with antibiotics prescribed was estimated. RESULTS There were 568 general practices analysed. The median general practice prescribed antibiotics at 54% of RTI consultations. At the highest prescribing 10% of practices, antibiotics were prescribed at 69% of RTI consultations. At the lowest prescribing 10% of practices, antibiotics were prescribed at 39% RTI consultations. The median practice prescribed antibiotics at 38% of consultations for 'colds and upper RTIs', 48% for 'cough and bronchitis', 60% for 'sore throat', 60% for 'otitis-media' and 91% for 'rhino-sinusitis'. The highest prescribing 10% of practices issued antibiotic prescriptions at 72% of consultations for 'colds', 67% for 'cough', 78% for 'sore throat', 90% for 'otitis-media' and 100% for 'rhino-sinusitis'. CONCLUSIONS Most UK general practices prescribe antibiotics to young and middle-aged adults with respiratory infections at rates that are considerably in excess of what is clinically justified. This will fuel antibiotic resistance.
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Affiliation(s)
- Martin C Gulliford
- King's College London, Primary Care and Public Health Sciences, London, UK
| | - Alex Dregan
- King's College London, Primary Care and Public Health Sciences, London, UK
| | - Michael V Moore
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Mark Ashworth
- King's College London, Primary Care and Public Health Sciences, London, UK
| | - Tjeerd van Staa
- Clinical Practice Research Datalink (CPRD) Division, Medicines and Healthcare Products Regulatory Agency, London, UK
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, London, UK
| | - Gerard McCann
- Clinical Practice Research Datalink (CPRD) Division, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Judith Charlton
- King's College London, Primary Care and Public Health Sciences, London, UK
| | - Lucy Yardley
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Lisa McDermott
- King's College London, Primary Care and Public Health Sciences, London, UK
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Johnson M, Oxley J, Newstead S, Charlton J. Safety in numbers? Investigating Australian driver behaviour, knowledge and attitudes towards cyclists. Accid Anal Prev 2014; 70:148-154. [PMID: 24769133 DOI: 10.1016/j.aap.2014.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/10/2014] [Accepted: 02/14/2014] [Indexed: 06/03/2023]
Abstract
A key tenet of the safety in numbers theory is that as the number of people cycling increases, more drivers will also be cyclists and therefore will give greater consideration to cyclists when driving. We tested this theory in relation to self-reported behaviour, attitudes and knowledge in relation to cycling. An online survey was conducted of Australian drivers (n=1984) who were also cyclists (cyclist-drivers) and drivers who did not cycle (drivers). Cyclist-drivers were 1.5 times more likely than drivers to report safe driving behaviours related to sharing the roads with cyclists (95% CI: 1.1-1.9, p<0.01). Cyclist-drivers had better knowledge of the road rules related to cycling infrastructure than drivers; however knowledge of road rules related to bike lanes was low for both groups. Drivers were more likely than cyclist-drivers to have negative attitudes (e.g. cyclists are unpredictable and repeatedly overtaking cyclists is frustrating). Findings from this study highlight the need for increased education and awareness in relation to safe driving behaviour, road rules and attitudes towards cyclists. Specific recommendations are made for approaches to improve safety for cyclists.
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Affiliation(s)
- Marilyn Johnson
- Institute of Transport Studies, Department of Civil Engineering, Monash University, Clayton, Australia; Amy Gillett Foundation, St Kilda, Melbourne, Australia; Monash University Accident Research Centre, Monash Injury Research Institute, Clayton, Australia.
| | - Jennie Oxley
- Monash University Accident Research Centre, Monash Injury Research Institute, Clayton, Australia.
| | - Stuart Newstead
- Monash University Accident Research Centre, Monash Injury Research Institute, Clayton, Australia.
| | - Judith Charlton
- Monash University Accident Research Centre, Monash Injury Research Institute, Clayton, Australia.
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Cotton J, Charlton J, Harkin G. Celebrating 50 years of water fluoridation in Birmingham--a time for decision-makers to tackle high tooth decay rates elsewhere. Community Dent Health 2014; 31:130-131. [PMID: 25300144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Gulliford MC, van Staa T, Dregan A, McDermott L, McCann G, Ashworth M, Charlton J, Little P, Moore MV, Yardley L. Electronic health records for intervention research: a cluster randomized trial to reduce antibiotic prescribing in primary care (eCRT study). Ann Fam Med 2014; 12:344-51. [PMID: 25024243 PMCID: PMC4096472 DOI: 10.1370/afm.1659] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 03/04/2014] [Accepted: 03/29/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study aimed to implement a point-of-care cluster randomized trial using electronic health records. We evaluated the effectiveness of electronically delivered decision support tools at reducing antibiotic prescribing for respiratory tract infections in primary care. METHODS Family practices from England and Scotland participating in the Clinical Practice Research Datalink (CPRD) were included in the trial; 53 family practices were allocated to intervention and 51 practices were allocated to usual care. Patients aged 18 to 59 years consulting for respiratory tract infections were eligible. The intervention was through remotely installed, computer-delivered decision support tools accessed during the consultations. Control practices provided usual care. The primary outcome was the proportion of consultations for respiratory tract infections with an antibiotic prescribed based on electronic health records. Family practice-specific proportions were included in a cluster-level analysis. RESULTS Data were analyzed for 603,409 patients: 317,717 at intervention practices and 285,692 at control practices. Use of the intervention was less than anticipated, varying among practices. There was a reduction in proportion of consultations with antibiotics prescribed of 1.85% (95% CI, 0.10%-3.59%, P=.038) and in the rate of antibiotic prescribing for respiratory tract infections (9.69%; 95% CI, 0.75%-18.63%, fewer prescriptions per 1,000 patient-years, P=.034). There were no adverse events. CONCLUSIONS Cluster randomized trials may be implemented efficiently in large samples from routine care settings by using primary care electronic health records. Future studies should develop and test multicomponent methods for remotely delivered intervention.
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Affiliation(s)
- Martin C Gulliford
- King's College London, Primary Care and Public Health Sciences, London, United Kingdom
| | - Tjeerd van Staa
- Clinical Practice Research Datalink (CPRD) Division, Medicines and Healthcare Products Regulatory Agency, London, United Kingdom London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alex Dregan
- King's College London, Primary Care and Public Health Sciences, London, United Kingdom
| | - Lisa McDermott
- Division of Community Clinical Sciences, University of Southampton, Southampton, United Kingdom
| | - Gerard McCann
- Clinical Practice Research Datalink (CPRD) Division, Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | - Mark Ashworth
- King's College London, Primary Care and Public Health Sciences, London, United Kingdom
| | - Judith Charlton
- King's College London, Primary Care and Public Health Sciences, London, United Kingdom
| | - Paul Little
- Division of Community Clinical Sciences, University of Southampton, Southampton, United Kingdom
| | - Michael V Moore
- Division of Community Clinical Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Division of Community Clinical Sciences, University of Southampton, Southampton, United Kingdom
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