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Martins SM, Dickens AP, Salibe-Filho W, Albuquerque Neto AA, Adab P, Enocson A, Cooper BG, Sousa LVA, Sitch AJ, Jowett S, Adams R, Cheng KK, Chi C, Correia-de-Sousa J, Farley A, Gale N, Jolly K, Maglakelidze M, Maghlakelidze T, Stavrikj K, Turner AM, Williams S, Jordan RE, Stelmach R. Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil. NPJ Prim Care Respir Med 2022; 32:55. [PMID: 36513683 PMCID: PMC9747958 DOI: 10.1038/s41533-022-00303-w] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/29/2022] [Indexed: 12/15/2022] Open
Abstract
In Brazil, prevalence of diagnosed COPD among adults aged 40 years and over is 16% although over 70% of cases remain undiagnosed. Hypertension is common and well-recorded in primary care, and frequently co-exists with COPD because of common causes such as tobacco smoking, therefore we conducted a cross-sectional screening test accuracy study in nine Basic Health Units in Brazil, among hypertensive patients aged ≥40 years to identify the optimum screening test/combinations to detect undiagnosed COPD. We compared six index tests (four screening questionnaires, microspirometer and peak flow) against the reference test defined as those below the lower limit of normal (LLN-GLI) on quality diagnostic spirometry, with confirmed COPD at clinical review. Of 1162 participants, 6.8% (n = 79) had clinically confirmed COPD. Peak flow had a higher specificity but lower sensitivity than microspirometry (sensitivity 44.3% [95% CI 33.1, 55.9], specificity 95.5% [95% CI 94.1, 96.6]). SBQ performed well compared to the other questionnaires (sensitivity 75.9% [95% CI 65.0, 84.9], specificity 59.2% [95% CI 56.2, 62.1]). A strategy requiring both SBQ and peak flow to be positive yielded sensitivity of 39.2% (95% CI 28.4, 50.9) and specificity of 97.0% (95% CI 95.7, 97.9). The use of simple screening tests was feasible within the Brazilian primary care setting. The combination of SBQ and peak flow appeared most efficient, when considering performance of the test, cost and ease of use (costing £1690 (5554 R$) with 26.7 cases detected per 1,000 patients). However, the choice of screening tests depends on the clinical setting and availability of resources.ISRCTN registration number: 11377960.
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Affiliation(s)
- S. M. Martins
- grid.412368.a0000 0004 0643 8839Family Medicine, ABC Medical School, Sao Paulo, Brazil
| | - A. P. Dickens
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK ,grid.500407.6Observational and Pragmatic Research Institute, Midview City, Singapore
| | - W. Salibe-Filho
- grid.412368.a0000 0004 0643 8839Family Medicine, ABC Medical School, Sao Paulo, Brazil ,grid.11899.380000 0004 1937 0722Respiratory Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - A. A. Albuquerque Neto
- grid.411249.b0000 0001 0514 7202Faculty of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - P. Adab
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A. Enocson
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - B. G. Cooper
- grid.412563.70000 0004 0376 6589Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L. V. A. Sousa
- grid.412368.a0000 0004 0643 8839Family Medicine, ABC Medical School, Sao Paulo, Brazil
| | - A. J. Sitch
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - S. Jowett
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R. Adams
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K. K. Cheng
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - C. Chi
- grid.411472.50000 0004 1764 1621Department of General Practice, Peking University First Hospital, Beijing, China
| | - J. Correia-de-Sousa
- International Primary Care Respiratory Group, Edinburgh, UK ,grid.10328.380000 0001 2159 175XLife and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga Portugal, ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - A. Farley
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - N. Gale
- grid.6572.60000 0004 1936 7486Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - K. Jolly
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M. Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia ,grid.444026.00000 0004 0519 9653Petre Shotadze Tbilisi Medical Academy, Tblisi, Georgia
| | - T. Maghlakelidze
- Georgian Respiratory Association, Tbilisi, Georgia ,grid.26193.3f0000 0001 2034 6082Ivane Javakhishvili Tbilisi State University, Tblisi, Georgia
| | - K. Stavrikj
- grid.7858.20000 0001 0708 5391Center for Family Medicine, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - A. M. Turner
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S. Williams
- International Primary Care Respiratory Group, Edinburgh, UK
| | - R. E. Jordan
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R. Stelmach
- grid.11899.380000 0004 1937 0722Respiratory Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Fabritz L, Connolly DL, Czarnecki E, Dudek D, Guasch E, Haase D, Huebner T, Zlahoda-Huzior A, Jolly K, Kirchhof P, Obergassel J, Schotten U, Vettorazzi E, Winkelmann SJ, Zapf A, Schnabel RB. Smartphone and wearable detected atrial arrhythmias in Older Adults: Results of a fully digital European Case finding study. Eur Heart J Digit Health 2022; 3:610-625. [PMID: 36710894 PMCID: PMC9779806 DOI: 10.1093/ehjdh/ztac067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/24/2022] [Indexed: 11/23/2022]
Abstract
Aims Simplified detection of atrial arrhythmias via consumer-electronics would enable earlier therapy in at-risk populations. Whether this is feasible and effective in older populations is not known. Methods and results The fully remote, investigator-initiated Smartphone and wearable detected atrial arrhythmia in Older Adults Case finding study (Smart in OAC-AFNET 9) digitally enrolled participants ≥65 years without known atrial fibrillation, not receiving oral anticoagulation in Germany, Poland, and Spain for 8 weeks. Participants were invited by media communications and direct contacts. Study procedures adhered to European data protection. Consenting participants received a wristband with a photoplethysmography sensor to be coupled to their smartphone. The primary outcome was the detection of atrial arrhythmias lasting 6 min or longer in the first 4 weeks of monitoring. Eight hundred and eighty-two older persons (age 71 ± 5 years, range 65-90, 500 (57%) women, 414 (47%) hypertension, and 97 (11%) diabetes) recorded signals. Most participants (72%) responded to adverts or word of mouth, leaflets (11%) or general practitioners (9%). Participation was completely remote in 469/882 persons (53%). During the first 4 weeks, participants transmitted PPG signals for 533/696 h (77% of the maximum possible time). Atrial arrhythmias were detected in 44 participants (5%) within 28 days, and in 53 (6%) within 8 weeks. Detection was highest in the first monitoring week [incidence rates: 1st week: 3.4% (95% confidence interval 2.4-4.9); 2nd-4th week: 0.55% (0.33-0.93)]. Conclusion Remote, digitally supported consumer-electronics-based screening is feasible in older European adults and identifies atrial arrhythmias in 5% of participants within 4 weeks of monitoring (NCT04579159).
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Affiliation(s)
- L Fabritz
- Corresponding author. Tel. +4940741057980,
| | - D L Connolly
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston Wolfson Drive, B15 2TT Birmingham, UK,Department of Cardiology and R&D, Birmingham City Hospital, Sandwell and West Birmingham Trust, Dudley Road, B18 7QH Birmingham, UK
| | - E Czarnecki
- Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | - D Dudek
- Jagiellonian University Medical College, Center for Digital Medicine and Robotics, Ul. Kopernika 7E, 33-332 Kraków, Poland,Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola RA, Italy
| | - E Guasch
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Carrer de Villaroel, 170, 08036 Barcelona, CA, Spain, Spain,IDIBAPS, Rosselló 149-153, 08036 Barcelona, CA, Spain,CIBERCV, Monforte de Lemos 3-5, Pabellon 11, Planta 0, 28029 Madrid, Spain
| | - D Haase
- Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | - T Huebner
- Preventicus GmbH, Ernst-Abbe-Straße 15, 07743 Jena, Germany
| | - A Zlahoda-Huzior
- Department of Measurement and Electronics, AGH University of Science and Technology, Al. Mickiewicza 30, 30-059 Kraków, Poland
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT Birmingham, UK
| | - P Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany,DZHK German Center for Cardiovascular Research, partner site Hamburg/Luebeck/Kiel, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston Wolfson Drive, B15 2TT Birmingham, UK,Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | - J Obergassel
- University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany,DZHK German Center for Cardiovascular Research, partner site Hamburg/Luebeck/Kiel, Germany
| | - U Schotten
- Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany,Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center +, Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - E Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Christoph-Probst-Weg 1, 20246 Hamburg, Germany
| | - S J Winkelmann
- University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany
| | - A Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Christoph-Probst-Weg 1, 20246 Hamburg, Germany
| | - R B Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany,DZHK German Center for Cardiovascular Research, partner site Hamburg/Luebeck/Kiel, Germany,Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
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Balai E, Gupta KK, Jolly K, Darr A. Posterior nasal nerve neurectomy for the treatment of rhinitis: a Systematic Review and Meta-Analysis. Eur Ann Allergy Clin Immunol 2022; 55:101-114. [PMID: 36066203 DOI: 10.23822/eurannaci.1764-1489.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Background. Posterior nasal nerve neurectomy (PNNN) is a surgical option for the treatment of refractory chronic rhinitis. It can be performed by surgical dissection, cryotherapy, or laser ablation. This systematic review aimed to assess the effect of PNNN on Total Nasal Symptom Score (TNSS) in adults with chronic rhinitis. Methods. A systematic review of EMBASE, MEDLINE, PubMed and ClinicalKey databases was conducted in November 2021. Studies reporting PNNN performed as a single procedure in adult patients with allergic, non-allergic or mixed chronic rhinitis, and TNSS as the outcome measure, were included. Results. Database search identified 39 articles, of which 8 (463 patients) were included in the review. Two were randomised sham-controlled trials and six were prospective single-arm, unblinded and uncontrolled studies. Pooled analysis of data from the two randomized controlled trials found active treatment was associated with a significantly greater responder (≥ 30% reduction in TNSS from baseline) rate (OR 3.85, 95%CI 2.23-6.64, p < 0.00001). Conclusions. This systematic review identified there is some limited evidence to suggest cryotherapy or radiofrequency ablation of the posterior nasal nerve can improve TNSS in adult patients. However, this is from a limited number of trials with short follow-up. Future research should focus on prospective randomised controlled trials with larger numbers of participants and medium to long term follow up in order to help draw more valid conclusions regarding the true effectiveness of PNNN in this patient cohort.
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Affiliation(s)
- E Balai
- University Hospitals Coventry and Warwickshire NHS Trust, U.K
| | - K K Gupta
- University Hospitals Birmingham NHS Foundation Trust, U.K
| | - K Jolly
- University Hospitals Birmingham NHS Foundation Trust, U.K
| | - A Darr
- The Royal Wolverhampton Hospitals NHS Trust, U.K
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Gokal K, Amos-Hirst R, Moakes CA, Sanders JP, Esliger DW, Sherar LB, Ives N, Biddle SJH, Edwardson C, Yates T, Frew E, Greaves C, Greenfield SM, Jolly K, Skrybant M, Maddison R, Mutrie N, Parretti HM, Daley AJ. Views of the public about Snacktivity™: a small changes approach to promoting physical activity and reducing sedentary behaviour. BMC Public Health 2022; 22:618. [PMID: 35351075 PMCID: PMC8964250 DOI: 10.1186/s12889-022-13050-x] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/17/2022] [Indexed: 12/14/2022] Open
Abstract
Background Many people do not meet the recommended health guidance of participation in a minimum of 150–300 min of moderate intensity physical activity per week, often promoted as at least 30 min of physical activity on 5 days of the week. This is concerning and highlights the importance of finding innovative ways to help people to be physically active each day. Snacktivity™ is a novel approach that aims to encourage people to do small, 2–5 min bouts of physical activity ‘snacks’ throughout the whole day, such that they achieve at least 150 min of moderate intensity activity per week. However, before it can be recommended, there is a need to explore whether the concept is acceptable to the public. Methods A survey to assess the views of the public about Snacktivity™ was distributed to adult patients registered at six general practices in the West Midlands, UK and to health care employees in the same region. Results A total of 5989 surveys were sent to patients, of which 558 were returned (9.3%). A further 166 surveys were completed by health care employees. A total of 85% of respondents liked the Snacktivity™ concept. The flexibility of the approach was highly rated. A high proportion of participants (61%) reported that the ability to self-monitor their behaviour would help them to do Snacktivity™ throughout their day. Physically inactive participants perceived that Snacktivity™ would help to increase their physical activity, more than those who were physically active (OR = 0.41, 95% CI: 0.25–0.67). Approximately 90% of respondents perceived that Snacktivity™ was easy to do on a non-working day compared to 60% on a working day. Aerobic activity ‘snacks’ were preferred to those which were strength based. Conclusions The Snacktivity™ approach to promoting physical activity was viewed positively by the public and interventions to test the merits of such an approach now need to be developed and tested in a variety of everyday contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13050-x.
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Affiliation(s)
- K Gokal
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK. .,The Centre for Lifestyle Medicine and Behaviour (CLiMB), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.
| | - R Amos-Hirst
- Birmingham Clinical Trials Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - C A Moakes
- Birmingham Clinical Trials Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - J P Sanders
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,The Centre for Lifestyle Medicine and Behaviour (CLiMB), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - D W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,The Centre for Lifestyle Medicine and Behaviour (CLiMB), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - L B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,The Centre for Lifestyle Medicine and Behaviour (CLiMB), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - N Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S J H Biddle
- Physically Active Lifestyles Research Group (USQ-PALs), Centre for Health Research, University of Southern Queensland, Springfield, QLD, 4300, Australia
| | - C Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - T Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - E Frew
- Health Economics Unit Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - C Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S M Greenfield
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - K Jolly
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - M Skrybant
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - R Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - N Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, EH8 8AQ, UK
| | - H M Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - A J Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,The Centre for Lifestyle Medicine and Behaviour (CLiMB), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
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Fabritz L, Connolly D, Czarnecki E, Dudek D, Zlahoda-Huzior A, Guasch E, Haase D, Huebner T, Jolly K, Kirchhof P, Schotten U, Zapf A, Schnabel RB. Remote Design of a Smartphone and Wearable Detected Atrial Arrhythmia in Older Adults Case Finding Study: Smart in OAC – AFNET 9. Front Cardiovasc Med 2022; 9:839202. [PMID: 35387433 PMCID: PMC8977585 DOI: 10.3389/fcvm.2022.839202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionScreening for atrial fibrillation and timely initiation of oral anticoagulation, rhythm management, and treatment of concomitant cardiovascular conditions can improve outcomes in high-risk populations. Whether wearables can facilitate screening in older adults is not known.Methods and AnalysesThe multicenter, international, investigator-initiated, single-arm case-finding Smartphone and wearable detected atrial arrhythmia in older adults case finding study (Smart in OAC – AFNET 9) evaluates the diagnostic yield of a validated, cloud-based analysis algorithm detecting atrial arrhythmias via a signal acquired by a smartphone-coupled wristband monitoring system in older adults. Unselected participants aged ≥65 years without known atrial fibrillation and not receiving oral anticoagulation are enrolled in three European countries. Participants undergo continuous pulse monitoring using a wristband with a photo plethysmography (PPG) sensor and a telecare analytic service. Participants with PPG-detected atrial arrhythmias will be offered ECG loop monitoring. The study has a virtual design with digital consent and teleconsultations, whilst including hybrid solutions. Primary outcome is the proportion of older adults with newly detected atrial arrhythmias (NCT04579159).DiscussionSmart in OAC – AFNET 9 will provide information on wearable-based screening for PPG-detected atrial arrhythmias in Europe and provide an estimate of the prevalence of atrial arrhythmias in an unselected population of older adults.
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Affiliation(s)
- Larissa Fabritz
- University Center of Cardiovascular Science, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Berlin, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Larissa Fabritz,
| | - D. Connolly
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Cardiology and R&D, Birmingham City Hospital, Sandwell and West Birmingham Trust, Birmingham, United Kingdom
| | | | - D. Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Maria Cecilia Hospital, GVM Care & Research, Ravennna, Italy
| | - A. Zlahoda-Huzior
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | - E. Guasch
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - D. Haase
- Atrial Fibrillation NETwork, Münster, Germany
| | | | - K. Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - P. Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Berlin, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- Atrial Fibrillation NETwork, Münster, Germany
| | - Ulrich Schotten
- Atrial Fibrillation NETwork, Münster, Germany
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Renate B. Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Berlin, Germany
- Atrial Fibrillation NETwork, Münster, Germany
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Balai E, Bhamra N, Gupta K, Jolly K, Barraclough J. Implementation of an acute tonsillitis management protocol within a clinical decisions unit. Ann R Coll Surg Engl 2021; 103:690-693. [PMID: 34436947 DOI: 10.1308/rcsann.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION With tonsillectomy surgery subject to increasingly strict commissioning criteria over the past 20 years in the UK, the total number of admissions for acute tonsillitis has been rising steadily. Multiple single-centre studies have demonstrated how introduction of a standardised management protocol can be effective in improving the delivery of treatment for acute tonsillitis in the emergency department. METHODS Using a novel approach, we aimed to implement an acute tonsillitis management protocol within a formal clinical decisions unit (CDU) pathway. Following a retrospective baseline audit, we carried out two post-intervention cycles of data collection to assess safety and efficacy. RESULTS The median number of initial treatments increased significantly from two of five at baseline, to three of five in both the first (U = 86, p = 0.004) and second (z = 2.959, p = 0.003) audit cycles. Admission rate was reduced from 0.79 to 0.44 in the first cycle, representing a 44.6% relative risk reduction [95% confidence interval (CI) 0.304-1.012; p = 0.0547]. Admission rate remained reduced at 0.48 in the second cycle, with a relative risk reduction of 39.2% compared with baseline (95% CI 0.380-0.972; p = 0.038). CONCLUSIONS Utilisation of the CDU led to an improvement in the delivery of initial treatment, an extended period of observation and subsequently a greater percentage of patients being discharged. An acute tonsillitis management protocol within a CDU appears to be a safe and effective model and is now standard practice in our hospital.
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Affiliation(s)
- E Balai
- The Royal Wolverhampton NHS Trust, UK
| | - N Bhamra
- The Royal Wolverhampton NHS Trust, UK
| | - K Gupta
- The Royal Wolverhampton NHS Trust, UK
| | - K Jolly
- The Royal Wolverhampton NHS Trust, UK
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Al-Hity S, Bhamra N, Kumar R, Gupta K, Howard J, Jolly K, Darr A. 908 Personal Protective Equipment (PPE) Guidance During A Global Pandemic: A Statistical Analysis of National Perceived Confidence, Knowledge, And Educational Deficits Amongst U.K. Based Doctors. Br J Surg 2021. [PMCID: PMC8135915 DOI: 10.1093/bjs/znab134.174] [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: 11/18/2022]
Abstract
Introduction March 11th, 2020 saw the World Health Organisation declare a global pandemic following the eruption of the novel coronavirus disease 2019. Unprecedented global demand for personal protective equipment (PPE) was complicated by limited availability and conflicting guidance from healthcare bodies. This study aimed to assess perceived confidence and knowledge of Public Health England’s PPE guidance amongst doctors of varying specialties and grades. Method A nationwide 11-point survey comprising of multiple-choice questions (MCQs) and a Likert scale assessing perceived confidence (1=not confident, 5=very confident) was disseminated to U.K. based doctors using multiple platforms. Results Data collated from 697 respondents revealed average perceived confidence was low. Notably, 59% felt they had received insufficient education regarding up-to-date guidance, with 81% advocating further training. Anaesthetics and ophthalmology were the highest and lowest scoring specialties in knowledge based MCQs, achieving 59% and 31% respectively. Subsequent statistical analysis revealed significant differences between specialties." Conclusions Ensuring consistency in published PPE guidance and education can develop doctor’s confidence and knowledge of appropriate PPE use. The absence of a unified consensus and global education regarding the use of PPE poses significant ramifications for patient and healthcare professional (HCP) safety whilst risking further depletion of already sparse resources.
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Affiliation(s)
- S Al-Hity
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - N Bhamra
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - R Kumar
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - K Gupta
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - J Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - K Jolly
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - A Darr
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
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8
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Jolly K, Gupta KK, Bhamra N, Aslanidou A, Batra R, Ahmed S. 404 Endonasal Endoscopic Management of Spontaneous Cerebrospinal Fluid Rhinorrhoea: Birmingham Experience. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.272] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Spontaneous cerebrospinal fluid (CSF) leak (SCSFL) occurs in the absence of any trauma, surgery or underlying intracranial pathology. SCSFL can lead to complications such as brain abscess, meningitis, decreased intracranial pressure (ICP), headache and brain herniation. We present our experience of SCSFL repair performed by a single surgeon at a tertiary centre via the endonasal endoscopic approach.
All patients who underwent CSF fistula repair at the Queen Elizabeth Hospital Birmingham, between 1st January 2012 and 31st December 2019, were identified and had their case notes analysed retrospectively.
We identified 33 patients who satisfied our inclusion criteria. They consisted of 27 (81.8%) female patients, ranging in age from 31 to 81 years (mean age 55.2 ± 13.2 years). Combined CT/MRI imaging was able to identify the leak in 30 patients (91%). Post-operative complications occurred in 2 patients (6.1%) with 1 patient developing meningitis (3.0%) and 1 patient experiencing epistaxis (3.0%). Overall, there was a successful primary repair in 32 (97.0%) cases.
Endoscopic endonasal repair of SCSFL has rapidly grown in popularity and now become the treatment of choice, overtaking open transcranial approaches. Several studies have demonstrated success rates of between 80-94% for spontaneous leaks however not all have addressed the issue of concurrent IIH post-operatively.
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Affiliation(s)
- K Jolly
- University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - K K Gupta
- University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - N Bhamra
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - A Aslanidou
- University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - R Batra
- University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - S Ahmed
- University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
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9
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Balai E, Jolly K, Bhamra N, Osborne MS, Barraclough J. The changing face of rhinology in the NHS: a study of septoplasty, septorhinoplasty and rhinoplasty hospital episode statistics. Ann R Coll Surg Engl 2021; 103:291-295. [PMID: 33661043 DOI: 10.1308/rcsann.2020.7034] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In 2011, septorhinoplasty and rhinoplasty were reclassified as procedures of limited clinical value in the NHS. The criteria for funding these operations varies across England. We used hospital episode statistics and freedom of information requests to review the total number of rhinology procedures performed across the previous decade, looking at trends in practice related to time, demographics and commissioning policy. MATERIALS AND METHODS Hospital episode statistics for 2012-2019 were used to calculate the number of septoplasty, septorhinoplasty, rhinoplasty and reduction rhinoplasty procedures performed in children and adults. Freedom of information requests were also made to all clinical commissioning groups in England asking for number of procedures performed and number of individual funding requests made. RESULTS A total of 158,031 procedures were performed over this period; the majority were in adult (99.0%) men (65.7%). Septoplasty was the most frequently performed operation; however, the total numbers declined by 5.4% over this period. There was a yearly reduction in the overall number of septorhinoplasty, rhinoplasty and reduction rhinoplasty operations. Four clinical commissioning groups provided a detailed breakdown of data by year and procedure. Those that required individual funding requests for all cases saw septorhinoplasty numbers fall by 81% and 75% over the period. Those that did not, saw numbers increase or remain the same. CONCLUSIONS We found an overall year-on-year reduction in the number of rhinology operations being performed in the NHS, but variation in trends between different clinical commissioning groups. A reduction in operative activity likely represents the effect of underlying restrictions on commissioning rather than reduced clinical need.
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Affiliation(s)
- E Balai
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - K Jolly
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - N Bhamra
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - M S Osborne
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - J Barraclough
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
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10
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Daley AJ, Jolly K, Bensoussane H, Ives N, Jebb SA, Tearne S, Greenfield SM, Yardley L, Little P, Tyldesley-Marshall N, Pritchett RV, Frew E, Parretti HM. Feasibility and acceptability of a brief routine weight management intervention for postnatal women embedded within the national child immunisation programme in primary care: randomised controlled cluster feasibility trial. Trials 2020; 21:757. [PMID: 32873323 PMCID: PMC7466790 DOI: 10.1186/s13063-020-04673-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 01/18/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of obesity in women continues to rise and pregnancy is a high-risk time for excessive weight gain. The period after childbirth represents an opportunity to offer women support to manage their weight. The primary aim here was to investigate the acceptability and feasibility of delivering a self-management intervention to postnatal women to support weight loss, embedded within the national child immunisation programme. METHODS The research involved a randomised controlled cluster feasibility trial. Data were collected at baseline and 3 months later. Twenty-eight postnatal women living with overweight or obesity were recruited via Birmingham Women Hospital or general practices. Babies are routinely immunised at 2, 3 and 4 months of age; the intervention was embedded within these appointments. The intervention involved brief motivation/support by practice nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme, when they attended their practice to have their child immunised. The role of the nurse was to provide external accountability for weight loss. Participants were asked to weigh themselves weekly and record this on a record card or using the online programme. The weight goal was for participants to lose 0.5 to 1 kg per week. Usual care received a healthy lifestyle leaflet. The primary outcome was the feasibility of a phase III trial to test the subsequent effectiveness of the intervention, as assessed against three stop-go traffic light criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). RESULTS The traffic light stop-go criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. DISCUSSION Whilst participants and nurses followed the trial protocol well and adherence to self-weighing was acceptable, recruitment was challenging and there is scope to improve engagement with the online weight management programme component of the intervention. TRIAL REGISTRATION ISRCTN 12209332 . Registration date is 04/12/18.
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Affiliation(s)
- A J Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - H Bensoussane
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - N Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - S Tearne
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - S M Greenfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - L Yardley
- School of Psychological Science, University of Bristol, Bristol, BS8 1TH, UK.,Department of Psychology, University of Southampton, Southampton, S017 1BJ, UK
| | - P Little
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - N Tyldesley-Marshall
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - R V Pritchett
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - E Frew
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - H M Parretti
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
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11
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Rafie A, Jolly K, Darr A, Thompson S. Adult cavernous haemangioma of the vocal cords with a unique presentation of acute respiratory distress: a case report. Ann R Coll Surg Engl 2020; 102:e152-e154. [PMID: 32306741 PMCID: PMC7450425 DOI: 10.1308/rcsann.2020.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 11/22/2022] Open
Abstract
Laryngeal haemangiomas can commonly be seen in children, and first-line treatment is usually propranolol. However, in adults, cavernous haemangioma of the vocal cord(s) is an extremely rare condition - with this being the only published adult case presenting with acute respiratory distress - the mainstay of treatment is surgical excision under microlaryngoscopy. Presentation in adults can be unpredictable, but primarily consists of hoarseness which can be associated with, dyspnoea, dysphagia, and haemoptysis - and in one documented case stenosis of the aero-digestive tract led to death. Due to these airway difficulties, surgery can often prove challenging. In this study, we explore the unusual case of a previously well 71-year-old gentleman presenting to the Emergency Department, with worsening shortness of breath as his primary complaint. Uniquely, in this case, an awake fibre-optic intubation was undertaken to manage the difficult airway and a microlaryngoscopy was performed. A 20x10x15mm lesion was excised, which had characteristics in keeping with a cavernous haemangioma on microscopic examination.
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Affiliation(s)
- A Rafie
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - K Jolly
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - A Darr
- New Cross Hospital, Wolverhampton, UK
| | - S Thompson
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
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12
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Abbas Y, Abdelkader M, Adams M, Addison A, Advani R, Ahmed T, Alexander V, Alexander V, Alli B, Alvi S, Amiraraghi N, Ashman A, Balakumar R, Bewick J, Bhasker D, Bola S, Bowles P, Campbell N, Can Guru Naidu N, Caton N, Chapman J, Chawdhary G, Cherko M, Coates M, Conroy K, Coyle P, Cozar O, Cresswell M, Dalton L, Danino J, Daultrey C, Davies K, Carrie S, Dick D, Dimitriadis PA, Doddi N, Dowling M, Easto R, Edmiston R, Ellul D, Erskine S, Evans A, Farboud A, Forde C, Fussey J, Gaunt A, Gilchrist J, Gohil R, Gosnell E, Grech Marguerat D, Green R, Grounds R, Hall A, Hardman J, Harris A, Harrison L, Hone R, Hoskison E, Howard J, Ioannidis D, Iqbal I, Janjua N, Jolly K, Kamal S, Kanzara T, Keates N, Kelly A, Khan H, Korampalli T, Kuet M, Kul‐loo P, Lakhani R, Lambert A, Lancer H, Leonard C, Lloyd G, Lowe E, Mair J, Maughan E, Gao C, Mayberry T, McCadden L, McClenaghan F, McKenzie G, Mcleod R, Meghji S, Mian M, Millington A, Mirza O, Mistry S, Molena E, Morris J, Myuran T, Navaratnam A, Noon E, Okonkwo O, Oremule B, Pabla L, Papesch E, Puranik V, Roplekar R, Ross E, Rudd J, Schechter E, Senior A, Sethi N, Sharma S, Sharma R, Shelton F, Sherazi Z, Tahir A, Tikka T, Tkachuk Hlinicanova O, To K, Tse A, Toll E, Ubayasiri K, Unadkat S, Upile N, Vijendren A, Walijee H, Wilkie M, Williams R, Williams M, Wilson G, Wong W, Wong G, Xie C, Yao A, Zhang H, Ellis M, Mehta N, Milinis K, Tikka T, Slovick A, Swords C, Hutson K, Smith ME, Hopkins C, Ng Kee Kwong F. Nasal Packs for Epistaxis: Predictors of Success. Clin Otolaryngol 2020; 45:659-666. [DOI: 10.1111/coa.13555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/08/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
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13
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Chan J, Jolly K, Darr A, Bowyer DJ. A rare case of unilateral hemifacial spasm and facial palsy associated with an abnormal anatomical variant of the posterior basilar circulation. Ann R Coll Surg Engl 2019; 101:e1-e3. [PMID: 31155905 DOI: 10.1308/rcsann.2019.0069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/22/2022] Open
Abstract
Tortuous vertebral arteries are a rare anatomical variant. Mild tortuosity is usually asymptomatic whereas severe tortuosity may present with ischaemic symptoms or compressive symptoms (focal neurological deficit). While a resulting hemifacial spasm has been previously described, sparse literature exists for its association with facial palsy. We present a rare case of facial spasm along with facial palsy in a 67-year-old woman who was found to have an anatomical variant in the posterior basilar circulation with an ectatic basilar artery and significantly displaced posterior vertebral artery impinging on the facial nerve.
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Affiliation(s)
- J Chan
- Department of Otolaryngology, Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust , Telford , UK
| | - K Jolly
- University Hospitals Birmingham NHS Foundation Trust , West Midlands , UK
| | - A Darr
- Royal Wolverhampton NHS Trust , West Midlands , UK
| | - D J Bowyer
- Department of Otolaryngology, Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust , Telford , UK
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14
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Graham J, Tudor K, Jebb SA, Lewis A, Tearne S, Adab P, Begh R, Jolly K, Daley A, Farley A, Lycett D, Nickless A, Aveyard P. The equity impact of brief opportunistic interventions to promote weight loss in primary care: secondary analysis of the BWeL randomised trial. BMC Med 2019; 17:51. [PMID: 30819170 PMCID: PMC6396456 DOI: 10.1186/s12916-019-1284-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/28/2018] [Accepted: 02/08/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Guidelines recommend that clinicians should make brief opportunistic behavioural interventions to patients who are obese to increase the uptake of effective weight loss programmes. The objective was to assess the effect of this policy on socioeconomic equity. METHODS One thousand eight hundred eighty-two consecutively attending patients with obesity and who were not seeking support for weight loss from their GP were enrolled in a trial. Towards the end of each consultation, GPs randomly assigned participants to one of two 30-s interventions. In the active intervention (support arm), the GP offered referral to a weight management group. In the control intervention (advice arm), the GP advised the patient that their health would benefit from weight loss. Agreement to attend a behavioural weight loss programme, attendance at the programme and weight loss at 12 months were analysed by socioeconomic status, measured by postcode using the Index of Multiple Deprivation (IMD). RESULTS Mean weight loss was 2.43 kg (sd 6.49) in the support group and 1.04 kg (sd 5.50) for the advice only group, but these effects were moderated by IMD (p = 0.039 for the interaction). In the support arm, weight loss was greater in higher socioeconomic groups. Participants from lower socioeconomic backgrounds were more likely to accept the offer and equally likely to attend a weight loss referral but attended fewer sessions. Adjusting for these sequentially reduced the gradient for the association of socioeconomic status with weight loss from + 0.035 to - 0.001 kg/IMD point. In the advice only arm, 10% took effective action to promote weight loss. The decision to seek support for weight loss outside of the trial did not differ by socioeconomic status, but weight loss among deprived participants who used external support was greater than among more affluent participants (p = 0.025). CONCLUSION Participants' responses to GPs' brief opportunistic interventions to promote weight loss differed by socioeconomic status and trial arm. In the support arm, more deprived people lost less weight because they attended fewer sessions at the programme. In the advice arm, more deprived people who sought and paid for support for weight loss themselves lost more weight than more affluent people who sought support. TRIAL REGISTRATION This trial is registered with the ISRCTN registry, number ISRCTN26563137 . Date of registration: January 3, 2013; date of first participant recruited: June 4, 2014.
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Affiliation(s)
- J Graham
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - K Tudor
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK.
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - A Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - S Tearne
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - P Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - R Begh
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - A Daley
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - A Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - D Lycett
- Faculty Research Centre for Advances in Behavioural Science, Coventry University, Coventry, CV1 5FB, UK
| | - A Nickless
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
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15
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Jolly K, Darr A, Arlt W, Ahmed S, Karavitaki N. Surgery for Cushing's disease in pregnancy: our experience and a literature review. Ann R Coll Surg Engl 2019; 101:e26-e31. [PMID: 30286651 PMCID: PMC6303815 DOI: 10.1308/rcsann.2018.0175] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 12/23/2022] Open
Abstract
Cushing's syndrome in pregnancy is a rare phenomenon and there is limited literature on its management. Cushing's disease in pregnancy is even less common and there is little guidance to help in the treatment for this patient group. Diagnosis of Cushing's syndrome in pregnancy is often delayed due to overlap of symptoms. In addition, there are no validated diagnostic tests or parameters documented. We present a case of a 30-year-old woman presenting to the antenatal clinic at 13 weeks of pregnancy with high suspicion of Cushing's disease. Her 21-week fetal scan showed a congenital diaphragmatic hernia and she underwent pituitary magnetic resonance imaging, which confirm Cushing's disease. She successfully underwent transsphenoidal adenomectomy with histology confirming a corticotroph adenoma. Tests following transsphenoidal surgery confirmed remission of Cushing's disease and she underwent an emergency caesarean section at 38 weeks. Unfortunately, her baby died from complications associated with the congenital abnormality 36 hours after birth. The patient remains in remission following delivery. To date, there have been no reported cases of congenital diaphragmatic hernia associated with Cushing's disease in pregnancy. In addition, we believe that this is only the eighth reported patient to have undergone successful transsphenoidal surgery for Cushing's disease in pregnancy.
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Affiliation(s)
- K Jolly
- Ear, Nose and Throat Department, University Hospital Birmingham, Birmingham, UK
| | - A Darr
- Ear, Nose and Throat Department, University Hospital Birmingham, Birmingham, UK
| | - W Arlt
- Department of Endocrinology, University Hospital Birmingham, Birmingham, UK
| | - S Ahmed
- Ear, Nose and Throat Department, University Hospital Birmingham, Birmingham, UK
| | - N Karavitaki
- Department of Endocrinology, University Hospital Birmingham, Birmingham, UK
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16
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Jolly K, Sidhu MS, Bates E, Majothi S, Sitch A, Bayliss S, Kim HJS, Jordan RE. Systematic review of the effectiveness of community-based self-management interventions among primary care COPD patients. NPJ Prim Care Respir Med 2018; 28:44. [PMID: 30470741 PMCID: PMC6251904 DOI: 10.1038/s41533-018-0111-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/23/2018] [Indexed: 11/08/2022] Open
Abstract
COPD self-management reduces hospital admissions and improves health-related quality of life (HRQoL). However, whilst most patients are managed in primary care, the majority of self-management trials have recruited participants with more severe disease from secondary care. We report the findings of a systematic review of the effectiveness of community-based self-management interventions in primary care patients with COPD. We systematically searched eleven electronic databases and identified 12 eligible randomised controlled trials with seven included in meta-analyses for HRQoL, anxiety and depression. We report no difference in HRQoL at final follow-up (St George's Respiratory Questionnaire total score -0.29; 95%CI -2.09, 1.51; I2 0%), nor any difference in anxiety or depression. In conclusion, supported self-management interventions delivered in the community to patients from primary care do not appear to be effective. Further research is recommended to identify effective self-management interventions suitable for primary care populations, particularly those with milder disease.
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Affiliation(s)
- K Jolly
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - M S Sidhu
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - E Bates
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S Majothi
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - A Sitch
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S Bayliss
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - H J Samuel Kim
- St John's College, University of Oxford, Oxford, OX1 3JP, UK
| | - R E Jordan
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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17
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Adab P, Fitzmaurice DA, Dickens AP, Ayres JG, Buni H, Cooper BG, Daley AJ, Enocson A, Greenfield S, Jolly K, Jowett S, Kalirai K, Marsh JL, Miller MR, Riley RD, Siebert WS, Stockley RA, Turner AM, Cheng KK, Jordan RE. Cohort Profile: The Birmingham Chronic Obstructive Pulmonary Disease (COPD) Cohort Study. Int J Epidemiol 2018; 46:23. [PMID: 27378796 DOI: 10.1093/ije/dyv350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D A Fitzmaurice
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J G Ayres
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - H Buni
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - B G Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A J Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K Kalirai
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J L Marsh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M R Miller
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R D Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - W S Siebert
- Business School, University of Birmingham, Birmingham, UK
| | - R A Stockley
- Queen Elizabeth Hospital Research Laboratories, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A M Turner
- School of Inflammation & Aging, University of Birmingham, UK
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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18
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Darr A, Jolly K, Martin T, Monaghan A, Grime P, Isles M, Beech T, Ahmed S. Three-layered technique to repair an oroantral fistula using a posterior-pedicled inferior turbinate, buccal fat pad, and buccal mucosal advancement flap. Br J Oral Maxillofac Surg 2018; 56:638-639. [PMID: 30017574 DOI: 10.1016/j.bjoms.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Affiliation(s)
- A Darr
- Department of Otolaryngology, Shrewsbury and Telford Hospitals NHS Trust, UK.
| | - K Jolly
- Department of Otolaryngology, Shrewsbury and Telford Hospitals NHS Trust, UK.
| | - T Martin
- Department of Head and Neck Surgery, University Hospitals Birmingham NHS Trust.
| | - A Monaghan
- Department of Head and Neck Surgery, University Hospitals Birmingham NHS Trust.
| | - P Grime
- Department of Head and Neck Surgery, University Hospitals North Midlands NHS Trust.
| | - M Isles
- Department of Otolaryngology, University Hospitals North Midlands NHS Trust.
| | - T Beech
- Department of Otolaryngology, University Hospitals Birmingham NHS Trust.
| | - S Ahmed
- Department of Otolaryngology, University Hospitals Birmingham NHS Trust.
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Madigan CD, Roalfe A, Daley AJ, Jolly K. What factors influence weight loss in participants of commercial weight loss programmes? Implications for health policy. Obes Res Clin Pract 2017; 11:709-717. [PMID: 28693984 DOI: 10.1016/j.orcp.2017.06.003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 06/02/2017] [Accepted: 06/17/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Finding effective referral policies for weight management services would have important public health implications. AIM Here we compare percentage weight change by referral methods, BMI categories and participants who have had attended weight loss programmes multiple times. DESIGN AND SETTINGS A prospective cohort study of 15,621 participants referred to 12-week behavioural weight loss programmes funded by the public health service in Birmingham, UK. METHODS Comparisons were made between GP versus self-referrals, BMI ≥40kg/m2-<40kg/m2 and multiple referrals compared to only one referral. Linear mixed modelling was used to assess percentage weight change after adjusting for covariates. RESULTS Participant's mean age was 48.5 years, 78.7% were of white ethnicity, 90.3% female and mean baseline BMI was 36.3kg/m2. There were no significant differences in percentage weight loss, between participants that self-referred and those that were referred by their general practitioner (GP) and no significant differences between baseline BMI categories. Referral to a weight loss programme more than once was associated with less weight loss at subsequent attendances (0.92%, 95% CI 0.70-1.14, p<0.001). CONCLUSION Allowing self-referral to a weight loss programme widens access without compromising amount of weight lost. These programmes are beneficial for all categories of obesity, including those with a BMI ≥40kg/m2. Attending weight management programmes more than once results in less weight loss and that swapping to a different program may be advisable.
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Affiliation(s)
- C D Madigan
- The Boden Institute, The University of Sydney, Charles Perkins Centre, Camperdown, New South Wales, 2006, Australia.
| | - A Roalfe
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - A J Daley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Spahr N, Hodkinson D, Jolly K, Williams S, Howard M, Thacker M. Distinguishing between nociceptive and neuropathic components in chronic low back pain using behavioural evaluation and sensory examination. Musculoskelet Sci Pract 2017; 27. [PMID: 28637600 PMCID: PMC5329124 DOI: 10.1016/j.msksp.2016.12.006] [Citation(s) in RCA: 30] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diagnosis of chronic low back pain (CLBP) is traditionally predicated on identifying underlying pathological or anatomical causes, with treatment outcomes modest at best. Alternately, it is suggested that identification of underlying pain mechanisms with treatments targeted towards specific pain phenotypes may yield more success. Differentiation between nociceptive and neuropathic components of CLBP is problematic; evidence suggests that clinicians fail to identify a significant neuropathic component in many CLBP patients. The painDETECT questionnaire (PDQ) was specifically developed to identify occult but significant neuropathic components in individuals thought to have predominantly nociceptive pain. METHODS Using the PDQ, we classified 50 CLBP patients into two distinct groups; those with predominantly nociceptive pain (Group 1) and those with a significant neuropathic component (Group 2). We characterised these two distinct CLBP sub-groups using a) questionnaire-based behavioural evaluation measuring pain-related function and quality of life, pain intensity and psychological well-being and b) sensory examination, using two-point and tactile threshold discrimination. OBJECTIVE We sought to determine if differences in the pain phenotype of each CLBP sub-group would be reflected in sensory and behavioural group profiles. RESULTS We report that Group 1 and Group 2 sub-groups demonstrate unique clinical profiles with significant differences in sensory tactile discrimination thresholds and in a wide range of behavioural domains measuring pain intensity, disability and psychological well-being. CONCLUSION We have demonstrated distinct clinical profiles for CLBP patient sub-groups classified by PDQ. Our results give diagnostic confidence in using the PDQ to characterise two distinct pain phenotypes in a heterogeneous CLBP population.
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Affiliation(s)
- N Spahr
- Dept. of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Dept. of Physiotherapy, Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - D Hodkinson
- Dept. of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - K Jolly
- Dept. of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - S Williams
- Dept. of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - M Howard
- Dept. of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - M Thacker
- Dept. of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Dept. of Physiotherapy, Guy's & St Thomas' NHS Foundation Trust, London, UK; Centre of Human & Aerospace Physiological Sciences, King's College London, UK
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21
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Eyre V, Lang CC, Smith K, Jolly K, Davis R, Hayward C, Wingham J, Abraham C, Green C, Warren FC, Britten N, Greaves CJ, Doherty P, Austin J, Van Lingen R, Singh S, Buckingham S, Paul K, Taylor RS, Dalal HM. Rehabilitation Enablement in Chronic Heart Failure-a facilitated self-care rehabilitation intervention in patients with heart failure with preserved ejection fraction (REACH-HFpEF) and their caregivers: rationale and protocol for a single-centre pilot randomised controlled trial. BMJ Open 2016; 6:e012853. [PMID: 27798024 PMCID: PMC5093626 DOI: 10.1136/bmjopen-2016-012853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 11/11/2022] Open
Abstract
INTRODUCTION The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure (HF) with preserved ejection fraction (REACH-HFpEF) pilot trial is part of a research programme designed to develop and evaluate a facilitated, home-based, self-help rehabilitation intervention to improve self-care and quality of life (QoL) in heart failure patients and their caregivers. We will assess the feasibility of a definitive trial of the REACH-HF intervention in patients with HFpEF and their caregivers. The impact of the REACH-HF intervention on echocardiographic outcomes and bloodborne biomarkers will also be assessed. METHODS AND ANALYSIS A single-centre parallel two-group randomised controlled trial (RCT) with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention) or usual care alone (control) in 50 HFpEF patients and their caregivers. The REACH-HF intervention comprises a REACH-HF manual with supplementary tools, delivered by trained facilitators over 12 weeks. A mixed methods approach will be used to assess estimation of recruitment and retention rates; fidelity of REACH-HF manual delivery; identification of barriers to participation and adherence to the intervention and study protocol; feasibility of data collection and outcome burden. We will assess the variance in study outcomes to inform a definitive study sample size and assess methods for the collection of resource use and intervention delivery cost data to develop the cost-effectiveness analyses framework for any future trial. Patient outcomes collected at baseline, 4 and 6 months include QoL, psychological well-being, exercise capacity, physical activity and HF-related hospitalisation. Caregiver outcomes will also be assessed, and a substudy will evaluate impact of the REACH-HF manual on resting global cardiovascular function and bloodborne biomarkers in HFpEF patients. ETHICS AND DISSEMINATION The study is approved by the East of Scotland Research Ethics Service (Ref: 15/ES/0036). Findings will be disseminated via journals and presentations to clinicians, commissioners and service users. TRIAL REGISTRATION NUMBER ISRCTN78539530; Pre-results .
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Affiliation(s)
- V Eyre
- Peninsula Clinical Trials Unit, Plymouth University, Plymouth, UK
| | - C C Lang
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - K Smith
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- School of Nursing & Midwifery, Dundee University, Dundee, UK
| | - K Jolly
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Davis
- Cardiology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - C Hayward
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - J Wingham
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
- Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - C Abraham
- Psychology Applied to Health Group, University of Exeter Medical School, Exeter, UK
| | - C Green
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - F C Warren
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - N Britten
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - C J Greaves
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - P Doherty
- Department of Health Sciences, University of York, York, UK
| | - J Austin
- Heart Failure Services and Cardiac Rehabilitation, Aneurin Bevan University Health Board, Nevill Hall Hospital, Abergavenny, UK
| | - R Van Lingen
- Cardiology Department, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - S Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - S Buckingham
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - K Paul
- REACH-HF Patient and Public Involvement Group, c/o Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - R S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - H M Dalal
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
- Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
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22
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Buckingham SA, Taylor RS, Jolly K, Zawada A, Dean SG, Cowie A, Norton RJ, Dalal HM. Home-based versus centre-based cardiac rehabilitation: abridged Cochrane systematic review and meta-analysis. Open Heart 2016; 3:e000463. [PMID: 27738516 PMCID: PMC5030549 DOI: 10.1136/openhrt-2016-000463] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/24/2016] [Accepted: 07/19/2016] [Indexed: 12/29/2022] Open
Abstract
Objective To update the Cochrane review comparing the effects of home-based and supervised centre-based cardiac rehabilitation (CR) on mortality and morbidity, quality of life, and modifiable cardiac risk factors in patients with heart disease. Methods Systematic review and meta-analysis. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL were searched up to October 2014, without language restriction. Randomised trials comparing home-based and centre-based CR programmes in adults with myocardial infarction, angina, heart failure or who had undergone coronary revascularisation were included. Results 17 studies with 2172 patients were included. No difference was seen between home-based and centre-based CR in terms of: mortality (relative risk (RR) 0.79, 95% CI 0.43 to 1.47); cardiac events; exercise capacity (mean difference (MD) −0.10, −0.29 to 0.08); total cholesterol (MD 0.07 mmol/L, −0.24 to 0.11); low-density lipoprotein cholesterol (MD −0.06 mmol/L, −0.27 to 0.15); triglycerides (MD −0.16 mmol/L, −0.38 to 0.07); systolic blood pressure (MD 0.2 mm Hg, −3.4 to 3.8); smoking (RR 0.98, 0.79 to 1.21); health-related quality of life and healthcare costs. Lower high-density lipoprotein cholesterol (MD −0.07 mmol/L, −0.11 to −0.03, p=0.001) and lower diastolic blood pressure (MD −1.9 mm Hg, −0.8 to −3.0, p=0.009) were observed in centre-based participants. Home-based CR was associated with slightly higher adherence (RR 1.04, 95% CI 1.01 to 1.07). Conclusions Home-based and centre-based CR provide similar benefits in terms of clinical and health-related quality of life outcomes at equivalent cost for those with heart failure and following myocardial infarction and revascularisation.
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Affiliation(s)
- S A Buckingham
- Department of Research, Development & Innovation , Royal Cornwall, Hospitals NHS Trust , Truro , UK
| | - R S Taylor
- Institute of Health Research (Primary Care), University of Exeter Medical School , Exeter, Devon , UK
| | - K Jolly
- Institute for Applied Health Research, University of Birmingham , Birmingham , UK
| | - A Zawada
- Agency for Health Technology Assessment and Tariff System , Warsaw , Poland
| | - S G Dean
- Institute of Health Research (Primary Care), University of Exeter Medical School , Exeter, Devon , UK
| | - A Cowie
- Cardiac Rehabilitation , University Hospital Ayr , Ayr , UK
| | - R J Norton
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London , London , UK
| | - H M Dalal
- Department of Research, Development & Innovation, Royal Cornwall, Hospitals NHS Trust, Truro, UK; Institute of Health Research (Primary Care), University of Exeter Medical School, Exeter, Devon, UK
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Jolly K, Hammond D, Maher M, Evriviades D. New technique for bloodless surgery to the scalp. Br J Oral Maxillofac Surg 2016; 54:e55-6. [PMID: 26948705 DOI: 10.1016/j.bjoms.2016.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- K Jolly
- Queen Elizabeth Hospital Birmingham.
| | | | - M Maher
- Queen Elizabeth Hospital Birmingham
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Daley AJ, Jolly K, Jebb SA, Roalfe AK, Mackillop L, Lewis AL, Clifford S, Kenyon S, MacArthur C, Aveyard P. Effectiveness of regular weighing, weight target setting and feedback by community midwives within routine antenatal care in preventing excessive gestational weight gain: randomised controlled trial. BMC Obes 2016; 3:7. [PMID: 26885375 PMCID: PMC4743115 DOI: 10.1186/s40608-016-0086-4] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
Background Many pregnant women gain excess weight during pregnancy which increases the health risks to the mother and her baby. Interventions to prevent excess weight gain need to be given to the whole population to prevent excess weight gain. The aim of this study was to assess the effectiveness of a simple and brief intervention embedded withinroutine antenatal care to prevent excessive gestation weight gain. Methods Six hundred and ten pregnant women (between 10-14 weeks gestation), aged ≥18 years with a body mass index (BMI) ≥18.5 kg/m2, planned to receive community midwife led care or shared care at the time of recruitment are eligible to take part in the study. Women will be recruited from four maternity centres in England. Community midwives complete a short training module before delivering the intervention. In the intervention, midwives weigh women, set maximum weight limits for weight gain at each antenatal appointment and ask women to monitor their weight at home. Themaximum weight limit is adjusted by the midwife at each antenatal appointment if women have exceeded their maximum weight gain limit set at their previous appointment. The intervention will be compared with usual antenatal care. The primary outcome is the proportion of women per group who exceed the Institute of Medicine guidelines for gestational weight gain at 38 weeks of pregnancy according to their early pregnancy BMI category. Discussion The proposed trial will test a brief intervention comprising regular weighing, target setting and monitoring ofweight during pregnancy that can be delivered at scale as part of routine antenatal care. Using the professional expertise of community midwives, but without specialist training in weight management, the intervention will incur minimal additionalhealthcare costs, and if effective at reducing excess weight gain, is likely to be very cost effective. Trial registration Current controlled trials ISRCTN67427351. Date assigned 29/10/2014.
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Affiliation(s)
- Amanda J Daley
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - K Jolly
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - A K Roalfe
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - L Mackillop
- Women's Centre, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
| | - A L Lewis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - S Clifford
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - S Kenyon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - C MacArthur
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
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Taylor RS, Hayward C, Eyre V, Austin J, Davies R, Doherty P, Jolly K, Wingham J, Van Lingen R, Abraham C, Green C, Warren FC, Britten N, Greaves CJ, Singh S, Buckingham S, Paul K, Dalal H. Clinical effectiveness and cost-effectiveness of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) facilitated self-care rehabilitation intervention in heart failure patients and caregivers: rationale and protocol for a multicentre randomised controlled trial. BMJ Open 2015; 5:e009994. [PMID: 26700291 PMCID: PMC4691763 DOI: 10.1136/bmjopen-2015-009994] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 09/14/2015] [Revised: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) trial is part of a research programme designed to develop and evaluate a health professional facilitated, home-based, self-help rehabilitation intervention to improve self-care and health-related quality of life in people with heart failure and their caregivers. The trial will assess the clinical effectiveness and cost-effectiveness of the REACH-HF intervention in patients with systolic heart failure and impact on the outcomes of their caregivers. METHODS AND ANALYSIS A parallel two group randomised controlled trial with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention group) or usual care alone (control group) in 216 patients with systolic heart failure (ejection fraction <45%) and their caregivers. The intervention comprises a self-help manual delivered by specially trained facilitators over a 12-week period. The primary outcome measure is patients' disease-specific health-related quality of life measured using the Minnesota Living with Heart Failure questionnaire at 12 months' follow-up. Secondary outcomes include survival and heart failure related hospitalisation, blood biomarkers, psychological well-being, exercise capacity, physical activity, other measures of quality of life, patient safety and the quality of life, psychological well-being and perceived burden of caregivers at 4, 6 and 12 months' follow-up. A process evaluation will assess fidelity of intervention delivery and explore potential mediators and moderators of changes in health-related quality of life in intervention and control group patients. Qualitative studies will describe patient and caregiver experiences of the intervention. An economic evaluation will estimate the cost-effectiveness of the REACH-HF intervention plus usual care versus usual care alone in patients with systolic heart failure. ETHICS AND DISSEMINATION The study is approved by the North West-Lancaster Research Ethics Committee (ref 14/NW/1351). Findings will be disseminated via journals and presentations to publicise the research to clinicians, commissioners and service users. TRIAL REGISTRATION NUMBER ISRCTN86234930; Pre-results.
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Affiliation(s)
- R S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - C Hayward
- Peninsula Clinical Trials Unit, Plymouth University, Plymouth, Devon, UK
| | - V Eyre
- Peninsula Clinical Trials Unit, Plymouth University, Plymouth, Devon, UK
| | - J Austin
- Heart Failure Services and Cardiac Rehabilitation, Aneurin Bevan University Health Board, Nevill Hall Hospital, Abergavenny, UK
| | - R Davies
- Cardiology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - P Doherty
- Department of Health Sciences, University of York, York, UK
| | - K Jolly
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Wingham
- Institute of Health Research, University of Exeter Medical School, Exeter, UK Department of Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - R Van Lingen
- Cardiology Department, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - C Abraham
- Psychology Applied to Health Group, University of Exeter Medical School, Exeter, UK
| | - C Green
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - F C Warren
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - N Britten
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - C J Greaves
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - S Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - S Buckingham
- Department of Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - K Paul
- REACH-HF Patient and Public Involvement Group, c/o Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - H Dalal
- Institute of Health Research, University of Exeter Medical School, Exeter, UK Department of Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
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Daley AJ, Jolly K, Jebb SA, Lewis AL, Clifford S, Roalfe AK, Kenyon S, Aveyard P. Feasibility and acceptability of regular weighing, setting weight gain limits and providing feedback by community midwives to prevent excess weight gain during pregnancy: randomised controlled trial and qualitative study. BMC Obes 2015; 2:35. [PMID: 26401345 PMCID: PMC4572649 DOI: 10.1186/s40608-015-0061-5] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/30/2015] [Indexed: 12/02/2022]
Abstract
Background Regular weighing in pregnant women is not currently recommended in many countries but has been suggested to prevent excessive gestational weight gain. This study aimed to establish the feasibility and acceptability of incorporating regular weighing, setting maximum weight gain targets and feedback by community midwives. Methods Low risk pregnant women cared for by eight community midwives were randomised to usual care or usual care plus the intervention at 10–14 weeks of pregnancy. The intervention involved community midwives weighing and plotting weight on a weight gain chart, setting weight gain limit targets, giving brief feedback at each antenatal appointment and encouraging women to weigh themselves weekly between antenatal appointments. Women and midwives were interviewed about their views of the intervention. The focus of the study was on process evaluation. Results Community midwives referred 123 women and 115 were scheduled for their dating scan within the study period. Of these, 84/115 were approached at their dating scan and 76/84 (90.5 %) randomised. Data showed a modest difference favouring the intervention group in the percentage of women gaining excessive gestational weight (23.5 % versus 29.4 %). The intervention group consistently reported smaller increases in depression and anxiety scores throughout pregnancy compared with usual care. Most women commented the intervention was useful in encouraging them to think about their weight and believed it should be part of routine antenatal care. Community midwives felt the intervention could be implemented within routine care without adding substantially to consultation length, thus not perceived as adding substantially to their workload. Conclusions The intervention was feasible and acceptable to pregnant women and community midwives and was readily implemented in routine care. Trial registration ISRCTN81605162
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Affiliation(s)
- A J Daley
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - K Jolly
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - A L Lewis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS South West England
| | - S Clifford
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - A K Roalfe
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - S Kenyon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - P Aveyard
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
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Daley AJ, Blamey RV, Jolly K, Roalfe AK, Turner KM, Coleman S, McGuinness M, Jones I, Sharp DJ, MacArthur C. A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial. Psychol Med 2015; 45:2413-2425. [PMID: 25804297 DOI: 10.1017/s0033291715000409] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Postnatal depression affects about 10-15% of women in the year after giving birth. Many women and healthcare professionals would like an effective and accessible non-pharmacological treatment for postnatal depression. METHOD Women who fulfilled the International Classification of Diseases (ICD)-10 criteria for major depression in the first 6 months postnatally were randomized to receive usual care plus a facilitated exercise intervention or usual care only. The intervention involved two face-to-face consultations and two telephone support calls with a physical activity facilitator over 6 months to support participants to engage in regular exercise. The primary outcome was symptoms of depression using the Edinburgh Postnatal Depression Scale (EPDS) at 6 months post-randomization. Secondary outcomes included EPDS score as a binary variable (recovered and improved) at 6 and 12 months post-randomization. RESULTS A total of 146 women were potentially eligible and 94 were randomized. Of these, 34% reported thoughts of self-harming at baseline. After adjusting for baseline EPDS, analyses revealed a -2.04 mean difference in EPDS score, favouring the exercise group [95% confidence interval (CI) -4.11 to 0.03, p = 0.05]. When also adjusting for pre-specified demographic variables the effect was larger and statistically significant (mean difference = -2.26, 95% CI -4.36 to -0.16, p = 0.03). Based on EPDS score a larger proportion of the intervention group was recovered (46.5% v. 23.8%, p = 0.03) compared with usual care at 6 months follow-up. CONCLUSIONS This trial shows that an exercise intervention that involved encouragement to exercise and to seek out social support to exercise may be an effective treatment for women with postnatal depression, including those with thoughts of self-harming.
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Affiliation(s)
- A J Daley
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham,Birmingham,UK
| | - R V Blamey
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham,Birmingham,UK
| | - K Jolly
- Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham,Birmingham,UK
| | - A K Roalfe
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham,Birmingham,UK
| | - K M Turner
- Academic Unit of Primary Health Care, University of Bristol,Bristol,UK
| | - S Coleman
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham,Birmingham,UK
| | - M McGuinness
- Perinatal Mental Health Service, The Barberry, Birmingham and Solihull Mental Health Foundation Trust,Birmingham,UK
| | - I Jones
- Institute of Psychological Medicine and Clinical Neurology, Cardiff University,Cardiff,UK
| | - D J Sharp
- Academic Unit of Primary Health Care, University of Bristol,Bristol,UK
| | - C MacArthur
- Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham,Birmingham,UK
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Jolly K, Faulconer R, McEwan R, Becker H, Garnham A. The incidence of hypomagnesaemia following abdominal aortic aneurysm surgery. Ann R Coll Surg Engl 2015; 97:379-81. [PMID: 26264091 PMCID: PMC5096578 DOI: 10.1308/003588415x14181254790004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Magnesium is important for cardiac function. Hypomagnesaemia is associated with a higher incidence of arrhythmias and poorer outcomes in cardiac surgery. No studies have investigated the incidence or impact of postoperative hypomagnesaemia after abdominal aortic aneurysm (AAA) surgery. We aim to assess the incidence of hypomagnesaemia after AAA repair in our population. METHODS Retrospective analysis was performed of patients who underwent elective AAA surgery at a single vascular centre. The last 110 patients undergoing open or endovascular AAA repair were identified. The hospital pathology system was used to identify the immediate postoperative serum magnesium levels as well as patient demographics and admission details. Hypomagnesaemia was defined as serum magnesium of <0.7 mmol/l. RESULTS A total of 211 patients were studied and there were 3 deaths. Of the patients included, 101 underwent open elective AAA repair and 110 underwent endovascular repair. In the elective open repair group, 73 patients (73%) were hypomagnesaemic. In the endovascular repair group, 35 (32%) had hypomagnesaemia. A t-test showed a statistically significant difference in hypomagnesaemia between the open and endovascular groups (p<0.001). CONCLUSIONS AAA surgery is associated with a high incidence of postoperative hypomagnesaemia, which is significantly greater among open repair patients. This is likely to have an effect on cardiac activity and lead to cardiac complications such as arrhythmias and poorer postoperative outcomes, especially in the open AAA repair subgroup. This stresses the importance of serum magnesium and cardiac monitoring in the postoperative phase. A prospective study is proposed to further investigate these findings, and their potential implications on perioperative morbidity and mortality.
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Affiliation(s)
- K Jolly
- Dudley Group NHS Foundation Trust, UK
| | | | - R McEwan
- Dudley Group NHS Foundation Trust, UK
| | - H Becker
- Dudley Group NHS Foundation Trust, UK
| | - A Garnham
- Dudley Group NHS Foundation Trust, UK
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Sidhu M, Daley A, Jolly K. A randomised controlled trial of a text supported weight maintenance programme. Lighten Up Plus. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.130] [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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Blissett D, Jowett S, Jordan R, Jolly K, Turner A, Barton P. S82 An Economic Evaluation Of Self-management Programs Delivered At Discharge After Acute Exacerbation, In Copd Patients In The Uk. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.88] [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: 11/04/2022]
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Daley A, Jolly K, Lewis A, Clifford S, Kenyon S, Roalfe AK, Jebb S, Aveyard P. The feasibility and acceptability of regular weighing of pregnant women by community midwives to prevent excessive weight gain: RCT. Pregnancy Hypertens 2014; 4:233-4. [PMID: 26104618 DOI: 10.1016/j.preghy.2014.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pregnancy is a critical period for the development of later obesity. Regular weighing of pregnant women is not currently recommended in the UK. This study aimed to demonstrate the feasibility of regular weighing by community midwives (CMWs) as a potential intervention to prevent excessive gestational weight gain. Low risk healthy/overweight pregnant women cared for by eight CMWs were randomised to usual care or usual care plus the intervention at 10-14 weeks of pregnancy. The intervention involved CMWs weighing and charting weight gain on an IOM weight gain chart, setting a weight target and giving brief feedback at antenatal appointments. The focus of the study was on process evaluation outcomes. Data on other outcomes were also collected including gestational weight gain. We interviewed women and CMWs about their views of the intervention. CMWs referred 123 women, 95 agreed to participate and 76 were randomised. Over 90% of women were weighed at 38 weeks of pregnancy demonstrating high follow up. There was no evidence the intervention caused anxiety. Most women commented they had found the intervention useful in encouraging them to think about their weight and believed it should be part of routine antenatal care. CMW's felt the intervention could be implemented within antenatal care without adding substantially to consultation length. To conclude, pregnant women were keen to participate in the study and the intervention was acceptable to pregnant women and CMWs. An effectiveness trial is now planned.
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Affiliation(s)
- A Daley
- University of Birmingham, United Kingdom
| | - K Jolly
- University of Birmingham, United Kingdom
| | - A Lewis
- University of Birmingham, United Kingdom
| | - S Clifford
- University of Birmingham, United Kingdom
| | - S Kenyon
- University of Birmingham, United Kingdom
| | - A K Roalfe
- University of Birmingham, United Kingdom
| | - S Jebb
- University of Birmingham, United Kingdom
| | - P Aveyard
- University of Birmingham, United Kingdom
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Daley A, Lewis A, Denley J, Adab P, Aveyard P, Jolly K. An RCT to compare the effectiveness of commercial and primary care led weight management programmes versus minimal intervention: The Lighten Up trial. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.802] [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: 12/01/2022]
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Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Duda W, Borowiack E, Roseboom T, Tomlinson J, Walczak J, Kunz R, Mol BW, Coomarasamy A, Khan KS. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess 2012; 16:iii-iv, 1-191. [PMID: 22814301 DOI: 10.3310/hta16310] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Around 50% of women of childbearing age are either overweight [body mass index (BMI) 25-29.9 kg/m(2)] or obese (BMI ≥ 30 kg/m(2)). The antenatal period provides an opportunity to manage weight in pregnancy. This has the potential to reduce maternal and fetal complications associated with excess weight gain and obesity. OBJECTIVES To evaluate the effectiveness of dietary and lifestyle interventions in reducing or preventing obesity in pregnancy and to assess the beneficial and adverse effects of the interventions on obstetric, fetal and neonatal outcomes. DATA SOURCES Major electronic databases including MEDLINE, EMBASE, BIOSIS and Science Citation Index were searched (1950 until March 2011) to identify relevant citations. Language restrictions were not applied. REVIEW METHODS Systematic reviews of the effectiveness and harm of the interventions were carried out using a methodology in line with current recommendations. Studies that evaluated any dietary, physical activity or mixed approach intervention with the potential to influence weight change in pregnancy were included. The quality of the studies was assessed using accepted contemporary standards. Results were summarised as pooled relative risks (RRs) with 95% confidence intervals (CIs) for dichotomous data. Continuous data were summarised as mean difference (MD) with standard deviation. The quality of the overall evidence synthesised for each outcome was summarised using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology and reported graphically as a two-dimensional chart. RESULTS A total of 88 studies (40 randomised and 48 non-randomised and observational studies, involving 182,139 women) evaluated the effect of weight management interventions in pregnancy on maternal and fetal outcomes. Twenty-six studies involving 468,858 women reported the adverse effect of the interventions. Meta-analysis of 30 RCTs (4503 women) showed a reduction in weight gain in the intervention group of 0.97 kg compared with the control group (95% CI -1.60 kg to -0.34 kg; p = 0.003). Weight management interventions overall in pregnancy resulted in a significant reduction in the incidence of pre-eclampsia (RR 0.74, 95% CI 0.59 to 0.92; p = 0.008) and shoulder dystocia (RR 0.39, 95% CI 0.22 to 0.70; p = 0.02). Dietary interventions in pregnancy resulted in a significant decrease in the risk of pre-eclampsia (RR 0.67, 95% CI 0.53 to 0.85; p = 0.0009), gestational hypertension (RR 0.30, 95% CI 0.10 to 0.88; p = 0.03) and preterm birth (RR 0.68, 95% CI 0.48 to 0.96; p = 0.03) and showed a trend in reducing the incidence of gestational diabetes (RR 0.52, 95% CI 0.27 to 1.03). There were no differences in the incidence of small-for-gestational-age infants between the groups (RR 0.99, 95% CI 0.76 to 1.29). There were no significant maternal or fetal adverse effects observed for the interventions in the included trials. The overall strength of evidence for weight gain in pregnancy and birthweight was moderate for all interventions considered together. There was high-quality evidence for small-for-gestational-age infants as an outcome. The quality of evidence for all interventions on pregnancy outcomes was very low to moderate. The quality of evidence for all adverse outcomes was very low. LIMITATIONS The included studies varied in the reporting of population, intensity, type and frequency of intervention and patient complience, limiting the interpretation of the findings. There was significant heterogeneity for the beneficial effect of diet on gestational weight gain. CONCLUSIONS Interventions in pregnancy to manage weight result in a significant reduction in weight gain in pregnancy (evidence quality was moderate). Dietary interventions are the most effective type of intervention in pregnancy in reducing gestational weight gain and the risks of pre-eclampsia, gestational hypertension and shoulder dystocia. There is no evidence of harm as a result of the dietary and physical activity-based interventions in pregnancy. Individual patient data meta-analysis is needed to provide robust evidence on the differential effect of intervention in various groups based on BMI, age, parity, socioeconomic status and medical conditions in pregnancy.
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Affiliation(s)
- S Thangaratinam
- Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Abstract
A 58-year-old white woman presented with sudden onset of diplopia, headache and vomiting with a history of tiredness and lethargy over the past four to six months. She had smooth, pale, hairless skin and on examination she was found to have left-sided third and sixth nerve palsy. Laboratory tests confirmed pan-anterior hypopituitarism. Computerized tomography scan of head and magnetic resonance imaging appearances were consistent with those of a sphenoid sinus mucocoele. Following adequate replacement with hydrocortisone and thyroxine she underwent sphenoid mucocoele drainage and endoscopic left sphenoethmoidectomy. Her symptoms were relieved over the next few days and she had a near-total recovery of ophthalmoplegia over the following three months. Pituitary function tests showed partial resolution of hypopituitarism with recovery of hypothalamic-pituitary-adrenal axis and hydrocortisone therapy was withdrawn, but she continued to require thyroxine.
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Affiliation(s)
- K Jolly
- Department of Endocrinology, New Cross Hospital, Wolverhampton, England, UK.
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Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, Kunz R, Mol BW, Coomarasamy A, Khan KS. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ 2012; 344:e2088. [PMID: 22596383 PMCID: PMC3355191 DOI: 10.1136/bmj.e2088] [Citation(s) in RCA: 543] [Impact Index Per Article: 45.3] [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] [Accepted: 03/02/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effects of dietary and lifestyle interventions in pregnancy on maternal and fetal weight and to quantify the effects of these interventions on obstetric outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Major databases from inception to January 2012 without language restrictions. STUDY SELECTION Randomised controlled trials that evaluated any dietary or lifestyle interventions with potential to influence maternal weight during pregnancy and outcomes of pregnancy. DATA SYNTHESIS Results summarised as relative risks for dichotomous data and mean differences for continuous data. RESULTS We identified 44 relevant randomised controlled trials (7278 women) evaluating three categories of interventions: diet, physical activity, and a mixed approach. Overall, there was 1.42 kg reduction (95% confidence interval 0.95 to 1.89 kg) in gestational weight gain with any intervention compared with control. With all interventions combined, there were no significant differences in birth weight (mean difference -50 g, -100 to 0 g) and the incidence of large for gestational age (relative risk 0.85, 0.66 to 1.09) or small for gestational age (1.00, 0.78 to 1.28) babies between the groups, though by itself physical activity was associated with reduced birth weight (mean difference -60 g, -120 to -10 g). Interventions were associated with a reduced the risk of pre-eclampsia (0.74, 0.60 to 0.92) and shoulder dystocia (0.39, 0.22 to 0.70), with no significant effect on other critically important outcomes. Dietary intervention resulted in the largest reduction in maternal gestational weight gain (3.84 kg, 2.45 to 5.22 kg), with improved pregnancy outcomes compared with other interventions. The overall evidence rating was low to very low for important outcomes such as pre-eclampsia, gestational diabetes, gestational hypertension, and preterm delivery. CONCLUSIONS Dietary and lifestyle interventions in pregnancy can reduce maternal gestational weight gain and improve outcomes for both mother and baby. Among the interventions, those based on diet are the most effective and are associated with reductions in maternal gestational weight gain and improved obstetric outcomes.
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Affiliation(s)
- S Thangaratinam
- Women's Health Research Unit, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Abstract
Anecdotal beliefs that exercise is an effective treatment for primary dysmenorrhoea have prevailed for many years although evidence is contradictory. Previous studies have also contained a number of methodological inadequacies. A questionnaire that assessed menstrual pain and levels of exercise was administered to 654 university students. Attempts were made to blind the purpose of the study. A response rate of 91.3% (597/654) was obtained. Analyses showed no association between participation in exercise and primary dysmenorrhoea. Prospective studies would be useful in further research.
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Affiliation(s)
- H Blakey
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Jolly K, Lip GYH, Taylor RS, Raftery J, Mant J, Lane D, Greenfield S, Stevens A. The Birmingham Rehabilitation Uptake Maximisation study (BRUM): a randomised controlled trial comparing home-based with centre-based cardiac rehabilitation. Heart 2008; 95:36-42. [PMID: 18332063 DOI: 10.1136/hrt.2007.127209] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare the outcomes of home-based (using the Heart Manual) and centre-based cardiac rehabilitation programmes. DESIGN Randomised controlled trial and parallel economic evaluation. SETTING Predominantly inner-city, multi-ethnic population in the West Midlands, England. PATIENTS 525 patients referred to four hospitals for cardiac rehabilitation following myocardial infarction or coronary revascularisation. INTERVENTIONS A home-based cardiac rehabilitation programme compared with centre-based programmes. MAIN OUTCOME MEASURES Smoking cessation, blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP)), total cholesterol (TC) and high-density lipoprotein (HDL)-cholesterol, psychological status (HADS anxiety and depression) and exercise capacity (incremental shuttle walking test, ISWT) measured at 12 months. Health service resource use, quality of life utility and costs were quantified. RESULTS There were no significant differences in the main outcomes when the home-based was compared with the centre-based programme at 12 months. Adjusted mean difference (95% CI) for SBP was 1.94 mm Hg (-1.1 to 5.0); DBP 0.42 mm Hg (-1.25 to 2.1); TC 0.1 mmol/l (-0.05 to 0.24); HADS anxiety -0.02 (-0.69 to 0.65); HADS depression -0.35 (-0.95 to 0.25); distance on ISWT -21.5 m (-48.3 to 5.2). The relative risk of being a smoker in the home arm was 0.90. The cost per patient to the NHS was significantly higher in the home arm at 198 pounds, (95% CI 189 to 208) compared to 157 pounds (95% CI 139 to 175) in the centre-based arm. However when the patients' cost of travel was included, these differences were no longer significant. Conclusions A home-based cardiac rehabilitation programme does not produce inferior outcomes when compared to traditional centre-based programmes as provided in the United Kingdom.
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Affiliation(s)
- K Jolly
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK.
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Jolly K, Taylor R, Lip GY, Greenfield S, Raftery J, Mant J, Lane D, Jones M, Lee KW, Stevens A. The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence. Health Technol Assess 2007; 11:1-118. [PMID: 17767899 DOI: 10.3310/hta11350] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the relative effectiveness and cost-effectiveness of a home-based programme of cardiac rehabilitation using the Heart Manual, with centre-based programmes. It also sought to explore the reasons for non-adherence to cardiac rehabilitation programmes. DESIGN An individually randomised trial, with minimisation for age, gender, ethnicity, initial diagnosis and hospital of recruitment. Participants were followed up after 6, 12 and 24 months by questionnaire and clinical assessment. Individual semistructured interviews were undertaken in the homes of a purposive sample of patients who did not adhere to their allocated programme, and focus groups were undertaken with groups of patients who adhered to the programmes. SETTING Four hospitals in predominantly inner-city, multi-ethnic, socio-economically deprived areas of the West Midlands in England, for 2 years from 1 February 2002. PARTICIPANTS A total of 525 patients who had experienced a myocardial infarction (MI) or coronary revascularisation within the previous 12 weeks. INTERVENTIONS All the rehabilitation programmes included exercise, relaxation, education and lifestyle counselling. All patients were seen by a cardiac rehabilitation nurse prior to hospital discharge and provided with information about their condition and counselling about risk factor modification. The four centre-based programmes varied in length from nine sessions at weekly intervals of education, relaxation and circuit training to 24 individualised sessions over 12 weeks of mainly walking, fixed cycling and rowing with group-based education. The home-based programme consisted of an appropriate version of the Heart Manual, home visits and telephone contact. The Heart Manual was introduced to patients on an individual basis, either in hospital or on a home visit. Home visits by a nurse took place at approximately 1, 6 and 12 weeks after recruitment, with a telephone call at 3 weeks. At the final visit, patients were encouraged to maintain their lifestyle changes and to continue with their exercise programme. Where needed, follow-up was made by a rehabilitation nurse who spoke Punjabi. An audiotape of an abridged version of the Heart Manual in Punjabi accompanied the manual for patients with a limited command of English. MAIN OUTCOME MEASURES Primary outcomes were smoking cessation, blood pressure, total and high-density lipoprotein cholesterol, exercise capacity measured by the incremental shuttle walking test and psychological status measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included self-reported diet, physical activity, cardiac symptoms and quality of life. Health service resource use and costs of rehabilitation programmes from health service and societal perspectives were also measured. Adherence to the physical activity element of the rehabilitation programmes was measured by questionnaire 6, 9 and 12 weeks. RESULTS No clinically or statistically significant differences were found in any of the primary or secondary outcome measures between the home- and centre-based groups. Significant improvements in total cholesterol, smoking prevalence, the HADS anxiety score, self-reported physical activity and diet were seen in both arms between baseline and the 6-month follow-up. Five or more contacts with a cardiac rehabilitation nurse were received by 96% of home-based participants, whereas only 56% of centre-based participants attended this many rehabilitation classes. The direct rehabilitation costs to the health service were significantly higher for the home-based programme (mean cost 198 pounds versus 157 pounds for the centre-based programme), but when patient costs were included the mean cost of the centre-based arm rose to 182 pounds. Patients' reasons for not taking up or adhering to cardiac rehabilitation were multifactorial and very individual. Other health problems limited some patients' ability to exercise. Most non-adherers found some aspects of their cardiac rehabilitation programme helpful. Many had adapted advice on rehabilitation and were continuing to exercise in other ways and had made lifestyle changes, particularly to their diet. The home-based patients' lack of motivation to exercise on their own at home was a major factor in non-adherence. The focus groups revealed little diversity of views among patients from each programme. Patients in the hospital programme enjoyed the camaraderie of group exercise and the home-based patients valued the wealth of information and advice in the Heart Manual. CONCLUSIONS A home-based cardiac rehabilitation programme for low- to moderate-risk patients does not produce inferior outcomes compared with the traditional centre-based programmes. With the level of home visiting in this trial, the home-based programme was more costly to the health service, but with the difference in costs borne by patients attending centre-based programmes. Different reasons were given by home and hospital cardiac rehabilitation patients for not taking up or adhering to cardiac rehabilitation, with home-based patients often citing a lack of motivation to exercise at home. Social characteristics, individual patient needs and the location of cardiac rehabilitation programmes need to be taken into account in programme design to maximise participation. Research is recommended into cardiac rehabilitation in patients from ethnic minority groups; measurement tools to assess physical activity and dietary change; evaluating the Heart Manual in patients who decline centre-based cardiac rehabilitation; the implementation of home-based programmes in the UK; and strategies that sustain physical activity in the long term.
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Affiliation(s)
- K Jolly
- Department of Public Health and Epidemiology, University of Birmingham, UK
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Lip GYH, Barnett AH, Bradbury A, Cappuccio FP, Gill PS, Hughes E, Imray C, Jolly K, Patel K. Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management. J Hum Hypertens 2007; 21:183-211. [PMID: 17301805 DOI: 10.1038/sj.jhh.1002126] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The United Kingdom is a diverse society with 7.9% of the population from black and minority ethnic groups (BMEGs). The causes of the excess cardiovascular disease (CVD) and stroke morbidity and mortality in BMEGs are incompletely understood though socio-economic factors are important. However, the role of classical cardiovascular (CV) risk factors is clearly important despite the patterns of these risk factors varying significantly by ethnic group. Despite the major burden of CVD and stroke among BMEGs in the UK, the majority of the evidence on the management of such conditions has been based on predominantly white European populations. Moreover, the CV epidemiology of African Americans does not represent well the morbidity and mortality experience seen in black Africans and black Caribbeans, both in Britain and in their native African countries. In particular, atherosclerotic disease and coronary heart disease are still relatively rare in the latter groups. This is unlike the South Asian diaspora, who have prevalence rates of CVD in epidemic proportions both in the diaspora and on the subcontinent. As the BMEGs have been under-represented in research, a multitude of guidelines exists for the 'general population.' However, specific reference and recommendation on primary and secondary prevention guidelines in relation to ethnic groups is extremely limited. This document provides an overview of ethnicity and CVD in the United Kingdom, with management recommendations based on a roundtable discussion of a multidisciplinary ethnicity and CVD consensus group, all of whom have an academic interest and clinical practice in a multiethnic community.
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Affiliation(s)
- G Y H Lip
- University Department of Medicine, City Hospital, Birmingham, UK.
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Lee KW, Blann AD, Jolly K, Lip GYH. Plasma haemostatic markers, endothelial function and ambulatory blood pressure changes with home versus hospital cardiac rehabilitation: the Birmingham Rehabilitation Uptake Maximisation Study. Heart 2006; 92:1732-8. [PMID: 16807272 PMCID: PMC1861270 DOI: 10.1136/hrt.2006.092163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation is an accepted therapeutic intervention in patients after myocardial infarction or coronary revascularisation. The effects of cardiac rehabilitation programmes, whether home based or hospital based, on haemostatic indices (as reflected by fibrinogen, plasma viscosity, fibrin D-dimer (an index of thrombogenesis), von Willebrand factor (vWf, an index of endothelial damage/dysfunction), soluble P-selectin (an index of platelet activation)), vasomotor function (using flow-mediated dilatation (FMD)) and ambulatory blood pressure (ABP) in patients with coronary heart disease are unknown. METHODS 81 patients (66 men, mean (SD) 59 (11) years) after myocardial infarction or coronary revascularisation were randomised to comprehensive hospital-based (n = 40) or home-based (n = 41) cardiac rehabilitation. Plasma levels of vWf, D-dimer, fibrinogen, soluble P-selectin and plasma viscosity, as well as FMD and 24-h ABP, were measured at baseline and after 3 months of cardiac rehabilitation. RESULTS In patients who completed cardiac rehabilitation, levels of vWf, fibrinogen and D-dimer were significantly lower and FMD improved (all p<or=0.001), whereas levels were unchanged in controls. Significant reductions were also observed in 24-h mean systolic blood pressure, diastolic blood pressure and mean aortic pressure after completion of cardiac rehabilitation (all p<0.05). No significant differences were observed between the hospital-based and home-based cardiac rehabilitation programmes on these indices. CONCLUSIONS Cardiac rehabilitation improves haemostasis, endothelial function and ABP in patients with coronary heart disease, with no significant differences between home-based and hospital-based cardiac rehabilitation programmes. These effects may contribute to the beneficial effects of cardiac rehabilitation programmes on CV outcomes.
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Affiliation(s)
- K W Lee
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK
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Lee KW, Blann AD, Ingram J, Jolly K, Lip GYH. Incremental shuttle walking is associated with activation of haemostatic and haemorheological markers in patients with coronary artery disease: the Birmingham rehabilitation uptake maximization study (BRUM). Heart 2005; 91:1413-7. [PMID: 15774609 PMCID: PMC1769168 DOI: 10.1136/hrt.2004.050005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To test the hypothesis that an incremental shuttle walk test (ISWT) affects plasma indices of endothelial damage and dysfunction (von Willebrand factor (vWf)), platelet activation (soluble P-selectin), thrombogenesis (D-dimer), fibrinogen, and plasma viscosity more adversely in coronary artery disease (CAD) than in health. ISWT is a standardised walking test that provokes maximal performance and correlates strongly with maximum oxygen uptake. METHODS Research indices were measured before a practice ISWT and immediately after the second ISWT in 53 patients with CAD (48 men, mean (SD) age 59 (10) years) and in 19 matched healthy controls (16 men, 61 (10) years). Data were analysed before and after ISWT. RESULTS Despite no significant difference in total distance walked between patients and controls, vWf (162 (45) before v 170 (48) UI/dl after) and fibrinogen (2.9 (0.7) v 3.1 (0.7) g/l) concentrations, plasma viscosity (1.63 (0.12) v 1.71 (0.14) mPa.s), and D-dimer (0.20 (interquartile range 0.10-0.30) v 0.21 (0.12-0.31 mg/l; all p < 0.05), but not soluble P-selectin, were significantly increased after ISWT in patients with CAD, even after correction for plasma volume change. Only fibrinogen (2.5 (0.7) v 2.7 (0.7 g/l) and plasma viscosity (1.60 (0.08) v 1.64 (0.08) mPa.s; both p < 0.01) increased among controls. The increment of fibrinogen was significantly higher in patients than in controls (p = 0.035) and correlated with total walking distance (r = 0.46, p < 0.001) and peak heart rate (r = 0.28, p = 0.02). The increment of plasma viscosity rise also significantly correlated with total distance walked (r = 0.66, p < 0.001). CONCLUSIONS ISWT in patients with CAD appears to increase fibrinogen, vWf, and D-dimer compared with healthy controls.
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Affiliation(s)
- K W Lee
- University Department of Medicine, City Hospital, Birmingham B18 7QH, UK
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Parry J, Jolly K, Rouse A, Wilson R. Re-organizing services for the management of upper gastrointestinal cancers: patterns of care and problems with change. Public Health 2004; 118:360-9. [PMID: 15178144 DOI: 10.1016/j.puhe.2003.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The 'Calman-Hine' report (1995) recommended that cancer surgery should be limited to specialist high-volume units. National guidance from the National Health Service (NHS) Executive in 2001 stated that specialist oesophagogastric cancer centres should 'aim to draw patients from catchment areas with a population of 1-2 million.' For pancreatic cancers, the catchment areas should be between 2 and 4 million, reflecting the relatively lower incidence of disease. For the West Midlands region, these recommendations would suggest that four or five centres might be required to provide specialist surgical management for oesophagogastric cancer, and one or two centres for pancreatic disease. We used Hospital Episode Statistics to analyse trends in management patterns for these tumours within the West Midlands during the period 1992-2000. Over 20 different units were involved in the management of oesophagogastric and pancreatic disease, and we were unable to discern any clear and consistent move towards the centralisation of the upper gastrointestinal work in high-volume units since the publication of the Calman-Hine report in 1995. Although the drive for centralisation might be anticipated to increase following the publication of the NHS Executive's guidance, there is a substantial way to go before the provision of surgical services for upper gastrointestinal cancers is limited to a small number of high-volume specialist units.
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Affiliation(s)
- J Parry
- Health Impact Assessment Research Unit, Department of Public Health & Epidemiology, University of Birmingham, Edgbaston, Birmingham, UK.
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Wallis GL, Easton RL, Jolly K, Hemming FW, Peberdy JF. Galactofuranoic-oligomannose N-linked glycans of alpha-galactosidase A from Aspergillus niger. Eur J Biochem 2001; 268:4134-43. [PMID: 11488905 DOI: 10.1046/j.1432-1327.2001.02322.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Extracellular alpha-galactosidase A was purified from the culture filtrate of an over-producing strain of Aspergillus niger containing multiple copies of the encoding aglA gene under the control of the glucoamylase (glaA) promoter. Endoglycosidase digestion followed by SDS/PAGE, lectin and immunoblotting suggested that glycosylation accounted for approximately 25% of the molecular size of the purified protein. Monosaccharide analysis showed that this was composed of N-acetyl glucosamine, mannose and galactose. Mild acid hydrolysis, mild methanolysis, immunoblotting and exoglycosidase digestion indicated that the majority of the galactosyl component was in the furanoic conformation (beta-D-galactofuranose, Galf). At least 20 different N-linked oligosaccharides were fractionated by high-pH anion-exchange chromatography following release from the polypeptide by peptide-N-glycosidase F. The structures of these were subsequently determined by fast atom bombardment mass spectrometry to be a linear series of Hex(7-26)HexHA(c2). Indicating that oligosaccharides from GlcNA(c2)Man(7), increasing in molecular size up to GlcNA(c2)Man(24) were present. Each of these were additionally substituted with up to three beta-Galf residues. Linkage analysis confirmed the presence of mild acid labile terminal hexofuranose residues. These results show that filamentous fungi are capable of producing a heterogeneous mixture of high molecular-size N-linked glycans substituted with galactofuranoic residues, on a secreted glycoprotein.
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Affiliation(s)
- G L Wallis
- School of Biological Sciences, University of Nottingham, Nottingham UK.
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Jolly K, Parry J, Rouse A, Stevens A. Volumes of cancer surgery for breast, colorectal and ovarian cancer 1992-97: Is there evidence of increasing sub-specialization by surgeons? Br J Cancer 2001; 84:1308-13. [PMID: 11355939 PMCID: PMC2363641 DOI: 10.1054/bjoc.2001.1794] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The ‘Calman–Hine Report’ (1995) recommended that cancer surgery should be limited to ‘high-volume’ consultants. Through an analysis of 5 years of Hospital Episode Statistics for the West Midlands region (1992–1997), we have investigated whether there is evidence of increasing numbers of patients with breast, colorectal or ovarian cancer being treated by high throughput, i.e. sub-specialist surgeons, who carry out more than a threshold level of primary cancer resections annually. The proportion of cases treated by the high-volume breast, colorectal and ovarian cancer surgeons increased annually during the 5 years. The absolute number of consultant firms who undertook breast cancer resections reduced during the 5 years; but the number doing colorectal and ovarian surgery increased. Throughout the 5 years, half of the ovarian cancer resections were carried out by consultant firms who did very few procedures – less than 5 of these procedures annually. The relatively high case-load, the elective nature of breast cancer surgery and an early policy change have undoubtedly facilitated the move towards sub-specialization. The weaker trends for colorectal and ovarian cancer surgery suggest continued monitoring is required to ensure that there is a reduction in the proportion of people treated by surgeons who undertake few cancer resections annually. © 2001 Cancer Research Campaign www.bjcancer.com
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Affiliation(s)
- K Jolly
- Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Jolly K, Stewart G. Epidemiology and diagnosis of meningitis: results of a five-year prospective, population-based study. Commun Dis Public Health 2001; 4:124-9. [PMID: 11525000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Implementation of the advice to give penicillin prior to admission, a fall in the lumbar puncture rate and the introduction into routine use of the meningococcal polymerase chain reaction (PCR) test are factors that have led us to reassess the way meningitis is diagnosed. We examined data for the period 1994-98 from a health district of 800,000 population. Of the 355 cases of meningitis reported, 258 (73%) had either confirmed, probable or possible meningococcal disease. Only 28% of meningococcal cases had received pre-admission benzylpenicillin. The proportion of suspected meningitis cases undergoing lumbar puncture fell over the period. It was 79% in 1994 and 61% in 1998 (p < 0.001). After meningococcal PCR was introduced in 1996, 73 (68%) meningococcal cases were microbiologically confirmed, compared to 72 (48%) before 1996 (p = 0.001). In all cases, age was an independent predictor of meningitis mortality, and for meningococcal cases, age and serogroup were independent predictors. Advice to general practitioners (GPs) to give preadmission benzylpenicillin to any suspected case of meningitis or meningococcal septicaemia should be reinforced regardless of age or whether a rash is present.
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Affiliation(s)
- K Jolly
- Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham, B15 2TT.
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Meads C, Cummins C, Jolly K, Stevens A, Burls A, Hyde C. Coronary artery stents in the treatment of ischaemic heart disease: a rapid and systematic review. Health Technol Assess 2001; 4:1-153. [PMID: 11074393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Coronary artery stents are prosthetic linings inserted into coronary arteries via a catheter to widen the artery and increase blood flow to ischaemic heart muscle. They are used in the treatment of ischaemic heart disease (IHD). IHD is a major cause of morbidity and mortality (123,000 deaths per annum) in the UK and a major cost to the NHS. Clinical effects of IHD include subacute manifestations (stable and unstable angina) and acute manifestations (particularly myocardial infarction [MI]). Treatment includes attention to risk factors, drug therapy, percutaneous invasive interventions (PCIs) (including percutaneous transluminal coronary angioplasty [PTCA] and stents) and coronary artery bypass graft surgery (CABG). In the last decade there has been a steady and significant increase in the rate of PCIs for IHD. In the UK, rates per million population increased from 174 in 1991 to 437 in 1998. Stents are now used in about 70% of PCIs. Data from the rest of Europe suggest there is potential for PCI and stent rates to increase considerably. In the UK there is evidence of under-provision and inequity of access to revascularisation procedures. OBJECTIVES The following questions were addressed. 1. What are the effects and effectiveness of elective stent insertion versus PTCA in subacute IHD, particularly stable angina and unstable angina? 2. What are the effects and effectiveness of elective stent insertion versus CABG in subacute IHD, particularly stable angina and unstable angina? 3. What are the effects and effectiveness of elective stent insertion versus PTCA in acute MI (AMI)? 4. What are best estimates of UK cost for elective stent insertion, PTCA and CABG in the circumstances of review questions 1 to 3? 5. What are best estimates of cost-effectiveness and cost-utility for elective stent insertion relative to PTCA or CABG in the circumstances of review questions 1 to 3? METHODS A systematic review addressing the objectives was undertaken. DATA SOURCES A search was made for RCTs comparing stents (inserted during a PTCA procedure) with PTCA alone or with CABG in any manifestation of IHD. The search strategy covered the period from 1990 to November 1999 and included searches of electronic databases (MEDLINE, EMBASE, BIDS ISI, The Cochrane Library), Internet sites, and hand-searches of cardiology conference abstracts and 1999 issues of cardiology journals. Lead researchers and local clinical experts were contacted. Manufacturers' submissions to the National Institute for Clinical Excellence were searched. The search strategy was expanded to look for relevant economic analyses and information to inform the economic model (including searching MEDLINE, the NHS Economic Evaluation Database and the Database of Abstracts of Reviews of Effectiveness). Searches focused on research that reported costs and quality of life data associated with IHD and interventional cardiology. STUDY SELECTION For the review of clinical effectiveness, inclusion criteria were: (i) RCT design; (ii) study population comprising adults with IHD in native or graft vessels (including patients with subacute IHD or AMI); (iii) procedure involving elective insertion of coronary artery stents; (iv) elective PTCA (including PTCA with provisional stenting) or CABG as comparator; (v) outcomes defined as one or more of: combined event rate (or event-free survival), death, MI, angina, target vessel revascularisation, CABG, repeat PTCA, angiographic outcomes; (vi) trials that had closed and reported results for all or almost all recruited patients. For the economic evaluation, studies of adults with IHD were included if they were of the following types: studies reporting UK costs; comparative economic evaluation combining both costs and outcomes; economic evaluations reporting costs and outcomes separately for the years 1998 and 1999 (to ensure current practice was included).(ABSTRACT TRUNCATED)
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Affiliation(s)
- C Meads
- Department of Public Health and Epidemiology, University of Birmingham, UK
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Rouse AM, Jolly K, Stevens AJ. Has Calman-Hine succeeded? Analysis of breast cancer procedure loads per consultant firm before and after the Calman-Hine report. Breast 2001; 10:55-7. [PMID: 14965561 DOI: 10.1054/brst.2000.0210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Calman-Hine report was published in the UK in April 1995. It recommended the reorganization of cancer services into high-volume specialist units. This study analyzes Health Episode Statistics from the West Midlands Region of the UK NHS in order to establish whether--for breast cancer--specialization is occurring. We believe it is. Each year since the start of our analysis (1992) the proportion of procedures performed by 'high-volume' firms increased. The number of firms undertaking breast cancer procedures fell.
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Affiliation(s)
- A M Rouse
- Department of Public Health and Epidemiology, The University of Birmingham, Birmingham, UK.
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