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Woodward M, Dixon-Woods M, Randall W, Walker C, Hughes C, Blackwell S, Dewick L, Bahl R, Draycott T, Winter C, Ansari A, Powell A, Willars J, Brown IAF, Olsson A, Richards N, Leeding J, Hinton L, Burt J, Maistrello G, Davies C, van der Scheer JW. How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study. BMJ Qual Saf 2024; 33:258-270. [PMID: 38124136 PMCID: PMC10982632 DOI: 10.1136/bmjqs-2023-016196] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
Clinical tools for use in practice-such as medicine reconciliation charts, diagnosis support tools and track-and-trigger charts-are endemic in healthcare, but relatively little attention is given to how to optimise their design. User-centred design approaches and co-design principles offer potential for improving usability and acceptability of clinical tools, but limited practical guidance is currently available. We propose a framework (FRamework for co-dESign of Clinical practice tOols or 'FRESCO') offering practical guidance based on user-centred methods and co-design principles, organised in five steps: (1) establish a multidisciplinary advisory group; (2) develop initial drafts of the prototype; (3) conduct think-aloud usability evaluations; (4) test in clinical simulations; (5) generate a final prototype informed by workshops. We applied the framework in a case study to support co-design of a prototype track-and-trigger chart for detecting and responding to possible fetal deterioration during labour. This started with establishing an advisory group of 22 members with varied expertise. Two initial draft prototypes were developed-one based on a version produced by national bodies, and the other with similar content but designed using human factors principles. Think-aloud usability evaluations of these prototypes were conducted with 15 professionals, and the findings used to inform co-design of an improved draft prototype. This was tested with 52 maternity professionals from five maternity units through clinical simulations. Analysis of these simulations and six workshops were used to co-design the final prototype to the point of readiness for large-scale testing. By codifying existing methods and principles into a single framework, FRESCO supported mobilisation of the expertise and ingenuity of diverse stakeholders to co-design a prototype track-and-trigger chart in an area of pressing service need. Subject to further evaluation, the framework has potential for application beyond the area of clinical practice in which it was applied.
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Affiliation(s)
- Matthew Woodward
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | | | | | - Louise Dewick
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Rachna Bahl
- Royal College of Obstetricians and Gynaecologists, London, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Tim Draycott
- Royal College of Obstetricians and Gynaecologists, London, UK
- North Bristol NHS Trust, Westbury on Trym, UK
| | | | - Akbar Ansari
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Powell
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Janet Willars
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Imogen A F Brown
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Annabelle Olsson
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Natalie Richards
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Joann Leeding
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lisa Hinton
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jenni Burt
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | - Jan W van der Scheer
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Vernooij RW, Hockham C, Barth C, Canaud B, Cromm K, Davenport A, Hegbrant J, Rose M, Strippoli G, Török M, Woodward M, Bots M, Blankestijn P. High-Target Hemodiafiltration Convective Dose Achieved in Most Patients in a 6-Month Intermediary Analysis of the CONVINCE Randomized Controlled Trial. Kidney Int Rep 2023; 8:2276-2283. [PMID: 38025213 PMCID: PMC10658200 DOI: 10.1016/j.ekir.2023.08.004] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction High convection volumes in hemodiafiltration (HDF) result in improved survival; however, it remains unclear whether it is achievable in all patients. Methods CONVINCE, a randomized controlled trial, randomized patients with end-stage kidney disease 1:1 to high-dose HDF versus high-flux hemodialysis (HD) continuation. We evaluated the proportion of patients achieving high-dose HDF target: convection volume per visit of ≥23 l (range ±1 l) at baseline, month 3, and month 6. We compared baseline characteristics in the following 2 ways: (i) patients on target for all 3 visits versus patients who missed target on ≥1 visits and (ii) patients on target for all 3 visits or missing it once versus patients who missed target on ≥2 visits. Results A total of 653 patients were randomized to HDF. Their mean age was 62.2 (SD 13.5) years, 36% were female, 81% had fistula vascular access, and 33% had diabetes. Across the 3 visits, 75 patients (11%), 27 patients (4%), and 11 patients (2%) missed the convection volume target once, twice, and thrice, respectively. Apart from diabetes, there were no apparent differences in patient characteristics between patients who always achieved the high-dose target (83%) and those who missed the target either once or more (17%) or twice or more (6%). Conclusion Achieving high-dose HDF is feasible for nearly all patients in CONVINCE and could be maintained during the 6-month follow-up period. Apart from diabetes, there were no other indications for confounding by indication on multivariable analyses that may explain the potential survival advantage for patients receiving high-dose HDF.
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Affiliation(s)
- Robin W.M. Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - C. Hockham
- George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - C. Barth
- B. Braun Avitum AG, Medical Scientific Affairs, Melsungen, Germany
| | - B. Canaud
- Montpellier University, School of Medicine, Montpellier, France and Global Medical Office, FMC Deutschland, Bad Homburg, Germany
| | - K. Cromm
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
| | - A. Davenport
- UCL Center for Nephrology, Royal Free Hospital, Division of Medicine, University College London, London, UK
| | - J. Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M. Rose
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Center of Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Berlin Institute of Health, Berlin, Germany
| | - G.F.M. Strippoli
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
- School of Public Health, University of Sydney, Sydney, Australia
| | - M. Török
- Corporate Medical Office Diaverum, Malmö, Sweden
| | - M. Woodward
- George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - M.L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P.J. Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Keit E, Lee SF, Woodward M, Shiue K, Desideri I, Oldenburger E, Beinz M, Agyeman MB, Theodorou M, Froid M, Simone CB, Yu HHM, Yarney J, Rembielak A, Rades D, Hoskin P, Johnstone PAS. Palliative Whole Brain Radiotherapy: International State of Practice 2022. Int J Radiat Oncol Biol Phys 2023; 117:e114-e115. [PMID: 37784656 DOI: 10.1016/j.ijrobp.2023.06.897] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Increasing technology of radiation treatment planning and delivery, better systemic therapies, and randomized trials in the population of patients (pts) with brain metastases have provided robust targeted options. This has resulted in palliative whole brain radiation therapy (WBRT) being used far less frequently than previously. Most centers preferentially use stereotactic radiation surgery (SRS) for pts with several lesions and may reserve WBRT for those with poor performance, with rapidly progressive disease, or with leptomeningeal presentation. We hypothesize that different trends in current WBRT regimens exist across different continents with varying rates of use of hippocampal avoidance (HA) and memantine. Despite differences in dose, fractionation, and treatment technique, we predict that survival post-WBRT will remain poor-indicating appropriate application of whole brain treatment in this era of SRS and improved systemic therapies. MATERIALS/METHODS A multi-center international analysis of pts receiving WBRT in 2022 was performed. Primary end point was survival after WBRT. Participating centers were located in Belgium, the United Kingdom, Hong Kong, Cyprus, Italy, Germany, Ghana, and the United States. De-identified data were collected and analyzed centrally. Pts receiving WBRT as part of a curative regimen (e.g., medulloblastoma, primary CNS lymphomas), prophylactically in small cell lung cancer, or as bridging prior to CAR-T were excluded. The collected data consisted of pt parameters including prior stereotactic radiosurgery (SRS), prescription dose and fractionation, use of HA technique with or without memantine, and survival after WBRT. Survival was calculated via the Kaplan-Meier method. RESULTS Of 23,332 RT prescriptions written at these centers in 2022, 399 (1.7%) were for palliative WBRT. Most frequent primary cancers were lung (42%) and breast (28%). Twenty-seven different dose regimens were used. The most common prescriptions were for 3 Gy daily fractions for 10 fractions (45%) and 4 Gy daily for 5 fractions (37%). Prior CNS SRS was delivered in 32 pts (7%). HA technique was used in 44 pts (10%); this technique was almost exclusively used in the United States. Memantine was prescribed in 93 pts (20%). Survival ranged from zero days to still surviving. The global median overall survival was 84 days after completion of treatment (95% CI: 68.0-104.0). Cumulative 3-month and 6-month actuarial survivals were 48% and 32%. CONCLUSION This "moment in time" analysis confirms that pts with poor expected survival are being appropriately selected for WBRT and demonstrates the variance in global practice. Since poor survival precludes these pts from deriving much benefit, memantine and HA may be best suited only for carefully selected cases; use of these is not Standard of Care in the participating European, Asian, and African centers.
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Affiliation(s)
- E Keit
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - S F Lee
- National University Cancer Institute Singapore, Singapore, Singapore
| | - M Woodward
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - K Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - I Desideri
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - M Beinz
- Mount Vernon Hospital, Northwood, United Kingdom
| | | | - M Theodorou
- Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | - M Froid
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - H H M Yu
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J Yarney
- National Centre for Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - A Rembielak
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - D Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - P A S Johnstone
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
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van der Scheer JW, Cornthwaite K, Hewitt P, Bahl R, Randall W, Powell A, Ansari A, Attal B, Willars J, Woodward M, Brown IAF, Olsson A, Richards N, Price E, Giusti A, Leeding J, Hinton L, Burt J, Dixon-Woods M, Maistrello G, Fahy N, Lyons O, Draycott T. Training for managing impacted fetal head at caesarean birth: multimethod evaluation of a pilot. BMJ Open Qual 2023; 12:e002340. [PMID: 37524515 PMCID: PMC10391817 DOI: 10.1136/bmjoq-2023-002340] [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] [Received: 03/03/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Implementation of national multiprofessional training for managing the obstetric emergency of impacted fetal head (IFH) at caesarean birth has potential to improve quality and safety in maternity care, but is currently lacking in the UK. OBJECTIVES To evaluate a training package for managing IFH at caesarean birth with multiprofessional maternity teams. METHODS The training included an evidence-based lecture supported by an animated video showing management of IFH, followed by hands-on workshops and real-time simulations with use of a birth simulation trainer, augmented reality and management algorithms. Guided by the Kirkpatrick framework, we conducted a multimethod evaluation of the training with multiprofessional maternity teams. Participants rated post-training statements about relevance and helpfulness of the training and pre-training and post-training confidence in their knowledge and skills relating to IFH (7-point Likert scales, strongly disagree to strongly agree). An ethnographer recorded sociotechnical observations during the training. Participants provided feedback in post-training focus groups. RESULTS Participants (N=57) included 21 midwives, 25 obstetricians, 7 anaesthetists and 4 other professionals from five maternity units. Over 95% of participants agreed that the training was relevant and helpful for their clinical practice and improving outcomes following IFH. Confidence in technical and non-technical skills relating to managing IFH was variable before the training (5%-92% agreement with the pre-training statements), but improved in nearly all participants after the training (71%-100% agreement with the post-training statements). Participants and ethnographers reported that the training helped to: (i) better understand the complexity of IFH, (ii) recognise the need for multiprofessional training and management and (iii) optimise communication with those in labour and their birth partners. CONCLUSIONS The evaluated training package can improve self-reported knowledge, skills and confidence of multiprofessional teams involved in management of IFH at caesarean birth. A larger-scale evaluation is required to validate these findings and establish how best to scale and implement the training.
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Affiliation(s)
- Jan W van der Scheer
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katie Cornthwaite
- Royal College of Obstetricians and Gynaecologists, London, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | | | - Rachna Bahl
- Royal College of Obstetricians and Gynaecologists, London, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Alison Powell
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Akbar Ansari
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bothaina Attal
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Janet Willars
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matthew Woodward
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Imogen A F Brown
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Annabelle Olsson
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Natalie Richards
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Evleen Price
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alessandra Giusti
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Joann Leeding
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lisa Hinton
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jenni Burt
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | - Oscar Lyons
- RAND Europe, Cambridge, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tim Draycott
- Royal College of Obstetricians and Gynaecologists, London, UK
- North Bristol NHS Trust, Westbury on Trym, UK
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Cassity-Caywood W, Griffiths A, Woodward M, Hatfield A. The Benefits and Challenges of Shifting to Telehealth During COVID-19: Qualitative Feedback from Kentucky's Sexual Violence Resource Centers and Children's Advocacy Centers. J Technol Behav Sci 2023; 8:87-99. [PMID: 36597503 PMCID: PMC9801142 DOI: 10.1007/s41347-022-00296-w] [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] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
The onset of the COVID-19 pandemic presented novel challenges for service providers addressing mental health issues with a large shift to the utilization of telehealth. While previous research has examined the benefits and challenges of providing mental health and crisis services remotely through telehealth, little research exists examining the use of telehealth in children's advocacy centers (CACs) and sexual violence resource centers (SVRCs). CACs and SVRCs are multi-disciplinary agencies taking a holistic approach to addressing interpersonal violence, making them unique in that they provide a range of direct services beyond mental health counseling (e.g., legal advocacy, medical exams, and prevention education) but all geared toward public health and safety. The current study explored the experiences of direct service providers in Kentucky CACs and SVRCs and their opinions about the most significant challenges and benefits of adapting their practices at the onset of the COVID-19 pandemic. A total of 118 providers participated in the study, and 88 reported using telehealth (defined as communicating with clients via technology such as videoconferencing, phone calls, or email) since the onset of COVID-19. Qualitative data from those 88 respondents regarding the challenges and benefits of using telehealth were collected and coded using a thematic content analysis. 78.6% of the sample indicated that they served primarily rural areas. Benefits noted included increasing treatment access, increasing treatment flexibility, and advancing continuity of care, while challenges included difficulties with technology, client engagement, privacy, and logistical challenges. Responses highlighted that telehealth presented both a number of advantages and difficulties and that more formal guidance for providers at CACs and SVRCs was desired.
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Affiliation(s)
- Whitney Cassity-Caywood
- Department of Community Leadership and Human Services, Murray State University, Murray, KY USA.,Lifeskills Center for Child Welfare Education and Research, Western Kentucky University, Bowling Green, KY USA.,Paducah Regional Campus, Murray State University, 4430 Sunset Ave, Paducah, KY 42001 USA
| | - Austin Griffiths
- The Department of Social Work Program, Western Kentucky University, Bowling Green, KY USA.,Lifeskills Center for Child Welfare Education and Research, Western Kentucky University, Bowling Green, KY USA
| | - Matthew Woodward
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY USA.,Lifeskills Center for Child Welfare Education and Research, Western Kentucky University, Bowling Green, KY USA
| | - Alecia Hatfield
- Department of Psychology, Western Kentucky University, Bowling Green, KY USA.,Lifeskills Center for Child Welfare Education and Research, Western Kentucky University, Bowling Green, KY USA
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Sakhuja S, Bittner VA, Brown TM, Farkouh ME, Levitan EB, Rosenson R, Safford MM, Muntner P, Chen L, Sun R, Noshad S, Dhalwani N, Woodward M, Colantonio LD. Recurrent atherosclerotic cardiovascular disease events preventable with guideline recommended lipid-lowering treatment following myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2374] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline provides recommendations for lipid-lowering therapy (LLT) including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) to prevent recurrent atherosclerotic cardiovascular disease (ASCVD) events in adults with established ASCVD. Many adults with ASCVD who are recommended to take statins, ezetimibe and/or PCSK9i do not receive these medications.
Purpose
To estimate the number of recurrent ASCVD events potentially prevented by population-wide use of guideline recommended LLT following a myocardial infarction (MI).
Methods
We simulated the population-wide impact of receipt of 2018 AHA/ACC cholesterol guideline recommended LLT over 3 and 5 years among US adults with government health insurance through Medicare or commercial health insurance following hospital discharge for MI. We used data from patients with an MI hospitalization in 2018–2019 to estimate the percentage receiving guideline recommended LLT defined by having the medications available to take in the 30 days after their discharge date. We used data from patients with an MI hospitalization in 2013–2016 to estimate the 3 and 5-year cumulative incidence of recurrent ASCVD events (i.e., MI, coronary revascularization or ischemic stroke). The reduction in ASCVD events associated with guideline recommended LLT was estimated from a meta-analysis by the Cholesterol-Lowering Treatment Trialists Collaboration. We conducted a sensitivity analysis estimating the number and percentage of ASCVD events prevented if LLT recommendations from the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) cholesterol guideline were followed. We repeated all analyses with recurrent coronary heart disease (i.e., MI or coronary revascularization) and ischemic stroke events as separate outcomes.
Results
Among 279,395 adults with an MI hospitalization in 2018–2019 (mean age 75 years, 54% men, mean low-density lipoprotein cholesterol 92 mg/dL), 27% were receiving guideline recommended LLT. With current lipid-lowering medication use, we estimated that 70,698 (95% CI: 70,311–71,077) and 89,255 (95% CI: 88,841–89,730) ASCVD events would occur in 3 and 5 years, respectively, after MI hospital discharge (Table, top panel). If all patients were to receive 2018 AHA/ACC guideline recommended LLT, the number of ASCVD events was estimated to be reduced by 21.6%, representing 15,264 (95% CI: 14,451–16,679) events prevented over 3 years and 19,271 (95% CI: 18,245–21,055) events prevented over 5 years. A higher number of recurrent ASCVD events were estimated to be averted following the LLT recommendations of the 2019 ESC/EAS cholesterol guideline (Table, bottom panel).
Conclusions
Population-wide implementation of guideline recommended LLT in adults with an MI hospitalization could prevent a substantial number of recurrent ASCVD events.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Amgen Inc.
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Affiliation(s)
- S Sakhuja
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - V A Bittner
- University of Alabama Birmingham, Department of Medicine, Division of Cardiovascular Disease , Birmingham , United States of America
| | - T M Brown
- University of Alabama Birmingham, Department of Medicine, Division of Cardiovascular Disease , Birmingham , United States of America
| | | | - E B Levitan
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - R Rosenson
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart , New York , United States of America
| | - M M Safford
- Weill Cornell Medicine , New York , United States of America
| | - P Muntner
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - L Chen
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - R Sun
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - S Noshad
- Amgen Inc. , Thousand Oaks , United States of America
| | - N Dhalwani
- Amgen Inc. , Thousand Oaks , United States of America
| | - M Woodward
- Imperial College London, The George Institute for Global Health , London , United Kingdom
| | - L D Colantonio
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
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7
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Wang N, Rueter P, Harris K, Woodward M, Chalmers J, Rodgers A. Cumulative Systolic Blood Pressure Load and Risk of Cardiovascular Outcomes in Patients With Diabetes. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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8
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van der Scheer JW, Woodward M, Ansari A, Draycott T, Winter C, Martin G, Kuberska K, Richards N, Kern R, Dixon-Woods M. Correction to: How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a frame work and a case study of its application. BMC Med Res Methodol 2021; 21:156. [PMID: 34325656 PMCID: PMC8323284 DOI: 10.1186/s12874-021-01345-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jan W van der Scheer
- THIS Institute (The Healthcare Improvement Studies Institute), Departmentof Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK.
| | - Matthew Woodward
- THIS Institute (The Healthcare Improvement Studies Institute), Departmentof Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Akbar Ansari
- THIS Institute (The Healthcare Improvement Studies Institute), Departmentof Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Tim Draycott
- Department of Translational Health Services, University of Bristol, Bristol, UK.,PROMPT Maternity Foundation, Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - Cathy Winter
- PROMPT Maternity Foundation, Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - Graham Martin
- THIS Institute (The Healthcare Improvement Studies Institute), Departmentof Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies Institute), Departmentof Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Natalie Richards
- THIS Institute (The Healthcare Improvement Studies Institute), Departmentof Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Ruth Kern
- THIS Institute (The Healthcare Improvement Studies Institute), Departmentof Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Departmentof Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
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de Courson H, Ferrer L, Barbieri A, Tully P, Woodward M, Chalmers J, Tzourio C, Leffondre K. Impact of model choice when studying the relationship between blood pressure variability and risk of stroke. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.095] [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: 11/16/2022] Open
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10
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van der Scheer JW, Woodward M, Ansari A, Draycott T, Winter C, Martin G, Kuberska K, Richards N, Kern R, Dixon-Woods M. How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application. BMC Med Res Methodol 2021; 21:103. [PMID: 33975550 PMCID: PMC8111055 DOI: 10.1186/s12874-021-01288-9] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements - the changes that need to be made in a healthcare process - remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study. METHODS Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus. RESULTS We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video. CONCLUSIONS The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation.
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Affiliation(s)
- Jan W van der Scheer
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK.
| | - Matthew Woodward
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Akbar Ansari
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Tim Draycott
- Department of Translational Health Services, University of Bristol, Bristol, UK
- PROMPT Maternity Foundation, Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - Cathy Winter
- PROMPT Maternity Foundation, Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - Graham Martin
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Natalie Richards
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Ruth Kern
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
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11
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Woodward M, Ansari A, Draycott T, Winter C, Marjanovic S, Dixon-Woods M. Characterising and describing postpartum haemorrhage emergency kits in context: a protocol for a mixed-methods study. BMJ Open 2021; 11:e044310. [PMID: 33875443 PMCID: PMC8057548 DOI: 10.1136/bmjopen-2020-044310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Postpartum haemorrhage (PPH) is an obstetric emergency requiring prompt and accurate response. PPH emergency kits containing equipment and medications can facilitate this kind of intervention, but their design and contents vary, potentially introducing risk of confusion or delay. Designs may be suboptimal, and relying on localised kit contents may result in supply chain costs, increased waste and missed opportunities for economies of scale. This study aims to characterise contextual influences on current practice in relation to PPH kits and to describe the range of kits currently employed in UK maternity units. METHODS AND ANALYSIS This mixed-methods study comprises two phases. The first will use field observations and semistructured interviews to research PPH kits in a small number (3-5) of maternity units that will be selected to represent diversity. Analysis will be conducted both using an established human factors and ergonomics framework and using the constant comparative method for qualitative data analysis. The second phase will use a research and development platform (Thiscovery) to conduct a crowdsourced photography-based audit of PPH kits currently in use in the UK. Participants will tag images to indicate which objects have been photographed. Quantitative analysis will report the frequency of inclusion of each item in kits and the content differences between kit and unit types. All maternity units in the UK will be invited to take part, with additional targeted recruitment strategies used, if necessary, to ensure that the final sample includes different maternity unit types, sizes and PPH kit types. Study results will inform future work to develop consensus on effective PPH kit designs. ETHICS AND DISSEMINATION Approval has been received from the UK Health Research Authority (project ID 274147). Study results will be reported through the research institute's website, presented at conferences and published in peer-reviewed journals.
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Affiliation(s)
- Matthew Woodward
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Akbar Ansari
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tim Draycott
- Women and Children's Health Research Unit, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
- PROMPT Maternity Foundation, Bristol, UK
| | - Cathy Winter
- Women and Children's Health Research Unit, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
- PROMPT Maternity Foundation, Bristol, UK
| | | | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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12
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Rahimi K, Nazarzadeh M, Pinho-Gomes A, Woodward M, Salimi-Khorshidi G, Ohkuma T, Fitzpatrick R, Tarassenko L, Denis M, Cleland J. Technology-supported home monitoring in heart failure patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1034] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Digital health promises to enhance the prevailing episodic models of chronic heart failure (HF) care.
Purpose
We aimed to test the hypothesis that digital home monitoring with centralised specialist support for remote management of HF and major vascular comorbidities is more effective in optimising medical therapy and improving patients' quality of life than digital home monitoring alone.
Methods and results
In a two-armed partially blinded parallel randomised controlled trial, seven sites in the United Kingdom recruited a total of 202 adults with HF (71.3 years SD 11.1; mean left ventricular ejection fraction 32.9% SD 15.4). Participants were selected for being at high risk of adverse outcomes or high potential to benefit from remote management. Participants in both study arms were given an internet-enabled tablet computer, Bluetooth-enabled blood pressure monitor and weighing scales for health monitoring. After a run-in period, participants randomized to intervention received additional regular feedback to support self-management and their primary care doctors received instructions on blood investigations and pharmacological treatment. The primary outcome was the use of recommended medical therapy, for chronic HF and major comorbidities, measured as a composite opportunity score. Co-primary outcome was change in physical score of Minnesota Living with Heart failure questionnaire.
At the end of the trial, the weighted opportunity score was 0.54 (CI 95% 0.46, 0.62) in the control group and 0.61 (CI 95% 0.52, 0.70) in the intervention arm (p for mean difference=0.25). Physical well-being of participants did not differ significantly between the groups either (p=0.55).
Conclusions
Central provision of tailored specialist management in a multimorbid HF population was feasible. However, there was no strong evidence for improvement in use of evidence-based therapies nor health-related quality of life.
Figure 1
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) Health Services Research and Delivery; NIHR Career Development Fellowship
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Affiliation(s)
- K Rahimi
- University of Oxford, Clinical Trial Service Unit, Oxford, United Kingdom
| | - M Nazarzadeh
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - A.C Pinho-Gomes
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - M Woodward
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - G.H Salimi-Khorshidi
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - T Ohkuma
- University of New South Wales, Sydney, Australia
| | - R Fitzpatrick
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - L Tarassenko
- University of Oxford, Institute of Biomedical Engineering, Oxford, United Kingdom
| | - M Denis
- University of Oxford, Oxford Academic Health Science Network, Oxford, United Kingdom
| | - J Cleland
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
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13
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Pinho-Gomes A, Azevedo L, Copland E, Canoy D, Nazarzadeh M, Remakrishnan R, Berge E, Sundstrom J, Kotecha D, Woodward M, Rahimi K. Blood pressure lowering treatment for prevention of cardiovascular events in patients with atrial fibrillation: an individual-participant data meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0672] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Randomised evidence showing that pharmacological blood pressure (BP) lowering can reduce cardiovascular risk of patients with atrial fibrillation (AF) is limited.
Purpose
This study aimed to compare the effect of BP-lowering treatment on fatal and non-fatal cardiovascular outcomes in patients with and without AF overall and by major drug classes.
Methods
We extracted individual participant data from all trials with over 1,000 person-years of follow-up that had randomly assigned patients to different classes of BP-lowering drugs, BP-lowering drugs vs placebo, or to more vs less intensive BP-lowering regimens. We investigated the effects of BP-lowering treatment on a composite endpoint of major cardiovascular events (stroke, ischaemic heart disease or heart failure) according to AF status at baseline using fixed-effect one-stage individual participant data meta-analyses based on Cox proportional hazards models stratified by trial.
Findings
Twenty-two trials were included with 188,570 patients, of whom 13,266 (7%) had AF at baseline. Patients with AF had lower BP at baseline than patients without AF (143/84 mmHg, SD 21/12mmHg) versus 155/88 mmHg, SD 21/13 mmHg, respectively). Meta-regression showed that relative risk reductions were proportional to trial-level intensity of BP lowering, both in patients with and without AF. The hazard ratio for major cardiovascular events was 0.91 in patients with AF (95% confidence interval [0.83–1.00]) and 0.91 without AF (95% confidence interval [0.88–0.93]) for each 5-mmHg reduction in systolic BP, with no difference between subgroups (p=0.91) (Figure 1). Similar patterns were observed for individual components of the composite primary outcome. In patients with AF, there was no evidence that treatment effects varied according to baseline systolic BP or use of specific drug classes.
Conclusion
This study demonstrated that BP-lowering treatment reduces the risk of major cardiovascular events in patients with AF to a similar extent to that of patients without AF, even when baseline BP is below recommended treatment thresholds. Owing to their higher absolute cardiovascular risk, treatment in patients with AF is likely to result in greater absolute risk reduction than in patients without AF. Guidelines should be updated to clearly recommend pharmacological BP lowering for prevention of cardiovascular events in patients with AF.
Figure 1. Forest plot
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
| | - L Azevedo
- University of Porto, Faculty of Medicine, Porto, Portugal
| | - E Copland
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - D Canoy
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - M Nazarzadeh
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - R Remakrishnan
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - E Berge
- Tromso University Hospital, Tromso, Norway
| | - J Sundstrom
- Uppsala University, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - D Kotecha
- Center for Cardiovascular Sciences, Birmingham, United Kingdom
| | - M Woodward
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - K Rahimi
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
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14
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Peters S, Colantonio L, Chen L, Bittner V, Farkouh M, Dluzniewski P, Poudel B, Muntner P, Woodward M. Sex differences in the rates of incident and recurrent coronary heart disease and all-cause mortality. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3171] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Women have lower age-specific rates of incident coronary heart disease (CHD) than men. However, it remains unclear whether women maintain the same advantage once they have had a cardiac event.
Purpose
To assess whether sex differences in the rates of cardiac events and all-cause mortality among individuals without a history of CHD persist following a myocardial infarction (MI).
Methods
We identified 171,897 women and 167,993 men <65 years of age with commercial health insurance and ≥66 years of age with government health insurance through Medicare who had a MI hospitalization between 2015 and 2016 in the US. These beneficiaries were matched to 687,588 women and 671,972 men without a history of CHD based on age and calendar year. Beneficiaries were followed until December 2017 for the occurrence of MI, CHD, heart failure, and all-cause mortality (Medicare only).
Results
The age-standardized rates of MI per 1,000 person-years were 4.5 in women and 5.7 in men without a history of CHD (multivariable-adjusted hazard ratio [HR] [95% confidence interval] of female sex: 0.64 [0.62; 0.67]) and 60.2 in women and 59.8 in men with a history of MI (HR: 0.94 [0.92, 0.96]) (Figure 1). Rates of CHD events in women vs. men were 6.3 vs. 10.7 among those without CHD (HR: 0.53 [0.51, 0.54]) and 84.5 vs. 99.3 among those with MI (HR: 0.87 [0.85, 0.89]). Heart failure hospitalization rates in women vs. men were 9.3 vs. 6.6 for those without CHD (HR: 0.93 [0.90, 0.96]) and 114.9 vs. 97.9 among those with MI (HR: 1.02 [1.00, 1.04]). All-cause mortality rates in women vs. men were 63.7 vs. 59.0 among those without CHD (HR: 0.72 [0.71; 0.73]) and 311.6 vs. 284.5 among those with a MI (HR: 0.90 [0.89, 0.92]).
Conclusion
The women advantage against MI, CHD, heart failure and all-cause mortality is considerably attenuated following a MI, suggesting that a prior MI puts women at almost the same high-risk of subsequent events as men.
Figure 1
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This work was funded by an industry/academic collaboration between Amgen Inc. and University of Alabama at Birmingham.
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Affiliation(s)
- S Peters
- University of Oxford, Oxford, United Kingdom
| | - L Colantonio
- University of Alabama Birmingham, Birmingham, United States of America
| | - L Chen
- University of Alabama Birmingham, Birmingham, United States of America
| | - V Bittner
- University of Alabama Birmingham, Birmingham, United States of America
| | - M Farkouh
- Peter Munk Cardiac Centre, Toronto, Canada
| | | | - B Poudel
- University of Alabama Birmingham, Birmingham, United States of America
| | - P Muntner
- University of Alabama Birmingham, Birmingham, United States of America
| | - M Woodward
- University of Oxford, Oxford, United Kingdom
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15
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Pinho-Gomes A, Azevedo L, Copland E, Canoy D, Nazarzadeh M, Remakrishnan R, Berge E, Sundstrom J, Kotecha D, Woodward M, Rahimi K. Effect of blood pressure lowering treatment on the risk of atrial fibrillation: an individual-participant data meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2771] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although observational studies have suggested an association between elevated blood pressure (BP) and increased risk of atrial fibrillation (AF), randomised evidence on the effects of pharmacological blood pressure lowering on the risk of new-onset AF remains limited.
Purpose
To investigate the effects of pharmacological BP lowering on the risk of AF overall and stratified by baseline risk of AF and by drug class.
Methods
We extracted individual participant data from trials with over 1,000 person-years of follow-up that had randomly assigned patients to different classes of BP-lowering drugs, BP-lowering drugs vs placebo, or to more vs less intensive BP-lowering regimens. We investigated the effects of BP lowering on the risk of new-onset AF using fixed-effect one-stage individual participant data meta-analyses based on Cox proportional hazards models stratified by trial.
Results
Twenty-one trials were included with a total of 194,041 patients, in whom 6,357 new-onset and 516 recurrent AF events were recorded. The hazard ratio for new-onset AF was 1.01, 95% CI [0.95–1.07] per each 5-mmHg reduction in systolic BP, and meta-regression suggested that treatment effects were similar irrespective of the intensity of systolic BP reduction. Patients were overall at low risk of AF at baseline (median 2.3%, IQR [1.2–3.4%] at 5 years), and there was no evidence of heterogeneity in treatment effects across thirds of risk and 10-mmHg strata of baseline systolic BP (Figure). There was also no clear evidence that treatment effects differed between drug classes when renin-angiotensin-aldosterone system inhibitors and calcium channel blockers were compared with placebo and/or standard treatment.
Conclusion
In a low-risk population, pharmacological BP lowering did not reduce the risk of new-onset AF. Further research is needed to understand whether the effects would be different in high-risk individuals, and to better clarify the existence of class-specific effects.
Figure 1. Forest plot
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
| | - L Azevedo
- University of Porto, Faculty of Medicine, Porto, Portugal
| | - E Copland
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - D Canoy
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - M Nazarzadeh
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - R Remakrishnan
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - E Berge
- Tromso University Hospital, Tromso, Norway
| | | | - D Kotecha
- Center for Cardiovascular Sciences, Birmingham, United Kingdom
| | - M Woodward
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - K Rahimi
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
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16
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Canoy D, Copland E, Ramakrishnan R, Pinho-Gomes A, Nazarzadeh M, Bidel Z, Salimi-Khorshidi G, Woodward M, Davis B, Pepine C, Chalmers J, Teo K, Rahimi K. Stratified effects of blood pressure-lowering treatment on long-term blood pressure: an individual patient-level meta-analysis involving 50 randomised trials and 334,219 participants. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2762] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Meta-analyses of randomised controlled trials (RCT) have shown the efficacy of pharmacologic lowering of blood pressure (BP) in reducing cardiovascular disease (CVD) risk. While efficacy has been shown across important patient characteristics, meta-analysis based on aggregate data could not fully account for potential sources of variation due to individual-level characteristics. Moreover, it is unclear if any variation in treatment effects due to patient characteristics are reflected in differential effects of BP-lowering treatment on long-term BP according to these characteristics.
Purpose
We determined the effects of BP-lowering treatment on repeated measures of blood pressure, identified trial- and participant-level sources of heterogeneity, and examined consistency of these BP-lowering effects across different patient characteristics.
Methods
We conducted an individual patient-level data meta-analysis (N=50 trials) using one-stage approach. We classified trials according to trial design: drug comparison (N=28), placebo-controlled (N=21) and BP-lowering intensity (N=8) trials. We fitted mixed models with fixed treatment effects and fixed time effect, random intercepts at trial and participant level, and a random slope for time at participant level. We adjusted for age, sex and baseline BP (except when used as stratification factor). We used likelihood ratio test and Akaike information criterion to compare models.
Results
This meta-analysis included 334,219 (42% women) participants. At baseline, mean age=65 (SD=9) years, among whom 18% were current smokers, 47% had cardiovascular disease, 29% had diabetes, and 73% were previously on BP-lowering medication. Participants had an average of 8 BP measurements over 4 years of mean follow-up. For drug comparison trials, mean differences (95% confidence interval) in systolic BP (SBP) and diastolic BP (DBP) between comparison arms were 1.3 (1.2 to 1.3) mmHg and 0.5 (0.5 to 0.5) mmHg, respectively; for placebo-controlled trials, the SBP and DBP differences were 4.2 (4.0 to 4.3) mmHg and 1.9 (1.9 to 2.0) mmHg, respectively; and for BP-lowering intensity trials, the SBP and DBP differences were 8.2 (8.0 to 8.4) mmHg and 3.7 (3.6 to 3.9) mmHg, respectively. However, BP reduction differed by duration of follow-up, type of trial. In particular, for placebo-controlled and BP-intensity trials, heterogeneity in BP reductions according to patient characteristics such as baseline BP, age, sex, prior CVD, diabetes and non-randomised anti-hypertensive use were observed.
Conclusion
This study shows the role of pharmacologic agents in effectively reducing long-term BP across individuals with a wide range of characteristics. The magnitude of BP reduction varied by several patient characteristics. This might have implications for investigation and explanation of any differential effects of BP treatment on major clinical outcomes.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): British Heart Foundation; NIHR Oxford Biomedial Research Centre
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Affiliation(s)
- D Canoy
- University of Oxford, Oxford, United Kingdom
| | - E Copland
- University of Oxford, Oxford, United Kingdom
| | | | | | | | - Z Bidel
- University of Oxford, Oxford, United Kingdom
| | | | - M Woodward
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - B.R Davis
- University of Texas, School of Public Health, Austin, United States of America
| | - C.J Pepine
- University of Florida, Department of Medicine, Florida, United States of America
| | - J Chalmers
- The George Institute for Global Health, Sydney, Australia
| | - K Teo
- McMaster University, Population Health Research Institute, Hamilton, Canada
| | - K Rahimi
- University of Oxford, Oxford, United Kingdom
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17
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Peters S, Woodward M. Oestradiol and the risk of myocardial infarction in women: a cohort study of UK Biobank participants. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3179] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
It is commonly assumed that high oestradiol levels in women are cardioprotective. We assessed the association between oestradiol and the risk of incident myocardial infarction in women.
Methods
We used data from 263,295 female UK Biobank participants (mean age 56.2; SD 8.0 years) without prior cardiovascular disease. Associations of oestradiol with age and other cardiovascular risk factors were assessed. Cox proportional hazards models estimated crude, age, and multiple-adjusted hazard ratios (HR) for MI associated with oestradiol levels.
Results
After a mean follow-up of 9 years, 2,206 incident cases of MI had been recorded, including 230 events among the 57,204 women (mean age 48) with detectable oestradiol levels. In the unadjusted analyses, a unit higher in log-transformed oestradiol was associated with a HR (95% CI) for MI of 0.73 (0.58; 0.92). After adjusting for age this HR became 0.94 (0.75; 1.17), and after further adjusting for classical CVD risk factors, 1.05 (0.83; 1.31. Results were similar in subgroup analyses defined by age, menopausal status, socioeconomic status, pill use, and the use of hormone replacement therapy. The multivariable adjusted HR for the 171,431 women (mean age 59) with undetectable levels of oestradiol, compared to those with detectable levels, was 0.97 (0.92; 1.02).
Conclusion
Higher levels of oestradiol were not associated with a decreased risk of MI. The presumed cardioprotective effects of oestradiol seem to be largely confounded by age, and further confounded by other cardiovascular risk factors.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Peters
- University of Oxford, Oxford, United Kingdom
| | - M Woodward
- University of Oxford, Oxford, United Kingdom
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18
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Hua X, Lung TWC, Woodward M, Salomon JA, Hamet P, Harrap SB, Mancia G, Poulter N, Chalmers J, Clarke PM. Self-rated health scores predict mortality among people with type 2 diabetes differently across three different country groupings: findings from the ADVANCE and ADVANCE-ON trials. Diabet Med 2020; 37:1379-1385. [PMID: 31967344 PMCID: PMC7496988 DOI: 10.1111/dme.14237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 01/19/2023]
Abstract
AIMS To explore whether there is a different strength of association between self-rated health and all-cause mortality in people with type 2 diabetes across three country groupings: nine countries grouped together as 'established market economies'; Asia; and Eastern Europe. METHODS The ADVANCE trial and its post-trial follow-up were used in this study, which included 11 140 people with type 2 diabetes from 20 countries, with a median follow-up of 9.9 years. Self-rated health was reported on a 0-100 visual analogue scale. Cox proportional hazard models were fitted to estimate the relationship between the visual analogue scale score and all-cause mortality, controlling for a range of demographic and clinical risk factors. Interaction terms were used to assess whether the association between the visual analogue scale score and mortality varied across country groupings. RESULTS The visual analogue scale score had different strengths of association with mortality in the three country groupings. A 10-point increase in visual analogue scale score was associated with a 15% (95% CI 12-18) lower mortality hazard in the established market economies, a 25% (95% CI 21-28) lower hazard in Asia, and an 8% (95% CI 3-13) lower hazard in Eastern Europe. CONCLUSIONS Self-rated health appears to predict 10-year all-cause mortality for people with type 2 diabetes worldwide, but this relationship varies across groups of countries.
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Affiliation(s)
- X. Hua
- School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - T. W. C. Lung
- George Institute for Global HealthUNSW SydneySydneyNSWAustralia
- School of Public HealthFaculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
| | - M. Woodward
- George Institute for Global HealthUNSW SydneySydneyNSWAustralia
- George Institute for Global HealthUniversity of OxfordOxfordUK
- Department of EpidemiologyJohns Hopkins UniversityBaltimoreMDUSA
| | - J. A. Salomon
- Department of MedicineStanford Medical SchoolStanfordCAUSA
| | - P. Hamet
- Centre de RechercheCentre Hospitalier de l'Université de MontréalMontréalQCCanada
- Department of MedicineUniversity of MontréalMontréalQCCanada
| | - S. B. Harrap
- Department of PhysiologyUniversity of MelbourneMelbourneVICAustralia
| | - G. Mancia
- University of Milano‐BicoccaMilanItaly
| | - N. Poulter
- Imperial Clinical Trials UnitSchool of Public HealthImperial College LondonLondonUK
| | - J. Chalmers
- George Institute for Global HealthUNSW SydneySydneyNSWAustralia
| | - P. M. Clarke
- School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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Woodward M, De Pennington N, Grandidge C, McCulloch P, Morgan L. Development and evaluation of an electronic hospital referral system: a human factors approach. Ergonomics 2020; 63:710-723. [PMID: 32220218 DOI: 10.1080/00140139.2020.1748232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
Coordinating care across hospitals has been identified as a patient safety risk as referrals are often paper-based and poorly documented. Electronic referral systems have the potential to improve the situation but can fail to gain uptake. We applied a human factors/ergonomics (HFE) approach to place analysis of local workflow and user engagement central to the development of a new regional electronic referral system. The intervention was evaluated with a before-and-after study. Referral quality improved, referrals containing sufficient clinical information for continuation of care increased from 36.9% to 83.5% and completeness of referral information significantly improved. There was a 35.7% reduction in the number of calls to the on-call specialist, and the mean period between admission and surgery for expedited transfers was reduced. Applying HFE informed design with use-based evidence; the system maintains sustained uptake three years after implementation. Reliable recording of information translates to better patient safety during inter-hospital transitions. Practitioners summary: This study developed, implemented and evaluated a clinical referral system using a human factors approach. Process analysis and usability studies were used to inform the application requirements and design. Region-wide implementation in hospitals resulted in the improved quality and completeness of clinical referral information and efficiencies in the referral process.
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Affiliation(s)
- Matthew Woodward
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Carly Grandidge
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lauren Morgan
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Peng K, Yao P, Yang L, Kartsonaki C, Bennett D, Tian M, Guo Y, Bian Z, Chen Y, Chen Z, Woodward M, Ivers R, Clarke R. Parenthood and risk of hip fracture: a 10-year follow-up prospective study of middle-aged women and men in China. Osteoporos Int 2020; 31:783-791. [PMID: 31768588 PMCID: PMC7075818 DOI: 10.1007/s00198-019-05185-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/01/2019] [Indexed: 12/02/2022]
Abstract
This prospective study of Chinese adults demonstrated an inverse J-shaped association of number of children with risk of hip fracture in both men and postmenopausal women aged 50 years or older. Women with 2 or 3 children and men with 4 children had the lowest risk of hip fracture. INTRODUCTION Women have higher absolute risks of fracture than men, which is believed to reflect differences in oestrogen exposure. The aim of this study was to compare the associations of number of children with risk of hip fracture between men and women aged over 50 years. METHODS The China Kadoorie Biobank (CKB) recruited 133,399 women and 110,296 men, aged 50 years or older between 2004 and 2008. During 10-year follow-up, 2068 participants (1394 women and 674 men) suffered a hip fracture. Cox regression analysis was used to estimate sex-specific adjusted hazard ratios (HRs) and 95% CI for incident hip fracture. RESULTS Over 98% of both subsets of men and women aged 50 or older reported having children. Women who had 2 or 3 children had the lowest risks of hip fracture compared with other groups. Compared with nulliparous women, the adjusted HR for hip fracture were 0.89 (95% CI; 0.72, 1.10) for 1 child, 0.79 (0.70, 0.90) for 2 children, 0.79 (0.72, 0.87) for 3 children, 0.81 (0.72, 0.91) for 4 children, and 0.95 (0.83, 1.10) for those with 5 or more children. The associations of number of children with hip fracture were broadly consistent in men of a similar age. CONCLUSIONS The concordant effects of the number of children with risk of hip fracture between men and women suggest that the lower risks in multiparous women are not due to differences in oestrogen exposure or other biological effects, but may reflect residual confounding by socioeconomic or lifestyle factors.
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Affiliation(s)
- K Peng
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - P Yao
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - L Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - C Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - D Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - M Tian
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Y Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Z Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - M Woodward
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health, Oxford University, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - R Ivers
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - R Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
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Peng K, Yao P, Yang L, Kartsonaki C, Bennett D, Tian M, Guo Y, Bian Z, Chen Y, Chen Z, Woodward M, Ivers R, Clarke R. Publisher Correction: Parenthood and risk of hip fracture: a 10-year follow-up prospective study of middle-aged women and men in China. Osteoporos Int 2020; 31:793. [PMID: 32047950 PMCID: PMC7645435 DOI: 10.1007/s00198-019-05272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The original version of this article, published on 25 November 2019, unfortunately contained a mistake.
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Affiliation(s)
- K Peng
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - P Yao
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - L Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - C Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - D Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - M Tian
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Y Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Z Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - M Woodward
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health, Oxford University, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - R Ivers
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - R Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
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22
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Liyanage T, Toyama T, Ninomiya T, Perkovic V, Woodward M, Fukagawa M, Matsushita K, Praditpornsilpa K, Seong H, Iseki K, Lin M, Stirnadel-Farrant H, Jha V, Jun M. SUN-107 THE PREVALENCE OF CHRONIC KIDNEY DISEASE IN ASIA – A SYSTEMATIC REVIEW AND ANALYSIS. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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23
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OSHIMA M, Wong M, Hara A, Toyama T, Jun M, Jardine M, Pollock C, Woodward M, Chalmers J, Perkovic V, Wada T. SUN-161 CIRCULATING AUTOANTIBODIES TO ERYTHROPOIETIN RECEPTOR AND KIDNEY DISEASE PROGRESSION IN TYPE 2 DIABETES MELLITUS: RESULTS FROM THE ADVANCE STUDIES. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.690] [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: 11/26/2022] Open
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24
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Hafiz N, Hyun K, Chow C, Briffa T, Gallagher R, Reid C, Hare D, Zwar N, Woodward M, Jan S, Atkins E, Laba T, Halcomb E, Billot L, Usherwood T, Redfern J. 732 Gender Comparison in the use of General Practice Management Plans (GPMPs) for Patients With Cardiovascular Disease (CVD). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Wang N, Harris K, Woodward M, Chalmers J, Rodgers A. 060 The Effects of Combination Blood Pressure Lowering in the Presence or Absence of Background Statin and Aspirin Therapy – a Combined Analysis of PROGRESS and ADVANCE. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.067] [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: 11/24/2022]
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26
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Hyun K, Hafiz N, Hare D, Reid C, Laba T, Usherwood T, Briffa T, Chow C, Gallagher R, Woodward M, Zwar N, Jan S, Atkins E, Billot L, Brieger D, Redfern J. 007 Characteristics of People With Cardiovascular Disease who did not Receive Influenza Vaccination: A Sub-Analysis Within QUEL Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Troxel W, D'Amico E, Dickerson D, Brown R, Klein D, Parker J, Woodward M, Johnson C. Psychosocial and cultural influences on sleep health in urban American Indian/ Alaskan native adolescents: preliminary results from the nayshaw study. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1090] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Peters SAE, Colantonio LD, Zhao H, Bittner V, Farkouh ME, Dluzniewski PJ, Poudel B, Muntner P, Woodward M. 5191Recurrent coronary heart disease in the year following myocardial infarction among US men and women between 2008 and 2015. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although the risk of recurrent events among adults with coronary heart disease (CHD) has declined considerably from the 1970's in the US and many Western countries, studies from the 2000's show that rates remain high. Women have lower rates of incident CHD but little is known about sex differences in recurrent events in adults with CHD.
Purpose
To examine trends in rates of recurrent myocardial infarction (MI), recurrent CHD, and all-cause mortality following a MI hospitalization between 2008 and 2015 among US men and women. Also, we compared sex differences in event rates among individuals with a MI hospitalization versus their counterparts without a history of CHD.
Methods
Data were used from 1,232,024 (53% women) US adults <65 years of age with commercial health insurance in the MarketScan database and US adults ≥66 years of age with government health insurance through Medicare who had a MI hospitalization between January 1, 2008 and December 31, 2015. For each calendar year, age-standardized sex-specific rates of recurrent MI, recurrent CHD (i.e., recurrent MI or coronary revascularization), and all-cause mortality (in Medicare only) were calculated through 365 days following the hospital discharge date for MI. In a secondary analyses, we assessed the rate of recurrent MI, CHD events and all-cause mortality among women versus men with a history of MI (n=324,283) and without a history of CHD (n=1,297,132) in 2014–2015. For these analyses, adjusted hazard ratios (95% confidence intervals) were calculated using follow-up through December 31, 2016.
Results
From 2008 to 2015, age-standardized rates over 365 days of follow-up for recurrent MI declined by 15%, from 94 to 80 per 1000 person-years, in men and by 14%, from 89 to 77 per 1000 person-years, in women. Age-standardized recurrent CHD rates decreased by 16%, from 163 to 138 per 1000 person-years, in men and by 17%, from 142 to 118 per 1000 person-years, in women. In the Medicare population, age-standardized all-cause mortality rates following MI decreased by 6%, from 446 to 421 per 1000 person-years, in men and by 3%, from 412 to 398 per 1000 person-years, in women. In the secondary analyses, the women-to-men hazard ratios for those with a history of MI and those without prior CHD were 0.97 (0.94–0.99) and 0.67 (0.65–0.69), respectively, for MI, 0.89 (0.87–0.91) and 0.52 (0.51–0.54), respectively, for CHD, and 0.84 (0.83–0.85) and 0.74 (0.73–0.75) respectively, for all-cause mortality.
Conclusion
Reductions in rates of recurrent MI, recurrent CHD, and all-cause mortality within 365 days after hospitalization for MI have been similar for US women and men. The lower risk for events comparing women versus men without prior CHD is attenuated after a MI.
Acknowledgement/Funding
The design and conduct of the study was supported through a research grant from Amgen, Inc.
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Affiliation(s)
- S A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - L D Colantonio
- University of Alabama at Birmingham, Epidemiology, Birmingham, United States of America
| | - H Zhao
- University of Alabama at Birmingham, Epidemiology, Birmingham, United States of America
| | - V Bittner
- University of Alabama at Birmingham, Medicine, Birmingham, United States of America
| | - M E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada
| | - P J Dluzniewski
- Amgen Inc., Thousand Oaks, California, United States of America
| | - B Poudel
- University of Alabama at Birmingham, Epidemiology, Birmingham, United States of America
| | - P Muntner
- University of Alabama at Birmingham, Epidemiology, Birmingham, United States of America
| | - M Woodward
- The George Institute for Global Health, Sydney, Australia
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Hubbard D, Colantonio LD, Rosenson RS, Brown TM, Jackson EA, Dai Y, Mues KE, Woodward M, Muntner PM, Farkouh ME. P3422Contrasting the risk for atherosclerotic cardiovascular disease events among individuals with lower extremity peripheral artery disease, coronary heart disease and cerebrovascular disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0296] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Having more vascular conditions, including coronary heart disease (CHD), cerebrovascular disease and lower extremity artery disease (LEAD), may increase the risk for atherosclerosis cardiovascular disease (ASCVD) events. Specific vascular conditions may increase the ASCVD event rate more than others.
Purpose
To compare the risk for future ASCVD events associated with the number and type of vascular conditions among adults with a history of CHD, cerebrovascular disease and/or LEAD.
Methods
We analyzed data from US adults ≥19 years of age with commercial or Medicare health insurance who had a history of CHD, cerebrovascular disease and/or LEAD as of December 31, 2014 (N=901,391). Individuals were followed through December 31, 2016 (median follow-up: 2 years) for ASCVD events, including myocardial infarction, coronary revascularization, stroke, carotid revascularization and lower extremity amputation or revascularization.
Results
Among individuals included in the current analysis (mean age 63 years, 45% female), 70%, 23% and 7% had 1, 2 and 3 vascular conditions, respectively. After adjustment for sociodemographic and cardiovascular risk factors, the hazard ratio for ASCVD among individuals with 2 and 3 versus 1 vascular conditions was 1.88 (1.85, 1.92) and 2.93 (2.86, 3.00), respectively. Among individuals with 1 vascular condition, the rate of ASCVD events per 1,000 person-years was 46.5 (95% CI 44.1, 49.0), 29.6 (95% CI 29.0, 30.1) and 19.9 (95% CI 19.2, 20.8) for those with LEAD, CHD and cerebrovascular disease, respectively. The multivariable-adjusted hazard ratio (95% CI) for ASCVD events comparing individuals with LEAD only and CHD only versus those with cerebrovascular disease only was 1.84 (1.77, 1.92) and 1.12 (1.08, 1.16), respectively. Among individuals with 2 vascular conditions, the ASCVD event rate per 1,000 person-years was higher in those with LEAD and CHD (122.0, 95% CI 112.5, 132.2) and with LEAD and cerebrovascular disease (92.4, 95% CI 79.9, 106.4), versus those with CHD and cerebrovascular disease (59.1, 95% CI 54.8, 63.6). The multivariable-adjusted hazard ratio (95% CI) comparing individuals with LEAD and CHD and those with LEAD and cerebrovascular disease versus those with CHD and cerebrovascular disease was 1.48 (1.44, 1.53) and 1.49 (1.41, 1.58), respectively.
Conclusion
Among adults with vascular disease, having LEAD confers a higher risk for future ASCVD events than CHD or cerebrovascular disease and this group may benefit from more intensive risk reduction treatment.
Acknowledgement/Funding
Amgen Inc.
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Affiliation(s)
- D Hubbard
- University of Alabama Birmingham, Department of Epidemiology, Birmingham, United States of America
| | - L D Colantonio
- University of Alabama Birmingham, Department of Epidemiology, Birmingham, United States of America
| | - R S Rosenson
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, United States of America
| | - T M Brown
- University of Alabama Birmingham, Department of Medicine, Birmingham, United States of America
| | - E A Jackson
- University of Alabama Birmingham, Department of Medicine, Birmingham, United States of America
| | - Y Dai
- University of Alabama Birmingham, Department of Epidemiology, Birmingham, United States of America
| | - K E Mues
- Amgen Inc., Center for Observational Research, Thousand Oaks, United States of America
| | - M Woodward
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - P M Muntner
- University of Alabama Birmingham, Department of Epidemiology, Birmingham, United States of America
| | - M E Farkouh
- University of Toronto and Heart and Stroke Richard Lewar Centre of Excellence, Peter Munk Cardiac Centre, Toronto, Canada
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Huang L, Trieu K, Yoshimura S, Woodward M, Campbell N, Lackland D, Leung A, Anderson CAM, MacGregor G, Neal B, He F. P1691Impact of dose and duration of dietary salt reduction on blood pressure levels: systematic review and meta-analysis of randomised trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Authoritative medical and public health agencies in most countries advise to reduce population dietary salt intake to under 5–6 g/day as a strategy for preventing high blood pressure and cardiovascular disease. However, there is still dispute about whether salt reduction should be adopted by all populations. In addition, the effect of duration of dietary salt reduction has not been sufficiently investigated.
Purpose
To understand the effect of dietary salt reduction on blood pressure and the impact of intervention duration.
Methods
A systematic review and meta-analysis was conducted. Randomized controlled trials that allocated participants to low and high salt intake, without confounding from unequal concomitant interventions, were included. We excluded studies done in individuals younger than 18 years, pregnant women, individuals with renal disease or heart failure, and studies with sodium excretion estimated from spot urine. Random effect meta-analysis was used to generate pooled estimates of the effect on 24-hour urinary sodium excretion, systolic and diastolic blood pressure. Multivariate meta-regression was used to quantify the dose response effect of dietary salt on blood pressure change and to understand the impact of the intervention duration.
Results
125 studies were included with 162 data points extracted. Ninety-nine data points (61%) had interventions under 4 weeks. Overall, 24-hour urinary sodium excretion changed by −141 mmol (95% CI: −156; −126), systolic blood pressure changed by −4.4 mm Hg (95% CI: −5.2; −3.7) and diastolic blood pressure changed by −2.4 mm Hg (95% CI: −2.9; −1.9). Sodium reduction resulted in a significant decrease of systolic blood pressure in all subgroups except in participants with low baseline sodium intake (<109 mmol) (Figure 1). Each 100 mmol reduction of sodium was associated with 2.7 mm Hg (95% CI: 1.0; 4.4; p=0.002) reduction of systolic blood pressure and 1.2 mm Hg (95% CI: 0.0; 2.4; p=0.046) reduction of diastolic blood pressure after adjusting for intervention duration, age, sex, race, baseline blood pressure, baseline sodium intake and interaction between age and baseline blood pressure. For the same amount of salt reduction, a 10 mm Hg higher baseline systolic blood pressure would result in 2.5 mm Hg greater reduction of systolic blood pressure. There is not enough evidence to show the impact of intervention duration.
Figure 1
Conclusions
Our meta-analysis showed that sodium reduction could reduce blood pressure in all adult populations regardless of age, sex and race. The effect of salt reduction on systolic blood pressure increases with higher baseline blood pressure. Further studies, designed to investigate the impact of intervention duration, are needed to understand the significance of the duration.
Acknowledgement/Funding
None
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Affiliation(s)
- L Huang
- The George Institute for Global Health, Sydney, Australia
| | - K Trieu
- The George Institute for Global Health, Sydney, Australia
| | - S Yoshimura
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - M Woodward
- The George Institute for Global Health, Sydney, Australia
| | | | - D Lackland
- Medical University of South Carolina, Charleston, United States of America
| | - A Leung
- University of Calgary, Calgary, Canada
| | - C A M Anderson
- University of California San Diego, San Diego, United States of America
| | - G MacGregor
- Queen Mary University of London, London, United Kingdom
| | - B Neal
- The George Institute for Global Health, Sydney, Australia
| | - F He
- Queen Mary University of London, London, United Kingdom
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Colantonio LD, Dai Y, Hubbard D, Rosenson RS, Brown TM, Jackson EA, Mues KE, Woodward M, Farkouh ME, Muntner P. P652Lower use of statins among patients with peripheral artery disease compared with those with coronary heart disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0259] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adults with atherosclerotic cardiovascular disease are recommended to take a statin to reduce their risk for future cardiovascular events. Prior studies suggest that statins are being taken by most adults with coronary heart disease (CHD). However, there are few data on the use of statins among adults with peripheral artery disease (PAD).
Purpose
To compare the use of statins among US adults with a history of PAD versus those with a history of CHD.
Methods
We conducted a retrospective cohort study among US adults ≥19 years of age with commercial or government health insurance who had a history of CHD or PAD as of December 31, 2014 (n=1,006,451, mean age 63 years, 47% male). We used pharmacy claims between January 1 and December 31, 2014 to identify use of any statin and of a high-intensity statin (i.e., atorvastatin 40–80 mg, rosuvastatin 20–40 mg, simvastatin 80 mg). Patients with a history of CHD without PAD (CHD only), both CHD and PAD, and PAD without CHD (PAD only) were analysed. Prevalence ratios for use of any statin and a high-intensity statin among those taking a statin were calculated after multivariable adjustment for sociodemographics and cardiovascular risk factors.
Results
Overall, 69.1% of patients included in the current analysis had CHD only, 21.4% had both CHD and PAD, and 9.5% had PAD only. Overall, 66.0%, 68.2% and 47.5% of patients with CHD only, CHD and PAD, and PAD only were taking a statin. After multivariable adjustment and compared to patients with CHD only, the prevalence ratio for statin use was 1.02 (95% CI 1.01, 1.02) for those with both CHD and PAD and 0.82 (95% CI 0.82, 0.83) for those with PAD only. Among patients taking a statin, 29.4% of those with CHD only, 28.6% of those with both CHD and PAD, and 17.3% of those with PAD only were taking a high-intensity dosage. Compared to patients with CHD only, the multivariable adjusted prevalence ratio for taking a high-intensity dosage was 1.05 (95% CI 1.04, 1.06) for those with both CHD and PAD and 0.71 (95% CI 0.70, 0.73) for those with PAD only.
Conclusion
Adults with PAD receive less intensive statin therapy compared with their counterparts who have CHD. Interventions aimed to increase statin use among patients with PAD are warranted.
Acknowledgement/Funding
This study was supported through a research grant from Amgen, Inc. (Thousand Oaks, CA, USA).
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Affiliation(s)
- L D Colantonio
- University of Alabama at Birmingham, Epidemiology, Birmingham, United States of America
| | - Y Dai
- University of Alabama at Birmingham, Epidemiology, Birmingham, United States of America
| | - D Hubbard
- University of Alabama at Birmingham, Epidemiology, Birmingham, United States of America
| | - R S Rosenson
- Mount Sinai School of Medicine, New York, United States of America
| | - T M Brown
- University of Alabama at Birmingham, Medicine, Birmingham, United States of America
| | - E A Jackson
- University of Alabama at Birmingham, Medicine, Birmingham, United States of America
| | - K E Mues
- Amgen Inc., Thousand Oaks, California, United States of America
| | - M Woodward
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - M E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Canada
| | - P Muntner
- University of Alabama at Birmingham, Epidemiology, Birmingham, United States of America
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OSHIMA M, Jun M, Toyama T, Perkovic V, Chalmers J, Woodward M. SAT-287 eGFR SLOPE AND THE SUBSEQUENT RISK OF CLINICAL OUTCOMES IN TYPE 2 DIABETES. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.325] [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: 11/25/2022] Open
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Navaneetharaja N, Mitchell A, Honney K, MacMillan F, Aldus C, Lane K, Woodward M, Bailey S, May H, Patel M. 23EVALUATING THE FIRST OLDER PEOPLE’S EMERGENCY DEPARTMENT. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Mitchell
- Norfolk and Norwich University Hospital, UK
| | - K Honney
- Norfolk and Norwich University Hospital, UK
| | | | - C Aldus
- University of East Anglia, School of Health Sciences, Norwich Research Park, UK
| | - K Lane
- University of East Anglia, School of Health Sciences, Norwich Research Park, UK
| | - M Woodward
- University of East Anglia, School of Health Sciences, Norwich Research Park, UK
| | - S Bailey
- Norfolk and Norwich University Hospital, UK
| | - H May
- Norfolk and Norwich University Hospital, UK
| | - M Patel
- Norfolk and Norwich University Hospital, UK
- University of East Anglia, School of Health Sciences, Norwich Research Park, UK
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Lee C, Mnatzaganian G, Woodward M, Chow C, Sitas F, Robinson S, Huxley R. Sex Disparities in the Management of Coronary Heart Disease in Primary Care in Australia. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.557] [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: 11/30/2022]
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Unsworth C, Russell K, Lovell R, Woodward M, Browne M. THE EFFECT OF ASSESSMENT LOCATION AND NUMBER OF ASSESSMENTS ON DRIVING PERFORMANCE OF PEOPLE WITH DEMENTIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - R Lovell
- Department of Occupational Therapy
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Feinberg J, Flynn L, Woodward M, Pennell C, Higham H, Morgan L, Holman L, Tully P, McCulloch P. Improving emergency surgical care for patients with right iliac fossa pain at a regional scale: A quality improvement study using the Supported Champions implementation strategy. Int J Surg 2018; 57:105-110. [PMID: 30114495 DOI: 10.1016/j.ijsu.2018.08.003] [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] [Received: 05/17/2018] [Revised: 06/22/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Methods to improve clinical systems safety suffer from significant difficulties in implementation and scaling up. We used an upscaling implementation strategy entitled Supported Champions in a quality and safety improvement programme for emergency surgery at regional level, focusing on patients with right iliac fossa pain. METHODS A before-after study was conducted across four acute NHS Trusts: A 6 month intervention phase was preceded and followed by 3 months of data collection. An established Human Factors intervention was led at each Trust by a small group of staff selected as Champions. Champions received training in teamwork and systems improvement and were supported by Human Factors experts. The primary improvement aim was to expedite surgery for patients with sepsis, using Royal College of Surgeons emergency surgery guidelines as the measure. Additional outcomes studied included length of inpatient stay and 30-day readmission rates. RESULTS Breaches of RCS urgency guidelines decreased markedly from 13.7% of operated patients pre-intervention to 3.5% post-intervention (p = 0.000). Mean time from booking to incision decreased in three of the four sites, whilst median length of stay increased in 3 of 4. Overall 30-day readmission rate remained stable (7.84% pre-intervention versus 7.31% post-intervention, p = 0.959). DISCUSSION The Supported Champions model allowed all surgical teams to reduce delay for septic patients by more than 50%, using distinct Quality Improvement strategies to address local issues. Improvement was implemented in 4 diverse settings with a quarter of the level of expert input previously used in a single hospital.
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Affiliation(s)
- Joshua Feinberg
- Nuffield Department of Surgery, University of Oxford, Oxford, UK; Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Lorna Flynn
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Matthew Woodward
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | | | - Helen Higham
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lauren Morgan
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Lance Holman
- Department of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Patrick Tully
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Peter McCulloch
- Nuffield Department of Surgery, University of Oxford, Oxford, UK.
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Brown TM, Colantonio LD, Bittner V, Zhao H, Deng L, Woodward M, Monda KL, Rosenson RS, Muntner P. P963Residual risk following myocardial infarction despite intensive medical management. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T M Brown
- University of Alabama Birmingham, Medicine, Birmingham, United States of America
| | - L D Colantonio
- University of Alabama Birmingham, Epidemiology, Birmingham, United States of America
| | - V Bittner
- University of Alabama Birmingham, Medicine, Birmingham, United States of America
| | - H Zhao
- University of Alabama Birmingham, Epidemiology, Birmingham, United States of America
| | - L Deng
- University of Alabama Birmingham, Epidemiology, Birmingham, United States of America
| | - M Woodward
- The George Institute for Global Health, Sydney, Australia
| | - K L Monda
- Amgen Inc., Thousand Oaks, California, United States of America
| | - R S Rosenson
- Mount Sinai School of Medicine, New York, United States of America
| | - P Muntner
- University of Alabama Birmingham, Epidemiology, Birmingham, United States of America
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Tiong XT, Nursara Shahirah A, Pun VC, Wong KY, Fong AYY, Sy RG, Castillo-Carandang NT, Nang EEK, Woodward M, van Dam RM, Tai ES, Venkataraman K. The association of the dietary approach to stop hypertension (DASH) diet with blood pressure, glucose and lipid profiles in Malaysian and Philippines populations. Nutr Metab Cardiovasc Dis 2018; 28:856-863. [PMID: 29853430 DOI: 10.1016/j.numecd.2018.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/31/2018] [Revised: 03/30/2018] [Accepted: 04/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Despite a growing body of evidence from Western populations on the health benefits of Dietary Approaches to Stop Hypertension (DASH) diets, their applicability in South East Asian settings is not clear. We examined cross-sectional associations between DASH diet and cardio-metabolic risk factors among 1837 Malaysian and 2898 Philippines participants in a multi-national cohort. METHODS AND RESULTS Blood pressures, fasting lipid profile and fasting glucose were measured, and DASH score was computed based on a 22-item food frequency questionnaire. Older individuals, women, those not consuming alcohol and those undertaking regular physical activity were more likely to have higher DASH scores. In the Malaysian cohort, while total DASH score was not significantly associated with cardio-metabolic risk factors after adjusting for confounders, significant associations were observed for intake of green vegetable [0.011, standard error (SE): 0.004], and red and processed meat (-0.009, SE: 0.004) with total cholesterol. In the Philippines cohort, a 5-unit increase in total DASH score was significantly and inversely associated with systolic blood pressure (-1.41, SE: 0.40), diastolic blood pressure (-1.09, SE: 0.28), total cholesterol (-0.015, SE: 0.005), low-density lipoprotein cholesterol (-0.025, SE: 0.008), and triglyceride (-0.034, SE: 0.012) after adjusting for socio-demographic and lifestyle groups. Intake of milk and dairy products, red and processed meat, and sugared drinks were found to significantly associated with most risk factors. CONCLUSIONS Differential associations of DASH diet and dietary components with cardio-metabolic risk factors by country suggest the need for country-specific tailoring of dietary interventions to improve cardio-metabolic risk profiles.
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Affiliation(s)
- X T Tiong
- Clinical Research Centre, Sarawak General Hospital, Kuching, Malaysia
| | | | - V C Pun
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - K Y Wong
- Clinical Research Centre, Sarawak General Hospital, Kuching, Malaysia
| | - A Y Y Fong
- Clinical Research Centre, Sarawak General Hospital, Kuching, Malaysia; Department of Cardiology, Sarawak General Hospital Heart Centre, Kota Samarahan, Malaysia
| | - R G Sy
- Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines; LIFECourse study in Cardiovascular Disease Epidemiology (LIFECARE), Philippines Study Group, Lipid Research Unit, UP-PGH, UP, Manila, Philippines
| | - N T Castillo-Carandang
- LIFECourse study in Cardiovascular Disease Epidemiology (LIFECARE), Philippines Study Group, Lipid Research Unit, UP-PGH, UP, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine; and Institute of Clinical Epidemiology, National Institutes of Health, University of Philippines, Manila, Philippines
| | - E E K Nang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - M Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; The George Institute for Global Health, University of Oxford, UK; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - R M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - E S Tai
- Department of Medicine, National University of Singapore and National University Health System, Singapore
| | - K Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Gnatiuc L, Herrington WG, Halsey J, Tuomilehto J, Fang X, Kim HC, De Bacquer D, Dobson AJ, Criqui MH, Jacobs DR, Leon DA, Peters SAE, Ueshima H, Sherliker P, Peto R, Collins R, Huxley RR, Emberson JR, Woodward M, Lewington S, Aoki N, Arima H, Arnesen E, Aromaa A, Assmann G, Bachman DL, Baigent C, Bartholomew H, Benetos A, Bengtsson C, Bennett D, Björkelund C, Blackburn H, Bonaa K, Boyle E, Broadhurst R, Carstensen J, Chambless L, Chen Z, Chew SK, Clarke R, Cox C, Curb JD, D'Agostino R, Date C, Davey Smith G, De Backer G, Dhaliwal SS, Duan XF, Ducimetiere P, Duffy S, Eliassen H, Elwood P, Empana J, Garcia-Palmieri MH, Gazes P, Giles GG, Gillis C, Goldbourt U, Gu DF, Guasch-Ferre M, Guize L, Haheim L, Hart C, Hashimoto S, Hashimoto T, Heng D, Hjermann I, Ho SC, Hobbs M, Hole D, Holme I, Horibe H, Hozawa A, Hu F, Hughes K, Iida M, Imai K, Imai Y, Iso H, Jackson R, Jamrozik K, Jee SH, Jensen G, Jiang CQ, Johansen NB, Jorgensen T, Jousilahti P, Kagaya M, Keil J, Keller J, Kim IS, Kita Y, Kitamura A, Kiyohara Y, Knekt P, Knuiman M, Kornitzer M, Kromhout D, Kronmal R, Lam TH, Law M, Lee J, Leren P, Levy D, Li YH, Lissner L, Luepker R, Luszcz M, MacMahon S, Maegawa H, Marmot M, Matsutani Y, Meade T, Morris J, Morris R, Murayama T, Naito Y, Nakachi K, Nakamura M, Nakayama T, Neaton J, Nietert PJ, Nishimoto Y, Norton R, Nozaki A, Ohkubo T, Okayama A, Pan WH, Puska P, Qizilbash N, Reunanen A, Rimm E, Rodgers A, Saitoh S, Sakata K, Sato S, Schnohr P, Schulte H, Selmer R, Sharp D, Shifu X, Shimamoto K, Shipley M, Silbershatz H, Sorlie P, Sritara P, Suh I, Sutherland SE, Sweetnam P, Tamakoshi A, Tanaka H, Thomsen T, Tominaga S, Tomita M, Törnberg S, Tunstall-Pedoe H, Tverdal A, Ueshima H, Vartiainen E, Wald N, Wannamethee SG, Welborn TA, Whincup P, Whitlock G, Willett W, Woo J, Wu ZL, Yao SX, Yarnell J, Yokoyama T, Yoshiike N, Zhang XH. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol 2018; 6:538-546. [PMID: 29752194 PMCID: PMC6008496 DOI: 10.1016/s2213-8587(18)30079-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men. METHODS In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes. RESULTS Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes. INTERPRETATION Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).
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Hignett S, Lang A, Pickup L, Ives C, Fray M, McKeown C, Tapley S, Woodward M, Bowie P. More holes than cheese. What prevents the delivery of effective, high quality and safe health care in England? Ergonomics 2018; 61:5-14. [PMID: 27712281 DOI: 10.1080/00140139.2016.1245446] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
What prevents the delivery of effective, high quality and safe health care in the National Health Service (NHS) in England? This paper presents 760 challenges which 330 NHS staff reported as preventing the delivery of effective, high quality and safe care. Some problems have been known for over 25 years (staff shortages, finance and patient complexity) but other challenges raise questions about the commitment of the NHS to patient and staff safety. For example, Organisational Culture leading to 'stifling bureaucracy', 'odds stacked against smooth […] working' and Workload resulting in 'firefighting daily' and 'perpetual crisis mode'. The role of Human Factors/Ergonomics professional input (engagement with safety scientists) is discussed in the context of success stories and examples of Human Factors Integration from other safety critical industries (Defence, Nuclear and Rail). Practitioner Summary: 760 challenges to the quality, effectiveness and safety of health care were identified at Human Factors/Ergonomics taster workshops in England. These are used to challenge health care providers to think about a Human Factors Integration (HFI systems) approach for safety, well-being and performance for all people involved in providing and receiving health care.
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Affiliation(s)
- Sue Hignett
- a Loughborough Design School , Loughborough University , Loughborough , UK
| | - Alexandra Lang
- b Faculty of Engineering, Human Factors Research Group , University of Nottingham , Nottingham , UK
| | - Laura Pickup
- c NIHR CLAHRC South West Peninsula (PenCLAHRC) , University of Exeter , Exeter , UK
| | - Christine Ives
- a Loughborough Design School , Loughborough University , Loughborough , UK
| | - Mike Fray
- a Loughborough Design School , Loughborough University , Loughborough , UK
| | - Celine McKeown
- d Link Ergonomics, Daneton Lodge, Manor Park , Nottingham , UK
| | | | - Matthew Woodward
- f Nuffield Department of Surgical Sciences , University of Oxford, John Radcliffe Hospital , Oxford , UK
| | - Paul Bowie
- g Safety & Improvement, NHS Education for Scotland , University of Glasgow , Glasgow , Scotland
- h Institute of Health & Wellbeing , University of Glasgow , Glasgow , Scotland
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Miller C, McGuiness W, Wilson S, Cooper K, Swanson T, Rooney D, Piller N, Woodward M. Concordance and acceptability of electric stimulation therapy: a randomised controlled trial. J Wound Care 2017; 26:508-513. [DOI: 10.12968/jowc.2017.26.8.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C. Miller
- La Trobe University, Melbourne, Australia
| | - W. McGuiness
- La Trobe University, Melbourne, Australia; Alfred Health, Melbourne, Australia
| | - S. Wilson
- La Trobe University, Melbourne, Australia
| | - K. Cooper
- La Trobe University, Melbourne, Australia; Austin Health, Melbourne, Australia
| | - T. Swanson
- Nurse Practitioner Wound Management, South West Healthcare, Warrnambool. Australia
| | - D. Rooney
- Goulburn Valley Health, Shepparton, Australia
| | - N. Piller
- Flinders University, Adelaide, Australia
| | - M. Woodward
- The Melbourne University, Melbourne, Australia
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Rahimi K, Mohseni H, Otto C, Conrad N, Tran J, Woodward M, Dwyer T, Macmahon S. P4932Elevated blood pressure and risk of mitral regurgitation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4932] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Colantonio L, Bittner V, Brown T, Chen L, Monda K, Rosenson R, Somaratne R, Taylor B, Woodward M, Muntner P. P4439Adherence to intensive medical management in the year following hospitalization for myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4439] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Willis E, Woodward M, Brown E, Popmihajlov Z. ZOSTER VACCINE LIVE: REVIEW OF POSTMARKETING SAFETY BY DECADE OF LIFE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E. Willis
- Merck & Co., Inc., Kennilworth, New Jersey
| | | | - E. Brown
- Merck & Co., Inc., Kennilworth, New Jersey
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Cross A, George J, Woodward M, Ames D, Brodaty H, Wolfe R, Connors M, Elliott R. POTENTIALLY INAPPROPRIATE MEDICATION AND MORTALITY IN OLDER PEOPLE ATTENDING MEMORY CLINICS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A.J. Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia,
| | - J. George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia,
| | - M. Woodward
- Medical and Cognitive Research Unit, Austin Health, Heidelberg, Victoria, Australia,
| | - D. Ames
- National Ageing Research Institute, Parkville, Victoria, Australia,
- University of Melbourne Academic Unit for Psychiatry of Old Age, St George’s Hospital, Kew, Victoria, Australia,
| | - H. Brodaty
- Dementia Collaborative Research Centre, School of Psychiatry, UNSW Australia, Sydney, New South Wales, Australia,
- Center for Healthy Brain Aging, School of Psychiatry, UNSW Australia, Sydney, New South Wales, Australia,
| | - R. Wolfe
- Department of Epidemiology and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia,
| | - M. Connors
- Dementia Collaborative Research Centre, School of Psychiatry, UNSW Australia, Sydney, New South Wales, Australia,
- Center for Healthy Brain Aging, School of Psychiatry, UNSW Australia, Sydney, New South Wales, Australia,
| | - R. Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia,
- Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
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Woodward M. RETINOPATHY OF PREMATURITY PRACTICES: A NATIONAL SURVEY OF CANADIAN NEONATAL INTENSIVE CARE UNITS. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.062] [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: 11/14/2022] Open
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Blomster JI, Zoungas S, Woodward M, Neal B, Harrap S, Poulter N, Marre M, Williams B, Chalmers J, Hillis GS. The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study. Diabetes Res Clin Pract 2017; 127:212-217. [PMID: 28395214 DOI: 10.1016/j.diabres.2017.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/16/2017] [Indexed: 11/29/2022]
Abstract
AIMS The relationship between educational level and the risk of all-cause mortality is well established, whereas the association with vascular events in individuals with type 2 diabetes is not well described. Any association may reflect a link with common cardiovascular or lifestyle-based risk factors. METHODS The relationships between the highest level of educational attainment and major cardiovascular events, microvascular complications and all-cause mortality were explored in a cohort of 11,140 individuals with type 2 diabetes. Completion of formal education before the age of 16 was categorized as a low level of education. Regional differences between Asia, East Europe and Established Market Economies were also assessed. RESULTS During a median of 5years of follow up, 1031 (9%) patients died, 1147 (10%) experienced a major cardiovascular event and 1136 (10%) a microvascular event. After adjustment for baseline characteristics and risk factors, individuals with lower education had an increased risk of cardiovascular events (hazard ratio (HR) 1.31, 95% CI 1.16-1.48, p<0.0001), microvascular events (HR 1.23, 95% CI 1.08-1.39, p=0.0013) and all-cause mortality (HR 1.34, 95% CI 1.18-1.52, p<0.0001). In regional analyses the increased risk of studied outcomes associated with lower education was weakest in Established Market Economies and strongest in East Europe. CONCLUSIONS A low level of education is associated with an increased risk of vascular events and death in patients with type 2 diabetes, independently of common lifestyle associated cardiovascular risk factors. The effect size varies between geographical regions.
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Affiliation(s)
- J I Blomster
- The George Institute for Global Health, University of Sydney, Sydney, Australia; University of Turku, Turku, Finland.
| | - S Zoungas
- The George Institute for Global Health, University of Sydney, Sydney, Australia; School of Public Health, Monash University, Melbourne, Australia
| | - M Woodward
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, USA; The George Institute for Global Health, University of Oxford, UK
| | - B Neal
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - S Harrap
- Department of Physiology, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - N Poulter
- Imperial College London and Hammersmith Hospital, London, UK
| | - M Marre
- Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
| | - B Williams
- University College London and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, UK
| | - J Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - G S Hillis
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Perth Hospital, Perth, Australia
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Smyth LA, Meader L, Xiao F, Woodward M, Brady HJM, Lechler R, Lombardi G. Constitutive expression of the anti-apoptotic Bcl-2 family member A1 in murine endothelial cells leads to transplant tolerance. Clin Exp Immunol 2017; 188:219-225. [PMID: 28120329 DOI: 10.1111/cei.12931] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 11/26/2022] Open
Abstract
Anti-apoptotic genes, including those of the Bcl-2 family, have been shown to have dual functionality inasmuch as they inhibit cell death but also regulate inflammation. Several anti-apoptotic molecules have been associated with endothelial cell (EC) survival following transplantation; however, their exact role has yet to be elucidated in respect to controlling inflammation. In this study we created mice expressing murine A1 (Bfl-1), a Bcl-2 family member, under the control of the human intercellular adhesion molecule 2 (ICAM-2) promoter. Constitutive expression of A1 in murine vascular ECs conferred protection from cell death induced by the proinflammatory cytokine tumour necrosis factor (TNF)-α. Importantly, in a mouse model of heart allograft transplantation, expression of A1 in vascular endothelium increased survival in the absence of CD8+ T cells. Better graft outcome in mice receiving an A1 transgenic heart correlated with a reduced immune infiltration, which may be related to increased EC survival and reduced expression of adhesion molecules on ECs. In conclusion, constitutive expression of the anti-apoptotic molecule Bfl1 (A1) in murine vascular ECs leads to prolonged allograft survival due to modifying inflammation.
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Affiliation(s)
- L A Smyth
- Medical Research Council (MRC) Centre for Transplantation, King's College London, London, UK, National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,School of Health, Sports and Biosciences, University of East London, London, UK
| | - L Meader
- Medical Research Council (MRC) Centre for Transplantation, King's College London, London, UK, National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - F Xiao
- Medical Research Council (MRC) Centre for Transplantation, King's College London, London, UK, National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - M Woodward
- Peter Gorer Department of Immunobiology, Borough Wing, Guy's Hospital, King's College, London, UK
| | - H J M Brady
- Immunology and Infection Section, Division of Cell and Molecular Biology, Sir Alexander Fleming Building, Imperial College, London, UK
| | - R Lechler
- Medical Research Council (MRC) Centre for Transplantation, King's College London, London, UK, National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - G Lombardi
- Medical Research Council (MRC) Centre for Transplantation, King's College London, London, UK, National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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50
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Miller C, McGuiness W, Wilson S, Cooper K, Swanson T, Rooney D, Piller N, Woodward M. Venous leg ulcer healing with electric stimulation therapy: a pilot randomised controlled trial. J Wound Care 2017; 26:88-98. [DOI: 10.12968/jowc.2017.26.3.88] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C. Miller
- La Trobe University, School of Nursing & Midwifery, La Trobe University, Australia
| | - W. McGuiness
- La Trobe University/Alfred Health, School of Nursing & Midwifery, La Trobe University, Australia
| | - S. Wilson
- La Trobe University, School of Nursing & Midwifery, La Trobe University, Australia
| | - K. Cooper
- La Trobe University/Austin Health, School of Nursing & Midwifery, La Trobe University, Australia
| | - T. Swanson
- Nurse Practitioner Wound Management, South West Healthcare, Warrnambool. Vic 3280, Australia
| | - D. Rooney
- Goulburn Valley Health, Home Nursing Services, Australia
| | - N. Piller
- Flinders University, Lymphoedema Clinical Research Unit, Department of Surgery, School of Medicine, Australia
| | - M. Woodward
- University of Melbourne, Continuing Care, Austin Health, Australia
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