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Harris DE, Torabi F, Mallory D, Akbari A, Thayer D, Wang T, Grundy S, Gravenor M, Alikhan R, Lister S, Halcox J. SAIL study of stroke, systemic embolism and bleeding outcomes with warfarin anticoagulation in non-valvular atrial fibrillation (S 4-BOW-AF). Eur Heart J Open 2023; 3:oead037. [PMID: 37143610 PMCID: PMC10153743 DOI: 10.1093/ehjopen/oead037] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Abstract
Aims In patients with non-valvular atrial fibrillation (NVAF) prescribed warfarin, the association between guideline defined international normalised ratio (INR) control and adverse outcomes in unknown. We aimed to (i) determine stroke and systemic embolism (SSE) and bleeding events in NVAF patients prescribed warfarin; and (ii) estimate the increased risk of these adverse events associated with poor INR control in this population. Methods and results Individual-level population-scale linked patient data were used to investigate the association between INR control and both SSE and bleeding events using (i) the National Institute for Health and Care Excellence (NICE) criteria of poor INR control [time in therapeutic range (TTR) <65%, two INRs <1.5 or two INRs >5 in a 6-month period or any INR >8]. A total of 35 891 patients were included for SSE and 35 035 for bleeding outcome analyses. Mean CHA2DS2-VASc score was 3.5 (SD = 1.7), and the mean follow up was 4.3 years for both analyses. Mean TTR was 71.9%, with 34% of time spent in poor INR control according to NICE criteria.SSE and bleeding event rates (per 100 patient years) were 1.01 (95%CI 0.95-1.08) and 3.4 (95%CI 3.3-3.5), respectively, during adequate INR control, rising to 1.82 (95%CI 1.70-1.94) and 4.8 (95% CI 4.6-5.0) during poor INR control.Poor INR control was independently associated with increased risk of both SSE [HR = 1.69 (95%CI = 1.54-1.86), P < 0.001] and bleeding [HR = 1.40 (95%CI 1.33-1.48), P < 0.001] in Cox-multivariable models. Conclusion Guideline-defined poor INR control is associated with significantly higher SSE and bleeding event rates, independent of recognised risk factors for stroke or bleeding.
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Affiliation(s)
| | | | - Daniel Mallory
- Population Data Science, Swansea University, Singleton Park, Swansea, SA28PP, UK
| | - Ashley Akbari
- Population Data Science, Swansea University, Singleton Park, Swansea, SA28PP, UK
| | - Daniel Thayer
- Population Data Science, Swansea University, Singleton Park, Swansea, SA28PP, UK
| | - Ting Wang
- Population Data Science, Swansea University, Singleton Park, Swansea, SA28PP, UK
| | - Sarah Grundy
- Medical Department, Bristol-Myers Squibb ltd, ARC Uxbridge, Sanderson Road, Denham, UB8 1DH, UK
| | - Mike Gravenor
- Population Data Science, Swansea University, Singleton Park, Swansea, SA28PP, UK
| | - Raza Alikhan
- Thrombosis Centre, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Steven Lister
- Department of Health Economics, Bristol-Myers Squibb ltd, ARC Uxbridge, Sanderson Road, Denham, UB8 1DH, UK
| | - Julian Halcox
- Population Data Science, Swansea University, Singleton Park, Swansea, SA28PP, UK
- Cardiology Department, Swansea Bay University Health Board, Sketty Lane, Swansea, SA28QA, UK
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Fry R, Hollinghurst J, North L, Emmerson C, Long S, Akbari A, Gravenor M, Lyons R. Assessing the impacts of COVID-19 on Care Homes in Wales. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesA defining feature of the COVID-19 pandemic in many countries were the tragic extent to which care home residents were affected and the difficulty in preventing the introduction and subsequent spread of infection.
ApproachUtilising linked data in the SAIL Databank we set out to develop a linked data platform as part of the ‘One Wales’ approach to generate evidence to inform policy makers on the key areas of transmission pathways, care home characteristics, excess mortality, and the impacts of vaccination. We used multi-sectoral linked data including routinely collected health data, administrative data and GIS generated metrics on care home characteristics and community infection rates to better understand how multiple factors impacted on care home residents.
ResultsWe created a care home index with enhanced care home characteristics for all care homes in Wales and were able to link 15,773 care home residents in the SAIL Databank to 923 care homes. We were able to generate early evidence demonstrating an increased risk of mortality for care home residents during Wave 1 (adjusted HR 1.72 compared to 2016). We were able to show that hospital discharge in Wales during the initial stages of the pandemic, although significant, had a much smaller impact on subsequent infections than care home size and accounted for 1.8% of infected discharge events. We also showed that community prevalence, inpatient appointments and people living with dementia all contributed to increased risks of catching COVID in a care home.
ConclusionThe response of the ‘One Wales’ team and the SAIL linked data platform facilitated meaningful insight on the impacts of COVID in social care settings in Wales. The evidence generated was used by policy makers from Welsh and UK Governments to inform policy direction as the pandemic progressed.
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Torabi F, Akbari A, Bedston S, Davies G, Abbasizanjani H, Gravenor M, Griffiths R, Harris D, Jenkins N, Lyons J, Morris A, North L, Halcox J, Lyons RA. Impact of COVID-19 pandemic on community medication dispensing: a national cohort analysis in Wales, UK. Int J Popul Data Sci 2022; 5:1715. [PMID: 35677101 PMCID: PMC9135049 DOI: 10.23889/ijpds.v5i4.1715] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Population-level information on dispensed medication provides insight on the distribution of treated morbidities, particularly if linked to other population-scale data at an individual-level. Objective To evaluate the impact of COVID-19 on dispensing patterns of medications. Methods Retrospective observational study using population-scale, individual-level dispensing records in Wales, UK. Total dispensed drug items for the population between 1 st January 2016 and 31 st December 2019 (3-years, pre-COVID-19) were compared to 2020 with follow up until 27 th July 2021 (COVID-19 period). We compared trends across all years and British National Formulary (BNF) chapters and highlighted the trends in three major chapters for 2019-21: 1-Cardiovascular system (CVD); 2-Central Nervous System (CNS); 3-Immunological & Vaccine. We developed an interactive dashboard to enable monitoring of changes as the pandemic evolves. Result Amongst all BNF chapters, 73,410,543 items were dispensed in 2020 compared to 74,121,180 items in 2019 demonstrating -0.96% relative decrease in 2020. Comparison of monthly patterns showed average difference (D) of -59,220 and average Relative Change (RC) of -0.74% between the number of dispensed items in 2020 and 2019. Maximum RC was observed in March 2020 (D = +1,224,909 and RC = +20.62), followed by second peak in June 2020 (D = +257,920, RC = +4.50%). A third peak was observed in September 2020 (D = +264,138, RC = +4.35%). Large increases in March 2020 were observed for CVD and CNS medications across all age groups. The Immunological and Vaccine products dropped to very low levels across all age groups and all months (including the March dispensing peak). Conclusions Reconfiguration of routine clinical services during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes.
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Affiliation(s)
- Fatemeh Torabi
- Population Data Science, Health Data Research UK, Swansea University
| | - Ashley Akbari
- Population Data Science, Health Data Research UK, Swansea University
| | - Stuart Bedston
- Population Data Science, Health Data Research UK, Swansea University
| | - Gareth Davies
- Population Data Science, Health Data Research UK, Swansea University
| | | | | | - Rowena Griffiths
- Population Data Science, Health Data Research UK, Swansea University
| | - Daniel Harris
- Population Data Science, Health Data Research UK, Swansea University
| | | | - Jane Lyons
- Population Data Science, Health Data Research UK, Swansea University
| | | | - Laura North
- Population Data Science, Health Data Research UK, Swansea University
| | - Julian Halcox
- Population Data Science, Health Data Research UK, Swansea University
| | - Ronan A. Lyons
- Population Data Science, Health Data Research UK, Swansea University
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Hollinghurst J, Lyons J, Fry R, Akbari A, Gravenor M, Watkins A, Verity F, Lyons RA. The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016-2020. Age Ageing 2021; 50:25-31. [PMID: 32951042 PMCID: PMC7546151 DOI: 10.1093/ageing/afaa207] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 07/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing. Aim to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years. Study Design and Setting we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020. Methods we calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions. Results survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020. Conclusions the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.
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Affiliation(s)
- Joe Hollinghurst
- Address correspondence to Joe Hollinghurst, Data Science Building, Swansea University (Singleton Campus), Swansea, UK.
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Torabi F, Harris D, Akbari A, Bodger O, Lyons R, Gravenor M, Halcox J. Longitudinal study of adherence to anticoagulation guidelines in patients with atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3524] [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
Introduction
Anticoagulation (AC) reduces the risk of stroke and systemic embolism (SSE) in patients with Atrial Fibrillation (AF). However, the association between changes in AF prevalence, risk factors for SSE, uptake of AC and incidence of SSE has not been documented specifically in these patients within a national population.
Purpose
Identifying antithrombotic prescribing and evaluating associations between changes in AF prevalence, SSE risk factors (CHA2DS2-VASC score) and uptake of AC. Evaluating relationships between changes in proportion of AF patients treated with AC and SSE rate at a population level. Developing a modelling tool which estimates rates of SSE (past and future) based on these factors, which can be used to drive improvements in health care.
Method
AF patients were identified in the population of Wales (SAIL databank) between 2012–2018. Temporal trends of AF, CHA2DS2-VASC scores, anti-thrombotic prescriptions and SSE events were evaluated. Multi-state Markov models were used to estimate SSE rates adjusted for AC and CHA2DS2-VASC scores. Simulation methods modelled SSE outcomes for the subsequent 7-years based on differing proportional population AC coverage.
Results
AF prevalence increased from 51,492 to 64,852 from 2012–18, with mean CHA2DS2-VASC score increasing from 3.0 to 3.9. AC prescription coverage increased (24,892 [48.3%] to 44,195 [68.1%]), whilst antiplatelet therapy alone or no antithrombotic therapy decreased (14,532 [28.0%] to 5,385 [8.3%] and 26,602 [52.0%] to 21,164 [33.0%] respectively). Hospitalisation rate for SSE in AF population decreased by over 20%, from 1,039 per 100,000 patients/quarter in 2012 to 809 per 100,000 patients/quarter in 2018.
Markov modelling demonstrated a 39% lower SSE rate with AC compared to no AC over time, after adjustment for individual CHA2DS2-VASC (HR=0.61, 95% CI [0.58, 0.63]). Using the estimated progression rates, simulation models shown that an expected 3,574 SSE events per 100,000 per year could have been reduced to 2,956 (17% reduction rate) if AC adherence had been at the now recommended 90% rate from 2012. This model also predicts that improving AC coverage to 90% of patients over the next 7-years would reduce SSE rates by 12% per year (assuming no further increase in mean CHA2DS2-VASC score).
Conclusion
Despite the increase in both prevalence of AF and CHA2DS2-VASC between 2012–18, we observed a progressive decrease in SSE events along with increasing AC prescribing. Our study suggests not only that improved AC coverage is associated with better clinical outcomes, but also that the rate of therapeutic implementation is likely a crucial factor. Reducing transition time between evidence-based guideline publication and widespread clinical uptake of the recommendations appears to be an important opportunity to improve clinical outcomes at a population level and should inform healthcare policy development and implementation.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Funded by research grant
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Affiliation(s)
- F Torabi
- Swansea University Medical School, Health Data Research UK, Swansea, United Kingdom
| | - D Harris
- Swansea University Medical School, Swansea Bay University Health Board, Health Data Research UK, Swansea, United Kingdom
| | - A Akbari
- Swansea University Medical School, Health Data Research UK, Swansea, United Kingdom
| | - O Bodger
- Swansea University Medical School, Swansea, United Kingdom
| | - R.A Lyons
- Swansea University Medical School, Health Data Research UK, Swansea, United Kingdom
| | - M Gravenor
- Swansea University Medical School, Swansea, United Kingdom
| | - J Halcox
- Swansea University Medical School, Swansea Bay University Health Board, Health Data Research UK, Swansea, United Kingdom
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Harris DE, Lacey A, Akbari A, Torabi F, Smith D, Jenkins G, Obaid D, Chase A, Gravenor M, Halcox J. Achievement of European guideline-recommended lipid levels post-percutaneous coronary intervention: A population-level observational cohort study. Eur J Prev Cardiol 2020; 28:854-861. [PMID: 34298561 DOI: 10.1177/2047487320914115] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/28/2020] [Indexed: 11/17/2022]
Abstract
AIMS European Society of Cardiology/European Atherosclerosis Society 2019 guidelines recommend more aggressive lipid targets in high- and very high-risk patients and the addition of adjuvant treatments to statins in uncontrolled patients. We aimed to assess (a) achievement of prior and new European Society of Cardiology/European Atherosclerosis Society lipid targets and (b) lipid-lowering therapy prescribing in a nationwide cohort of very high-risk patients. METHODS We conducted a retrospective observational population study using linked health data in patients undergoing percutaneous coronary intervention (2012-2017). Follow-up was for one-year post-discharge. RESULTS Altogether, 10,071 patients had a documented LDL-C level, of whom 48% had low-density lipoprotein cholesterol (LDL-C)<1.8 mmol/l (2016 target) and (23%) <1.4 mmol/l (2019 target). Five thousand three hundred and forty patients had non-high-density lipoprotein cholesterol (non-HDL-C) documented with 57% <2.6 mmol/l (2016) and 37% <2.2 mmol/l (2019). In patients with recurrent vascular events, fewer than 6% of the patients achieved the 2019 LDL-C target of <1.0 mmol/l. A total of 10,592 patients had triglyceride (TG) levels documented, of whom 14% were ≥2.3 mmol/l and 41% ≥1.5 mmol/l (2019). High-intensity statins were prescribed in 56.4% of the cohort, only 3% were prescribed ezetimibe, fibrates or prescription-grade N-3 fatty acids. Prescribing of these agents was lower amongst patients above target LDL-C, non-HDL-C and triglyceride levels. Females were more likely to have LDL-C, non-HDL-C and triglyceride levels above target. CONCLUSION There was a low rate of achievement of the new European Society of Cardiology/European Atherosclerosis Society lipid targets in this large post-percutaneous coronary intervention population and relatively low rates of intensive lipid-lowering therapy prescribing in those with uncontrolled lipids. There is considerable potential to optimise lipid-lowering therapy further through statin intensification and appropriate use of novel lipid-lowering therapy, especially in women.
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Affiliation(s)
- Daniel E Harris
- Swansea University Medical School, UK.,Swansea Bay University Health Board, UK.,Health Data Research UK Wales & Northern Ireland
| | | | - Ashley Akbari
- Swansea University Medical School, UK.,Health Data Research UK Wales & Northern Ireland
| | - Fatemeh Torabi
- Swansea University Medical School, UK.,Health Data Research UK Wales & Northern Ireland
| | | | | | - Daniel Obaid
- Swansea University Medical School, UK.,Swansea Bay University Health Board, UK
| | | | | | - Julian Halcox
- Swansea University Medical School, UK.,Swansea Bay University Health Board, UK.,Health Data Research UK Wales & Northern Ireland
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Harris DE, Thayer D, Wang T, Brooks C, Murley G, Gravenor M, Hill NR, Lister S, Halcox J. An observational study of international normalized ratio control according to NICE criteria in patients with non-valvular atrial fibrillation: the SAIL Warfarin Out of Range Descriptors Study (SWORDS). Eur Heart J Cardiovasc Pharmacother 2019; 7:40-49. [PMID: 31774502 PMCID: PMC7811400 DOI: 10.1093/ehjcvp/pvz071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/31/2019] [Accepted: 11/25/2019] [Indexed: 12/14/2022]
Abstract
AIMS In patients with non-valvular atrial fibrillation prescribed warfarin, the UK National Institute of Health and Care Excellence (NICE) defines poor anticoagulation as a time in therapeutic range (TTR) of <65%, any two international normalized ratios (INRs) within a 6-month period of ≤1.5 ('low'), two INRs ≥5 within 6 months, or any INR ≥8 ('high'). Our objectives were to (i) quantify the number of patients with poor INR control and (ii) describe the demographic and clinical characteristics associated with poor INR control. METHOD AND RESULTS Linked anonymized health record data for Wales, UK (2006-2017) was used to evaluate patients prescribed warfarin who had at least 6 months of INR data. 32 380 patients were included. In total, 13 913 (43.0%) patients had at least one of the NICE markers of poor INR control. Importantly, in the 24 123 (74.6%) of the cohort with an acceptable TTR (≥65%), 5676 (23.5%) had either low or high INR readings at some point in their history. In a multivariable regression female gender, age (≥75 years), excess alcohol, diabetes heart failure, ischaemic heart disease, and respiratory disease were independently associated with all markers of poor INR control. CONCLUSION Acceptable INR control according to NICE standards is poor. Of those with an acceptable TTR (>65%), one-quarter still had unacceptably low or high INR levels according to NICE criteria. Thus, only using TTR to assess effectiveness with warfarin has the potential to miss a large number of patients with non-therapeutic INRs who are likely to be at increased risk.
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Affiliation(s)
- Daniel E Harris
- Swansea University Medical School, Swansea University, Swansea SA28PP, UK.,Swansea Bay University Health Board, Morriston Hospital, Swansea SA66NL, UK.,HDR UK Wales & Northern Ireland, Data Science Building, Swansea University, Swansea SA28PP, UK
| | - Daniel Thayer
- Swansea University Medical School, Data Science Building, Swansea University, Swansea SA28PP, UK
| | - Ting Wang
- SAIL Databank, Data Science Building, Swansea University, Swansea SA28PP, UK
| | - Caroline Brooks
- SAIL Databank, Data Science Building, Swansea University, Swansea SA28PP, UK
| | - Geoff Murley
- Swansea University Medical School, Data Science Building, Swansea University, Swansea SA28PP, UK
| | - Mike Gravenor
- Swansea University Medical School, Data Science Building, Swansea University, Swansea SA28PP, UK
| | - Nathan R Hill
- Department of Outcomes Research, Bristol-Myers Squibb Ltd, Sanderson Rd, Uxbridge UB8 1DH, UK
| | - Steven Lister
- Department of Health Economics, Bristol-Myers Squibb Ltd, Uxbridge UB8 1DH, UK
| | - Julian Halcox
- Swansea University Medical School, Swansea University, Swansea SA28PP, UK.,Swansea Bay University Health Board, Morriston Hospital, Swansea SA66NL, UK.,HDR UK Wales & Northern Ireland, Data Science Building, Swansea University, Swansea SA28PP, UK
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8
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Davies G, Jordan S, Brooks CJ, Thayer D, Storey M, Morgan G, Allen S, Garaiova I, Plummer S, Gravenor M. Long term extension of a randomised controlled trial of probiotics using electronic health records. Sci Rep 2018; 8:7668. [PMID: 29769554 PMCID: PMC5955897 DOI: 10.1038/s41598-018-25954-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/09/2018] [Indexed: 12/12/2022] Open
Abstract
Most randomised controlled trials (RCTs) are relatively short term and, due to costs and available resources, have limited opportunity to be re-visited or extended. There is no guarantee that effects of treatments remain unchanged beyond the study. Here, we illustrate the feasibility, benefits and cost-effectiveness of enriching standard trial design with electronic follow up. We completed a 5-year electronic follow up of a RCT investigating the impact of probiotics on asthma and eczema in children born 2005–2007, with traditional fieldwork follow up to two years. Participants and trial outcomes were identified and analysed after five years using secure, routine, anonymised, person-based electronic health service databanks. At two years, we identified 93% of participants and compared fieldwork with electronic health records, highlighting areas of agreement and disagreement. Retention of children from lower socio-economic groups was improved, reducing volunteer bias. At 5 years we identified a reduced 82% of participants. These data allowed the trial’s first robust analysis of asthma endpoints. We found no indication that probiotic supplementation to pregnant mothers and infants protected against asthma or eczema at 5 years. Continued longer-term follow up is technically straightforward.
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Affiliation(s)
- Gareth Davies
- Swansea University Medical School, Singleton Park, Swansea, UK
| | - Sue Jordan
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, UK.
| | | | - Daniel Thayer
- Swansea University Medical School, Singleton Park, Swansea, UK
| | - Melanie Storey
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, UK
| | - Gareth Morgan
- The Children's Trust, Tadworth, Surrey, UK.,The Harley Street Clinic Children's Hospital, London, UK
| | - Stephen Allen
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Iveta Garaiova
- Research Department, Cultech Limited, Baglan Industrial Park, Port Talbot, UK
| | - Sue Plummer
- Research Department, Cultech Limited, Baglan Industrial Park, Port Talbot, UK
| | - Mike Gravenor
- Swansea University Medical School, Singleton Park, Swansea, UK
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Wilson RP, Holton MD, Walker JS, Shepard ELC, Scantlebury DM, Wilson VL, Wilson GI, Tysse B, Gravenor M, Ciancio J, McNarry MA, Mackintosh KA, Qasem L, Rosell F, Graf PM, Quintana F, Gomez-Laich A, Sala JE, Mulvenna CC, Marks NJ, Jones MW. A spherical-plot solution to linking acceleration metrics with animal performance, state, behaviour and lifestyle. Mov Ecol 2016; 4:22. [PMID: 27688882 PMCID: PMC5035456 DOI: 10.1186/s40462-016-0088-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/16/2016] [Indexed: 05/02/2023]
Abstract
BACKGROUND We are increasingly using recording devices with multiple sensors operating at high frequencies to produce large volumes of data which are problematic to interpret. A particularly challenging example comes from studies on animals and humans where researchers use animal-attached accelerometers on moving subjects to attempt to quantify behaviour, energy expenditure and condition. RESULTS The approach taken effectively concatinated three complex lines of acceleration into one visualization that highlighted patterns that were otherwise not obvious. The summation of data points within sphere facets and presentation into histograms on the sphere surface effectively dealt with data occlusion. Further frequency binning of data within facets and representation of these bins as discs on spines radiating from the sphere allowed patterns in dynamic body accelerations (DBA) associated with different postures to become obvious. METHOD We examine the extent to which novel, gravity-based spherical plots can produce revealing visualizations to incorporate the complexity of such multidimensional acceleration data using a suite of different acceleration-derived metrics with a view to highlighting patterns that are not obvious using current approaches. The basis for the visualisation involved three-dimensional plots of the smoothed acceleration values, which then occupied points on the surface of a sphere. This sphere was divided into facets and point density within each facet expressed as a histogram. Within each facet-dependent histogram, data were also grouped into frequency bins of any desirable parameters, most particularly dynamic body acceleration (DBA), which were then presented as discs on a central spine radiating from the facet. Greater radial distances from the sphere surface indicated greater DBA values while greater disc diameter indicated larger numbers of data points with that particular value. CONCLUSIONS We indicate how this approach links behaviour and proxies for energetics and can inform our identification and understanding of movement-related processes, highlighting subtle differences in movement and its associated energetics. This approach has ramifications that should expand to areas as disparate as disease identification, lifestyle, sports practice and wild animal ecology. UCT Science Faculty Animal Ethics 2014/V10/PR (valid until 2017).
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Affiliation(s)
- Rory P. Wilson
- Swansea Lab for Animal Movement, Biosciences, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Mark D. Holton
- Visual Computing, Computer Science, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - James S. Walker
- Visual Computing, Computer Science, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Emily L. C. Shepard
- Swansea Lab for Animal Movement, Biosciences, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - D. Mike Scantlebury
- School of Biological Sciences, Institute for Global Food Security, Queen’s University Belfast, Medical Biology Centre, 97, Lisburn Road, Belfast, BT9 7BL UK
| | - Vianney L. Wilson
- Swansea Lab for Animal Movement, Biosciences, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Gwendoline I. Wilson
- Swansea Lab for Animal Movement, Biosciences, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Brenda Tysse
- Swansea Lab for Animal Movement, Biosciences, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Mike Gravenor
- Institute of Life Science, Swansea University Medical School, Swansea, SA2 8PP UK
| | - Javier Ciancio
- Centro Nacional Patagonico, Boulevard Brown s/n, Chubut, Argentina
| | - Melitta A. McNarry
- Applied Sports Science Technology and Medicine Research Centre, College of Engineering, Swansea University, Fabian Way, Swansea, SA1 8EN UK
| | - Kelly A. Mackintosh
- Applied Sports Science Technology and Medicine Research Centre, College of Engineering, Swansea University, Fabian Way, Swansea, SA1 8EN UK
| | - Lama Qasem
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, 2713 Qatar
| | - Frank Rosell
- Faculty of Arts and Sciences, Department of Environmental and Health Studies, Telemark University College, N-3800 Bø i, Telemark, Norway
| | - Patricia M. Graf
- Faculty of Arts and Sciences, Department of Environmental and Health Studies, Telemark University College, N-3800 Bø i, Telemark, Norway
- Department of Integrative Biology and Biodiversity Research, Institute of Wildlife Biology and Game Management, University of Natural Resources and Life Sciences, Vienna, A-1180 Vienna Austria
| | - Flavio Quintana
- Centro Nacional Patagonico, Boulevard Brown s/n, Chubut, Argentina
| | | | - Juan-Emilio Sala
- Centro Nacional Patagonico, Boulevard Brown s/n, Chubut, Argentina
| | - Christina C. Mulvenna
- School of Biological Sciences, Institute for Global Food Security, Queen’s University Belfast, Medical Biology Centre, 97, Lisburn Road, Belfast, BT9 7BL UK
| | - Nicola J. Marks
- School of Biological Sciences, Institute for Global Food Security, Queen’s University Belfast, Medical Biology Centre, 97, Lisburn Road, Belfast, BT9 7BL UK
| | - Mark W. Jones
- Visual Computing, Computer Science, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP UK
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Mishra PK, Thekkudan J, Sahajanandan R, Gravenor M, Lakshmanan S, Fayaz KM, Luckraz H. The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting. Ann Card Anaesth 2015; 18:45-51. [PMID: 25566711 PMCID: PMC4900327 DOI: 10.4103/0971-9784.148321] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE OBJECTIVE platelet function assessment after cardiac surgery can predict postoperative blood loss, guide transfusion requirements and discriminate the need for surgical re-exploration. We conducted this study to assess the predictive value of point-of-care testing platelet function using the Multiplate® device. METHODS Patients undergoing isolated coronary artery bypass grafting were prospectively recruited ( n = 84). Group A ( n = 42) patients were on anti-platelet therapy until surgery; patients in Group B ( n = 42) stopped anti-platelet treatment at least 5 days preoperatively. Multiplate® and thromboelastography (TEG) tests were performed in the perioperative period. Primary end-point was excessive bleeding (>2.5 ml/kg/h) within first 3 h postoperative. Secondary end-points included transfusion requirements, re-exploration rates, intensive care unit and in-hospital stays. RESULTS Patients in Group A had excessive bleeding (59% vs. 33%, P = 0.02), higher re-exploration rates (14% vs. 0%, P < 0.01) and higher rate of blood (41% vs. 14%, P < 0.01) and platelet (14% vs. 2%, P = 0.05) transfusions. On multivariate analysis, preoperative platelet function testing was the most significant predictor of excessive bleeding (odds ratio [OR]: 2.3, P = 0.08), need for blood (OR: 5.5, P < 0.01) and platelet transfusion (OR: 15.1, P < 0.01). Postoperative "ASPI test" best predicted the need for transfusion (sensitivity - 0.86) and excessive blood loss (sensitivity - 0.81). TEG results did not correlate well with any of these outcome measures. CONCLUSIONS Peri-operative platelet functional assessment with Multiplate® was the strongest predictor for bleeding and transfusion requirements in patients on anti-platelet therapy until the time of surgery.
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Affiliation(s)
- Pankaj Kumar Mishra
- Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, United Kingdom WV10 0QP,
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Friedmann Y, Gravenor M, Bodger O, Temple M. Impact of hand washing on bacteraemia rates. BMJ 2012; 344:e4299. [PMID: 22734098 DOI: 10.1136/bmj.e4299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bunting H, Still R, Williams DR, Gravenor M, Austin MW. Evaluation of plasma glutamate levels in normal tension glaucoma. Ophthalmic Res 2009; 43:197-200. [PMID: 20068372 DOI: 10.1159/000272024] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Accepted: 08/12/2009] [Indexed: 11/19/2022]
Abstract
AIM/BACKGROUND Abnormal metabolism of the neurotransmitter glutamate is implicated in a number of neurodegenerative conditions. Patients with migraine have been shown to have elevated plasma glutamate levels. Migraine is a risk factor both in terms of prevalence and progression in normal-tension glaucoma (NTG). The aim of this study was to determine whether or not plasma glutamate levels are also elevated in NTG. METHODS Patients were recruited into 2 groups, NTG and control, according to inclusion and exclusion criteria. Patients with migraine were excluded from both groups. Fasting blood samples were collected in lithium heparin tubes, transported on ice, and centrifuged for storage at -21 degrees C. Plasma glutamate levels were measured by an amino acid analyser. Data for each group were compared by applying the Mann-Whitney test. Ethical approval and independent statistical advice for the study was obtained. RESULTS A total of 27 subjects were recruited: 14 to the NTG group and 13 to the control group. No significant difference was found between the plasma glutamate levels in the 2 groups (p = 0.67). CONCLUSION Although an association between normal tension and migraine is recognized, unlike studies in migraine sufferers, this study finds no evidence that patients with NTG have elevated plasma glutamate.
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Affiliation(s)
- H Bunting
- Department of Ophthalmology, Singleton Hospital, Sketty, Swansea, UK.
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Affiliation(s)
- N Nicholls
- Institute for Animal Health, Compton, Newbury, Berkshire RG20 7NN
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Abstract
The mechanisms of neuronal loss during the course of the prion diseases are not fully understood. In this study, neurones treated with certain non-steroidal anti-inflammatory drugs (NSAIDs) were protected against the otherwise toxic effects of a peptide derived from the prion protein, or extracts containing infectious prions (PrP ). These NSAIDs inhibit the cyclo-oxygenase (cox) enzymes that metabolise arachidonic acid to prostaglandins (PG). Conversely, drugs that inhibited the metabolism of arachidonic acid to leucotrienes enhanced neurotoxicity. Studies with selective inhibitors highlighted the importance of the cox-1 isoform in prion-induced neurotoxicity. The cox-1 inhibitors also inhibited neuronal PGE production and protected both neuroblastoma cells and primary cortical neurones against prions. They also reduced microglia-mediated killing of prion-treated neurones.
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Affiliation(s)
- Clive Bate
- Institute of Comparative Medicine, Glasglow University Veterinary School, Glasgow, UK.
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Gravenor M. Sulpiride (Eglonyl)--use to stimulate lactation. S Afr Med J 1996; 86:846. [PMID: 8764918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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