Associations between study questionnaire-assessed need and school doctor-evaluated benefit of routine health checks: an observational study

Abstract Background In Finland, school doctors examine all children at predetermined ages in addition to annual health checks by school nurses. This study explored the association of study questionnaire-assessed need for and school doctor-evaluated benefit of routine health checks conducted by doctors. Methods Between August 2017 and August 2018, we recruited a random sample of 1341 children in grades 1 and 5 (aged seven and eleven years, respectively) from 21 elementary schools in four Finnish municipalities. Children mainly studying in special education groups or whose parents needed an interpreter were excluded. School nurses performed their health check as usual. Parents, nurses, and teachers then completed study questionnaires that assessed the concerns of parents, school nurses, and teachers regarding each child’s physical, mental and social health. Doctors, blinded to the responses, routinely examined all the children. The primary outcome measures were (1) the need for a health check based on the study questionnaires and (2) the benefit/harm of the appointment as estimated by the doctors according to predetermined criteria, and (3) the patient-reported experience measures (PREMs) of benefit/harm of the appointment as estimated by the parents and children. We compared the need for a health check with the doctor-evaluated benefit using multilevel logistic regression. Results The participation rate was 75.5 %. According to all questionnaires, 20–25 % of the 1013 children had no need for a health check. The doctors regarded 410 (40.6 %) and the parents 812 (83.4 %) of the appointments as being beneficial. Respondents rarely reported harm. The children who were classified as needing a health check more often benefitted from the health check (assessed by the doctor) than children with no need for one (OR 3.53; 95 % CI 2.41–5.17). Conclusions The need for a health check is an important predictor of school-doctor evaluated benefit of the health check. This approach could allow school doctors to allocate time for the children who need them most. Trial registration ClinicalTrials.gov, Identifier NCT03178331, registration June 6th 2017.

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Associating school doctor interventions with the benefit of the health check: an observational study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.939 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

K Nikander ◽

S Kosola ◽

T Vahlberg ◽

M Kaila ◽

E Hermanson

Keyword(s):

Elementary Schools ◽

Secondary Care ◽

General Health ◽

Elementary School Children ◽

Laboratory Tests ◽

School Nurses ◽

Multilevel Logistic Regression ◽

Health Checks ◽

Subjective Perceptions

Abstract Background In Finland, most school doctor resources are dedicated to general health checks at predetermined ages in addition to annual health checks by school nurses. This study explored the association of school doctor interventions with the doctor- and the parent-evaluated benefit of the appointment. Methods Between August 2017 and August 2018, we recruited a random sample of 1341 children from grades one and five, aged seven and eleven years, respectively, from 21 Finnish elementary schools in four municipalities. Doctors routinely examined all children accompanied by parents and reported their interventions. They estimated the benefit/harm of the appointment according to predetermined criteria, whereas parents provided their subjective perceptions. Multilevel logistic regression was used for comparisons. Results The doctors conducted interventions for 78% of the participating 1013 children. The interventions included: referrals to secondary care (5%), laboratory tests or medical imaging (8%), prescriptions (10%), referrals to experts (13%), instructions/significant discussions (60%), and additional appointments (17%). The doctors and parents found 41% and 83% of the health checks beneficial, respectively. The doctors reported 52% and the parents 87% of the appointments with interventions beneficial. The doctors considered none and the parents 68% of the appointments with no interventions beneficial. All interventions were associated with the doctor-evaluated benefit. All interventions except referrals to secondary care, guidance to experts, and additional appointments were associated with the parent-evaluated benefit. Conclusions Parents valued immediate help and testing from the doctor instead of referrals to other experts or follow-up. Doctors mostly valued the appointments that required their expertise. These findings support the evidence for directing school doctor resources to the children who need doctor's expertise. Key messages Parents could benefit from information when school doctor’s expertise is pivotal. Doctors are frequently not essential in general health checks of elementary school children. This supports the evidence for focusing school doctor resources to the children who need them most.

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Patient Tolerability of Bowel Preparation is Associated with Polyp Detection Rate During Colonoscopy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.232.ewh1 ◽

2014 ◽

Vol 23 (2) ◽

pp. 135-140 ◽

Cited By ~ 5

Author(s):

Edward W. Holt ◽

Kidist K. Yimam ◽

Hanley Ma ◽

Richard E. Shaw ◽

Richard A. Sundberg ◽

...

Keyword(s):

Bowel Preparation ◽

Primary Outcome ◽

Secondary Outcome ◽

Polyp Detection ◽

Cross Sectional ◽

Quality Outcomes ◽

Negative Experience ◽

Polyp Detection Rate ◽

Patient Reported ◽

Bowel Prep

Background & Aims: A number of factors have been identified that influence the yield of screeningcolonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.Methods: We performed a cross-sectional cohort study of 413 consecutive adult patients presenting foroutpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.Results: Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, k=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).Conclusions: A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.

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NHS Health Checks for people with mental ill-health 2013–2017: an observational study

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001006 ◽

2020 ◽

Vol 29 ◽

Author(s):

C. Garriga ◽

J. Robson ◽

C. Coupland ◽

J. Hippisley-Cox

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Events ◽

Health Check ◽

Health Checks ◽

Hazard Ratios ◽

Nationally Representative ◽

Nhs Health Checks ◽

Nhs Health Check

Abstract Aims People living with serious mental ill-health experience adverse cardiovascular outcomes causing some of the greatest health inequality gaps in England, UK. We describe uptake of the NHS Health Check programme in people with mental ill-health, and rates of new diagnoses and management of cardiovascular risk factors in those who attend NHS Health Checks in comparison to those people without mental ill-health. Methods We used a large nationally representative database of people registered with general practitioners in England (QResearch). Between 2013 and 2017, we analysed attendance at NHS Health Checks and outcomes in the succeeding 12 months, in people with serious mental illness (SMI) including psychoses and in people prescribed long-term antidepressant medications (LTAD), with comparison to attendees who did not have these conditions. Hazard ratios (HR) were used to describe the association between outcomes and SMI and LTAD adjusting for sociodemographic variables. Results In those eligible for the NHS Health Check programme, we found a higher percentage of people with SMI attended an NHS Health Check (65 490, 19.8%) than those without SMI (524 728, 16.6%); adjusted HR 1.05 [95% confidence interval 1.02–1.08]. We also observed a higher percentage of attendance in people on LTAD (46 437, 20.1%) compared to people who were not prescribed LTAD (543 781, 16.7%); adjusted HR 1.10 (1.08–1.13). People with SMI were more likely to be identified with chronic kidney disease (CKD, HR 1.23, 1.12–1.34) and type 2 diabetes (HR 1.14, 1.03–1.25) within the 12 months following their NHS Health Check compared with those without SMI. People on LTAD were more likely to be identified with CKD (HR 1.55, 1.42–1.70) and type 2 diabetes (HR 1.45, 1.31–1.60) and also hypertension, cardiovascular disease, non-diabetic hyperglycaemia, familial hypercholesterolemia and dementia within the 12 months following their NHS Health Check. Statins were more likely to be prescribed to NHS Health Check attendees with SMI and those on LTAD than those without these conditions; HR 1.31 (1.25–1.38) and 1.91 (1.82–2.01), respectively. Antihypertensives were more likely to be prescribed to those on LTAD; HR 1.21 (1.14–1.29). Conclusions We found evidence that people with SMI or on LTAD treatment were 5–10% more likely to access NHS Health Checks than people without these conditions. People with SMI or on LTAD treatment who attended NHS Health Checks had higher rates of diagnosis of CKD, type 2 diabetes and some other relevant co-morbidities and increased treatment with statins and also anti-hypertensive medication in people on LTAD. This is likely to contribute to equitable reduction in adverse cardiovascular events for people with mental ill-health.

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Scope and heterogeneity of outcomes reported in randomized trials in patients receiving peritoneal dialysis

Clinical Kidney Journal ◽

10.1093/ckj/sfaa224 ◽

2020 ◽

Author(s):

Karine E Manera ◽

David W Johnson ◽

Yeoungjee Cho ◽

Benedicte Sautenet ◽

Jenny Shen ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Patient Reported Outcomes ◽

Randomized Trials ◽

Primary Outcome ◽

Median Number ◽

Patient Reported Outcome ◽

Patient Reported ◽

Inform Decision Making ◽

Solute Clearance

Abstract Background Randomized trials can provide evidence to inform decision-making but this may be limited if the outcomes of importance to patients and clinicians are omitted or reported inconsistently. We aimed to assess the scope and heterogeneity of outcomes reported in trials in peritoneal dialysis (PD). Methods We searched the Cochrane Kidney and Transplant Specialized Register for randomized trials in PD. We extracted all reported outcome domains and measurements and analyzed their frequency and characteristics. Results From 128 reports of 120 included trials, 80 different outcome domains were reported. Overall, 39 (49%) domains were surrogate, 23 (29%) patient-reported and 18 (22%) clinical. The five most commonly reported domains were PD-related infection [59 (49%) trials], dialysis solute clearance [51 (42%)], kidney function [45 (38%)], protein metabolism [44 (37%)] and inflammatory markers/oxidative stress [42 (35%)]. Quality of life was reported infrequently (4% of trials). Only 14 (12%) trials included a patient-reported outcome as a primary outcome. The median number of outcome measures (defined as a different measurement, aggregation and metric) was 22 (interquartile range 13–37) per trial. PD-related infection was the most frequently reported clinical outcome as well as the most frequently stated primary outcome. A total of 383 different measures for infection were used, with 66 used more than once. Conclusions Trials in PD include important clinical outcomes such as infection, but these are measured and reported inconsistently. Patient-reported outcomes are infrequently reported and nearly half of the domains were surrogate. Standardized outcomes for PD trials are required to improve efficiency and relevance.

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Estimates of the mean difference in orthopaedic randomized trials: obligatory yet obscure

BMC Medical Research Methodology ◽

10.1186/s12874-021-01249-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lauri Raittio ◽

Antti Launonen ◽

Ville M. Mattila ◽

Aleksi Reito

Keyword(s):

Primary Outcome ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Ceiling Effect ◽

Mean Difference ◽

Discussion Section ◽

Power Calculations ◽

Randomized Controlled ◽

Patient Reported ◽

The Mean

Abstract Background Randomized controlled trials in orthopaedics are powered to mainly find large effect sizes. A possible discrepancy between the estimated and the real mean difference is a challenge for statistical inference based on p-values. We explored the justifications of the mean difference estimates used in power calculations. The assessment of distribution of observations in the primary outcome and the possibility of ceiling effects were also assessed. Methods Systematic review of the randomized controlled trials with power calculations in eight clinical orthopaedic journals published between 2016 and 2019. Trials with one continuous primary outcome and 1:1 allocation were eligible. Rationales and references for the mean difference estimate were recorded from the Methods sections. The possibility of ceiling effect was addressed by the assessment of the weighted mean and standard deviation of the primary outcome and its elaboration in the Discussion section of each RCT where available. Results 264 trials were included in this study. Of these, 108 (41 %) trials provided some rationale or reference for the mean difference estimate. The most common rationales or references for the estimate of mean difference were minimal clinical important difference (16 %), observational studies on the same subject (8 %) and the ‘clinical relevance’ of the authors (6 %). In a third of the trials, the weighted mean plus 1 standard deviation of the primary outcome reached over the best value in the patient-reported outcome measure scale, indicating the possibility of ceiling effect in the outcome. Conclusions The chosen mean difference estimates in power calculations are rarely properly justified in orthopaedic trials. In general, trials with a patient-reported outcome measure as the primary outcome do not assess or report the possibility of the ceiling effect in the primary outcome or elaborate further in the Discussion section.

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Accessing Voluntary HIV Testing in the Construction Industry: A Qualitative Analysis of Employee Interviews from the Test@Work Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084184 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4184

Author(s):

Sarah Somerset ◽

Catrin Evans ◽

Holly Blake

Keyword(s):

Sexual Health ◽

Hiv Testing ◽

Construction Industry ◽

Large Scale ◽

Early Stage ◽

Structured Interview ◽

Health Check ◽

Public Health Issue ◽

Health Awareness ◽

Health Checks

HIV, globally, remains a significant public health issue and community HIV testing can help to identify those with HIV at an early stage of disease. The workplace offers a prime location for provision of opt-in HIV testing as part of wider health promotion initiatives. The construction industry offers a key opportunity for HIV testing provision in a generally male-dominated group exhibiting some risky behaviors related to HIV. The intervention was an optional one-off individual health check with tailored health advice and signposting, offered to the construction workforce in health check events delivered as part of a large-scale multi-site research program called Test@Work. The events were undertaken at 10 participating organizations (21 events across 16 different sites), none had previously offered sexual health awareness or HIV testing to their workforce. Participants were invited to participate in a semi-structured interview following general health checks which included HIV testing. Out of 426 employees attending the health check events, 338 (79.3%) consented to interview on exit. Accessing HIV testing at work was valued because it was convenient, quick, and compatible with work demands. Interviewees identified HIV risks for construction including drug use, high numbers of sexual partners and job-related exposures, e.g., to used needles. Health seeking in construction was limited by stigma and low support, with particular barriers for non-permanent workers. The organization of the construction industry is complex with multiple organizations of different sizes having responsibility for varying numbers of employees. A disparity between organizational policies and employment circumstances is evident, and this generates significant health inequalities. To combat this, we recommend that organizations in the construction sector offer their employees awareness-raising around health behaviors and health protection in packages, such as toolbox talks. We recommend these be accompanied by annual health checks, including sexual health awareness and opt-in workplace HIV testing. This approach is highly acceptable to the workforce in the industry and removes barriers to access to healthcare.

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Reasons why people do not attend NHS Health Checks: a systematic review and qualitative synthesis

British Journal of General Practice ◽

10.3399/bjgp17x693929 ◽

2017 ◽

Vol 68 (666) ◽

pp. e28-e35 ◽

Cited By ~ 16

Author(s):

Emma Harte ◽

Calum MacLure ◽

Adam Martin ◽

Catherine L Saunders ◽

Catherine Meads ◽

...

Keyword(s):

Systematic Review ◽

Health Management ◽

Health Check ◽

Cochrane Library ◽

Inclusion Criteria ◽

Qualitative Synthesis ◽

Health Checks ◽

The Impact ◽

Nhs Health Checks ◽

Nhs Health Check

BackgroundThe NHS Health Check programme is a prevention initiative offering cardiovascular risk assessment and management advice to adults aged 40–74 years across England. Its effectiveness depends on uptake. When it was introduced in 2009, it was anticipated that all those eligible would be invited over a 5-year cycle and 75% of those invited would attend. So far in the current cycle from 2013 to 2018, 33.8% of those eligible have attended, which is equal to 48.5% of those invited to attend. Understanding the reasons why some people do not attend is important to maximise the impact of the programmes.AimTo review why people do not attend NHS Health Checks.Design and settingA systematic review and thematic synthesis of qualitative studies.MethodAn electronic literature search was carried out of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index to Nursing and Allied Health Literature, Global Health, PsycINFO, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov, and the ISRCTN registry from 1 January 1996 to 9 November 2016, and the reference lists of all included papers were also screened manually. Inclusion criteria were primary research studies that reported the views of people who were eligible for but had not attended an NHS Health Check.ResultsNine studies met the inclusion criteria. Reasons for not attending included lack of awareness or knowledge, misunderstanding the purpose of the NHS Health Check, aversion to preventive medicine, time constraints, difficulties with access to general practices, and doubts regarding pharmacies as appropriate settings.ConclusionThe findings particularly highlight the need for improved communication and publicity around the purpose of the NHS Health Check programme and the personal health benefits of risk factor detection.

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Treatment of osteoarthritis with autologous, micro-fragmented adipose tissue: a study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05628-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rasmus Kramer Mikkelsen ◽

Lars Blønd ◽

Lisbeth Rosenkrantz Hölmich ◽

Cecilie Mølgaard ◽

Anders Troelsen ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Adipose Tissue ◽

Knee Injury ◽

Primary Outcome ◽

Morphological Changes ◽

Controlled Trial ◽

Control Group ◽

Randomized Controlled ◽

Outcome Score ◽

Patient Reported

Abstract Background Osteoarthritis is a destructive joint disease that leads to degeneration of cartilage and other morphological changes in the joint. No medical treatment currently exists that can reverse these morphological changes. Intra-articular injection with autologous, micro-fragmented adipose tissue has been suggested to relieve symptoms. Methods/Design The study is a blinded randomized controlled trial with patients allocated in a 1:1 ratio to 2 parallel groups. Patients suffering from pain and functional impairment due to osteoarthritis Kellgren-Lawrence grades 2–3 in the tibiofemoral joint are eligible for inclusion. The intervention group is treated with an intra-articular injection with autologous, micro-fragmented adipose tissue prepared using the Lipogems® system. The control group receives an intra-articular injection with isotonic saline. In total, 120 patients are to be included. The primary outcome is The Knee injury and Osteoarthritis Outcome Score (KOOS4) evaluated at 6 months. Secondary outcomes are KOOS at 3, 12 and 24 months; the Tegner activity score; treatment failure; and work status of the patient. The analysis will be conducted both as intention-to-treat and per-protocol analysis. Discussion This trial is the first to investigate the efficacy of autologous, micro-fragmented adipose tissue in a randomized controlled trial. The study uses the patient-reported outcome measure Knee Injury and Osteoarthritis Outcome Score (KOOS4) after 6 months as the primary outcome, as it is believed to be a valid measure to assess the patient’s opinion about their knee and associated problems when suffering from osteoarthritis.

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Trust compliance with best practice tariff criteria for total hip and knee replacement

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.9.537 ◽

2019 ◽

Vol 80 (9) ◽

pp. 537-540

Author(s):

Ivor Vanhegan ◽

Andrew Sankey ◽

Warwick Radford ◽

Simon Ball ◽

Charles Gibbons

Keyword(s):

Knee Replacement ◽

Best Practice ◽

Outcome Measure ◽

Participation Rate ◽

Patient Reported Outcome ◽

Measure Data ◽

National Joint Registry ◽

Joint Registry ◽

Patient Reported Outcome Measure ◽

Patient Reported

Background: Satisfaction of the best practice tariff criteria for primary hip and knee replacement enables on average an additional £560 of reimbursement per case. The Getting it Right First Time report highlighted poor awareness of these criteria among orthopaedic departments. Methods: The authors investigated the reasons for non-compliance with the best practice tariff criteria at their trust and implemented a quality improvement approach to ensure successful adherence to the standards (a minimum National Joint Registry compliance rate of 85%, a National Joint Registry unknown consent rate below 15%, a patient-reported outcome measure participation rate of ≥50%, and an average health gain not significantly below the national average). This was investigated using quarterly online reports from the National Joint Registry and NHS Digital. Results: Initially, the trust had a 31% patient-reported outcome measures participation rate arising from a systematic error in the submission of preoperative patient-reported outcome measure scores. Re-audit following the resubmission of patient-reported outcome measure data under the trust's correct organization data service code confirmed an improvement in patient-reported outcome measure compliance to 90% and satisfaction of all criteria resulting in over £450 000 of additional reimbursement to the trust. Conclusions: The authors would urge others to review their compliance with these four best practice tariff criteria to ensure that they too are not missing out on this significant reimbursement sum.

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Towards automated detection of psychosocial risk factors with text mining

Occupational Medicine ◽

10.1093/occmed/kqaa022 ◽

2020 ◽

Vol 70 (3) ◽

pp. 203-206

Author(s):

L Uronen ◽

H Moen ◽

S Teperi ◽

K-P Martimo ◽

J Hartiala ◽

...

Keyword(s):

Risk Factors ◽

Text Mining ◽

Occupational Health ◽

Sick Leave ◽

Early Retirement ◽

Psychosocial Risk Factors ◽

Health Check ◽

Psychosocial Risk ◽

Free Text ◽

Health Checks

Abstract Background Psychosocial risk factors influence early retirement and absence from work. Health checks by occupational health nurses (OHNs) may prevent deterioration of work ability. Health checks are documented electronically mostly as free text, and therefore the effect of psychological risk factors on working capacity is difficult to detect. Aims To evaluate the potential of text mining for automated early detection of psychosocial risk factors by examining health check free-text documentation, which may indicate medical statements recommending early retirement, prolonged sick leave or rehabilitation. Psychosocial risk factors were extracted from OHN documentation in a nationwide occupational health care registry. Methods Analysis of health check documentation and medical statements regarding pension, sick leave and rehabilitation. Annotations of 13 psychosocial factors based on the Prima-EF standard (PAS 1010) were used with a combination of unsupervised machine learning, a document search engine and manual filtering. Results Health check documentation was analysed for 7078 employees. In 83% of their health checks, psychosocial risk factors were mentioned. All of these occurred more frequently in the group that received medical statements for pension, rehabilitation or sick leave than the group that did not receive medical statement. Documentation of career development and work control indicated future loss of work ability. Conclusions This study showed that it was possible to detect risk factors for sick leave, rehabilitation and pension from free-text documentation of health checks. It is suggested to develop a text mining tool to automate the detection of psychosocial risk factors at an early stage.

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