Monitoring Psychosis in General Practice: A Controlled Trial

BackgroundThis trial evaluated the feasibility, acceptability and effectiveness of a structured approach to the management of schizophrenia in general practice.MethodAll patients with non-affective psychosis (mainly schizophrenia) in four inner-city general practices were recruited. A check-list and a set of outcome measures were used by the general practitioner and the practice nurses. Information on attendances at the general practice and psychiatric out-patient departments was also collected.ResultsTwo practices took part in the intervention and two served as control practices. Sixty-seven patients with non-affective psychosis were identified. Thirty-three (81%) of the 41 patients in the two intervention practices attended the initial assessment by the doctor and nurse, but only 13 (32%) attended the first review assessment. The attendance for the second review, after six months, was six out of 15 (40%) in one practice, but rose to 16 out of 18 (89%) in the other practice. Significant improvements were recorded in the intervention group on the Global Assessment Scale (GAS) and the Behaviour, Speech and Other Syndromes (BSO) subscore of the Present State Examination (PSE). The absolute risk reduction and relative risk reduction as a result of the intervention as measured by the GAS scores, was 29% (95% CI 4% to 54%) and 36% (95% CI 5% to 66%), respectively, and in the case of the BSO subscores of the PSE, this was 23% (95% CI – 1.8% to 47.2%) and 28% (95% CI – 2.2% to 57%), respectively. For one patient to show an improvement in GAS and BSO scores 3.5 patients (95% CI 1.85 to 25) and 4.3 patients (95% CI – 55 to 2.1), respectively, would need to receive the intervention. There was a significant increase in consultation rates for patients in the intervention practices.ConclusionsHealth surveillance of patients with non-affective psychosis is possible in general practice.

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Abstract 3544: One year follow-up after acute Coronary Artery Disease (CAD) - Immediate hospital discharge vs. cardiac rehabilitation

Circulation ◽

10.1161/circ.116.suppl_16.ii_802-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Bernhard Schwaab ◽

Annika Waldmann ◽

Alexander Katalinic ◽

Britta Poppe ◽

Abdolhamid Sheikhzadeh ◽

...

Keyword(s):

Risk Reduction ◽

Absolute Risk ◽

Controlled Trial ◽

Absolute Risk Reduction ◽

Number Needed To Treat ◽

Preventive Medication ◽

All Cause Mortality ◽

Artery Disease ◽

One Year ◽

The Impact

Background: The evidence of cardiac Rehab is not fully settled as meta-analysis mostly included studies without acute revascularisation and modern preventive medication. Method: In a multicentre randomised controlled trial, 1.474 patients (pts.) with acute CAD were included to investigate the impact of telemedicine on chronic CAD: 679 pts. were included immediately at discharge from the hospital (Hosp), 795 pts. after three week in-patient Rehab. All pts. had acute coronary angiography and were followed for one year. As Hosp pts. were included 11,3 ± 3 days (median 11) earlier than Rehab pts., events in the Hosp group were counted from day 12. Results: Rehab pts. were older (64 ±10 vs. 62 ±10 years; p<.001), had more congestive heart failure (64 vs. 40%, p<.001), renal insufficiency (10 vs. 7%, p=.036), hypercholesterolemia (79 vs. 74%, p=.023), and carotid stenosis (8 vs. 4%, p=.004). Telemedicine device prescription, gender, atrial fibrillation, peripheral artery disease, diabetes, hypertension, education and social status were similar in groups. After one year, Rehab pts. had more β-blockers (88 vs. 75%, p<.001), ACE-inhibitors (81 vs. 70%, p<.001), lower LDL-C (102 ±35 vs. 121 ±47 mg/dl, p<.001) and a higher proportion of non-smokers (62 vs. 56%, p=.024). There was no difference in platelet inhibition, anticoagulation and statin therapy (81 vs. 79%). The primary combined endpoint of all-cause mortality, acute myocardial infarction (AMI), coronary revascularisation and hospitalisation occurred in 32.6% of Rehab pts. and in 38.7% of Hosp pts. (p=.014; absolute risk reduction (ARR) 0.0615, relative risk reduction (RRR) 16%, number needed to treat (NNT) 17). AMI (1.8 vs. 3.8%, p=.015; ARR 0.0207, RRR 54%, NNT 49) was reduced. Revascularisation (4.2 vs. 5.4%), hospitalisation (33.6 vs. 38.0%) and all-cause mortality (2.1 vs. 2.4%) were similar between groups. After multivariate analysis, the primary endpoint was still significant: OR 0.716 (95% CI 0.575–0.892; p=0.003) giving a RRR of 28% in favour of Rehab therapy. Conclusion: Although Rehab pts. were sicker at entry, cardiac Rehab substantially reduced relevant clinical endpoints within one year. With a very low NNT, Rehab is highly effective and should be advised to all suitable patients with acute CAD.

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Communicating risk using absolute risk reduction or prolongation of life formats: cluster-randomised trial in general practice

British Journal of General Practice ◽

10.3399/bjgp14x677824 ◽

2014 ◽

Vol 64 (621) ◽

pp. e199-e207 ◽

Cited By ~ 21

Author(s):

Charlotte Gry Harmsen ◽

Ivar Sønbø Kristiansen ◽

Pia Veldt Larsen ◽

Jørgen Nexøe ◽

Henrik Støvring ◽

...

Keyword(s):

General Practice ◽

Risk Reduction ◽

Absolute Risk ◽

Randomised Trial ◽

Absolute Risk Reduction ◽

Cluster Randomised Trial ◽

Cluster Randomised ◽

Prolongation Of Life ◽

Communicating Risk

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The Danish Model for Improvement of Diabetes Care in General Practice: Impact of Automated Collection and Feedback of Patient Data

International Journal of Family Medicine ◽

10.1155/2012/208123 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 13

Author(s):

Henrik Schroll ◽

René dePont Christensen ◽

Janus Laust Thomsen ◽

Morten Andersen ◽

Søren Friborg ◽

...

Keyword(s):

General Practice ◽

Quality Of Care ◽

Risk Reduction ◽

Absolute Risk ◽

Absolute Risk Reduction ◽

Data Capture ◽

Lipid Lowering ◽

Control Group ◽

Electronic Data

Background. Sentinel Data Capture is an IT program designed to collect data automatically from GPs’ electronic health record system. Data include ICPC diagnoses, National Health Service disbursement codes, laboratory analysis, and prescribed drugs. Quality feedback reports are generated individually for each practice on the basis of the accumulated data and are available online only for the specific practice. Objective. To describe the development of the quality of care concerning drug prescriptions for diabetes patients listed with GPs using the Data Capture module. Methods. In a cohort study, among 8320 registered patients with diabetes, we analyzed the change in the proportion of medication for uncontrolled cases of diabetes. Results. From 2009 to 2010, there was an absolute risk reduction of 1.35% (0.89–1.81: ) in proportion of persons not in antidiabetic medication despite an HbA1c above 7.0. Similarly, there was a 4.51% (3.42–5.61: ) absolute risk reduction in patients not in antihypertensive treatment despite systolic blood pressure above 130 mm Hg and 4.73% (3.56–5.90: ) absolute risk reduction in patients with total cholesterol level above 4.5 mmol/L and not receiving lipid-lowering treatment. Conclusions. Structured collection of electronic data from general practice and feedback with reports on quality of care for diabetes patient seems to give a significant reduction in proportion of patients with no medical treatment over one year for participating GPs. Due to lack of a control group, we are, however, not able to say if the drop in the proportion of uncontrolled cases is a result of participation in collection of electronic data and feedback alone.

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A Randomized, Controlled Trial of Chlorhexidine-Soaked Cloths to Reduce Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus aureusCarriage Prevalence in an Urban Jail

Infection Control and Hospital Epidemiology ◽

10.1086/678606 ◽

2014 ◽

Vol 35 (12) ◽

pp. 1466-1473 ◽

Cited By ~ 8

Author(s):

Michael Z. David ◽

Jane D. Siegel ◽

Janet Henderson ◽

Greg Leos ◽

Kaming Lo ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Risk Reduction ◽

Absolute Risk ◽

Controlled Trial ◽

Absolute Risk Reduction ◽

Methicillin Resistant ◽

Randomized Controlled ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective.To assess an intervention to limit community-associated methicillin-resistantStaphylococcus aureus(MRSA) dissemination.Design.Randomized, controlled trial.Setting.County Jail, Dallas, Texas.Participants.A total of 4,196 detainees in 68 detention tanks.Methods.Tanks were randomly assigned to 1 of 3 groups: in group 1, detainees received cloths that contained chlorhexidine gluconate (CHG) to clean their entire skin surface 3 times per week for 6 months; group 2 received identical cloths containing only water; and group 3 received no skin treatment. During the study, all newly arrived detainees were invited to enroll. Nares and hand cultures were obtained at baseline and from all current enrollees at 2 and 6 months.Results.At baseline,S. aureuswas isolated from 41.2% and MRSA from 8.0% (nares and/or hand) of 947 enrollees. The average participation rate was 47%. At 6 months, MRSA carriage was 10.0% in group 3 and 8.7% in group 1 tanks (estimated absolute risk reduction [95% confidence interval (CI)], 1.4% [−4.8% to 7.1%];P= .655). At 6 months, carriage of anyS. aureuswas 51.1% in group 3, 40.7% in group 1 (absolute risk reduction [95% CI], 10.4% [0.01%–20.1%];P= .047), and 42.8% (absolute risk reduction [95% CI], 8.3% [−1.4% to 18.0%];P= .099) in group 2.Conclusions.Skin cleaning with CHG for 6 months in detainees, compared with no intervention, significantly decreased carriage ofS. aureus, and use of water cloths produced a nonsignificant but similar decrease. A nonsignificant decrease in MRSA carriage was found with CHG cloth use.Trial registration.ClinicalTrials.gov identifier NCT00785200.

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Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001523 ◽

2021 ◽

pp. 1-6

Author(s):

A S Khatiwada ◽

A S Harris

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Clinical Trials ◽

Total Thyroidectomy ◽

Risk Reduction ◽

Operative Treatment ◽

Absolute Risk ◽

Absolute Risk Reduction ◽

Vitamin D Supplementation ◽

Absolute Reduction

Abstract Objective This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy. Method This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy. Results Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13–59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11–40 per cent) following pre-operative supplementation. Conclusion Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.

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Sofosbuvir with daclatasvir and the outcomes of patients with COVID-19: a systematic review and meta-analysis with GRADE assessment

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-140287 ◽

2021 ◽

pp. postgradmedj-2021-140287

Author(s):

Ahmad Fariz Malvi Zamzam Zein ◽

Catur Setiya Sulistiyana ◽

Wilson Matthew Raffaello ◽

Arief Wibowo ◽

Raymond Pranata

Keyword(s):

Systematic Review ◽

Absolute Risk ◽

Controlled Trial ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Intervention Group ◽

Control Group ◽

Reduce Mortality Rate ◽

Icu Admission ◽

Clinical Recovery

PurposeThis systematic review and meta-analysis aimed to evaluate the effect of sofosbuvir/daclatasvir (SOF/DCV) on mortality, the need for intensive care unit (ICU) admission or invasive mechanical ventilation (IMV) and clinical recovery in patients with COVID-19.MethodsWe performed a systematic literature search through the PubMed, Scopus and Embase from the inception of databases until 6 April 2021. The intervention group was SOF/DCV, and the control group was standard of care. The primary outcome was mortality, defined as clinically validated death. The secondary outcomes were (1) the need for ICU admission or IMV and (2) clinical recovery. The pooled effect estimates were reported as risk ratios (RRs).ResultsThere were four studies with a total of 231 patients in this meta-analysis. Three studies were randomised controlled trial, and one study was non-randomised. SOF/DCV was associated with lower mortality (RR: 0.31 (0.12, 0.78); p=0.013; I2: 0%) and reduced need for ICU admission or IMV (RR: 0.35 (0.18, 0.69); p=0.002; I2: 0%). Clinical recovery was achieved more frequently in the SOF/DCV (RR: 1.20 (1.04, 1.37); p=0.011; I2: 21.1%). There was a moderate certainty of evidence for mortality and need for ICU/IMV outcome, and a low certainty of evidence for clinical recovery. The absolute risk reductions were 140 fewer per 1000 for mortality and 186 fewer per 1000 for the need for ICU/IMV. The increase in clinical recovery was 146 more per 1000.ConclusionSOF/DCV may reduce mortality rate and need for ICU/IMV in patients with COVID-19 while increasing the chance for clinical recovery.Protocol registrationPROSPERO: CRD42021247510.

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Amblyopia screening effectiveness at 3–4 years old: a cohort study

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000599 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000599

Author(s):

Sandra Guimaraes ◽

Andreia Soares ◽

Cristina Freitas ◽

Pedro Barros ◽

Ricardo Dourado Leite ◽

...

Keyword(s):

Risk Reduction ◽

Treatment Effectiveness ◽

Absolute Risk ◽

Absolute Risk Reduction ◽

Number Needed To Screen ◽

History Of ◽

Disease Study ◽

New Diagnosis ◽

Screening Effectiveness ◽

Timely Referral

ObjectiveTo study the effectiveness of amblyopia screening at ages 3–4.Methods and AnalysisFrom a population with no previous screening, a cohort of 2300 children with 3–4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated.ResultsPast/present history of amblyopia was higher than 3.1%–4.2%, depending on amblyopia definition normatives. Screening at age 3–4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3–4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia.ConclusionsScreening amblyopia in a whole-population setting at age 3–4 is highly effective. For each 48 children screened at age 3–4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3–4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3–4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3–4 seems a rational/effective way of controlling amblyopia.

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Pharmacists in general practice: a qualitative process evaluation of the General Practice Pharmacist (GPP) study

Family Practice ◽

10.1093/fampra/cmaa044 ◽

2020 ◽

Vol 37 (5) ◽

pp. 711-718

Author(s):

Oscar James ◽

Karen Cardwell ◽

Frank Moriarty ◽

Susan M Smith ◽

Barbara Clyne

Keyword(s):

General Practice ◽

Process Evaluation ◽

Controlled Trial ◽

Qualitative Approach ◽

Structured Interviews ◽

Practice Staff ◽

Practice Nurses ◽

Practice Team ◽

Prescribing Quality ◽

Descriptive Qualitative

Abstract Background There is some evidence to suggest that pharmacists integrated into primary care improves patient outcomes and prescribing quality. Despite this growing evidence, there is a lack of detail about the context of the role. Objective To explore the implementation of The General Practice Pharmacist (GPP) intervention (pharmacists integrating into general practice within a non-randomized pilot study in Ireland), the experiences of study participants and lessons for future implementation. Design and setting Process evaluation with a descriptive qualitative approach conducted in four purposively selected GP practices. Methods A process evaluation with a descriptive qualitative approach was conducted in four purposively selected GP practices. Semi-structured interviews were conducted, transcribed verbatim and analysed using a thematic analysis. Results Twenty-three participants (three pharmacists, four GPs, four patients, four practice nurses, four practice managers and four practice administrators) were interviewed. Themes reported include day-to-day practicalities (incorporating location and space, systems and procedures and pharmacists’ tasks), relationships and communication (incorporating GP/pharmacist mode of communication, mutual trust and respect, relationship with other practice staff and with patients) and role perception (incorporating shared goals, professional rewards, scope of practice and logistics). Conclusions Pharmacists working within the general practice team have potential to improve prescribing quality. This process evaluation found that a pharmacist joining the general practice team was well accepted by the GP and practice staff and effective interprofessional relationships were described. Patients were less clear of the overall benefits. Important barriers (such as funding, infrastructure and workload) and facilitators (such as teamwork and integration) to the intervention were identified which will be incorporated into a pilot cluster randomized controlled trial.

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Abstract P297: Long-Term Benefit Comparison of Absolute Risk Reduction versus Absolute Risk to Prioritize Statin Therapy

Circulation ◽

10.1161/circ.137.suppl_1.p297 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Ciaran N Kohli-Lynch ◽

Andrew E Moran ◽

George Thanassoulis ◽

Allan D Sniderman ◽

Yiyi Zhang ◽

...

Keyword(s):

Risk Factor ◽

Statin Therapy ◽

Risk Reduction ◽

Treatment Initiation ◽

Absolute Risk ◽

Treatment Strategies ◽

Absolute Risk Reduction ◽

Statin Treatment ◽

Policy Model

Introduction: Individuals with no established cardiovascular disease (CVD) are currently recommended preventive statin therapy based on 10-year absolute risk (AR) of CVD, and individuals with a 10-year AR ≥7.5% are recommended statins. However, individuals with elevated LDL cholesterol experience greater absolute CVD absolute risk reduction (ARR) from statin therapy compared with those with the same 10-year AR but with lower LDL. A previous study showed that ARR-based statin treatment would prevent more CVD events than AR-based treatment in the 10 years following treatment initiation. Objective: This study aimed to quantify the long-term benefits of treating patients based on ARR rather than AR. Methods: A microsimulation version of the CVD Policy Model, a decision-analytic state transition model, simulated intermediate-strength statin therapy in 40,000 CVD-free US adults (50% female) under a variety of treatment strategies. The model predicts health outcomes for individuals based on their age, sex, and risk factor profile, accounting for the competing risk of non-CVD mortality. Individuals entered the model aged 40 years, and a time horizon of 40 years was employed. Life year gains and CVD events prevented compared to no treatment were estimated for a range of 10-year ARR and AR treatment initiation thresholds. Results: At the same numbers of patient-years of treatment (PYoT), ARR consistently produced more life year gains than AR (Figure). A 10-year ARR threshold of ≥2.62% would lead to approximately the same PYoT as standard of care (10-year AR ≥7.5%) while preventing 60 additional CVD events and producing 421 additional life year gains in the cohort. Conclusion: Treating patients with statins based on ARR would yield significant health gains in the U.S. population compared to standard AR-based treatment strategies. The ARR strategy may also achieve greater adherence and uptake as it focuses on individuals with elevated levels of a modifiable risk factor.

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