scholarly journals The Welsh Government Flying Start Data Linking Project

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Laura Herbert ◽  
Tony Whiffen ◽  
Sarah Lowe ◽  
Craiger Solomons
Keyword(s):  
Health Education ◽  
School Attendance ◽  
Evidence Base ◽  
Early Years ◽  
Current Evidence ◽  
Special Educational Needs ◽  
Parenting Support ◽  
Individual Level ◽  
Current Evidence Base ◽  
The Impact

Background with rationale Flying Start is the Welsh Government’s (WG) flagship Early Years programme for families with children aged less than 4 years of age. Running since 2006, the four entitlements are: Enhanced Health Visiting Free part-time childcare for 2-3 year olds Parenting support Speech, language, and communication support Previous Flying Start evaluations have focused on area-based analysis to explore outcomes of Flying Start eligible children. The current project is the first to obtain individual level Flying Start data to look at outcomes around health, education and social care and to explore these outcomes in relation to levels of engagement with different entitlements of Flying Start. Main Aim The aim of the project is to link individual-level Flying Start intervention data with health, education and other data to investigate the potential impact of Flying Start. Methods/Approach Individual level data for Flying Start children is currently being obtained from six pilot Local Authorities in Wales using the Secure Anonymised Information Linkage (SAIL) databank. The Flying Start data will be linked to other data within the SAIL databank in order to investigate the impact of the Flying Start programme on a number of different outcomes including hospitalisations, Accident & Emergency (A&E) attendances, Primary Care interactions, educational attainment, school attendance and Special Educational Needs (SEN). Results The project will report on the emerging findings from the analysis of pilot data. It is anticipated that Flying Start dosage effects will also be investigated and reported on. Conclusion The findings will feed into the current evidence base for Flying Start and help to inform future policy-making. If successful, this model of evaluation is likely to be adopted by related WG programmes.

scholarly journals Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

2020 ◽  
pp. 1-15
Author(s):  
Daniel Joseph Lamport ◽  
Claire Michelle Williams
Keyword(s):  
Systematic Reviews ◽  
Evidence Base ◽  
Epidemiological Studies ◽  
Cognitive Outcome ◽  
Current Evidence ◽  
Duration Of Treatment ◽  
Current Evidence Base ◽  
Cognitive Benefits ◽  
Meta Analyses ◽  
The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

scholarly journals Welsh Government Flying Start Programme Evaluation Using Linked Data

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Sarah Lowe ◽  
Laura McGinn ◽  
Marcos Quintela ◽  
Luke Player ◽  
Karen Tingay
Keyword(s):  
Evidence Base ◽  
Development Project ◽  
Early Years ◽  
Local Authorities ◽  
Parenting Support ◽  
Individual Level ◽  
Level Data ◽  
Part Time ◽  
The Individual ◽  
Families With Children

BackgroundFlying Start (FS) is the Welsh Government’s (WG) flagship Early Years programme for families with children aged less than 4 years of age. Running since 2006, the four entitlements are: Free part-time childcare for 2-3 year olds Enhanced Health Visiting Parenting support Speech, language, and communication support ObjectivesCurrently, while we know which areas in Wales are receiving FS support, individual-level data on which child received what entitlements is not available. Area-level outcomes can be used as proxy indicators but the individual impact of receiving FS support cannot be examined.The project aims to evaluate FS by linking the FS cohort to a range of outcomes including health, education and social care. MethodsA Dataflow Development Project (DDP) has been launched to install SAIL (Secure Anonymised Information Linkage) appliances into 6 pilot Local Authorities in Wales which will test acquiring and linking the individual level FS data from pilot Local Authorities with other datasets in SAIL. FindingsThe project will report some emerging findings from the analysis of pilot data. ImplicationsThere is a growing interest in using linked administrative data to evaluate government initiatives, and mounting enthusiasm in Local Government. If successful, this model is likely to be adopted by related WG programmes; improving the evidence base, facilitating effective evaluation, and adding to the data available for re-use in Wales.

scholarly journals Welsh Government Flying Start Programme Evaluation Using Linked Data

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Sarah Lowe ◽  
Laura McGuinn ◽  
Marcos Quintela ◽  
Luke Player
Keyword(s):  
Pilot Project ◽  
Evidence Base ◽  
Development Project ◽  
Early Years ◽  
Local Authorities ◽  
Parenting Support ◽  
Individual Level ◽  
Pilot Data ◽  
Level Data ◽  
The Individual

IntroductionFlying Start (FS) is the Welsh Government’s (WG) flagship Early Years programme for families with children aged less than 4 years of age. Running since 2006, the four entitlements are: Free part-time childcare for 2-3 year olds Enhanced Health Visiting Parenting support Speech, language, and communication support Objectives and ApproachCurrently, while we know which areas in Wales are receiving FS support, individual-level data on which child received what entitlements is not available. This means that area-level outcomes can be used as proxy indicators but the individual impact of receiving FS support cannot be examined. This project describes the issues around collecting individual-level data in deprived Welsh regions, a pilot project to facilitate this collection and will report some emerging findings from the analysis of pilot data. ResultsFollowing from previous studies funded by the ESRC and WG (e.g. Supporting People Data Linking Feasibility Study), a Dataflow Development Project (DDP) has been launched to install Secure Anonymised Information Linkage (SAIL) appliances into 6 pilot Local Authorities in Wales. The SAIL appliance technology will provide Local Authorities with the ability to link individual-level data within a Local Authority or between Local Authorities and to securely anonymise data into the SAIL Databank or ADRC-W. The DDP will test acquiring the individual level FS data from pilot Local Authorities into SAIL. The project aims to evaluate FS by linking the FS cohort to a range of outcomes including health, education and social care. We will report emerging findings from the analysis of pilot data. Conclusion/ImplicationsThere is grow interest in using linked administrative data to evaluate government initiatives, and mounting enthusiasm in Local Government. If successful, this model is likely to be adopted by related WG programmes; improving the evidence base, facilitating effective evaluation, and adding to the data available for re-use in Wales.

Abstract 4450: Does the Evidence Support Guideline Recommendations for Clopidogrel Pretreatment?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Shervin Eshaghian ◽  
Stanley Chou ◽  
Jayanta Das ◽  
George A Diamond ◽  
Prediman K Shah ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Time Course ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Evidence Base ◽  
Current Evidence ◽  
Optimal Timing ◽  
Significant Heterogeneity ◽  
Current Evidence Base ◽  
The Impact

Although few concrete data exist about the optimal timing and dose of clopidogrel pretreatment, the ACC/AHA & ESC guidelines endorse pretreatment with 300 – 600 mg of clopidogrel at least 2– 6 hours before PCI as Class IA (ACS) and Class IC (elective PCI) recommendation. To evaluate the current evidence base in support for clopidogrel pretreat-ment. Five trials examining the impact of clopidogrel pretreatment in stable and unstable CAD were evaluated: PCI-CURE, PCI-CLARITY, CREDO, PRAGUE-8, ARMYDA-5. Because of substantial clinical heterogeneity in trial design and population, concomitant therapies (glycoprotein 2b/3a inhibitors, thrombolysis, etc), loading dose, pretreatment duration and analysis plan between PCI-CURE, PCI-CLARITY and the rest, a formal meta-analysis was confined only to CREDO, PRAGUE-8, ARMYDA-5. The key data are summarized in the Table . Clopidogrel pretreatment was associated with significant reduction in ischemic outcomes without a significant increase in major bleeding in two out of the 5 trials (PCI-CURE and PCI-CLARITY). Both these trials utilized nonrandomized subgroup comparisons with pretreatment duration longer than that typically encountered in clinical practice (<48h). A meta-analysis of the 3 trials demonstrated a nonsignificant 23% odds reduction in efficacy (P=0.1) and a nonsignificant 29% odds increase in major bleeding (P=0.24). No significant heterogeneity was observed for pooled efficacy (P=0.79) or bleeding (P=0.77) outcomes. Pretreatment hypothesis is currently not validated in rigorous prospective assessments, thereby calling into question the Class I recommendation (benefit >>>risk) endorsed by the guidelines. Clearly, further clinical data regarding dose, time course of pretreatment and associated benefit are warranted to provide unequivocal support. Until then, it is prudent to rule out surgical CAD before pretreatment to avoid bleeding risk. Trials Assessing Clopidogrel Pretreatment

scholarly journals P-26 Challenging the pressure on nhs resources: could 48-hour continuous subcutaneous infusions (CSCIS) help? a systematically-structured review of the current evidence base

2017 ◽  
Vol 7 (Suppl 1) ◽  
pp. A9.3-A10
Author(s):  
James Baker ◽  
Andrew Dickman ◽  
Stephen Mason ◽  
John Ellershaw ◽  
Paul Skipper ◽  
...  
Keyword(s):  
Evidence Base ◽  
Current Evidence ◽  
Current Evidence Base

scholarly journals Rates of violence in patients classified as high risk by structured risk assessment instruments

2014 ◽  
Vol 204 (3) ◽  
pp. 180-187 ◽  
Author(s):  
Jay P. Singh ◽  
Seena Fazel ◽  
Ralitza Gueorguieva ◽  
Alec Buchanan
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Groups ◽  
Evidence Base ◽  
Assessment Tools ◽  
Current Evidence ◽  
Assessment Instruments ◽  
Individual Liberty ◽  
Current Evidence Base ◽  
Study Heterogeneity

BackgroundRates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.AimsTo analyse the variation in rates of violence in individuals identified as high risk by SRAIs.MethodA systematic search of databases (1995–2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.ResultsInformation was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.ConclusionsAfter controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.

scholarly journals Toward the diagnosis of rare childhood genetic diseases: what do parents value most?

2021 ◽  
Author(s):  
Samantha Pollard ◽  
Deirdre Weymann ◽  
Jessica Dunne ◽  
Fatemeh Mayanloo ◽  
John Buckell ◽  
...  
Keyword(s):  
Focus Groups ◽  
Genetic Disease ◽  
Diagnostic Yield ◽  
Management Strategies ◽  
Health Benefit ◽  
Sampling Technique ◽  
Evidence Base ◽  
Current Evidence ◽  
Genomic Testing ◽  
Current Evidence Base

AbstractGenomic testing is becoming routine for diagnosing rare childhood genetic disease. Evidence underlying sustainable implementation is limited, focusing on short-term endpoints such as diagnostic yield, unable to fully characterize patient and family valued outcomes. Although genomic testing is becoming widely available, evidentiary and outcomes uncertainty persist as key challenges for implementation. We examine whether the current evidence base reflects public tolerance for uncertainty for genomics to diagnose rare childhood genetic disease. We conducted focus groups with general population parents in Vancouver, Canada, and Oxford, United Kingdom, to discuss expectations and concerns related to genomic testing to diagnose rare childhood genetic disease. Applying a purposive sampling technique, recruitment continued until thematic saturation was reached. Transcripts were analysed using thematic analysis. Thirty-three parents participated across four focus groups. Participants valued causal diagnoses alongside management strategies to improve patient health and wellbeing. Further, participants valued expanding the evidence base to reduce evidentiary uncertainty while ensuring security of information. Willingness to pay out of pocket for testing reflected perceived familial health benefit. Diagnostic yield fails to fully capture valued outcomes, and efforts to resolve uncertainty better reflect public priorities. Evaluations of genomic testing that fully integrate valued endpoints are necessary to ensure consistency with best practices and public willingness to accept the uncertain familial benefit.

scholarly journals SSRI use in pregnancy: Evaluating the risks and benefits

2015 ◽  
Vol 21 (2) ◽  
pp. 6
Author(s):  
Elsa Du Toit ◽  
Eileen Thomas ◽  
Liezl Koen ◽  
Bavi Vythilingum ◽  
Stoffel Grobler ◽  
...  
Keyword(s):  
Antidepressant Treatment ◽  
Severe Depression ◽  
Evidence Base ◽  
Current Evidence ◽  
Benefit Analysis ◽  
Medication Effects ◽  
Current Evidence Base ◽  
Pregnancy And Lactation ◽  
Potential Risks ◽  
Risk Benefit Analysis

<p>Selective serotonin reuptake inhibitor (SSRI) antidepressants are considered the primary pharmacological treatment for moderate to severe depression during pregnancy.<span><em> </em></span>Data regarding the safety of their use during pregnancy remain controversial and conflicting. Decisions regarding the prescription of antidepressant treatment are often fraught with concern around potential harmful medication effects on the pregnancy, fetus and infant. Information on potential risks remains extremely varied and inconsistent across sources. This lack of clarity regarding drug safety brings significant uncertainty not only for treating physicians, but also for women seeking information about depression during pregnancy. This review aims to summarise and evaluate the current evidence base and to aid clinicians in performing a risk/benefit analysis for SSRI use during pregnancy and lactation.</p><div> </div>

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