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32 ["Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool"] 10.1136/bmjqs-2019-009587 http://dx.doi.org/10.1136/bmjqs-2019-009587 2019-09-16T21:15:37Z [] 94 2 ["2044-5415", "2044-5423"] BMJ Quality & Safety <jats:sec><jats:title>Objectives</jats:title><jats:p>To develop and validate a tool to predict the risk of an older adult experiencing medication-related harm (MRH) requiring healthcare use following hospital discharge.</jats:p></jats:sec><jats:sec><jats:title>Design, setting, participants</jats:title><jats:p>Multicentre, prospective cohort study recruiting older adults (≥65 years) discharged from five UK teaching hospitals between 2013 and 2015.</jats:p></jats:sec><jats:sec><jats:title>Primary outcome measure</jats:title><jats:p>Participants were followed up for 8 weeks in the community by senior pharmacists to identify MRH (adverse drug reactions, harm from non-adherence, harm from medication error). Three data sources provided MRH and healthcare use information: hospital readmissions, primary care use, participant telephone interview. Candidate variables for prognostic modelling were selected using two systematic reviews, the views of patients with MRH and an expert panel of clinicians. Multivariable logistic regression with backward elimination, based on the Akaike Information Criterion, was used to develop the PRIME tool. The tool was internally validated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>1116 out of 1280 recruited participants completed follow-up (87%). Uncertain MRH cases (‘possible’ and ‘probable’) were excluded, leaving a tool derivation cohort of 818. 119 (15%) participants experienced ‘definite’ MRH requiring healthcare use and 699 participants did not. Modelling resulted in a prediction tool with eight variables measured at hospital discharge: age, gender, antiplatelet drug, sodium level, antidiabetic drug, past adverse drug reaction, number of medicines, living alone. The tool’s discrimination C-statistic was 0.69 (0.66 after validation) and showed good calibration. Decision curve analysis demonstrated the potential value of the tool to guide clinical decision making compared with alternative approaches.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:ti… 10 ["http://orcid.org/0000-0002-9988-3717"] ["Nikesh Parekh", "Khalid Ali", "John Graham Davies", "Jennifer M Stevenson", "Winston Banya", "Stephen Nyangoma", "Rebekah Schiff", "Tischa van der Cammen", "Jatinder Harchowal", "Chakravarthi Rajkumar"] ["PB-PG-0711-25094"] ["National Institute for Health Research"] ["10.13039/501100000272"]
33 ["Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study"] 10.1136/heartjnl-2019-315307 http://dx.doi.org/10.1136/heartjnl-2019-315307 2019-10-10T21:25:20Z ["Cardiology and Cardiovascular Medicine"] 30 2 ["1355-6037", "1468-201X"] Heart <jats:sec><jats:title>Background</jats:title><jats:p>Despite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (EHRs).</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In UK primary care EHR (The Health Information Network 2011–2016), we investigated adherence and persistence at 1 year for oral anticoagulants (OACs) in adults with incident AF. Baseline characteristics were analysed by OAC and adherence/persistence status. Risk factors for non-adherence and non-persistence were assessed using Cox and logistic regression. Patterns of adherence and persistence were analysed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 36 652 individuals with incident AF, cardiovascular comorbidities (median CHA<jats:sub>2</jats:sub>DS<jats:sub>2</jats:sub>VASc[Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category] 3) and polypharmacy (median number of drugs 6) were common. Adherence was 55.2% (95% CI 54.6 to 55.7), 51.2% (95% CI 50.6 to 51.8), 66.5% (95% CI 63.7 to 69.2), 63.1% (95% CI 61.8 to 64.4) and 64.7% (95% CI 63.2 to 66.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. One-year persistence was 65.9% (95% CI 65.4 to 66.5), 63.4% (95% CI 62.8 to 64.0), 61.4% (95% CI 58.3 to 64.2), 72.3% (95% CI 70.9 to 73.7) and 78.7% (95% CI 77.1 to 80.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. Risk of non-adherence and non-persistence increased over time at individual and system levels. Increasing comorbidity was associated with reduced risk of non-adherence a… 11 ["http://orcid.org/0000-0001-8741-3411"] ["Amitava Banerjee", "Valerio Benedetto", "Philip Gichuru", "Jane Burnell", "Sotiris Antoniou", "Richard J Schilling", "William David Strain", "Ronan Ryan", "Caroline Watkins", "Tom Marshall", "Chris J Sutton"] ["(FP/2007-2013)/ERC Grant Agreement no. 339239."] ["FP7 Ideas: European Research Council"] ["10.13039/100011199"]
34 ["Pneumothorax after acupuncture"] 10.1136/bcr-2018-228770 http://dx.doi.org/10.1136/bcr-2018-228770 2019-06-12T11:35:13Z [] 16 2 ["1757-790X"] BMJ Case Reports <jats:p>Acupuncture is a well-known form of complementary medicine that is increasingly being used worldwide. Despite being rare, pneumothorax is the most common serious complication described in acupuncture. A 79-year-old woman was admitted to the emergency department with a pneumothorax. Two days before, she had undergone an acupuncture treatment for chronic back pain. She felt a sharp right shoulder pain as needles were inserted in the interscapular area. As the pain did not resolve, she consulted her general practitioner and had a chest radiography done, revealing a right-sided pneumothorax. At the hospital, a right chest tube was inserted with relief of the symptoms and lung expansion. The chest tube was removed on the second day of admission, and she was discharged on the third day. Both acupuncturists and clinicians need to be aware of the possibility of adverse events following acupuncture, especially in those who develop symptoms.</jats:p> 4 ["http://orcid.org/0000-0003-3408-0515"] ["Sofia Costa Corado", "Margarida Gra\u00e7a Santos", "Lu\u00edsa Quaresma", "Jos\u00e9 Rodrigues Baltazar"] [""] [""] [""]
35 ["Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis"] 10.1136/gutjnl-2020-321191 http://dx.doi.org/10.1136/gutjnl-2020-321191 2020-04-10T21:25:23Z ["Gastroenterology"] 0 2 ["0017-5749", "1468-3288"] Gut <jats:sec><jats:title>Objectives</jats:title><jats:p>National guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We performed a systematic review and network meta-analysis to try to resolve this uncertainty.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>We searched the medical literature through January 2020 for randomised controlled trials (RCTs) assessing efficacy of psychological therapies for adults with IBS, compared with each other, or a control intervention. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic, with a 95% CI to summarise efficacy of each comparison tested, and ranked by therapy according to P score.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We identified 41 eligible RCTs, containing 4072 participants. After completion of therapy, the psychological interventions with the largest numbers of trials, and patients recruited, demonstrating efficacy included self-administered or minimal contact cognitive behavioural therapy (CBT) (RR 0.61; 95% CI 0.45 to 0.83, P score 0.66), face-to-face CBT (RR 0.62; 95% CI 0.48 to 0.80, P score 0.65) and gut-directed hypnotherapy (RR 0.67; 95% CI 0.49 to 0.91, P score 0.57). After completion of therapy, among trials recruiting only patients with refractory symptoms, group CBT and gut-directed hypnotherapy were more efficacious than either education and/or support or routine care, and CBT via the telephone, contingency management, CBT via the internet and dynamic psychotherapy were all superior to routine care. Risk of bias of trials was high, with evidence of funnel plot asymmetry; the efficacy of psychological therapies is therefore likely to have been overestimated.</jats:p></jats:sec><jats:sec><… 6 ["http://orcid.org/0000-0003-4151-7180", "http://orcid.org/0000-0001-6371-4359"] ["Christopher J Black", "Elyse R Thakur", "Lesley A Houghton", "Eamonn M M Quigley", "Paul Moayyedi", "Alexander C Ford"] [""] [""] [""]
36 ["THE TOS2 STUDY: AN INTERNATIONAL MULTI-CENTRE AUDIT ASSESSING THE STANDARD OF NEUROLOGICAL EXAMINATION"] 10.1136/jnnp-2015-312379.1 http://dx.doi.org/10.1136/jnnp-2015-312379.1 2015-10-14T18:12:15Z [] 0 2 ["0022-3050", "1468-330X"] Journal of Neurology, Neurosurgery & Psychiatry <jats:p>Having previously demonstrated that in-patients referred to neurology at two UK hospitals were not fully examined prior to referral, we designed an audit with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention.</jats:p><jats:p>In-patients referred to neurology over a 4 month period in the UK, Jordan, Sweden and the United Arab Emirates were asked whether they recalled examination with a Tendon hammer, Ophthalmoscope and Stethoscope since admission. Results were disseminated to local medical teams and data were collected for a further 4 months. Pre and post-intervention data were available for 11 centres with 407 and 391 patients in each arm. 264 patients (64.86%) recalled examination with a tendon hammer pre-intervention, which significantly improved to 298 (76.21%) (p&lt;0.001). 119 (29.24%) recollected ophthalmoscopy pre-intervention, which significantly improved to 149 (38.11%) (p=0.009). 321 (78.87%) recalled examination with a stethoscope pre-intervention, which significantly improved to 330 (84.4%) (p=0.045). Most patients were not fully examined prior to neurology referral, yet a simple assessment score and educational intervention can improve the standard of neurological examination. This is the largest and – to our knowledge – only study to assess the standard of neurological examination internationally. This has implications for national neurological educators.</jats:p> 10 [] ["JP Appleton", "A Ilinca", "AG Lindgren", "A Puschmann", "M Habahbeh", "K Siddiqui", "R DeSilva", "M Jones", "R Butterworth", "DJ Nicholl"] [""] [""] [""]
37 ["Palliative care research centre's move into social media: constructing a framework for ethical research, a consensus paper"] 10.1136/bmjspcare-2015-000889 http://dx.doi.org/10.1136/bmjspcare-2015-000889 2016-01-29T03:54:13Z ["Medicine (miscellaneous)", "Oncology(nursing)", "Medical\u2013Surgical", "General Medicine"] 13 2 ["2045-435X", "2045-4368"] BMJ Supportive & Palliative Care <jats:sec><jats:title>Background</jats:title><jats:p>Social media (SM) have altered the way we live and, for many, the way we die. The information available on even the rarest conditions is vast. Free from restrictions of mobility, time and distance, SM provides a space for people to share experiences of illness, death and dying, and potentially benefit from the emotional and practical support of others n similar positions. The communications that take place in these spaces also create large amounts of ‘data’ which, for any research centre, cannot be ignored. However, for a palliative care research centre the use of this ‘data’ comes with specific ethical dilemmas.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This paper details the process that we, as a research, went through in constructing a set of ethical guidelines by which to work. This involved conducting two consensus days; one with researchers from within the centre, and one with the inclusion of external researchers with a specific interest in SM.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The primary themes that emerged from the consensus meetings includes; SM as a public or private space; the status of open and closed groups; the use of historical data; recruiting participants and obtaining informed consent and problems of anonymity associated with dissemination.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These are the themes that this paper will focus on prior to setting out the guidelines that we subsequently constructed.</jats:p></jats:sec> 12 [] ["Noreen Hopewell-Kelly", "Jessica Baillie", "Stephanie Sivell", "Emily Harrop", "Anna Bowyer", "Sophia Taylor", "Kristen Thomas", "Alisha Newman", "Hayley Prout", "Anthony Byrne", "Mark Taubert", "Annmarie Nelson"] [""] [""] [""]

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