• Patient and other factors influencing the prescribing of cardiovascular prevention therapy in the general practice setting with and without nurse assessment

      Mohammed, Mohammed A.; El Sayed, C.; Marshall, T. (2012)
      BACKGROUND: Although guidelines indicate when patients are eligible for antihypertensives and statins, little is known about whether general practitioners (GPs) follow this guidance. OBJECTIVE: To determine the factors influencing GPs decisions to prescribe cardiovascular prevention drugs. DESIGN OF STUDY: Secondary analysis of data collected on patients whose cardiovascular risk factors were measured as part of a controlled study comparing nurse-led risk assessment (four practices) with GP-led risk assessment (two practices). SETTING: Six general practices in the West Midlands, England. PATIENTS: Five hundred patients: 297 assessed by the project nurse, 203 assessed by their GP. MEASUREMENTS: Cardiovascular risk factor data and whether statins or antihypertensives were prescribed. Multivariable logistic regression models investigated the relationship between prescription of preventive treatments and cardiovascular risk factors. RESULTS: Among patients assessed by their GP, statin prescribing was significantly associated only with a total cholesterol concentration >/= 7 mmol/L and antihypertensive prescribing only with blood pressure >/= 160/100 mm Hg. Patients prescribed an antihypertensive by their GP were five times more likely to be prescribed a statin. Among patients assessed by the project nurse, statin prescribing was significantly associated with age, sex, and all major cardiovascular risk factors. Antihypertensive prescribing was associated with blood pressures >/= 140/90 mm Hg and with 10-year cardiovascular risk. LIMITATIONS: Generalizability is limited, as this is a small analysis in the context of a specific cardiovascular prevention program. CONCLUSIONS: GP prescribing of preventive treatments appears to be largely determined by elevation of a single risk factor. When patients were assessed by the project nurse, prescribing was much more consistent with established guidelines.
    • Perceptions of absolute versus relative differences between personal and comparison health risk

      Mason, Dan; Prevost, A.T.; Sutton, S. (2008)
      OBJECTIVE: To explain inconsistent results in previous attempts to determine whether, when presented with health risk information, people focus primarily on information about their own risk status or on a comparison with others. DESIGN: A randomized between-groups experiment in which participants were presented with hypothetical cardiac risk information. We examined whether affective responses were primarily sensitive to the relative difference between personal and comparison risk, rather than the absolute difference. MAIN OUTCOME MEASURES: Participants' negative affective response to the risk information. RESULTS: When relative differences were held constant, participants' responses were independently influenced by both personal risk and comparative standing, effects that were greatly attenuated when absolute differences were held constant. When maintaining constant absolute differences, personal and comparison risk information appeared to interact. CONCLUSION: Previous studies tended to maintain constant absolute risk differences and so may have underestimated the impact of personal risk information. Participants' responses were sensitive to the way the risk difference was constructed. Basing experimental design decisions on assumptions about the information participants will respond to can lead to misinterpretations of the basis of risk judgments.
    • Severe neonatal hypernatraemia: a population based study

      Oddie, S.J.; Craven, V.; Deakin, K.; Westman, J.; Scally, Andy J. (2013)
      AIMS: To describe incidence, presentation, treatment and short term outcomes of severe neonatal hypernatraemia (SNH, sodium >/=160 mmol/l). METHODS: Prospective, population based surveillance study over 13 months using the British Paediatric Surveillance Unit. Cases were >33 weeks gestation at birth, fed breast or formula milk and <28 days of age at presentation. RESULTS: Of 62 cases of SNH reported (7, 95% CI 5.4 to 9.0 per 1 00 000 live births), 61 mothers had intended to achieve exclusive breast feeding. Infants presented at median day 6 (range 2-17) with median weight loss of 19.5% (range 8.9-30.9). 12 had jaundice and 57 weight loss as a presenting feature. 58 presented with weight loss >/=15%. 25 babies had not stooled in the 24 h prior to admission. Serum sodium fell by median 12.9 mmol/l per 24 h (range 0-30). No baby died, had seizures or coma or was treated with dialysis or a central line. At discharge, babies had regained 11% of initial birth weight after a median admission of 5 (range 2-14) days. 10 were exclusively breast fed on discharge from hospital. CONCLUSIONS: Neonatal hypernatraemia at this level, in this population, is strongly associated with weight loss. It occurs almost exclusively after attempts to initiate breast feeding, occurs uncommonly and does not appear to be associated with serious short term morbidities, beyond admission to hospital.
    • The Enriched Opportunities Programme for people with dementia: a cluster-randomised controlled trial in 10 extra care housing schemes

      Brooker, Dawn J.R.; Argyle, Elaine; Scally, Andy J.; Clancy, David (2011)
      OBJECTIVES: The Enriched Opportunities Programme (EOP) is a multi-level intervention focussing on improved quality of life for people with dementia. This study compared the experience of people living with dementia and other mental health problems in extra care housing schemes that utilised EOP with schemes that employed an active control intervention. METHOD: Ten extra care housing schemes were cluster randomised to receive either the EOP intervention or an active control intervention for an 18-month period. Residents with dementia or other significant mental health problems (20-30 per scheme) were assessed on a number of outcome measures at baseline, six months, one year and 18 months. The primary outcome measure was quality of life. Self-reported depression was an important secondary outcome. RESULTS: The EOP-participating residents rated their quality of life more positively over time (4.0 (SE 0.6) units; 14% p < 0.001) than the active control (1.3 (SE 0.6) units; 4% p = 0.003). There was also a significant group-time interaction for depressive symptoms (p = 0.003). The EOP-participating residents reported a reduction of 25% at both six and 12 months and a 37% reduction at 18 months (all p's < 0.001). EOP residents were less likely than residents in the active control sites to move to a care home or to be admitted to a hospital inpatient bed. They were more likely to be seen by a range of community health professionals. CONCLUSION: The EOP had a positive impact on the quality of life of people with dementia in well-staffed extra care housing schemes.