A pilot study of a computerized assessment (AGE-PC) for the elderly in general practice

A pilot project was undertaken in Liverpool UK, to investigatewhether data useful for both general practice and public healthpurposes could be collected by primary care personnel usinga computerized semi-structured interview (AGE-PC) for assessmentof patients aged 75 and over. A high degree of variation betweenpractices was found in the proportion of elderly assessed withAGE-PC largely related to motivation to undertake assessmentsand methods employed to approach patients. Considerable differencesbetween and within practices were evident in staff attitudesto the need for detailed formal assessments and the use of computers.Several aspects of the AGE-PC package itself were identifiedas requiring modification including streamlining data transfermethods, adding facilities for analysis and giving users a degreeof choice over content of the assessment. This technique doesoffer a potentially efficient means of collecting very detailedstandardized data for intra- or inter-practice analysis whileat the same time generating a comprehensive report for individualpatients. However, in the context of the over-75 assessmentsit was too time-consuming. Possible future strategies are discussedsuch as using an initial screening stage with a self-reportquestionnaire to reduce numbers needing full assessment andthe use of the package for the community care assessments. Thepilot project highlighted some of the potential advantages anddisadvantages of collecting data from primary health care forpublic health purposes. One of the most salient lessons learntwas the importance of involving the different team members inthe planning process so that there is agreement on: the essentialdata items required by both parties, the use of a uniform methodof approaching and sampling patients for assessments, the importanceof accuracy and obtaining a high response rate, and finallythat the whole procedure must be easy and not involve too muchtime or effort on the part of the overloaded primary care staff.     

The design of the Dutch EASYcare study: a randomised controlled trial on the effectiveness of a problem-based community intervention model for frail elderly people [NCT00105378]

Background  

Because of their complex clinical presentations and needs frail elderly people require another approach than people who age without many complications. Several inpatient geriatric health services have proven effectiveness in frail persons. However, the wish to live independently and policies that promote independent living as an answer to population aging call for community intervention models for frail elderly people. Maybe models such as preventive home visits, comprehensive geriatric assessment, and intermediate care qualify, but their efficacy is controversial, especially in frail elderly persons living in the community. With the Dutch EASYcare Study Geriatric Intervention Programme (DGIP) we developed a model to study effectiveness of problem based community intervention models in frail elderly people.     

Rational Prescribing in Primary Care (RaPP-trial). A randomised trial of a tailored intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs in general practice [ISRCTN48751230]

Background  

The underlying reasons for differences between clinical practice and systematically developed guidelines vary from one clinical problem to another. It is therefore logical to tailor strategies to support the implementation of guidelines to address identified barriers to change. The objective of this trial is to evaluate the effects of a tailored intervention to support the implementation of systematically developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease.     

Pharmaceutical care for elderly patients shared between community pharmacists and general practitioners: a randomised evaluation. RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) [ISRCTN16932128]

BACKGROUND: This trial aims to investigate the effectiveness and cost implications of 'pharmaceutical care' provided by community pharmacists to elderly patients in the community. As the UK government has proposed that by 2004 pharmaceutical care services should extend nationwide, this provides an opportunity to evaluate the effect of pharmaceutical care for the elderly. DESIGN: The trial design is a randomised multiple interrupted time series. We aim to recruit 700 patients from about 20 general practices, each associated with about three community pharmacies, from each of the five Primary Care Trusts in North and East Yorkshire. We shall randomise the five resulting groups of practices, pharmacies and patients to begin pharmaceutical care in five successive phases. All five will act as controls until they receive the intervention in a random sequence. Until they receive training community pharmacists will provide their usual dispensing services and so act as controls. The community pharmacists and general practitioners will receive training in pharmaceutical care for the elderly. Once trained, community pharmacists will meet recruited patients, either in their pharmacies (in a consultation room or dispensary to preserve confidentiality) or at home. They will identify drug-related issues/problems, and design a pharmaceutical care plan in conjunction with both the GP and the patient. They will implement, monitor, and update this plan monthly. The primary outcome measure is the 'Medication Appropriateness Index'. Secondary measures include adverse events, quality of life, and patient knowledge and compliance. We shall also investigate the cost of pharmaceutical care to the NHS, to patients and to society as a whole.     

The association between impetigo, insect bites and air temperature: a retrospective 5-year study (1999-2003) using morbidity data collected from a sentinel general practice network database

BACKGROUND: Impetigo is one of the commonest childhood skin infections. Insect bites are commonly implicated in the development of impetigo. There are, however, very few data available to describe the seasonal incidences and association between the two conditions. OBJECTIVES: To describe the seasonal incidence of impetigo in England and Wales and to investigate the reported association with insect bites. METHODS: Clinical diagnoses of impetigo and insect bites were recorded from a sentinel GP network over the years 1999-2003. RESULTS: The highest mean weekly rates of impetigo were in children aged 0-4 years (84 per 100 000) and in those aged 5-14 years (54 per 100 000). In contrast, the incidence of insect bite only varied between 3 and 5 per 100 000 for males and between 5 and 9 per 100 000 for females. The relative risk (RR) for females consulting over males with impetigo was similar in children [RR 0.99 (95% CI 0.96-1.02)] and adults [RR 1.20 (1.16-1.25)]; the RR of insect bite was similar in children [RR 1.21 (1.09-1.34)] but almost twice as likely in adults [RR 2.13 (2.02-2.25)]. Insect bite peaked almost coincidentally with temperature whereas there was a lag of one-to-two 4-week periods between impetigo and temperature. CONCLUSION: There is suggestion of some degree of association between impetigo and insect bites. The improved management of patients consulting with insect bites and better use of antiseptic treatments might provide the basis for reducing the incidence of impetigo in the community.     

A pilot intervention to reduce postpartum weight retention and central adiposity in first‐time mothers: results from the mums OnLiNE (Online,Lifestyle, Nutrition & Exercise) study

Background

Postpartum weight retention (PPWR ) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour.

Methods

A subsample of first‐time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n  =  28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n  =  48; n  =  43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self‐reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum.

Results

Mean PPWR decreased in the (I) group (?1.2 kg) and the C2 group (?1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (?6.4 cm) compared to C1 (?1.1 cm; P  =  0.002) and C2 (?3.3 cm; P  =  0.001). Changes in diet, physical activity or sedentary behaviour were not significant.

Conclusions

The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

     

The cytotoxic properties and preferential toxicity to tumour cells displayed by some 2,4-bis(benzylidene)-8-methyl-8-azabicyclo[3.2.1] octan-3-ones and 3,5-bis(benzylidene)-1-methyl-4-piperidones

This study demonstrated that replacement of the axial protons on the C2 and C6 atoms of various 1-methyl-3,5-bis(benzylidene)-4-piperidones 3 by a dimethylene bridge leading to series 2 lowered cytotoxic potencies. Four compounds 2a and 3a-c emerged as lead molecules based on their toxicity towards different neoplasms and their selective toxicity for malignant rather than normal cells. Some possible reasons for the disparity between the IC(50) values in the two series of compounds are presented based on molecular modeling, logP values and respiration in rat liver mitochondria.     

A primary health-care intervention on pre- and postnatal risk factor behavior to prevent childhood allergy. The Prevention of Allergy among Children in Trondheim (PACT) study

Background  

This study aimed to evaluate the impact of a primary prevention intervention program on risk behavior for allergic diseases among children up to 2 years of age. The setting was in ordinary pre- and postnatal primary health care in Trondheim, Norway.     

A randomised controlled trial to assess the efficacy of Laparoscopic Uterosacral Nerve Ablation (LUNA) in the treatment of chronic pelvic pain: The trial protocol [ISRCTN41196151]

Background  

Chronic pelvic pain is a common condition with a major impact on health-related quality of life, work productivity and health care utilisation. The cause of the pain is not always obvious as no pathology is seen in 40–60% of the cases. In the absence of pathology there is no established treatment. The Lee-Frankenhauser sensory nerve plexuses and parasympathetic ganglia in the uterosacral ligaments carry pain from the uterus, cervix and other pelvic structures. Interruption of these nerve trunks by laparoscopic uterosacral nerve ablation (LUNA) may alleviate pain. However, the balance of benefits and risks of this intervention have not been reliably assessed. LUNA has, nevertheless, been introduced into practice, although there remains controversy regarding indications for LUNA. Hence, there is an urgent need for a randomised controlled trial to confirm, or refute, any worthwhile effectiveness. The principal hypothesis is that, in women with chronic pelvic pain in whom diagnostic laparoscopy reveals either no pathology or mild endometriosis (AFS score ≤ 5) LUNA alleviates pain and improves life quality at 12 months.