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المؤلفون: George Stoye, Alex Bottle, Carol Propper, Samantha Burn, Max Warner, Paul Aylin
المصدر: BMJ Quality & Safety
مصطلحات موضوعية: Inequality, IMPACT, media_common.quotation_subject, 1302 Curriculum and Pedagogy, Ethnic group, UNITED-STATES, State Medicine, 1117 Public Health and Health Services, Pandemic, Ethnicity, Humans, Medicine, Policy Making, Pandemics, Socioeconomic status, Minority Groups, Health policy, Original Research, media_common, Science & Technology, business.industry, Health Policy, Health services research, COVID-19, 1103 Clinical Sciences, Census, health services research, Hospitals, Health Care Sciences & Services, Socioeconomic Factors, Health Policy & Services, Observational study, business, Life Sciences & Biomedicine, Demography
الوصف: IntroductionHospital admissions in many countries fell dramatically at the onset of the COVID-19 pandemic. Less is known about how care patterns differed by patient groups. We sought to determine whether areas with higher levels of socioeconomic deprivation or larger ethnic minority populations saw larger falls in emergency and planned admissions in England.MethodsWe conducted a national observational study of hospital care in the English National Health Service (NHS) in 2019–2020. Weekly volumes of elective (planned) and emergency admissions in 2020 compared with 2019 were calculated for each census area. Multiple linear regression analysis was used to estimate the reductions in volumes for areas in different quintiles of socioeconomic deprivation and ethnic minority populations after controlling for national time trends and local area composition.ResultsBetween March and December 2020, there were 35.5% (3.0 million) fewer elective admissions and 22.0% (1.2 million) fewer emergency admissions with a non-COVID-19 primary diagnosis than in 2019. Areas with the largest share of ethnic minority populations experienced a 36.7% (95% CI 24.1% to 49.3%) larger reduction in non-primary COVID-19 emergency admissions compared with those with the smallest. The most deprived areas experienced a 10.1% (95% CI 2.6% to 17.7%) smaller reduction in non-COVID-19 emergency admissions compared with the least deprived. These patterns are not explained by differential prevalence of COVID-19 cases by area.ConclusionsEven in a healthcare system founded on the principle of equal access for equal need, the impact of COVID-19 on NHS hospital care for non-COVID patients has not been spread evenly by ethnicity and deprivation in England. While we cannot conclusively determine the mechanisms behind these differences, they risk exacerbating prepandemic health inequalities.
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المؤلفون: Charles Coughlan, Behrouz Nezafat Maldonado, Mitch Blair, Alex Bottle, Dougal S Hargreaves, Francesca K Neale, Sonia Saxena, Judith Ruzangi
المساهمون: NIHR, Research Trainees Coordinating Centre, National Institute of Health and Medical Research
المصدر: Archives of Disease in Childhood
مصطلحات موضوعية: General Practice, Ethnic group, Pediatrics, State Medicine, Cohort Studies, 0302 clinical medicine, DISPARITIES, ADOLESCENTS, Epidemiology, Ethnicity, 030212 general & internal medicine, Child, Referral and Consultation, Original Research, education.field_of_study, 030503 health policy & services, Attendance, Health services research, health services research, Hospitalization, England, Child, Preschool, Cohort, INEQUALITIES, epidemiology, Emergency Service, Hospital, 0305 other medical science, Life Sciences & Biomedicine, medicine.medical_specialty, Adolescent, Population, Black People, CULTURAL COMPETENCE, 1117 Public Health and Health Services, 03 medical and health sciences, Asian People, medicine, Humans, Healthcare Disparities, education, Retrospective Studies, Science & Technology, business.industry, Racial Groups, Infant, Newborn, Infant, 1103 Clinical Sciences, Retrospective cohort study, Health Status Disparities, Emergency department, Patient Acceptance of Health Care, Socioeconomic Factors, Pediatrics, Perinatology and Child Health, 1114 Paediatrics and Reproductive Medicine, business, Demography
الوصف: Objective To describe social and ethnic group differences in children’s use of healthcare services in England, from 2007 to 2017. Design Population-based retrospective cohort study. Setting/Patients We performed individual-level linkage of electronic health records from general practices and hospitals in England by creating an open cohort linking data from the Clinical Practice Research Datalink and Hospital Episode Statistics. 1 484 455 children aged 0–14 years were assigned to five composite ethnic groups and five ordered groups based on postcode mapped to index of multiple deprivation. Main outcome measures Age-standardised annual general practitioner (GP) consultation, outpatient attendance, emergency department (ED) visit and emergency and elective hospital admission rates per 1000 child-years. Results In 2016/2017, children from the most deprived group had fewer GP consultations (1765 vs 1854 per 1000 child-years) and outpatient attendances than children in the least deprived group (705 vs 741 per 1000 child-years). At the end of the study period, children from the most deprived group had more ED visits (447 vs 314 per 1000 child-years) and emergency admissions (100 vs 76 per 1000 child-years) than children from the least deprived group. In 2016/2017, children from black and Asian ethnic groups had more GP consultations than children from white ethnic groups (1961 and 2397 vs 1824 per 1000 child-years, respectively). However, outpatient attendances were lower in children from black ethnic groups than in children from white ethnic groups (732 vs 809 per 1000 child-years). By 2016/2017, there were no differences in outpatient, ED and in-patient activity between children from white and Asian ethnic groups. Conclusions Between 2007 and 2017, children living in more deprived areas of England made greater use of emergency services and received less scheduled care than children from affluent neighbourhoods. Children from Asian and black ethnic groups continued to consult GPs more frequently than children from white ethnic groups, though black children had significantly lower outpatient attendance rates than white children across the study period. Our findings suggest substantial levels of unmet need among children living in socioeconomically disadvantaged areas. Further work is needed to determine if healthcare utilisation among children from Asian and black ethnic groups is proportionate to need.
Population-based retrospective cohort study using individual linked data from 2007 to 2017 show social and ethnic group differences in children’s use of healthcare services in England, with deprivation associated with higher emergency and lower scheduled care use. -
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المؤلفون: Puji Faitna, Paul Aylin, Martin R. Cowie, Alex Bottle
المساهمون: National Institute for Health Research, Telstra Health UK
المصدر: ESC Heart Failure, Vol 8, Iss 4, Pp 2438-2447 (2021)
ESC Heart Failureمصطلحات موضوعية: Implantable cardioverter‐defibrillator (ICD), Cardiac resynchronization therapy (CRT), Cardiac & Cardiovascular Systems, medicine.medical_treatment, 030204 cardiovascular system & hematology, law.invention, Cardiac Resynchronization Therapy, 0302 clinical medicine, Randomized controlled trial, law, Original Research Articles, Atrial Fibrillation, Original Research Article, 030212 general & internal medicine, 1102 Cardiorespiratory Medicine and Haematology, CARDIAC-RESYNCHRONIZATION THERAPY, Real‐world data, Atrial fibrillation, Hospitals, Defibrillators, Implantable, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, Real world data, medicine.medical_specialty, Administrative data, Cardiac resynchronization therapy, Implantable cardioverter-defibrillator (ICD), Heart failure, HEART-FAILURE INCIDENCE, 03 medical and health sciences, LEFT-VENTRICULAR DYSFUNCTION, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Dementia, DEFIBRILLATOR IMPLANTATION, Survival rate, Science & Technology, business.industry, MORTALITY, Emergency department, medicine.disease, TRENDS, Real-world data, Cardiac implantable electronic devices, RC666-701, Emergency medicine, Cardiovascular System & Cardiology, business
الوصف: Aims Guidelines recommend the use of an implantable cardioverter‐defibrillator (ICD) and/or cardiac resynchronization therapy (CRT) device based on the results of randomized controlled trials (RCTs), typically with selected patients and short follow‐up. Methods and results We describe the 5 year survival rate and use of hospital services following ICD and CRT implantation in England from April 2011 to March 2013 using the national hospital administrative database covering emergency department visits, inpatient admissions, and clinic appointments, linked to the national death register. Five‐year survival was 64% after ICD implantation and 58% after CRT implantation, with median survival times of 6.8 and 6.2 years, respectively. Hospital use was high in both device groups, for the 5 years prior and after implantation, peaking around the implantation date. Most hospital activity was not primarily related to heart failure. Healthcare costs were dominated by admissions, but emergency department and clinic activity were both high. Only the CRT group saw total per‐patient costs fall after the index month (implantation), driven by a slight fall in the heart failure admission rate. Patients were typically older than in the trials, but with similar co‐morbidity except for substantially more atrial fibrillation and less dementia. Survival and device complications were similar to the RCTs. Conclusions Clinical and cost‐effectiveness assessments of ICD and CRT implantation are supported by real‐world data, although the prevalence of atrial fibrillation remains substantially higher than in the RCTs.
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المؤلفون: Paul Aylin, Henry Wynn-Jones, R. Griffiths, Emyr A. Chowdhury, Helen Wilson, Iain K. Moppett, Alex Bottle, Stuart M. White, Benjamin Davies
المساهمون: Dr Foster Ltd, National Institute for Health Research, Bottle, Alex [0000-0001-9978-2011], Moppett, Iain [0000-0003-3750-6067], Davies, Benjamin M [0000-0002-4878-0697], Apollo - University of Cambridge Repository
المصدر: BMJ Open, Vol 10, Iss 12 (2020)
BMJ Openمصطلحات موضوعية: Reoperation, medicine.medical_specialty, IMPACT, Arthroplasty, Replacement, Hip, Periprosthetic, adult orthopaedics, Logistic regression, 1117 Public Health and Health Services, symbols.namesake, Medicine, General & Internal, General & Internal Medicine, Bone plate, Epidemiology, Medicine, Humans, Poisson regression, Epidemics, Aged, Geriatrics, Aged, 80 and over, Science & Technology, HIP-FRACTURES, business.industry, geriatric medicine, Mortality rate, 1103 Clinical Sciences, General Medicine, England, Emergency medicine, symbols, Observational study, Surgery, epidemiology, Periprosthetic Fractures, business, Life Sciences & Biomedicine, Femoral Fractures, 1199 Other Medical and Health Sciences
الوصف: ObjectivesPeriprosthetic fractures have considerable clinical implications for patients and financial implications for healthcare systems. This study aims to determine the burden of periprosthetic fractures of the lower and upper limbs in England and identify any factors associated with differences in treatment and outcome.DesignA national, observational study.SettingEngland.ParticipantsAll individuals admitted to hospital with periprosthetic fractures between 1 April 2015 and 31 December 2018.Primary and secondary outcome measuresMortality, length of stay, change in rate of admissions.MethodsWe analysed Hospital Episode Statistics data using the International Classification of Diseases 10th Revision code M96.6 (Fracture of bone following insertion of orthopaedic implant, joint prosthesis, or bone plate) to identify periprosthetic fractures recorded between April 2013 and December 2018. We determined the demographics, procedures performed, mortality rates and discharge destinations. Patient characteristics associated with having a procedure during the index admission were estimated using logistic regression. The annual rate of increase in admissions was estimated using Poisson regression.ResultsBetween 1 April 2015 and 31 December 2018, there were 13 565 patients who had 18 888 admissions (89.5% emergency) with M96.6 in the primary diagnosis field. There was a 13% year-on-year increase in admissions for periprosthetic fracture in England during that period. Older people, people living in deprived areas and those with heart failure or neurological disorders were less likely to receive an operation. 14.4% of patients did not return home after hospital discharge. The overall inpatient mortality was 4.3% and total 30-day mortality was 3.3%.ConclusionsThe clinical and operational burden of periprosthetic fractures is considerable and increasing rapidly. We suggest that the management of people with periprosthetic fractures should be undertaken and funded in a similar manner to that successfully employed for people sustaining hip fractures, using national standards and data collection to monitor and improve performance.
وصف الملف: application/vnd.openxmlformats-officedocument.wordprocessingml.document; application/pdf; text/xml
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المؤلفون: Foley, Kimberley A, Venkatraman, Tishya, Ram, Bina, Ells, Louisa, Van Sluijs, Esther, Hargreaves, Dougal S, Greaves, Felix, Taghavi Azar Sharabiani, Mansour, Viner, Russell M, Bottle, Alex, Saxena, Sonia
المساهمون: Foley, Kimberley A [0000-0003-3664-8100], Venkatraman, Tishya [0000-0001-6171-2384], Ram, Bina [0000-0003-0023-1573], Ells, Louisa [0000-0003-0559-4832], van Sluijs, Esther [0000-0001-9141-9082], Hargreaves, Dougal S [0000-0003-0722-9847], Greaves, Felix [0000-0001-9393-3122], Taghavi Azar Sharabiani, Mansour [0000-0003-3808-277X], Viner, Russell M [0000-0003-3047-2247], Bottle, Alex [0000-0001-9978-2011], Saxena, Sonia [0000-0003-3787-2083], Apollo - University of Cambridge Repository, NIHR, National Institute for Health Research, The Daily Mile Foundation
المصدر: BMJ Open
مصطلحات موضوعية: medicine.medical_specialty, Consensus, Consensus Development Conferences as Topic, education, Psychological intervention, Delphi method, Outcome (game theory), 1117 Public Health and Health Services, Likert scale, primary schools, 03 medical and health sciences, Medicine, General & Internal, 0302 clinical medicine, consensus methods, Stakeholder Participation, General & Internal Medicine, Intervention (counseling), Surveys and Questionnaires, ADOLESCENTS, Protocol, Medicine, Humans, 030212 general & internal medicine, Exercise, School Health Services, Protocol (science), Medical education, Science & Technology, Physical Education and Training, Schools, business.industry, 4. Education, Public health, Stakeholder, 1103 Clinical Sciences, General Medicine, 3. Good health, core outcomes set, Research Design, Public Health, delphi technique, business, Life Sciences & Biomedicine, physical activity interventions, 030217 neurology & neurosurgery, 1199 Other Medical and Health Sciences
الوصف: IntroductionPrimary school-based physical activity interventions, such as The Daily Mile initiative, have the potential to increase children’s physical activity levels over time, which is associated with a variety of health benefits. Comparing interventions or combining results of several studies of a single intervention is challenging because previous studies have examined different outcomes or used different measures that are not feasible or relevant for researchers in school settings. The development and implementation of a core outcome set (COS) for primary school-based physical activity interventions would ensure outcomes important to those involved in implementing and evaluating interventions are standardised.Methods and analysisOur aim is to develop a COS for studies of school-based physical activity interventions. We will achieve this by undertaking a four-stage process:(1) identify a list of outcomes assessed in studies through a systematic review of international literature; (2) establish domains from these outcomes to produce questionnaire items; (3) prioritise outcomes through a two-stage Delphi survey with four key stakeholder groups (researchers, public health professionals, educators and parents), where stakeholders rate the importance of each outcome on a 9-point Likert scale (consensus that the outcomes should be included in the COS will be determined as 70% or more of all stakeholders scoring the outcome 7%–9% and 15% or less scoring 1 to 3); (4) achieve consensus on a final COS in face-to-face meetings with a sample of stakeholders and primary school children.Ethics and disseminationWe have received ethical approval from Imperial College London (ref: 19IC5428). The results of this study will be disseminated via conference presentations/public health meetings, peer-reviewed publications and through appropriate media channels.Trial registration numberCore Outcome Measures in Effectiveness Trials Initiative (COMET) number: 1322.
وصف الملف: application/vnd.openxmlformats-officedocument.wordprocessingml.document; application/pdf; text/xml
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::177ec40bf2e6c62ca1aac99c67d5922b
https://www.repository.cam.ac.uk/handle/1810/299635 -
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المؤلفون: Y. Wang, Stefano Giuliani, Paul Aylin, Alex Bottle, Kate Honeyford
المساهمون: Dr Foster Intelligence, National Institute for Health Research
المصدر: BJS Open, Vol 3, Iss 3, Pp 305-313 (2019)
BJS Openمصطلحات موضوعية: medicine.medical_specialty, Pediatrics, SURGERY, Birth weight, lcsh:Surgery, INFANTS, DISEASE, Pediatric surgery, Epidemiology, medicine, EPIDEMIOLOGY, PREDICTORS, Science & Technology, business.industry, MORTALITY, Mortality rate, Incidence (epidemiology), Gestational age, Congenital diaphragmatic hernia, General Medicine, Original Articles, lcsh:RD1-811, medicine.disease, RISK-FACTORS, EXPERIENCE, Original Article, CASE VOLUME, Live birth, business, Life Sciences & Biomedicine
الوصف: Background Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and long‐term morbidity. The aim of this study was to benchmark trends in 1‐year and hospital volume outcomes for this condition. Methods This study included all infants born with CDH in England between 2003 and 2016. This was a retrospective analysis of the Hospital Episode Statistics database. The main outcomes were: 1‐year mortality, neonatal length of hospital stay (nLOS), total bed‐days at 1 year and readmission rate. The association between hospital volume and outcomes was assessed for specialist paediatric surgery centres. Results A total of 2336 infants were included (incidence 2·5 per 10 000 live births). No significant time trends were found in incidence and main outcomes. Some 1491 infants (63·8 per cent) underwent surgical repair. The 1‐year mortality rate was 31·2 per cent. Median nLOS and total bed‐days were 17 and 19 days respectively. The readmission rate in specialist paediatric centres was 6·3 per cent. Higher mortality was associated with birthweight lower than 1 kg (OR 5·90, 95 per cent c.i. 1·03 to 33·75), gestational age of 36 weeks or less (OR 1·75, 1·12 to 2·75) and black ethnicity (OR 2·13, 1·03 to 4·48). Only 4·0 per cent had extracorporeal membrane oxygenation, which was associated with higher mortality (OR 5·34, 3·01 to 9·46), longer nLOS (OR 3·70, 2·14 to 6·14) and longer total bed‐days (OR 3·87, 2·19 to 6·83). Specialist paediatric centres showed variation in 30‐day mortality (4·6 per cent with 84 per cent coefficient of variation), nLOS (median 25 (i.q.r. 15–42) days) and total bed‐days (median 28 (i.q.r. 16–51) days), but no significant volume–outcome relationship. Conclusion Key outcomes for CDH were similar to those of other developed countries. High variation among specialist paediatric centres was found and should be investigated further to explore the value of regionalization of care.
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المؤلفون: Azeem Majeed, Martin R. Cowie, Benedict Hayhoe, Dani Kim, Andrew Clegg, Paul Aylin, Alex Bottle
المساهمون: National Institute for Health Research, Dr Foster Intelligence
المصدر: Age and Ageing. 48:347-354
مصطلحات موضوعية: Male, Aging, Geriatrics & Gerontology, Time Factors, Comorbidity, older people, READMISSION, 0302 clinical medicine, Risk Factors, Medicine, 030212 general & internal medicine, RISK, Aged, 80 and over, Geriatrics, Age Factors, General Medicine, Middle Aged, Hospitalization, Creatinine, Female, Co morbidity, Life Sciences & Biomedicine, CLINICAL-TRIALS, Adult, medicine.medical_specialty, Frail Elderly, MODELS, frailty, Primary care, Population based, VALIDATION, 1117 Public Health and Health Services, 03 medical and health sciences, Humans, CPRD, Aged, Heart Failure, Science & Technology, Primary Health Care, business.industry, MORTALITY, emergency hospitalisation, 1103 Clinical Sciences, medicine.disease, Clinical trial, 1701 Psychology, Heart failure, Emergency medicine, Observational study, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery
الوصف: Background: frailty has only recently been recognised as important in patients with heart failure (HF), but little has been done to predict the first hospitalisation after diagnosis in unselected primary care populations. Objectives: to predict the first unplanned HF or all-cause admission after diagnosis, comparing the effects of comorbidity and frailty, the latter measured by the recently validated electronic frailty index (eFI). Design: observational study. Setting: primary care in England. Subjects: all adult patients diagnosed with HF in primary care between 2010 and 2013. Methods: we used electronic health records of patients registered with primary care practices sending records to the Clinical Practice Research Datalink (CPRD) in England with linkage to national hospital admissions and death data. Competing-risk time-to-event analyses identified predictors of first unplanned hospitalisation for HF or for any condition after diagnosis. Results: of 6,360 patients, 9% had an emergency hospitalisation for their HF, and 39% had one for any cause within a year of diagnosis; 578 (9.1%) died within a year without having any emergency admission. The main predictors of HF admission were older age, elevated serum creatinine and not being on a beta-blocker. The main predictors of all-cause admission were age, comorbidity, frailty, prior admission, not being on a beta-blocker, low haematocrit and living alone. Frailty effects were largest in patients aged under 85. Conclusions: this study suggests that frailty has predictive power beyond its comorbidity components. HF patients in the community should be assessed for frailty, which should be reflected in future HF guidelines.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::87dfdea86b9aff7477ab94756c83c1f0
https://doi.org/10.1093/ageing/afy194 -
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المؤلفون: Martin R. Cowie, Alex Bottle, Benedict Hayhoe, Dani Kim, Paul Aylin
المساهمون: Dr Foster Ltd, National Institute for Health Research, Guys & St Thomas NHS Foundation Trust
المصدر: Br J Gen Pract
e572
e563مصطلحات موضوعية: Adult, medicine.medical_specialty, Cross-sectional study, outpatient services, medicine.medical_treatment, secondary care, 030204 cardiovascular system & hematology, PROFILE, 1117 Public Health and Health Services, primary care, 03 medical and health sciences, Health services, Appointments and Schedules, Medicine, General & Internal, 0302 clinical medicine, General & Internal Medicine, London, medicine, Humans, USAGE, 030212 general & internal medicine, Service (business), Heart Failure, Science & Technology, Rehabilitation, Primary Health Care, business.industry, Research, CARE, Patient Acceptance of Health Care, medicine.disease, Mental health, Cross-Sectional Studies, Mental Health, CLINICAL-PRACTICE, North west, Family medicine, Heart failure, Community setting, Female, Public Health, Family Practice, business, Life Sciences & Biomedicine, cluster analysis
الوصف: BackgroundThe complex nature of heart failure (HF) management, often involving multidimensional care, is widely recognised, but overall health service utilisation by patients with HF has not previously been described.AimTo describe overall health service use by adults with HF living in a community setting.Design and settingCross-sectional analysis of prevalent HF cases from January 2015 to December 2018 using an administrative dataset covering primary and secondary care, and ‘other’ (community, mental health, social care) services in North West London.MethodHealthcare use of each service was described overall and by individual components of secondary care (such as, outpatient appointments), and ‘other’ services (such as, nursing contacts). Usage patterns were identified using k-means cluster analysis, using all distinct contacts for the whole study period, and visualised with a heatmap.ResultsA total of 39 301 patients with a prevalent diagnosis of HF between 1 January 2015 and 31 December 2018 were found. Of those, approximately 90% used health services during the study period, most commonly outpatient services, GP consultations, unplanned accident and emergency visits, and community services. Use of cardiology-specific services ranged from around 3% (cardiology-related community care) to around 20% (outpatient cardiology visits). GP consultations decreased by 11% over the study period. Five clusters of patients were identified, each with statistically significantly different care usage patterns and patient characteristics.ConclusionPatients with HF make heavy but heterogeneous use of services. Relatively low and falling use of GP consultations, and the apparently low uptake of community rehabilitation services by patients with HF, is concerning and suggests challenges in primary care access and integration of care.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::adf29903876b8f3e0f9ade4908e1731c
https://pubmed.ncbi.nlm.nih.gov/32540872 -
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المؤلفون: C Alexakis, Azeem Majeed, Richard Pollok, Alex Bottle, Sonia Saxena, Elizabeth Cecil, Jonathan Blackwell
مصطلحات موضوعية: Male, SURGERY, medicine.medical_treatment, THIOPURINE TREATMENT, Inflammatory bowel disease, 0302 clinical medicine, Adrenal Cortex Hormones, Risk Factors, Pharmacology (medical), Pharmacology & Pharmacy, 030212 general & internal medicine, Young adult, Colectomy, RISK, Thiopurine methyltransferase, biology, Smoking, Gastroenterology, Middle Aged, Prognosis, Ulcerative colitis, CROHNS-DISEASE, PREVALENCE, 3. Good health, Hospitalization, Treatment Outcome, behavior and behavior mechanisms, Disease Progression, Female, 030211 gastroenterology & hepatology, 1115 Pharmacology and Pharmaceutical Sciences, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Adolescent, DIAGNOSIS, Young Adult, 03 medical and health sciences, Internal medicine, medicine, Humans, METAANALYSIS, Aged, Retrospective Studies, Science & Technology, Gastroenterology & Hepatology, Hepatology, business.industry, 1103 Clinical Sciences, Retrospective cohort study, NATURAL-HISTORY, medicine.disease, United Kingdom, Clinical research, biology.protein, Smoking cessation, Colitis, Ulcerative, Smoking Cessation, business, INFLAMMATORY-BOWEL-DISEASE
الوصف: Background Smokers are less likely to develop ulcerative colitis (UC) but the impact of smoking and subsequent cessation on clinical outcomes in UC is unclear. Aim To evaluate the effect of smoking status and smoking cessation on disease outcomes. Methods Using a nationally representative clinical research database, we identified incident cases of UC during 2005-2016. Patients were grouped as never-smokers, ex-smokers and smokers based on smoking status recorded in the 2 years preceding UC diagnosis. We defined subgroups of persistent smokers and smokers who quit within 2 years after diagnosis. We compared the rates of overall corticosteroid use, corticosteroid-requiring flares, corticosteroid dependency, thiopurine use, hospitalisation and colectomy between these groups. Results We identified 6754 patients with a new diagnosis of UC over the study period with data on smoking status, of whom 878 were smokers at diagnosis. Smokers had a similar risk of corticosteroid-requiring flares (OR 1.16, 95% CI 0.92-1.25), thiopurine use (HR 0.84, 95% CI 0.62-1.14), corticosteroid dependency (HR 0.85, 95% CI 0.60-1.11), hospitalisation (HR 0.92, 95% CI 0.72-1.18) and colectomy (HR 0.78, 95% CI 0.50-1.21) in comparison with never-smokers. Rates of flares, thiopurine use, corticosteroid dependency, hospitalisation and colectomy were not significantly different between persistent smokers and those who quit smoking after a diagnosis of UC. Conclusions Smokers and never-smokers with UC have similar outcomes with respect to flares, thiopurine use, corticosteroid dependency, hospitalisation and colectomy. Smoking cessation was not associated with worse disease course. The risks associated with smoking outweigh any benefits. UC patients should be counselled against smoking.
وصف الملف: application/vnd.openxmlformats-officedocument.wordprocessingml.document
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المؤلفون: Elaine M. Burns, Chanpreet Arhi, Paul Aylin, Paul Ziprin, George Bouras, Ara Darzi, Alex Bottle
المساهمون: Imperial College Healthcare NHS Trust, National Institute of Health Research, National Institute for Health Research
المصدر: Br J Gen Pract
E471
E463مصطلحات موضوعية: Adult, medicine.medical_specialty, SYMPTOMS, Referral, IMPACT, Colorectal cancer, colorectal cancer, survival, 1117 Public Health and Health Services, primary care, 03 medical and health sciences, Medicine, General & Internal, 0302 clinical medicine, General & Internal Medicine, Internal medicine, DIAGNOSTIC INTERVALS, medicine, cancer, Humans, UK, 030212 general & internal medicine, Stage (cooking), THERAPEUTIC DELAY, Referral and Consultation, RECTAL-CANCER, Retrospective Studies, Science & Technology, Primary Health Care, delays, business.industry, Research, COLON-CANCER, Hazard ratio, Cancer, Retrospective cohort study, medicine.disease, stage, Confidence interval, TIME, Cancer registry, England, 030220 oncology & carcinogenesis, referral, Public Health, PRACTICE RESEARCH DATABASE, Family Practice, business, Colorectal Neoplasms, Life Sciences & Biomedicine
الوصف: BackgroundDelays in referral for patients with colorectal cancer may occur if the presenting symptom is falsely attributed to a benign condition.AimTo investigate whether delays in referral from primary care are associated with a later stage of cancer at diagnosis and worse prognosis.Design and settingA national retrospective cohort study in England including adult patients with colorectal cancer identified from the cancer registry with linkage to Clinical Practice Research Datalink, who had been referred following presentation to their GP with a ‘red flag’ or ‘non-specific’ symptom.MethodThe hazard ratios (HR) of death were calculated for delays in referral of between 2 weeks and 3 months, and >3 months, compared with referrals within 2 weeks.ResultsA total of 4527 (63.5%) patients with colon cancer and 2603 (36.5%) patients with rectal cancer were included in the study. The percentage of patients presenting with red-flag symptoms who experienced a delay of >3 months before referral was 16.9% of those with colon cancer and 13.5% of those with rectal cancer, compared with 35.7% of patients with colon cancer and 42.9% of patients with rectal cancer who presented with non-specific symptoms. Patients referred after 3 months with red-flag symptoms demonstrated a significantly worse prognosis than patients who were referred within 2 weeks (colon cancer: HR 1.53; 95% confidence interval [CI] = 1.29 to 1.81; rectal cancer: HR 1.30; 95% CI = 1.06 to 1.60). This association was not seen for patients presenting with non-specific symptoms. Delays in referral were associated with a significantly higher proportion of late-stage cancers.ConclusionThe first presentation to the GP provides a referral opportunity to identify the underlying cancer, which, if missed, is associated with a later stage in diagnosis and worse survival.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1879ee4d1a6dc2e72e05dd5b1b21be31
https://pubmed.ncbi.nlm.nih.gov/32540874
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