scholarly journals The Danish Model for Improvement of Diabetes Care in General Practice: Impact of Automated Collection and Feedback of Patient Data

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Henrik Schroll ◽  
René dePont Christensen ◽  
Janus Laust Thomsen ◽  
Morten Andersen ◽  
Søren Friborg ◽  
...  
Keyword(s):  
General Practice ◽  
Quality Of Care ◽  
Risk Reduction ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Data Capture ◽  
Lipid Lowering ◽  
Control Group ◽  
Electronic Data

Background. Sentinel Data Capture is an IT program designed to collect data automatically from GPs’ electronic health record system. Data include ICPC diagnoses, National Health Service disbursement codes, laboratory analysis, and prescribed drugs. Quality feedback reports are generated individually for each practice on the basis of the accumulated data and are available online only for the specific practice. Objective. To describe the development of the quality of care concerning drug prescriptions for diabetes patients listed with GPs using the Data Capture module. Methods. In a cohort study, among 8320 registered patients with diabetes, we analyzed the change in the proportion of medication for uncontrolled cases of diabetes. Results. From 2009 to 2010, there was an absolute risk reduction of 1.35% (0.89–1.81: ) in proportion of persons not in antidiabetic medication despite an HbA1c above 7.0. Similarly, there was a 4.51% (3.42–5.61: ) absolute risk reduction in patients not in antihypertensive treatment despite systolic blood pressure above 130 mm Hg and 4.73% (3.56–5.90: ) absolute risk reduction in patients with total cholesterol level above 4.5 mmol/L and not receiving lipid-lowering treatment. Conclusions. Structured collection of electronic data from general practice and feedback with reports on quality of care for diabetes patient seems to give a significant reduction in proportion of patients with no medical treatment over one year for participating GPs. Due to lack of a control group, we are, however, not able to say if the drop in the proportion of uncontrolled cases is a result of participation in collection of electronic data and feedback alone.

Monitoring Psychosis in General Practice: A Controlled Trial

1996 ◽  
Vol 169 (4) ◽  
pp. 475-482 ◽  
Author(s):  
Irwin Nazareth ◽  
Michael King ◽  
Sharon See Tai
Keyword(s):  
General Practice ◽  
Risk Reduction ◽  
Absolute Risk ◽  
Controlled Trial ◽  
Intervention Group ◽  
Absolute Risk Reduction ◽  
Initial Assessment ◽  
Global Assessment Scale ◽  
Affective Psychosis ◽  
Practice Nurses

BackgroundThis trial evaluated the feasibility, acceptability and effectiveness of a structured approach to the management of schizophrenia in general practice.MethodAll patients with non-affective psychosis (mainly schizophrenia) in four inner-city general practices were recruited. A check-list and a set of outcome measures were used by the general practitioner and the practice nurses. Information on attendances at the general practice and psychiatric out-patient departments was also collected.ResultsTwo practices took part in the intervention and two served as control practices. Sixty-seven patients with non-affective psychosis were identified. Thirty-three (81%) of the 41 patients in the two intervention practices attended the initial assessment by the doctor and nurse, but only 13 (32%) attended the first review assessment. The attendance for the second review, after six months, was six out of 15 (40%) in one practice, but rose to 16 out of 18 (89%) in the other practice. Significant improvements were recorded in the intervention group on the Global Assessment Scale (GAS) and the Behaviour, Speech and Other Syndromes (BSO) subscore of the Present State Examination (PSE). The absolute risk reduction and relative risk reduction as a result of the intervention as measured by the GAS scores, was 29% (95% CI 4% to 54%) and 36% (95% CI 5% to 66%), respectively, and in the case of the BSO subscores of the PSE, this was 23% (95% CI – 1.8% to 47.2%) and 28% (95% CI – 2.2% to 57%), respectively. For one patient to show an improvement in GAS and BSO scores 3.5 patients (95% CI 1.85 to 25) and 4.3 patients (95% CI – 55 to 2.1), respectively, would need to receive the intervention. There was a significant increase in consultation rates for patients in the intervention practices.ConclusionsHealth surveillance of patients with non-affective psychosis is possible in general practice.

scholarly journals Communicating risk using absolute risk reduction or prolongation of life formats: cluster-randomised trial in general practice

2014 ◽  
Vol 64 (621) ◽  
pp. e199-e207 ◽  
Author(s):  
Charlotte Gry Harmsen ◽  
Ivar Sønbø Kristiansen ◽  
Pia Veldt Larsen ◽  
Jørgen Nexøe ◽  
Henrik Støvring ◽  
...  
Keyword(s):  
General Practice ◽  
Risk Reduction ◽  
Absolute Risk ◽  
Randomised Trial ◽  
Absolute Risk Reduction ◽  
Cluster Randomised Trial ◽  
Cluster Randomised ◽  
Prolongation Of Life ◽  
Communicating Risk

Continuous intrapartum support to reduce primary cesarean in Mexico

2020 ◽  
Author(s):  
Luz Maria Cardona-Torres ◽  
Rafael Leyva-Jimenez
Keyword(s):  
Risk Reduction ◽  
Cesarean Delivery ◽  
Absolute Risk ◽  
Obstetric Care ◽  
Absolute Risk Reduction ◽  
Delivery Rate ◽  
Control Group ◽  
Study Group ◽  
Cesarean Deliveries ◽  
Cesarean Delivery Rate

Abstract Background Cesarean deliveries are effective in saving maternal and infant lives, but only when they are necessary for medical reasons. In Mexico, the average cesarean delivery rate in 2015 was reported at 45%, the high incidence of cesarean deliveries is considered a problem of public health in the country, our purpose was to reduce the cesarean delivery rate for primary cesarean, in nulliparous women, term, singleton, vertex presentation and under 40 years through continuous intrapartum support provided by a professional nurse. Methods This was a historical control study, in a health institution in Mexico, in the period de July-December 2018. The control group received the usual obstetric care, without continuous intrapartum support. The study group received the usual obstetric care plus continuous intrapartum support, it was obtained the cesarean delivery rate, estimating the risk ratio, the absolute risk reduction and odds ratio, in addition, a binomial logistic regression model was carried out and was adjusted with possible covariates. Results In the study group the cesarean delivery rate was 1.7% (1 of 60) significantly lower than in the control group (29.1% (16 of 55) [X 2 = 17.13, df = 1, N = 115, p < .001], with a risk ratio of 0.06 (95% CI: 0.01 to 0.42), the absolute risk reduction was 27.4%, (95% CI: 15% - 40%), also the hours of labor were significantly lower (p < 0.001) in the study group (median = 6.7 hours, 95% CI: 6.0-8.1), than in the control group (median = 13.4 hours, 95% CI: 10.7 - 16.1) and no significant covariates were found. Keywords: Cesarean delivery rate, Continuous intrapartum support, labor

scholarly journals Effectiveness of Metformin in the Prevention of Gestational Diabetes Mellitus in Obese Pregnant Women

2018 ◽  
Vol 40 (04) ◽  
pp. 180-187 ◽  
Author(s):  
Willian Sales ◽  
Iramar Nascimento ◽  
Guilherme Dienstmann ◽  
Matheus Souza ◽  
Grazielle Silva ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Risk Reduction ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Control Group ◽  
Significant Difference ◽  
The Absolute

Objective To assess the effectiveness of metformin in the incidence of gestational diabetes mellitus (GDM) in obese pregnant women attending a public maternity hospital in Joinville, Santa Catarina, Brazil. Methods Randomized clinical trial including obese pregnant women with a body mass index (BMI) ≥ 30 kg/m2, divided into two groups (control and metformin). Both groups received guidance regarding diet and physical exercise. The participants were assessed at two moments, the first at enrollment (gestational age ≤ 20) and the second at gestational weeks 24–28. The outcomes assessed were BMI and gestational diabetes mellitus (GDM) diagnosis. The data distribution was assessed with the Friedman test. For all the analytical models, the p-values were considered significant when lower than 0.05. The absolute risk reduction was also estimated. Results Overall, 164 pregnant women were assessed and further divided into 82 participants per group. No significant difference was observed in BMI variation between the control and metformin groups (0.9 ± 1.2 versus 1.0 ± 0.9, respectively, p = 0.63). Gestational diabetes mellitus was diagnosed in 15.9% (n = 13) of the patients allocated to the metformin group and 19.5% (n = 16) of those in the control group (p = 0.683). The absolute risk reduction was 3.6 (95% confidence interval 8.0–15.32) in the group treated with metformin, which was not significant. Conclusion Metformin was not effective in reducing BMI and preventing GDM in obese pregnant women.

Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review

2021 ◽  
pp. 1-6
Author(s):  
A S Khatiwada ◽  
A S Harris
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Clinical Trials ◽  
Total Thyroidectomy ◽  
Risk Reduction ◽  
Operative Treatment ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Vitamin D Supplementation ◽  
Absolute Reduction

Abstract Objective This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy. Method This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy. Results Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13–59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11–40 per cent) following pre-operative supplementation. Conclusion Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.

scholarly journals What is the potential cardiovascular risk reduction associated with achieving LDL-C levels recommended in the ESC/EAS guidelines for very high-risk patients? Data from 18 European countries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.K Ray ◽  
S Bray ◽  
A.L Catapano ◽  
N Poulter ◽  
G Villa
Keyword(s):  
High Risk ◽  
Risk Reduction ◽  
Absolute Risk ◽  
European Countries ◽  
Lipid Lowering ◽  
Funding Source ◽  
Lipid Lowering Therapy ◽  
Cardiovascular Risk Reduction ◽  
Private Company ◽  
Very High

Abstract Background/Introduction For patients at very-high risk of cardiovascular (CV) events, the 2016 ESC/EAS dyslipidaemia guidelines recommended lipid-lowering therapy (LLT) to achieve an LDL-C level below 70 mg/dL. This was lowered to an LDL-C level below 55 mg/dL in the 2019 guidelines. Purpose To assess: 1) the risk profile of European patients with established atherosclerotic CV disease (ASCVD) receiving LLT; and 2) the treatment gap between the estimated risk and the population benefits if all patients were to achieve LDL-C levels of 70 mg/dL and 55 mg/dL. Methods We used data from Da Vinci, an observational cross-sectional study conducted across 18 European countries. Data were collected at a single visit between June 2017 and November 2018, for consented adults who had received any LLT in the prior 12 months and had an LDL-C measurement in the prior 14 months. LDL-C level was assessed at least 28 days after starting the most recent LLT (stabilised LLT). For each patient with established ASCVD receiving stabilised LLT, we: 1) calculated their absolute LDL-C reduction required to achieve LDL-C levels of 70 mg/dL and 55 mg/dL; 2) predicted their 10-year CV risk using the REACH score based on demographic and medical history; 3) simulated their relative risk reduction (RRR) by randomly sampling from the probability distribution of the rate ratio per 38.7 mg/dL (1 mmol/L) estimated by the Cholesterol Treatment Trialists Collaboration meta-analysis; and 4) calculated their absolute risk reduction (ARR) achieved by meeting LDL-C levels of 70 mg/dL and 55 mg/dL. Results A total of 2039 patients with established ASCVD were included in the analysis. Mean (SD) LDL-C was 83.1 (35.2) mg/dL. 40.4% and 19.3% of patients achieved LDL-C levels of 70 mg/dL and 55 mg/dL, respectively. Mean (SD) 10-year CV risk calculated using the REACH score was 36.3% (15.4%). Mean absolute LDL-C reductions of 19.6 mg/dL and 30.4 mg/dL were needed to reach LDL-C levels of 70 mg/dL and 55 mg/dL, respectively. When adjusted for the LDL-C reduction required to achieve an LDL-C level of 70 mg/dL, mean ARR was 3.0%, leaving a mean (SD) residual 10-year CV risk of 33.3% (15.5%). When adjusted for the LDL-C reduction required to achieve an LDL-C level of 55 mg/dL, mean ARR was 4.6%, leaving a mean (SD) residual 10-year CV risk of 31.7% (15.2%). Conclusion(s) In a contemporary European cohort with ASCVD receiving LLT, the 10-year risk of CV events is high and many patients do not achieve LDL-C levels of 55 mg/dL or even of 70 mg/dL. Moreover, even if all patients were to achieve recommended LDL-C levels, they would still remain at a high residual risk of CV events. These data suggest these patients require even more intensive LLT. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen

scholarly journals Amblyopia screening effectiveness at 3–4 years old: a cohort study

2021 ◽  
Vol 6 (1) ◽  
pp. e000599
Author(s):  
Sandra Guimaraes ◽  
Andreia Soares ◽  
Cristina Freitas ◽  
Pedro Barros ◽  
Ricardo Dourado Leite ◽  
...  
Keyword(s):  
Risk Reduction ◽  
Treatment Effectiveness ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Number Needed To Screen ◽  
History Of ◽  
Disease Study ◽  
New Diagnosis ◽  
Screening Effectiveness ◽  
Timely Referral

ObjectiveTo study the effectiveness of amblyopia screening at ages 3–4.Methods and AnalysisFrom a population with no previous screening, a cohort of 2300 children with 3–4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated.ResultsPast/present history of amblyopia was higher than 3.1%–4.2%, depending on amblyopia definition normatives. Screening at age 3–4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3–4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia.ConclusionsScreening amblyopia in a whole-population setting at age 3–4 is highly effective. For each 48 children screened at age 3–4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3–4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3–4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3–4 seems a rational/effective way of controlling amblyopia.

Innovative Technique to Reduce Incidence of Frey's Syndrome after Parotid Surgery

2011 ◽  
Vol 77 (3) ◽  
pp. 351-354 ◽  
Author(s):  
Neeraj Singh ◽  
Monica Kohli ◽  
Harjeet Kohli
Keyword(s):  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Control Group ◽  
Regenerated Cellulose ◽  
P Value ◽  
Frey’S Syndrome ◽  
Exact Test ◽  
Parotid Surgery ◽  
Frey's Syndrome ◽  
Aberrant Regeneration

Frey's syndrome was first described by Lucia Frey, a Polish neurologist in 1923. It is well accepted that it involves injury to the branches of the auriculotemporal nerve with subsequent aberrant regeneration. Due to this abnormal communication, the skin glands and vessels are always stimulated at the same time as eating and mastication, which results in symptoms such as flushing and sweating. The incidence of Frey's syndrome in the literature has been variously described from 6 to 96 per cent. We analyzed the chart of 18 patients who had parotidectomy from March 2002 to December 2009. All procedures were performed by a single surgeon at the same facility. A total of 16 superficial and three total parotidectomies were done; one patient had bilateral parotidectomy. Oxidized regenerated cellulose (Interceed) was used after 10 surgeries (study group) and no adjuvant was used after nine surgeries (control group). All of the surgeries were done using similar technique. All the patients were followed-up with for a period of about 6 months postoperatively. The absolute risk reduction associated with the placement of an Interceed was 11 per cent. The small number of cases (n = 19) and an empty cell limits statistical analysis (a Fisher's exact test revealed a P value of 0.44). Clearly the low number of procedures restricted the power to test these differences. The development of Frey's syndrome is a very disabling but under-reported complication. The placement of a temporary barrier like Interceed may help in the prevention of Frey's syndrome without increasing any complications.

scholarly journals Predictors of the quality of care for asthma in general practice: an observational study

2009 ◽  
Vol 27 (2) ◽  
pp. 186-191 ◽  
Author(s):  
A. S Abdelhamid ◽  
S. Maisey ◽  
N. Steel
Keyword(s):  
General Practice ◽  
Quality Of Care ◽  
Observational Study
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