4,322 research outputs found
Cluster randomized trial in the general practice research database: 2. Secondary prevention after first stroke (eCRT study): study protocol for a randomized controlled trial.
Full text linkBACKGROUND: The purpose of this research is to develop and evaluate methods for conducting pragmatic cluster randomized trials in a primary care electronic database. The proposal describes one application, in a less frequent chronic condition of public health importance, secondary prevention of stroke. A related protocol in antibiotic prescribing was reported previously. METHODS/DESIGN: The study aims to implement a cluster randomized trial (CRT) using the electronic patient records of the General Practice Research Database (GPRD) as a sampling frame and data source. The specific objective of the trial is to evaluate the effectiveness of a computer-delivered intervention at enhancing the delivery of stroke secondary prevention in primary care. GPRD family practices will be allocated to the intervention or usual care. The intervention promotes the use of electronic prompts to support adherence with the recommendations of the UK Intercollegiate Stroke Working Party and NICE guidelines for the secondary prevention of stroke in primary care. Primary outcome measure will be the difference in systolic blood pressure between intervention and control trial arms at 12-month follow-up. Secondary outcomes will be differences in serum cholesterol, prescribing of antihypertensive drugs, statins, and antiplatelet therapy. The intervention will continue for 12 months. Information on the utilization of the decision-support tools will also be analyzed. DISCUSSION: The CRT will investigate the effectiveness of using a computer-delivered intervention to reduce the risk of stroke recurrence following a first stroke event. The study will provide methodological guidance on the implementation of CRTs in electronic databases in primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN35701810
Adrian Caesar speaking at Alex Miller author: A Celebration, held at the National Library, Canberra, 30 October 2011 /
No full textTitle from information supplied by photographer.; Part of the collection: Alex Miller author: A Celebration, held at the National Library of Australia theatre, 30 October 2011.; Mode of access: Online.; Photographed by a staff member of the National Library of Australia
[Letter from Alex Bradford to Lieutenant and Mrs. Ray Starner - November 4, 1940]
No full textLetter from Alex Bradford to Lieutenant and Mrs. Ray Starner describing the the current state of affairs that the author was experiencing, including: the London blitz, the moral of the troops on the ground, and the collective company of men opposing the Nazi regime
Potential application of item-response theory to interpretation of medical codes in electronic patient records
Full text linkBackground: electronic patient records are generally coded using extensive sets of codes but the significance of the utilisation of individual codes may be unclear. Item response theory (IRT) models are used to characterise the psychometric properties of items included in tests and questionnaires. This study asked whether the properties of medical codes in electronic patient records may be characterised through the application of item response theory models.Methods: data were provided by a cohort of 47,845 participants from 414 family practices in the UK General Practice Research Database (GPRD) with a first stroke between 1997 and 2006. Each eligible stroke code, out of a set of 202 OXMIS and Read codes, was coded as either recorded or not recorded for each participant. A two parameter IRT model was fitted using marginal maximum likelihood estimation. Estimated parameters from the model were considered to characterise each code with respect to the latent trait of stroke diagnosis. The location parameter is referred to as a calibration parameter, while the slope parameter is referred to as a discrimination parameter.Results: there were 79,874 stroke code occurrences available for analysis. Utilisation of codes varied between family practices with intraclass correlation coefficients of up to 0.25 for the most frequently used codes. IRT analyses were restricted to 110 Read codes. Calibration and discrimination parameters were estimated for 77 (70%) codes that were endorsed for 1,942 stroke patients. Parameters were not estimated for the remaining more frequently used codes. Discrimination parameter values ranged from 0.67 to 2.78, while calibration parameters values ranged from 4.47 to 11.58. The two parameter model gave a better fit to the data than either the one- or three-parameter models. However, high chi-square values for about a fifth of the stroke codes were suggestive of poor item fit.Conclusion: the application of item response theory models to coded electronic patient records might potentially contribute to identifying medical codes that offer poor discrimination or low calibration. This might indicate the need for improved coding sets or a requirement for improved clinical coding practice. However, in this study estimates were only obtained for a small proportion of participants and there was some evidence of poor model fit. There was also evidence of variation in the utilisation of codes between family practices raising the possibility that, in practice, properties of codes may vary for different coder
Alex Haley, author
No full textExamines the life and achievements of Alex Haley, celebrated author of "Roots" and other writings, discussing his life and literary career, as well as his obsession with researching his family's history
Description by author Alex Irvine of his recent participation in the San Diego C
No full textDescription by author Alex Irvine of his recent participation in the San Diego Comic-Con, one of the largest conferences of comic/media/book producers and consumers. Irvine was there to promote his new fiction book, One King, One Soldier, published by Del Rey
Recovery through contradiction?
Full text linkWith this new drug strategy, the circle has turned. It was a Conservative government
that introduced the first drug strategy, Tackling Drugs Together, in 1995. This aimed
to reduce drug related crime, protect young people and reduce health harms by
discouraging drug use. It was criticised at the time for having unrealistic, intangible
aims and for not providing the necessary funding. New Labour’s strategies introduced
increasingly specific targets and massively expanded the funding of treatment. This
new Coalition strategy has no targets and provides no new funding
Alex Miller signing books at the National Library of Australia, Canberra, 30 October 2011 /
No full textTitle from information supplied by photographer.; Part of the collection: Alex Miller author: A Celebration, held at the National Library of Australia theatre, 30 October 2011.; Mode of access: Online.; Photographed by a staff member of the National Library of Australia
Alex Miller taking questions at the National Library of Australia, Canberra, 30 October 2011 /
No full textTitle from information supplied by photographer.; Part of the collection: Alex Miller author: A Celebration, held at the National Library of Australia theatre, 30 October 2011.; Mode of access: Online.; Photographed by a staff member of the National Library of Australia
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