1,720,990 research outputs found
Where now for proteinuria testing in chronic kidney disease? Good evidence can clarify a potentially confusing message
No full textInequity of use of implantable cardioverter defibrillators in England: retrospective analysis
No full textSudden cardiac death occurs in approximately 100 000 people annually in the United Kingdom and can be prevented by implantable cardioverter defibrillators (ICDs).1 Rates of implantation of ICDs in England have been increasing but lag behind those in other western European countries and North America. The National Institute for Clinical Excellence has recommended indications for use in patients with ventricular arrhythmias and proposed an annual implantation rate of 50 per million population.2 We present data on current use, geographical and social equity, and barriers to care in the provision of ICDs in England
Hybrid simulation modelling for dementia care services planning
No full textDementia is an increasing problem in today’s ageing society, and meeting future demand for care is a major concern for policy-makers and planners. This paper presents a novel hybrid simulation model that simultaneously takes population-level and patient-level perspectives to calculate the numbers of patients at different stages of disease severity over time, and their associated care costs. System Dynamics is used at population level to capture ageing, dementia onset, and all-cause mortality, whereas disease progression is modelled at individual patient level using Agent-Based methods. This enables the model to account for variability between patients in the rate of cognitive decline, dementia-related mortality and response to treatment interventions. Using epidemiological data from the medical literature, disease progression is modelled via a longitudinal clustering method to identify progression type, followed by mixed-effects regression to reflect each individual’s rate of cognitive decline. Results are presented for population data from the south of England, and show that the currently available interventions have only modest effects at population level
Using simulation modelling for evaluation screening services for diabetic retinopathy
No full textIn using discrete event simulation for planning services in the health sector, epidemiologists and clinicians were closely involved in model design, data collection, analysis, validation and experimentation. For patients with diabetes, loss of sight can be prevented by timely treatment if detected sufficiently early. Simulation models, using the patient oriented simulation technique, POST, have been developed to assist policy makers in the choice of screening strategy in terms of operator, equipment, frequency of screening and target population. The models describe the progress of a population of diabetic patients, including new arrivals, over 25 years. The initial population were given characteristics retrospectively and the parameters were derived from peer reviewed publications. The results from the models show that the interval between screening is more important than screening sensitivity. The simulation can determine the expected workload and the amount of vision loss prevented for any population group
Global multimorbidity: a cross-sectional study of 28 countries using the World Health Surveys, 2003
No full textGlobal multimorbidity: a cross-sectional study of 28 countries using the World Health Surveys, 2003
No full textBackgroundMultimorbidity defined as the “the coexistence of two or more chronic diseases” in one individual, is increasing in prevalence globally. The aim of this study was to compare the prevalence of multimorbidity across middle-income countries (MICs) and high-income countries (HICs), and investigate patterns by age and socio-economic status (SES).MethodsChronic disease data from 28 countries of the World Health Survey (2003) were extracted and inter-country socio-economic differences were examined using gross domestic product (GDP). Regression analyses were applied to examine associations of SES with multimorbidity by region adjusted for age and sex distributions.ResultsThe mean world standardized prevalence was 7.8% (95% CI = 7.79–7.83). In all countries, multimorbidity increased significantly with age. A positive but non–linear relationship was found between country GDP and multimorbidity prevalence. Trend analyses of multimorbidity by SES suggest that there are intergenerational differences, with a more inverse SES gradient for younger adults compared to older adults. Higher SES was significantly associated with a decreased risk of multimorbidity in the all-region analyses.ConclusionMultimorbidity is a global phenomenon, not just affecting older adults in HICs. Policy makers worldwide need to address these health inequalities, and support the complex service needs of a growing multimorbid population
Psychosocial interventions for depression in dialysis patients
No full textBackgroundDepression is the most common psychological problem in the dialysis population. The diagnosis of depression in dialysis patients is confounded by the fact that several symptoms of uraemia mimic the somatic components of depression. It affects the physical, psychological and social well being of the dialysis population in several ways.ObjectivesThe aim of this systematic review was to assess the effectiveness of psychosocial interventions in the treatment of depression in patients who are dialysed for end-stage renal disease.Search strategyA comprehensive search strategy was employed to identify all randomised controlled trials (RCTs) relevant to the treatment of depression in dialysis patients. The following databases were searched - MEDLINE (1966 - October 2003), EMBASE (1980 - October 2003), PsycINFO (1872 - October 2003) and The Cochrane Library (issue 3, 2003). Authors of potential studies were contacted, reference lists of identified RCTs and relevant narrative reviews were screened.Selection criteriaRCTs comparing any psychosocial intervention with control intervention or no intervention in depressed dialysis patients.Data collection and analysisData were to be abstracted by two investigators independently onto a standard form and entered into Review Manager 4.2. Relative risk (RR) for dichotomous data and a (weighted) mean difference (MD) for continuous data were to be calculated with 95% confidence intervals (CI).Main resultsDespite extensive searching, no RCTs were identified.Authors' conclusionsData were not available to draw conclusions about the effectiveness of psychosocial interventions in the treatment of depression in the chronic dialysis population, as we did not find any RCTs of psychosocial interventions to treat depression in dialysis patients. This review highlights the need for commencing and completing adequately powered RCTs to address the issue of psychosocial interventions for depression in dialysis patients
Suboptimal blood pressure control in chronic kidney disease stage 3: baseline data from a cohort study in primary care
Full text linkBackground: poorly controlled hypertension is independently associated with mortality, cardiovascular risk and disease progression in chronic kidney disease (CKD). In the UK, CKD stage 3 is principally managed in primary care, including blood pressure (BP) management. Controlling BP is key to improving outcomes in CKD. This study aimed to investigate associations of BP control in people with CKD stage 3.Methods: 1,741 patients with CKD 3 recruited from 32 general practices for the Renal Risk in Derby Study underwent medical history, clinical assessment and biochemistry testing. BP control was assessed by three standards: National Institute for Health and Clinical Excellence (NICE), National Kidney Foundation Kidney Disease Outcome Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Descriptive statistics were used to compare characteristics of people achieving and not achieving BP control. Univariate and multivariate logistic regression was used to identify factors associated with BP control.Results: the prevalence of hypertension was 88%. Among people with hypertension, 829/1426 (58.1%) achieved NICE BP targets, 512/1426 (35.9%) KDOQI targets and 859/1426 (60.2%) KDIGO targets. Smaller proportions of people with diabetes and/or albuminuria achieved hypertension targets. 615/1426 (43.1%) were only taking one antihypertensive agent. On multivariable analysis, BP control (NICE and KDIGO) was negatively associated with age (NICE odds ratio (OR) 0.27; 95% confidence interval (95% CI) 0.17-0.43) 70–79 compared to <60), diabetes (OR 0.32; 95% CI 0.25-0.43)), and albuminuria (OR 0.56; 95% CI 0.42-0.74)). For the KDOQI target, there was also association with males (OR 0.76; 95% CI 0.60-0.96)) but not diabetes (target not diabetes specific). Older people were less likely to achieve systolic targets (NICE target OR 0.17 (95% CI 0.09,0.32) p?<?0.001) and more likely to achieve diastolic targets (OR 2.35 (95% CI 1.11,4.96) p?<?0.001) for people >80 compared to?<?60).Conclusions: suboptimal BP control was common in CKD patients with hypertension in this study, particularly those at highest risk of adverse outcomes due to diabetes and or albuminuria. This study suggests there is scope for improving BP control in people with CKD by using more antihypertensive agents in combination while considering issues of adherence and potential side effects.<br/
Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010
No full textDesign: Cross-sectional analysis of nationally representative Health Survey for England (HSE) random samples.Setting: England 2003 and 2009/2010.Survey participants: 13?896 adults aged 16+ participating in HSE, adjusted for sampling and non-response, 2009/2010 surveys combined.Main outcome measure: Change in prevalence of estimated glomerular filtration rate (eGFR) <60?mL/min/1.73?m2 (as proxy for stage 3–5 CKD), from 2003 to 2009/2010 based on a single serum creatinine measure using an isotope dilution mass spectrometry traceable enzymatic assay in a single laboratory; eGFR derived using Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) eGFR formulae.Analysis: Multivariate logistic regression modelling to adjust time changes for sociodemographic and clinical factors (body mass index, hypertension, diabetes, lipids). A correction factor was applied to the 2003 HSE serum creatinine to account for a storage effect.Results: National prevalence of low eGFR (<60) decreased within each age and gender group for both formulae except in men aged 65–74. Prevalence of obesity and diabetes increased in this period, while there was a decrease in hypertension. Adjustment for demographic and clinical factors led to a significant decrease in CKD between the surveyed periods. The fully adjusted OR for eGFR <60?mL/min/1.73?m2 was 0.75 (0.61 to 0.92) comparing 2009/2010 with 2003 using the MDRD equation, and was similar using the CKDEPI equation 0.73 (0.57 to 0.93).Conclusions: The prevalence of a low eGFR indicative of CKD in England appeared to decrease over this 7-year period, despite the rising prevalence of obesity and diabetes, two key causes of CKD. Hypertension prevalence declined and blood pressure control improved but this did not appear to explain the fall. Periodic assessment of eGFR and albuminuria in future HSEs is needed to evaluate trends in CKD
- …
