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Temporal trends and practice variation of paediatric diagnostic tests in primary care:retrospective analysis of 14 million tests

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Family Medicine and Community Health 2024年第4期12卷 1-8页

作者： Elizabeth T Thomas Diana R Withrow Cynthia Wright Drakesmith Peter J Gill Rafael Perera-Salazar Carl heneghan Centre for Evidence-Based Medicine Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK Nuffield Department of Primary Care Health Sciences University of OxfordOxfordUK Department of Pediatrics University of TorontoTorontoOntarioCanada Hospital for Sick Children TorontoOntarioCanada

Objective The primary objective was to investigate temporal trends and between-practice variability of paediatric test use in primary *** and analysis This was a descriptive study of population-based data from Clinical Practice Research Datalink Aurum primary care consultation records from 1 January 2007 to 31 December *** aged 0–15 who were registered to one of the eligible 1464 general practices and had a diagnostic test code in their clinical record were *** primary outcome measures were(1)temporal changes in test rates measured by the average annual percent change,stratified by test type,gender,age group and deprivation level and(2)practice variability in test use,measured by the coefficient of *** 14299598 diagnostic tests were requested over 27.8 million child-years of observation for 2542101 *** test use increased by 3.6%/year(95%CI 3.4 to 3.8%)from 399/1000 child-years to 608/1000 child-years,driven by increases in blood tests(8.0%/year,95%CI 7.7 to 8.4),females aged 11–15(4.0%/year,95%CI 3.7 to 4.3),and children from the most socioeconomically deprived group(4.4%/year,95%CI 4.1 to 4.8).Tests subject to the greatest temporal increases were faecal calprotectin,fractional exhaled nitric oxide and vitamin *** classified as high-use and high-practice variability were iron studies,coeliac testing,vitamin B12,folate,and vitamin *** In this first nationwide study of paediatric test use in primary care,we observed significant temporal increases and practice variability in *** reflects inconsistency in practice and diagnosis rates and a scarcity of evidence-based *** test use generates more clinical activity with significant resource implications but conversely may improve clinical *** research should evaluate whether increased test use and variability are warranted by exploring test indications and test results and directly examine how increased test use impacts

关键词： vitamin nationwide stratified

Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation

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World Journal of Hepatology 2017年第20期9卷 884-895页

作者： Mohammad A B Al-Freah Carl Moran Matthew R Foxton Kosh Agarwal Julia A Wendon Nigel D Heaton michael a.heneghan Institute of Liver Studies King’s College HospitalLondon SE5 9RSUnited Kingdom

AIM To determine the impact of Charlson comorbidity index(CCI) on waiting list(WL) and post liver retransplantation(LRT) *** Comparative study of all adult patients assessed for primary liver transplant(PLT)(n = 1090) and patients assessed for LRT(n = 150), 2000-2007 at our centre. Demographic, clinical and laboratory variables were recorded. RESULTS Median age for all patients was 53 years and 66% were men. Median model for end stage liver disease(MELD) score was 15. Median follow-up was 7- years. For retransplant patients, 84(56%) had ≥ 1 comorbidity. The most common comorbidity was renal impairment in 66(44.3%). WL mortality was higher in patients with ≥ 1 comorbidity(76% vs 53%, P = 0.044). CCI(OR = 2.688, 95%CI: 1.222-5.912, P = 0.014) was independently associated with WL mortality. Patients with MELD score ≥ 18 had inferior WL survival(LogRank 6.469, P = 0.011). On multivariate analysis,CCI(OR = 2.823, 95%CI: 1.563-5101, P = 0.001), MELD score ≥ 18(OR 2.506, 95%CI: 1.044-6.018, P = 0.04), and requirement for organ support prior to LRT(P < 0.05) were associated with reduced post-LRT survival. Donor/graft parameters were not associated with survival(P = NS). Post-LRT mortality progressively increased according to the number of transplanted grafts(Log-Rank 18.455, P < 0.001). Post-LRT patient survival at 1-, 3- and 5-years were significantly inferior to those of PLT at 88% vs 73%, P < 0.001, 81% vs 71%, P = 0.018 and 69% vs 55%, P = 0.006, respectively. CONCLUSION Comorbidity increases WL and post-LRT mortality. Patients with MELD ≥ 18 have increased WL mortality. Patients with comorbidity or MELD ≥ 18 may benefit from earlier LRT. LRT for ≥ 3 grafts may not represent appropriate use of donated grafts.

关键词： Hepatic Organ Outcome Diabetes Renal

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遵循严格评估的基本原则

英国医学杂志中文版 2006年第5期9卷 315-316页

作者： Carl J heneghan clinical research fellow Centre for Evidence-Based Medicine Department of Primary Health CareUniversity of OxfordOxford OX3 7LF carl

编辑：你好。在刘祖联等作者关于高压氧治疗的系统性综述中（见本刊2006，4期，212～215页），一些方法学问题需要强调。轮流分配病人到不同治疗组，或根据患者的出生日期、人院次序或者就诊时间等特点进行分组的方法并非可靠的随机方... 详细信息

编辑：你好。在刘祖联等作者关于高压氧治疗的系统性综述中（见本刊2006，4期，212～215页），一些方法学问题需要强调。轮流分配病人到不同治疗组，或根据患者的出生日期、人院次序或者就诊时间等特点进行分组的方法并非可靠的随机方式。这样得到的分配顺序是可预知的，不能保证没有因预先干涉而排除潜在的研究对象。。对这类研究以及方法部分未提到“随机”的研究都应再做敏感度分析。如果研究资料报告不充分，作者有责任解释清楚。

关键词：评估严格系统性综述高压氧治疗敏感度分析法学问题出生日期就诊时间

Evaluation of current surgeon practice for patients undergoing lumbar spinal fusion surgery in the United Kingdom

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World Journal of Orthopedics 2015年第6期6卷 483-490页

作者： Alison Rushton Louise White Alison Heap Nicola.heneghan School of Sport Exercise and Rehabilitation Sciences College of Life and Environmental Sciences University of Birmingham University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital Queen Elizabeth Medical Centre

AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic ***: The response rate was 73.8%. Most surgeons(84%) were orthopaedic surgeons. Range of surgeon experience(1-15 years), number of operations performed in the previous 12 mo(4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients. CONCLUSION: Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfactionit is important that further research evaluates optimal management.

关键词： Lumbar spinal fusion Spinal surgery Surgeon practice Management Fusion

Diagnostic technology:alternative sampling methods for collection of urine specimens in older adults

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Family Medicine and Community Health 2013年第2期1卷 43-49页

作者： KATRIEN LATOUR ANNETTE PLÜDDEMANN MATTHEW THOMPSON BOUDEWIJN CATRY CHRISTOPHER P PRICE CARL heneghan FRANK BUNTINX University of Leuven Belgium

Clinical Question Which sampling methods other than in-and-out catheterization or suprapubic aspiration can be used to collect valid uncontaminated urine specimens for microbiological culture in older adults?Background,Current Practice and Advan-tages over Existing Technology Urinary tract infections(UTIs)are one of the most common bacterial infections in older *** increasing research into this infectious disease,substantial uncertainty still surrounds its *** tend to be less specific in frail elderly and difficulties with cognition or communication can further impair clinical evaluation[1,2].Consequently,physi-cians often resort to urinary analysis to support the diagnosis.

关键词： urine urinary resort

Developing a donation after cardiac death risk index for adult and pediatric liver transplantation

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World Journal of Transplantation 2017年第3期7卷 203-212页

作者： Shirin Elizabeth Khorsandi Emmanouil Giorgakis Hector Vilca-Melendez John O'Grady michael heneghan Varuna Aluvihare Abid Suddle Kosh Agarwal Krishna Menon Andreas Prachalias Parthi Srinivasan Mohamed Rela Wayel Jassem Nigel Heaton Institute of Liver Studies King’s College Hospital

AIM To identify objective predictive factors for donor after cardiac death(DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index(DCD-RI) to help in prospective decision making on organ *** The model included objective data from a single institute DCD database(2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival *** DCD graft survival predictors were primary indication for transplant(P = 0.066), retransplantation(P = 0.176), MELD > 25(P = 0.05), cold ischemia > 10 h(P = 0.292) and donor hepatectomy time > 60 min(P = 0.028).According to the calculated DCD-RI score three risk classes could be defined of low(DCD-RI 5) with a 5 years graft survival of 86%, 78% and 34%, *** The DCD-RI score independently predicted graft loss(P < 0.001) and the DCD-RI class predicted graft survival(P < 0.001).

关键词： Liver transplant Donor after cardiac death Pediatric Adult Survival

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偏倚一览:选择性报告结果偏倚

英国医学杂志中文版 2022年第6期25卷 350-352页

作者： Elizabeth T Thomas Carl heneghan 孟玲慧(译) Centre for Evidence-Based Medicine NuffieldDepartment of Primary Care Health SciencesUniversity of OxfordOxfordUK 首都儿科研究所循证医学中心

背景临床试验能够降低干预措施利弊的不确定性。目标结果在试验前就应(预先)确定,并充分考虑临床相关的患者照护问题。

关键词：干预措施临床试验不确定性偏倚照护临床相关选择性报告

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不建议使用抗精神病药物预防和治疗谵妄

英国医学杂志中文版 2020年第8期23卷 458-459页

作者： Carl heneghan Jack O'Sullivan 张蕾(译) 王立伟(校) Centre for Evidence-Based Medicine Nuffield Dept of Primary Care Health SciencesUniversity of OxfordOxfordUK School of Medicine Stanford UniversityStanfordCaliforniaUSA 复旦大学附属华山医院精神科

谵妄是一种常见的使人衰弱的状态,会引起注意力和认知障碍,通常急性起病,并且与住院时间延长、并发症增加以及预后变差相关。老年人的谵妄风险尤其高,他们对基础生理变化更敏感,并且由于临床上与痴呆和精神病相似,谵妄容易被误诊\尽管... 详细信息

谵妄是一种常见的使人衰弱的状态,会引起注意力和认知障碍,通常急性起病,并且与住院时间延长、并发症增加以及预后变差相关。老年人的谵妄风险尤其高,他们对基础生理变化更敏感,并且由于临床上与痴呆和精神病相似,谵妄容易被误诊\尽管指南强调了非药物治疗的重要性,但最近发表的两篇系统综述为药物治疗的作用提供了必要依据。

关键词：抗精神病药物非药物治疗谵妄系统综述认知障碍精神病预防和治疗生理变化

B38-21 来自于嗜热真菌Talaromyces emersonii的α-葡萄糖醛酸苷酶的克隆、鉴定和表达分析

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中国医药工业杂志 2007年第11期38卷 804-804页

作者： heneghan MN 陈祈磊（译）胡又佳（校）

通过简并PCR技术从嗜热真菌Talaromyces emersonii中分离到了编码α-葡萄糖醛酸苷酶的aguA基因。该基因没有内含子，由一个2511bp的开放阅读框（ORF）组成，可能编码一含837个氨基酸的蛋白质。推测该蛋白的N-末端有一个由l7个氨基酸组... 详细信息

通过简并PCR技术从嗜热真菌Talaromyces emersonii中分离到了编码α-葡萄糖醛酸苷酶的aguA基因。该基因没有内含子，由一个2511bp的开放阅读框（ORF）组成，可能编码一含837个氨基酸的蛋白质。推测该蛋白的N-末端有一个由l7个氨基酸组成的信号肽，成熟蛋白共含820个氨基酸，预计其分子量约为91．6k。确定了20个可能的N-糖基化及4个O-糖基化位点。

关键词：葡萄糖醛酸苷酶嗜热真菌表达分析氨基酸组成 N-糖基化克隆鉴定 PCR技术