Does the content of symptoms and history taught at Aston University reflect the habits of optometrists working in multiple practice?

The purpose of this study was to determine whether Aston University’s undergraduate classes on the symptoms and history element of eye examinations reflected the habits of optometrists working in multiple practice, the destination of most optometry graduates. Data abstraction was carried out on a single free text field within electronic eye examination records taken from a major community multiple practice. Company policy required optometrists to enter symptoms and history in this field. The feasibility of carrying out Bayesian searches on free text fields was investigated. Electronic searches were carried out to identify 163 text items linked to 11 classes of presenting symptoms in 51,944 records. Likelihood ratios were calculated for all text item/presenting symptom combinations in a training dataset of 1075 manually classified records. These likelihood ratios were applied to naïve Bayesian searches for presenting symptoms in the training dataset. Post-test probability threshold values were adjusted to match known and estimated prevalence for each symptom presentation type. These adjusted threshold values resulted in diagnostic accuracy of between 83 and 99% (depending on the presenting symptom class). The same likelihood ratios and adjusted threshold values were applied to larger scale naïve Bayesian searches in order to estimate the prevalence of each presenting symptom class in all 51,944 records. This part of the study showed that similar Bayesian searches on the more complex and numerous elements of complete symptoms and history free text fields would not have been feasible. This being the case, detailed manual searches through 224 free text fields to determine how often optometrists asked 105 symptom and history test items taught at Aston University. Asking rates varied from 0 to 88%. The proportion of expected questions asked in individual records (conformity) tended to be higher for eye examinations that were routine (no presenting symptoms: 95% confidence limits 41 to 51%) compared to those with presenting symptoms (the means for which ranged from 25 to 34%). Optometrists tended to ask database-style questions (mean asking rates varied from 33 to 40% depending on the presenting symptom) more often than problem-orientated style questions (mean asking rates varied from 22 to 33% depending on the presenting symptoms). Decision tree analyses were used to explore the data in more depth and showed statistically significant regional variations in conformity. In summary, typical practice did not reflect what was taught at Aston University. Optometrists tended not to vary the questions asked according to the presenting symptoms. It was anticipated that these findings would be of interest to optometry schools and members of legal teams involved with fitness to practice disputes

Eyes on the prize: early economic evaluation to guide translational research:examples from the development of biomarkers for type 2 diabetes

The Center for Translational Molecular Medicine (CTMM) was a large public-private partnership that existed between 2008 and 2016. It was dedicated to the development of new technologies in molecular medicine. The main objectives of the CTMM were to reduce mortality in the Dutch population by 20% and healthcare expenditures by 1 billion Euro’s by 2019. The PREDDICCt project (€18.4 million budget) was one of the projects of the CTMM. This project aimed to develop innovative biomarker-based technologies to identify individuals at high risk of developing type 2 diabetes or its complications. In my doctoral research we evaluated the output of the PREDICCt project. To that end, we developed new methods for the early economic evaluation of biomedical innovation.We assessed in which application new biomarkers for type 2 diabetes would have the largest clinical and economic value and estimated the value of the biomarkers developed in the PREDICCt project. We have concluded that the developed biomarkers, as well as number of the applications for which the project aimed to develop new biomarkers, have very limited value and are unlikely to result in useful new technologies.Based on our research, we concluded that the main objectives of the CTMM have not been achieved. We have, however, demonstrated that using early economic evaluation it is possible to identify the most promising research strategies before the start and during translational research projects. This can prevent the waste of public and private research funding in the future

Evaluation of strategies for reducing the burden of COPD in the UK using Bayesian methods

Chronic obstructive pulmonary disease (COPD) is responsible for 5.3% of all deaths and 1.7% of all hospital admissions in the UK. This thesis focuses on strategies to reduce COPD burden by targeting three aspects across the public healthcare system: prevention, emergency treatment, and long-term management. Analyses were performed in a Bayesian framework to exploit its flexibility in modelling uncertainty and the incorporation of prior knowledge. First, I assessed whether communication of personalised disease risk in primary care is an effective smoking cessation intervention, using cost-effectiveness and value of information analyses based on various data sources across the literature. The odds ratio for the effectiveness of communication of personalised disease risk was 1.48 (95%CrI:0.91-2.26). While I found a probability of cost-effectiveness of about 90%, further research up to a maximum of £27 million is justified to reduce the uncertainty around this estimate. Secondly, I assessed whether case ascertainment affects the detection of poorly performing hospital trusts in the treatment of acute exacerbation of COPD (AECOPD) in secondary care, using data from the National Asthma and COPD Audit Programme. Case ascertainment was associated with 30-day mortality (OR:1.74; 1.25-2.41) and adjusting for it impacted the findings, with 5 trusts becoming outliers and 2 trusts no longer classified as outliers. Finally, using general practice data from Clinical Practice Research Datalink, I assessed whether new guidelines suggesting triple therapy (long-acting beta-2 agonists, LABA + long-acting muscarinic antagonists, LAMA + inhaled corticosteroids, ICS) for the treatment of those with poorly-controlled COPD on LABA+LAMA dual therapy improves disease outcomes. Triple therapy was not associated with severe AECOPD (IRR:1.00; 0.93-1.07) or mortality (IRR:0.95; 0.86-1.06), but was associated with increased risk of pneumonia (IRR:1.19; 1.05-1.35). This thesis applied sophisticated Bayesian methods to increase understanding of how COPD burden could be reduced in different areas of the public healthcare system.Open Acces

Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation.

Peer reviewe

Assessment of the management and clinical outcomes of patients with non-diabetic hyperglycaemia and newly diagnosed type 2 diabetes in primary care in England

Background It is unknown whether the detection of non-diabetic hyperglycaemia before the diagnosis of Type 2 diabetes is associated with vascular disease at time or following the diagnosis of Type 2 diabetes. Aim I assessed the association between glycaemic testing and detection of non-diabetic hyperglycaemia before the diagnosis of Type 2 diabetes is associated and vascular disease at time or following the diagnosis of Type 2 diabetes. Methods I identified 159,736 individuals with newly diagnosed Type 2 diabetes from the CPRD database in England between 2004 and 2017. I used logistic regression models to compare presence of vascular disease at the time of Type 2 diabetes diagnosis by prior glycaemic status. I employed time-partitioned Cox regression models to model differences in rates of vascular disease and mortality following the diagnosis of Type 2 diabetes. Results Half of the study population (49.9%) had at least one vascular disease, over one-third (37.4%) had microvascular disease, and almost a quarter (23.5%) had a diagnosed macrovascular disease at the time of Type 2 diabetes diagnosis. Individuals with prior non-diabetic hyperglycaemia were more likely to have microvascular disease and coronary heart disease at time of diagnosis of Type 2 diabetes. As compared with individuals with glycaemic values within the normal range in the three years before the diagnosis of Type 2 diabetes, those detected with non-diabetic hyperglycaemia had increased risk of microvascular disease that persisted up to 7.5 years. Conclusions Non-diabetic hyperglycaemia before diagnosis of Type 2 diabetes is associated with increased odds of microvascular disease and coronary heart disease in newly diagnosed Type 2 diabetes. It is also associated with increased rates of microvascular disease following the diagnosis of Type 2 diabetes. Detection of non-diabetic hyperglycaemia might represent an opportunity for a timely identification of NDH and specific clustering of NDH with other risk factors for T2D, which might prompt earlier assessment for risk factors and tailored cardiovascular risk reduction strategies during the NDH phase to reduce the burden of vascular disease.Open Acces

Integrated Framework of Knowledge Discovery and Knowledge Management for E-health In Saudi Arabia: Supporting Citizens with Diabetes Mellitus

Saudi Arabia experiences insufficient effort in terms of patients’ education in relation to a number of prevalent diseases, including diabetes mellitus, musculoskeletal disorders and upper respiratory tract infections. In addition, the number of studies related to e-health initiatives to support patients in the Kingdom are limited and only benefit patients of a few hospitals. This situation leads to deficient application of self-management and education strategies to empower patients to manage their diseases. Unfortunately, such a deficiency can affect the health status in the Kingdom negatively as diabetes mellitus is reported as the first cause of death in the Kingdom among all other prevalent diseases. Although knowledge management has been proven to be a valuable approach to sharing knowledge and educating users to manage their illnesses, it has not been implemented appropriately to support the increasing number of diabetic citizens in Saudi Arabia. In this research, knowledge management is integrated with knowledge discovery to support specific needs of the diabetic community in the Kingdom. Such an integration constitutes an e-health initiative to support diabetic citizens and healthcare professionals to manage this expanding illness in Saudi Arabia. Knowledge discovery is implemented through data mining to elicit useful knowledge related to specific diabetes complications encountered by diabetic citizens in the Kingdom. The integrated framework applies the SECI model to capture and disseminate useful diabetes self-management and educational expertise to support the management of diabetes complications. This integrated approach to knowledge management and knowledge discovery has provided a valuable tool implemented in terms of a web portal. This has facilitated the exchange and dissemination of tacit and explicit knowledge of the diabetic community in the forms of strategies, guidelines and best practices. It has also overcome the issues faced by the organisational and national cultures affecting knowledge management practice in Saudi Arabia

Factors contributing to a delay in reporting for labour by pregnant women at a regional hospital, Mopani District

The study was aimed at exploring and describing factors that influence the delay in reporting for labour by women in Mopani District and to evaluate the impact of the delay in the process and outcome of labour and to develop recommendations to address the contributory factors. The study was conducted at a regional hospital in the Mopani District. A qualitative descriptive research design was used for the participants to describe the factors that delays pregnant woman in reporting for labour in the regional hospital. A non-probability sampling design was used in the study. Data were collected through unstructured one-on-one interview. Thirteen (n=13) pregnant women who delayed reporting for labour in the regional hospital at Mopani District participated in the interviews. Data were collected and analysed through the use of content analysis approach. Seven themes developed from the findings leading to the establishment of the following recommendations including the use of theory as support system, making the availability of resources a priority, increasing capacity of all clinics to offer skilled birth, expansion of Mom-Connect into rural areas, establishment of MWHs in the rural areas, and increasing transportation such as ambulances.Health StudiesM.A. (Nursing science

Public Health in Developing Countries

Public health entails the use of models, technologies, experience and evidence derived through consumer participation, translational research and population sciences to protect and improve the health of the population. Enhancing public health is of significant importance to the development of a nation, particularly for developing countries where the health care system is underdeveloped, fragile or vulnerable.This book examines progress and challenges with regards to public health in developing countries in two parts: Part 1 “General and Crosscutting Issues in Public Health and Case Studies” and Part 2 “Country-Specific Issues in Public Health.” For example, assuring equity for marginalized indigenous groups and other key populations entails the application of transdisciplinary interventions including legislation, advocacy, financing, empowerment and de-stigmatization. The diverse structural, political, economic, technological, geographical and social landscape of developing countries translates to unique public health challenges, infrastructure and implementation trajectories in addressing issues such as vector-borne diseases and intimate partner violence.This volume will be of interest to researchers, health ministry policy makers, public health professionals and non-governmental organizations whose work entails collaborations with public health systems of developing nations and regions