Mortality post inpatient alcohol detoxification: a descriptive case series

<br>Background: Individuals with alcohol dependence often die prematurely. Scotland in particular has high rates of alcohol misuse compared to the rest of the UK and Europe. Although there is some evidence that rates of alcoholrelated harm and alcohol-related deaths are reducing in Europe, there is little evidence of this trend occurring in Scotland. Inpatient detoxification is an important, but expensive, option in the management of alcohol dependence. Little work has been done with regard possible clinical characteristics associated with mortality post discharge in this cohort of patients.</br> <br>Methods: Retrospective electronic records were used to identify patients admitted electively for alcohol detoxification into a psychiatric ward in a district general hospital under the care of a single consultant addiction psychiatrist between 1/1/05 and 31/12/07 inclusively. Demographic and clinical factors were recorded. 5-year mortality data was obtained by linkage to the National Records of Scotland.</br> <br>Results: 25.2% of patients admitted for elective alcohol detoxification died during the 5-year follow up period. 42.9% of deaths (n=12) were due to alcoholic liver disease, one death (3.6%) was of undetermined intent. A higher proportion of the deceased cohort was likely to have continued disulfiram (93% vs. 80%) and acamprosate (81% vs. 60%) than those surviving. There was no statistically significant difference in survival between individuals on medication and those not on medications in our cohort. The average consumption of units of alcohol per week in the deceased cohort was significantly higher than that calculated for the surviving cohort (298.8 units vs. 233.3 units p=0.0137).</br> <br>Conclusion: Inpatient detoxification was associated with significant mortality at 5-year follow up post- discharge. The majority of deaths were due to liver disease while deaths due to accidents and of undetermined intent were relatively infrequent. Increased education and practical strategies such as “space and pace” aimed both at an individual and societal level to reduce alcohol consumption may help to reduce mortality associated with alcohol dependence post inpatient detoxification.</br&gt

A contemporary history of the origins and development of UK Biobank, 1998-2005

Background: This thesis examines the origins and early development of UK Biobank. This is a resource funded in 2002 by the Medical Research Council, the Wellcome Trust, the Department of Health and the Scottish Executive to gather genetic and lifestyle information from half a million participants aged 4069 years old in the UK and monitor their health for up to thirty years in order to improve the prevention, diagnosis and treatment of major diseases. UK Biobank was set up following the completion of the Human Genome Project in 2001, and was one of many established at around the same time with the goal of translating the knowledge of the human genome sequence into practical benefits for human health. (National genetic databases were also set up or proposed in Iceland, Estonia, Latvia, Sweden, Singapore, Tonga, Spain, and the United States). They, and the Human Genome Project, had raised a number of important issues about access to and ownership of genetic information. Aims: The original aim of my PhD was to examine lay and professional understandings and responses to Biobank in the light of this background. However, UK Biobank took longer than expected to reach the stage of data collection, in part because of negotiations about its organisational structure. The aim therefore changed to address the question of how and why was UK Biobank initially configured in the manner it was. Organisational structure: UK Biobank was originally set up by the funders with a ‘hub’ and ‘spoke’ model, with calls for bids from UK Universities for a central ‘hub’ charged with financial management and overall control of data and samples, and ‘spokes’ who were responsible for recruitment and data collection through primary care. The selection of both was made through the procurement rules of the EU. The hub (Manchester), six regional spokes, and the CEO (from Oxford) were all appointed simultaneously in 2003 and subsequently a Board of Directors and a number of committees were appointed. The CEO resigned in late 2004, and a new CEO and Principal Investigator was appointed in 2005, after which there were significant changes to the organisational structure. Methods: I conducted 76 oral history interviews with academic scientists directly and indirectly involved in UK Biobank, representatives of all four funding bodies, and representatives of UK Biobank Limited (the company set up to manage UK Biobank). I also conducted archival analysis of the MRC’s official documents concerning the origins and development of UK Biobank. Findings: From its beginning UK Biobank was marked by tension between academic scientists on the one hand and representatives of the funding bodies and UK Biobank Limited on the other. Academic scientists criticised the funding bodies for establishing UK Biobank in a way that departed from what I have termed ‘standard academic scientific practice’. Spokes felt they should receive some privileged access to data they would contribute to collecting, and felt that the set up did not recognise the performance indicators driving scientists and universities. Lack of clarity over who was in control of UK Biobank contributed to these tensions as both spokes and funders felt that the other exerted undue influence. Some mistrust developed between academic scientists and representatives of the funding bodies and UK Biobank Limited. Discussion: The configuration of UK Biobank was difficult for academic scientists and representatives of both the funding bodies and UK Biobank alike. Organisational issues, typical of those confronting Big Science initiatives, were largely responsible for this difficult legacy. Issues of leadership, the hub and spoke model, the sequencing of funding decisions, appointment of groups and committees and protocol development, uncertainties about who was in control, and ambiguities within the organisational structure as a whole were the most significant issues in the origins and development of UK Biobank, as the organisational changes in 2005 testify

‘It's like the bad guy in a movie who just doesn't die’ : a qualitative exploration of young people's adaptation to eczema and implications for self‐care

Background Eczema is a common childhood inflammatory skin condition, affecting more than one in five children. A popular perception is that children ‘outgrow eczema’, although epidemiological studies have shown that, for many, eczema follows a lifelong episodic course. Objectives To explore the perceptions of young people about the nature of their eczema and how these perceptions relate to their self‐care and adapting to living with eczema. Methods This is a secondary inductive thematic analysis of interviews conducted for Healthtalk.org. In total 23 interviews with young people with eczema were included. Of the 23 participants, 17 were female and six male, ranging from 17 to 25 years old. Results Participants generally experienced eczema as an episodic long‐term condition and reported a mismatch between information received about eczema and their experiences. The experience of eczema as long term and episodic had implications for self‐care, challenging the process of identifying triggers of eczema flare‐ups and evaluating the success of treatment regimens. Participants’ experiences of eczema over time also had implications for adaptation and finding a balance between accepting eczema as long term and hoping it would go away. This linked to a gradual shift in treatment expectations from ‘cure’ to ‘control’ of eczema. Conclusions For young people who continue to experience eczema beyond childhood, a greater focus on self‐care for a long‐term condition may be helpful. Greater awareness of the impact of early messages around ‘growing out of’ eczema and provision of high‐quality information may help patients to manage expectations and support adaptation to treatment regimens

Which Came First: Literacy or Social Studies? How Primary Sources Can Bridge the Divide

Due to the implementation of No Child Left Behind and the Common Core State Standards, disciplinary literacy has become a vital component of social studies instruction in middle and secondary classrooms. This paper determines the degree to which nine middle and high school social studies teachers were successful in designing integrated learning experiences for their students after attending professional development. Data from semi-structured interviews, teachers’ instructional units, workshop surveys and field notes were collected and analyzed for the qualitative study. The study considers how teachers’ instructional units incorporated primary sources to support students’ foundational literacy skills, scaffolded disciplinary understanding, historical analysis, and highlighted community issues that connected their lived experiences to broader social concerns

Using Primary Sources in Content Areas to Increase Disciplinary Literacy Instruction

This paper describes how a three-day summer workshop on using primary sources helped teachers increase the emphasis placed on disciplinary literacy when teaching social studies and history. Two specific issues in teacher education and practice are addressed. First, increasing teachers’ content knowledge of history topics can help them plan lessons that connect local and global events. Second, content area reading requires literacy practices, which are unique to disciplines. Therefore, teachers need to apply historical inquiry and disciplinary literacy methods in the curriculum

Missing data in randomized controlled trials testing palliative interventions pose a significant risk of bias and loss of power: a systematic review and meta-analyses

Objectives To assess the risk posed by missing data (MD) to the power and validity of trials evaluating palliative interventions. Study Design and Setting A systematic review of MD in published randomized controlled trials (RCTs) of palliative interventions in participants with life-limiting illnesses was conducted, and random-effects meta-analyses and metaregression were performed. CENTRAL, MEDLINE, and EMBASE (2009-2014) were searched with no language restrictions. Results One hundred and eight RCTs representing 15,560 patients were included. The weighted estimate for MD at the primary endpoint was 23.1% (95% confidence interval [CI] 19.3, 27.4). Larger MD proportions were associated with increasing numbers of questions/tests requested (odds ratio [OR] , 1.19; 95% CI 1.05, 1.35) and with longer study duration (OR, 1.09; 95% CI 1.02, 1.17). Meta-analysis found evidence of differential rates of MD between trial arms, which varied in direction (OR, 1.04; 95% CI 0.90, 1.20; I 2 35.9, P = 0.001). Despite randomization, MD in the intervention arms (vs. control) were more likely to be attributed to disease progression unrelated to the intervention (OR, 1.31; 95% CI 1.02, 1.69). This was not the case for MD due to death (OR, 0.92; 95% CI 0.78, 1.08). Conclusion The overall proportion and differential rates and reasons for MD reduce the power and potentially introduce bias to palliative care trials