PACE-UP (Pedometer and consultation evaluation--UP)--a pedometer-based walking intervention with and without practice nurse support in primary care patients aged 45-75 years: study protocol for a randomised controlled trial.

BACKGROUND: Most adults do not achieve the 150 minutes weekly of at least moderate intensity activity recommended for health. Adults' most common physical activity (PA) is walking, light intensity if strolling, moderate if brisker. Pedometers can increase walking; however, most trials have been short-term, have combined pedometer and support effects, and have not reported PA intensity. This trial will investigate whether pedometers, with or without nurse support, can help less active 45-75 year olds to increase their PA over 12 months. METHODS/DESIGN: DESIGN: Primary care-based 3-arm randomized controlled trial with 12-month follow-up and health economic and qualitative evaluations. PARTICIPANTS: Less active 45-75 year olds (n = 993) will be recruited by post from six South West London general practices, maximum of two per household and households randomised into three groups. Step-count and time spent at different PA intensities will be assessed for 7 days at baseline, 3 and 12 months by accelerometer. Questionnaires and anthropometric assessments will be completed. INTERVENTION: The pedometer-alone group will be posted a pedometer (Yamax Digi-Walker SW-200), handbook and diary detailing a 12-week pedometer-based walking programme, using targets from their baseline assessment. The pedometer-plus-support group will additionally receive three practice nurse PA consultations. The handbook, diary and consultations include behaviour change techniques (e.g., self-monitoring, goal-setting, relapse prevention planning). The control group will receive usual care. OUTCOMES: Changes in average daily step-count (primary outcome), time spent sedentary and in at least moderate intensity PA weekly at 12 months, measured by accelerometry. Other outcomes include change in body mass index, body fat, self-reported PA, quality of life, mood and adverse events. Cost-effectiveness will be assessed by the incremental cost of the intervention to the National Health Service and incremental cost per change in step-count and per quality adjusted life year. Qualitative evaluations will explore reasons for trial non-participation and the interventions' acceptability. DISCUSSION: The PACE-UP trial will determine the effectiveness and cost-effectiveness of a pedometer-based walking intervention delivered by post or practice nurse to less active primary care patients aged 45-75 years old. Approaches to minimise bias and challenges anticipated in delivery will be discussed

A pedometer-based walking intervention in 45- to 75-year-olds, with and without practice nurse support: The PACE-UP three-arm cluster RCT

Background Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits. Objectives To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults, delivered postally or through dedicated practice nurse physical activity (PA) consultations. Design Parallel three-arm trial, cluster randomised by household. Setting Seven London-based general practices. Participants A total of 11,015 people without PA contraindications, aged 45–75 years, randomly selected from practices, were invited. A total of 6399 people were non-responders, and 548 people self-reporting achieving PA guidelines were excluded. A total of 1023 people from 922 households were randomised to usual care (n = 338), postal intervention (n = 339) or nurse support (n = 346). The recruitment rate was 10% (1023/10,467). A total of 956 participants (93%) provided outcome data. Interventions Intervention groups received pedometers, 12-week walking programmes advising participants to gradually add ‘3000 steps in 30 minutes’ most days weekly and PA diaries. The nurse group was offered three dedicated PA consultations. Main outcome measures The primary and main secondary outcomes were changes from baseline to 12 months in average daily step counts and time in MVPA (in ≥ 10-minute bouts), respectively, from 7-day accelerometry. Individual resource-use data informed the within-trial economic evaluation and the Markov model for simulating long-term cost-effectiveness. Qualitative evaluations assessed nurse and participant views. A 3-year follow-up was conducted. Results Baseline average daily step count was 7479 [standard deviation (SD) 2671], average minutes per week in MVPA bouts was 94 minutes (SD 102 minutes) for those randomised. PA increased significantly at 12 months in both intervention groups compared with the control group, with no difference between interventions; additional steps per day were 642 steps [95% confidence interval (CI) 329 to 955 steps] for the postal group and 677 steps (95% CI 365 to 989 steps) for nurse support, and additional MVPA in bouts (minutes per week) was 33 minutes per week (95% CI 17 to 49 minutes per week) for the postal group and 35 minutes per week (95% CI 19 to 51 minutes per week) for nurse support. Intervention groups showed no increase in adverse events. Incremental cost per step was 19p and £3.61 per minute in a ≥ 10-minute MVPA bout for nurse support, whereas the postal group took more steps and cost less than the control group. The postal group had a 50% chance of being cost-effective at a £20,000 per quality-adjusted life-year (QALY) threshold within 1 year and had both lower costs [–£11M (95% CI –£12M to –£10M) per 100,000 population] and more QALYs [759 QALYs gained (95% CI 400 to 1247 QALYs)] than the nurse support and control groups in the long term. Participants and nurses found the interventions acceptable and enjoyable. Three-year follow-up data showed persistent intervention effects (nurse support plus postal vs. control) on steps per day [648 steps (95% CI 272 to 1024 steps)] and MVPA bouts [26 minutes per week (95% CI 8 to 44 minutes per week)]. Limitations The 10% recruitment level, with lower levels in Asian and socioeconomically deprived participants, limits the generalisability of the findings. Assessors were unmasked to the group. Conclusions A primary care pedometer-based walking intervention in 45- to 75-year-olds increased 12-month step counts by around one-tenth, and time in MVPA bouts by around one-third, with similar effects for the nurse support and postal groups, and persistent 3-year effects. The postal intervention provides cost-effective, long-term quality-of-life benefits. A primary care pedometer intervention delivered by post could help address the public health physical inactivity challenge. Future work Exploring different recruitment strategies to increase uptake. Integrating the Pedometer And Consultation Evaluation-UP (PACE-UP) trial with evolving PA monitoring technologies. Trial registration Current Controlled Trials ISRCTN98538934National Institute for Health Research (NIHR) Health Technology Assessment programm

Effect of a primary care walking intervention with and without nurse support on physical activity levels in 45- to 75-year-olds: The pedometer and consultation evaluation (PACE-UP) cluster randomised clinical trial

Background Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations. Methods and Findings A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45–75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012–2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329–955) and 677 for nurse support (95% CI 365–989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17–49) and 35 for nurse support (95% CI 19–51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation. Conclusions A primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge.The PACE-UP trial was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number HTA 10/32/02 ISRCTN42122561) and will be published in full in Health Technology Assessment. The funders had no role in study design (beyond the commissioned call outline), data collection and analysis, decision to publish, or preparation of the manuscript

Education Day 2017 Proceedings - Transformational Education: Learning for Life

Proceedings from St George's, University of London Education Day 2017.<br><br>Contents<br><br>Part 1: Insights <br><br> 1. Transformation & the St. George’s Education and Students Strategy<br> Jane Saffell <br><br> 2. A Critical Introduction<br> Johan Geertsema <br><br> 3. Interview with Professor Linda Price, Keynote Speaker<br> Linda Price and Roberto Di Napoli <br><br><br>Part 2: Sharing Expertise <br><br> Introduction<br> Elizabeth Miles <br><br> 4. Making MOOCs in medicine and healthcare<br> Luke Woodham, Kate Tatton-Brown, Fiona Howat, Sheetal Kavia, Trupti Jivram, Aurora Sesé Hernandez, Supriya Krishnan, Ella Poulton, Kavirthana Krishnamoorthy, Terry Poulton <br><br> 5. Genomic medicine and a flexible curriculum<br> Kate Tatton-Brown <br><br> 6. Simulation-based education of MBBS students at satellite sites of St. George’s, University of London<br> Aaron O’Callaghan, Christopher J.D. Threapleton, Teck Khong <br><br> 7. Teaching the transition from medical student to doctor: the ‘Preparation for Medicine’ sessions<br> Claire Spiller <br><br> 8. Transforming education at St. George’s with Canvas<br> Evan Dickerson, Kerry Dixon, Bryony Williams <br><br><br>Part 3: Student Voices <br><br> Introduction<br> David Oliveira <br><br> 9. Connect - a transformational student platform<br> Alexander Zargaran, Amal Thomas, Aasim Murtaza, Harry Spiers, Mohammed Turki <br><br><br>Part 4: Poster Commentaries and Other Contributions <br><br> Introduction<br> Judith Ibison <br><br> 10. A temporary transformation - the first women medical students at St. George’s Medical School, London<br> Jenny Day, Hugh Thomas <br><br> 11. Reflecting on practice: 2500 years of getting it wrong - a brief history of medical error<br> Jonathan Round <br><br> 12. Transforming approaches to critical thinking: the use of a critical thinking skills framework to enhance learning, teaching and assessment<br> Hilary Wason, Cheryl Whiting, Fran Arrigoni, Colin Clarke <br><br> 13 Reflective piece - quality improvement projects<br> Saba Khan <br><br> 14 Transformative learning in Public Health - using a Dragon’s Den approach<br> Georgina Pearson, Hugh Thomas <br><br> 15 Educational transformation and the poster presentation of the incidence and management of anticoagulants in the HEMS population<br> Rose Hall, Anthony Hudson <br><br> 16 Training Against Medical Error (TAME) - transforming medical education using medical error virtual patient cases<br> Trupti Jivram, Luke Woodham, Ella Poulton, Jonathan Round, Terry Poulton<br><br><br>Online resources and supplementary material for this publication can be accessed via the link referenced below.<br><br><br

The short-term and long-term cost-effectiveness of a pedometer-based intervention in primary care: a within trial analysis and beyond-trial modelling

Background There is little evidence of the cost-effectiveness of pedometer-based interventions. We examined the short-term and long-term cost-effectiveness of a pedometer-based walking intervention in inactive adults. Methods Data were collected as part of a three-arm cluster-randomised trial conducted (2012–14) in seven primary care practices in London to assess the effectiveness of pedometer-based walking interventions (PACE-UP trial). Eligible participants were inactive adults aged 45–75 years, without contraindications to increasing moderate-tovigorous physical activity. 11 015 people were mailed an invitation. 6399 were non-responders, and 548 individuals who self-reported as being active were excluded. 1023 people were randomised to usual care (control, n=338), postal pedometer (339), and nurse-supported pedometer interventions (346). 956 participants (93%) provided outcome data. Intervention groups received pedometers, 12 week walking programmes, and diaries to record physical activity. The nurse group was also offered three physical activity consultations. A within trial cost-effectiveness analysis was done at 1 year. Additionally, a Markov model, using routine data obtained via reviews of epidemiological and economic literature, was used to extend trial results to a life-time horizon. Cost per change in physical activity (step count, and moderate-to-vigorous physical activity in ≥10 minute bouts) and quality-adjusted life-years (QALYs) for interventions were assessed. Costs (in 2013 prices) are presented from a health-care provider’s perspective and uncertainty as a costeff-ectiveness acceptability curve. Ethics approval was provided by London Research Ethics Committee (Hampstead). PACE-UP is registered with Current Controlled Trials, ISRCTN98538934. Findings In the short term, incremental cost per step and cost per min in a 10 min or more bout of moderate-to-vigorous physical activity were £0·19 and £3·61, respectively, for nurse-support. The postal group took a greater number of steps and cost less. In the long term, the postal group dominated both control and nurse groups in that QALY gains (759, 95% CI 400 to 1247) added to increased cost savings (–£11 million, 95% CI –12 to –10), resulting in an incremental net monetary benefit of £26 million (based on a hypothetical cohort of 100 000 people). The postal group had a 50% chance of being cost-effective in terms of QALYs at 1 year and, at a £20 000 per QALY threshold, robustly dominated both nurse and control groups in the long term. Interpretation A pedometer-based intervention delivered by post, compared with current practice, would deliver cost savings in the short term and the most quality of life benefits in the long term.National Institute for Health Research Health Technology Assessment Programm

COVIRA: COmputer VIsion in RAdiology

Kuhn MH, Carlsen IC, Menhardt W, et al. COVIRA: COmputer VIsion in RAdiology. In: Noothoven van Goor J, ed. Advances in medical informatics: results of the AIM exploratory action. Studies in health technology and informatics ; 2. Amsterdam [u.a.]: IOS Press; 1992: 88-101

Baseline characteristics of 1,023 randomised participants.

<p>Baseline characteristics of 1,023 randomised participants.</p