Identifying acne treatment uncertainties via a James Lind Alliance Priority Setting Partnership

Objectives: The Acne Priority Setting Partnership (PSP) was set up to identify and rank treatment uncertainties by bringing together people with acne, and professionals providing care within and beyond the National Health Service (NHS). Setting: The UK with international participation. Participants: Teenagers and adults with acne, parents, partners, nurses, clinicians, pharmacists, private practitioners. Methods: Treatment uncertainties were collected via separate online harvesting surveys, embedded within the PSP website, for patients and professionals. A wide variety of approaches were used to promote the surveys to stakeholder groups with a particular emphasis on teenagers and young adults. Survey submissions were collated using keywords and verified as uncertainties by appraising existing evidence. The 30 most popular themes were ranked via weighted scores from an online vote. At a priority setting workshop, patients and professionals discussed the 18 highest-scoring questions from the vote, and reached consensus on the top 10. Results: In the harvesting survey, 2310 people, including 652 professionals and 1456 patients (58% aged 24 y or younger), made submissions containing at least one research question. After checking for relevance and rephrasing, a total of 6255 questions were collated into themes. Valid votes ranking the 30 most common themes were obtained from 2807 participants. The top 10 uncertainties prioritised at the workshop were largely focused on management strategies, optimum use of common prescription medications and the role of nondrug based interventions. More female than male patients took part in the harvesting surveys and vote. A wider range of uncertainties were provided by patients compared to professionals. Conclusions: Engaging teenagers and young adults in priority setting is achievable using a variety of promotional methods. The top 10 uncertainties reveal an extensive knowledge gap about widely used interventions and the relative merits of drug versus non-drug based treatments in acne management

Zircon U-Pb, Hf and O isotope constraints on growth versus reworking of continental crust in the subsurface Grenville orogen, Ohio, USA

Combined U-Pb, O and Hf isotope data in zircon allows discrimination between juvenile and reworked crust, and is therefore a useful tool for understanding formation and evolution of the continental crust. The crustal evolution of basement rocks in central North America (Laurentia) is poorly constrained, as it is almost entirely overlain by Palaeozoic cover. In order to improve our understanding of the evolution of this region we present U-Pb, O and Hf isotope data from zircon in drill-core samples from the subsurface basement of Ohio. The Hf isotope data suggests juvenile crust formation at similar to 1650 Ma followed by continued reworking of a single reservoir. This similar to 1650 Ma reservoir was tapped at similar to 1450 Ma during the formation of the Granite-Rhyolite Province and subsequently reworked again during the Grenvillian orogeny. The similar to 1650 Ma crust formation model age for the suite of samples along with the presence of similar to 1650 Ma magmatic rocks suggests an eastward extension of the Mazatzal Province (or Mazatzal-like crust) and makes it a possible protolith to the subsurface basement of Ohio and surrounding Mesoproterozoic (i.e. Grenville-age) rocks. The eastward extension of this similar to 1650 Ma crustal reservoir into Ohio requires a revision of the crustal boundary defined by Nd isotopic data to be located further east, now overlapping with the Grenville front magnetic lineament in Ohio. In fact, the easternmost sample in this study is derived from a more depleted reservoir. This limits the extent of >1.5 Ga basement in subsurface Ohio and constrains the location of the crustal boundary. Further, syn-orogenic magmatism at similar to 1050 Ma suggests a potential extrapolation of the Interior Magmatic Belt into Ohio. Oxygen isotopic data in zircon suggests that during Grenvillian metamorphism, zircon recrystallisation occurred in the presence of heavy delta O-18 fluids resulting in zircon with elevated delta O-18 values. (C) 2015 Elsevier B.V. All rights reserved

Protocol for a prospective observational study of adverse drug reactions of antiepileptic drugs in children in the UK

Background Epilepsy is a common chronic disease of children that can be treated with anti-epileptic drugs (AEDs). AEDs, however, have significant side effects. Newer AEDs are thought to have fewer side effects. There have, however, been few comparative studies of AED toxicity. The aim is to compare the safety profile of the most frequently used AEDs by performing a multicentre prospective cohort study. This protocol describes the planned study. Design A multicentre prospective cohort study of children on AED treatment in hospitals across the UK. Ethical approval will be obtained. Sample size Three thousand children on treatment for epilepsy will be recruited from paediatric clinics. It is expected that this sample size will have the potential to compare toxicity between the most frequently used AEDs. Duration of study 24 months. Outcome measure Adverse drug reactions (ADRs) to AEDs. These will be identified by the use of a validated questionnaire, the Paediatric Epilepsy Side Effect Questionnaire. They will be evaluated using the Naranjo algorithm. Preventability will be assessed using the Schumock and Thornton scale. Discussion Toxicity of individual AEDs when given as monotherapy and polytherapy will be determined. Additionally, discontinuation rates due to ADRs will be determined. The data will assist clinicians in choosing AEDs with the least toxicity

Early death following revision total hip arthroplasty

Introduction:The frequency of primary total hip arthroplasty procedures is increasing, with a subsequent rise in revision procedures. This study aims to describe timing and surgical mortality associated with revision total hip arthroplasty (THA) compared to those on the waiting list.Methods:All patients from a single institution who underwent revision total hip arthroplasty or were added to the waiting list for the same procedure between 2003 and 2013 were recorded. Mortality rates were calculated at 30 and 90 days following surgery or addition to the waiting list.Results:561 patients were available for the survivorship analysis in the surgical group. Following exclusion, 901 and 484 patients were available for the 30 and the 90-day analysis in the revision THA waiting list group. 30- and 90-day mortality rates were significantly greater for the revision THA group compared to the waiting list group (excess surgical mortality at 30 days = 0.357%, p = 0.037; odds ratio of 5.22, excess surgical mortality at 90 days = 0.863%, p = 0.045).Conclusions:Revision total hip arthroplasty is associated with a significant excess surgical mortality rate until 90 days post-operation when compared to the waiting list population. We would encourage other authors with access to larger samples to use our method to quantify excess mortality after both primary and revision arthroplasty procedures.</jats:sec

The model of mortality with incident cirrhosis (MoMIC) and the model of long-term outlook of mortality in dcirrhosis (LOMiC)

The purpose of this study was to produce two statistical survival models in those with cirrhosis utilising only routine parameters, including non-liver-related clinical factors that influence survival. The first model identified and utilised factors impacting short-term survival to 90-days post incident diagnosis, and a further model characterised factors that impacted survival following this acute phase. Data were from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. Incident cases in patients ≥18 years were identified between 1998 and 2014. Patients that had prior history of cancer or had received liver transplants prior were excluded. Model-1 used a logistic regression model to predict mortality. Model-2 used data from those patients who survived 90 days, and used an extension of the Cox regression model, adjusting for time-dependent covariables. At 90 days, 23% of patients had died. Overall median survival was 3.7 years. Model-1: numerous predictors, prior comorbidities and decompensating events were incorporated. All comorbidities contributed to increased odds of death, with renal disease having the largest adjusted odds ratio (OR = 3.35, 95%CI 2.97–3.77). Model-2: covariables included cumulative admissions for liver disease-related events and admissions for infections. Significant covariates were renal disease (adjusted hazard ratio (HR = 2.89, 2.47–3.38)), elevated bilirubin levels (aHR = 1.38, 1.26–1.51) and low sodium levels (aHR = 2.26, 1.84–2.78). An internal validation demonstrated reliability of both models. In conclusion: two survival models that included parameters commonly recorded in routine clinical practice were generated that reliably forecast the risk of death in patients with cirrhosis: in the acute, post diagnosis phase, and following this critical, 90 day phase. This has implications for practice and helps better forecast the risk of mortality from cirrhosis using routinely recorded parameters without inputs from specialists

Paid parental leave evaluation: Phase 1

From 1 January 2011, Australian families in which a mother was in the paid workforce before the birth or adoption of a baby may be eligible for a new Australian Government-funded Paid Parental Leave (PPL)1 scheme. The scheme provides eligible parents with up to 18 weeks of Parental Leave Pay (PLP), paid at the National Minimum Wage, following the birth of a child. The PPL scheme brings Australia into line with all other OECD countries, except the United States, in having a national scheme for paid leave available to mothers following childbirth. [Executive summary extract