Clinical informatics to improve quality of care: a population-based system for patients with diabetes mellitus

Background The prevalence of diabetes mellitus is increasing in the USA. However, control of intermediate outcome measures remains substandard. Recently, significant emphasis has been placed on the value of electronic medical records and informatics systems to improve the delivery of health care. Objective To determine whether a clinical informatics system improves care of patients with diabetes mellitus. Methods In this quality improvement pilot initiative, we identified 48 patients with diabetes mellitus who were due for their annual haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and microalbumin tests. Through our newly developed clinical informatics initiative, patients were reminded to schedule tests and a physician appointment. Seventy-five patients without reminders served as controls. Results A significant improvement in LDL control was achieved in the intervention group (35.4% vs 13.3%; P=0.004). The intervention group had a greater percentage of patients who underwent the three tests, and members of this group also showed greater control of haemoglobin A1c, but these differences were not statistically significant. Conclusions A clinical informatics system, used to deliver proactive, co-ordinated care to a population of patients with diabetes mellitus, can improve process and also quality outcome measures. Larger studies are needed to confirm these early findings

Mitigating risk in Norwegian psychiatric care:Identifying triggers of adverse events through Global Trigger Tool for psychiatric care

BACKGROUND: Patients treated in psychiatric care are exposed to the risk of adverse events, similar to patients treated in somatic health care. OBJECTIVES: In this article we report the findings of triggers associated with adverse events (AEs) identified by a version of the Global Trigger Tool - Psychiatry (GTT-P) adapted for Norwegian hospital-based psychiatric treatment. METHODS: The design was a retrospective analysis of a random sample of 240 patient records from a psychiatric clinic in one Norwegian hospital. Patient records were sampled from both inpatient and outpatient psychiatric clinics in hospitals serving the northern part of the county of Trøndelag, Norway. RESULTS: Our analysis was based on the identification of 32 potential triggers of adverse events. Eighteen of the triggers were significantly related to adverse events. No adverse events were identified in patient records that did not also contain triggers included in the Global Trigger Tool. CONCLUSIONS: There is a clear relationship between the presence of triggers in a patient record and the likelihood of adverse events. Particularly relevant for psychiatric patients is 'suffering' as a trigger and this may also be relevant to somatic care and has implications for inclusion in the GTT-P

Longitudinal Synaptic Loss in Primary Tauopathies: An In Vivo [11 C]UCB-J Positron Emission Tomography Study

BACKGROUND: Synaptic loss is characteristic of many neurodegenerative diseases; it occurs early and is strongly related to functional deficits. OBJECTIVE: In this longitudinal observational study, we determine the rate at which synaptic density is reduced in the primary tauopathies of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD), and we test the relationship with disease progression. METHODS: Our cross-sectional cohort included 32 participants with probable PSP and 16 with probable CBD (all amyloid-negative corticobasal syndrome), recruited from tertiary care centers in the United Kingdom, and 33 sex- and age-matched healthy control subjects. Synaptic density was estimated by positron emission tomography imaging with the radioligand [11 C]UCB-J that binds synaptic vesicle 2A. Clinical severity and cognition were assessed by the PSP Rating Scale and the Addenbrooke's cognitive examination. Regional [11 C]UCB-J nondisplaceable binding potential was estimated in Hammersmith Atlas regions of interest. Twenty-two participants with PSP/CBD had a follow-up [11 C]UCB-J positron emission tomography scan after 1 year. We calculated the annualized change in [11 C]UCB-J nondisplaceable binding potential and correlated this with the change in clinical severity. RESULTS: We found significant annual synaptic loss within the frontal lobe (-3.5%, P = 0.03) and the right caudate (-3.9%, P = 0.046). The degree of longitudinal synaptic loss within the frontal lobe correlated with the rate of change in the PSP Rating Scale (R = 0.47, P = 0.03) and cognition (Addenbrooke's Cognitive Examination-Revised, R = -0.62, P = 0.003). CONCLUSIONS: We provide in vivo evidence for rapid progressive synaptic loss, correlating with clinical progression in primary tauopathies. Synaptic loss may be an important therapeutic target and outcome variable for early-phase clinical trials of disease-modifying treatments. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Gender and release from imprisonment: Convict licensing systems in mid to late 19th century England

This paper draws on the research undertaken into the lives and prison experiences of around 650 male and female convicts who were released on licence (an early form of parole) from sentences of long term imprisonment (three years to life) in England in the mid- to late-nineteenth century. Our project confirmed the patterns of offending seen in other studies of female and male offending, namely, that women were committed to periods of long-term imprisonment overwhelmingly for crimes of larceny and sometimes low-level violence (or their criminal backgrounds indicated this type of low-level disorderly behaviour) and only in the minority for crimes of serious interpersonal violence. Similarly, the majority of men were also committed to the convict system for larceny. Yet how male and female offenders were treated by the prison licensing system did differ significantly. The vast majority of all prisoners, male and female, were released early on licence from their prison terms, even those who had committed very serious offences. All licences had several conditions in them and licence-holders were free so long as they met these conditions. Any breach of the above conditions meant that the individual would be returned to prison to serve out the remainder of their sentence.However, a proportion of female offenders were released slightly earlier than their male counterparts, though not directly into the community but on a conditional licence to Female Refuges. Out of the 288 women researched in our project, 200 of them were released in this manner; under further confinement in a refuge. Women stayed in such refuges for on average between six and nine months, before their final release was then approved by the Directors of the Convict Prisons

"Monstrous and indefensible"? Newspaper accounts of sexual assaults on children in nineteenth-century England and Wales

This material has been published in Women's Criminality in Europe, 1600–1914 edited by Edited by Manon van der Heijden, Marion Pluskota, Sanne Muurling, https://doi.org/10.1017/9781108774543. This version is free to view and download for private research and study only. Not for re-distribution or re-use. © 2020 Cambridge University Press.Popular crime reportage of sexual violence has a long history in England. Despite the fact that from the 1830s onwards newspapers and periodicals – and sometimes even law reports – were increasingly liable to skim over the reporting of sexual offences as ‘unfit for publication’, this does not mean that such reportage vanished entirely. Instead, certain linguistic codes and euphemisms were invoked to maintain a respectable discourse. Given the serious problems with gaps in the surviving archival record for modern criminal justice, newspapers remain an essential tool for understanding the history of sexual violence in nineteenth century England and Wales. Using keyword searches in digitized newspaper databases such as the British Newspaper Archive and Welsh Newspapers Database, this chapter examines the continuities and changes in the reporting of sexual violence against children between 1800 and 1900, and explores what these euphemisms and elisions reveal about attitudes to gender and crime in nineteenth-century England and Wales.Peer reviewe

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)