Review of speech and language therapy, phsyiotherapy and occupational therapy for children, and speech and language therapy for adults with learning disabilities and autistic spectrum disorder.

This report outlines the work of the Review of Speech and Language Therapy, Occupational Therapy and Physiotherapy for children and Speech and Language Therapy for adults with learning disabilities in Scotland, commissioned by the Scottish Executive in 2002. The review was carried out by researchers from Queen Margaret University College, guided by a steering group made up of representatives from the Scottish Executive Education Department and the Scottish Executive Health Department as well as advisors from a number of stakeholder groups.caslpub2215pu

An exploration of the lived experiences of people with alcohol related harm in Scotland

Background; Alcohol consumption has posed well documented problems for Scottish society, in terms of morbidity, mortality and wider societal costs. Objectives; To investigate the lived experiences and drinking behaviours of people with alcohol-related harm in Scotland, against a backdrop of recent economic downturn, falling incomes, welfare reform and changes to state benefits. Methods; As part of a larger Scottish study (2012-2014) of 639 individuals attending hospital or admitted, relating to an alcohol problem, 20 participants completed semi-structured interviews about their drinking and purchasing habits which were subjected to thematic analysis. Conclusions; Key themes elucidated participants' everyday drink-related behaviours within their local environment including drinking triggers, sourcing alcohol, resourcing alcohol purchase and views relating to substitution. The majority of participants had experienced reduced income, and adapted their alcohol purchasing behaviours accordingly, including 'trading down' to cheaper alcohol. A reduction in food purchasing and heating was a common outcome, as was falling into, or increasing current, debt. More attention should be paid to the prevalence and accessibility of alcohol within local communities. Ultimately, as long as there is highly visible and easily accessible cheap alcohol, heavy drinkers may struggle to undertake positive steps to reduce their damaging consumption levels.div_PaSAnderson, P., & Baumberg, B. (2006). Alcohol in Europe. A public health perspective: London: Institute of Alcohol Studies; 2006. Beeston, C., McAdams, R., Craig, N., Gordon, R., Graham, L., MacPherson, M., McAuley, A., McCartney, G., Robinson, M., Shipton, D., & Van Heelsum, A. (2016). Monitoring and Evaluating Scotland's Alcohol Strategy. Final Report. Edinburgh: NHS Health Scotland. Black, H., Gill, J., & Chick, J. (2011). The price of a drink: levels of consumption and price paid per unit of alcohol by Edinburgh's ill drinkers with a comparison to wider alcohol sales in Scotland. Addiction, 106(4), 729-736. BMA (2012). Reducing the affordability of alcohol. A briefing from the BMA Board of Science: British Medical Association, London: BMA; 2012. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. Cohn, S. (2016). Reconceptualising public acceptability: A study of the ways people respond to policies aimed to reduce alcohol consumption. Health, 20, 203-219. Cook, P., Phillips-Howard, P., Morleo, M., Harkins, C., Briant, L., & Bellis, M. (2011). The Big Drink Debate: perceptions of the impact of price on alcohol consumption form a large scale cross-sectional convenience survey in north west England. BMC Public Health, 11, 664. doi: 10.1186/1471-2458-11-664. 21 Duffy, J., & Snowdon, C. (2012). The minimal evidence for minimum pricing: London: ASI (Research) Ltd. Forsyth, A.J.M., Ellaway, A., & Davidson, N. (2014). How might the Alcohol Minimum Unit Pricing (MUP) impact upon local off-sales shops and the communities which they serve? Alcohol and Alcoholism, 49(1), 96-102. Foster, J., & Ferguson, C. (2012). Home drinking in the UK: trends and causes. Alcohol and Alcoholism, 47(3), 355-358. Gill, J., Chick, J., Black, H., Rees, C., O'May, F., Rush, R., & McPake, B.A. (2015). Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity. Public Health, 129(12), 1571-1578. Gmel, G., Holmes, J. & Studer, J. (2016). Are alcohol outlet densities strongly associated with alcohol-related outcomes? A critical review of recent evidence. Drug and Alcohol Review, 35, 40-54. HM Government (2012). Welfare Reform Act 2012. Retrieved from http://services.parliament.uk/bills/2010-11/welfarereform.html (last accessed 14 January 2016) ISD (2015). Alcohol-related Hospital Statistics Scotland 2014/15. Edinburgh: Information and Statistics Division. Retrieved from http://www.isdscotland.org/Health-Topics/Drugs-and- 22 Alcohol-Misuse/Publications/2015-10-13/2015-10-13-ARHS2014-15-Report.pdf (last accessed 14 January 2016) Ludbrook, A., Petrie, D., McKenzie, L., & Farrar, S. (2012). Tackling alcohol misuse purchasing patterns affected by minimum pricing for alcohol. Applied Health Economics and Health Policy, 10(1), 51-63. MacNaughton, P., & Gillan, E. (2011). Re-thinking alcohol licensing. Edinburgh: Alcohol Focus Scotland/Scottish Health Action on Alcohol Problems. Makela, P., Herttua, K., & Martikainen, P. (2015). The socioeconomic differences in alcohol-related harm and the effects of alcohol prices on them: a summary of evidence from Finland. Alcohol and Alcoholism, 50(6), 661-669. Nakamura, R., Suhrcke, M., Pechey, R., Morciano, M., Roland, M., & Marteau, T.M. (2014a). Impact on alcohol purchasing of a ban on multi-buy promotions: a quasi-experimental evaluation comparing Scotland with England and Wales. Addiction 109(4): 558-567. Nakamura, R., Pechey, R., Suhrcke, M., Jebb, S., & Marteau, T. (2014b). Sales impact of displaying alcoholic and no-alcoholic beverages in end-of-aisle locations: an observational study. Social Science & Medicine 108: 68-73. ONS (2014). Office for National Statistics. Statistical Bulletin: Alcohol-related deaths in the United Kingdom, registered in 2012. Retrieved from http://www.ons.gov.uk/ons/dcp171778_353201.pdf (last accessed 14 January 2016). 23 O'May, F., Black, H., Gill, J., Rees, C., Chick, J., & McPake, B. (2016) Dependent drinkers' perspectives on minimum unit pricing for alcohol in Scotland: a qualitative interview study. SAGEOpen, DOI: 10.1177/2158244016657141. O'May F, Whittaker A, Black H and Gill J. (2016) The families and friends of heavy drinkers; caught in the cross fire of policy change? Drug and Alcohol Review 2016 Apr 13. doi: 10.1111/dar.12403. Orford, J., Velleman, R., Copello, A., Templeton, L. & Ibanga, A. (2010). The experiences of affected family members: a summary of two decades of qualitative research. Drug Education Prevention and Policy, 17, 44-62. Orford, J., Velleman, R., Natera, G., Templeton, L. & Coppello, A. (2013). Addiction in the family is a major but neglected contributor to the global burden of adult ill-health. Social Science & Medicine, 78, 70-77. Rice, P. (2014). Why do the health professions want minimum unit price in Scotland? In Proceedings of Scotland the Brave! - Alcohol Policy in Scotland, 5 September, 2014, Brussels. Retrieved from http://www.shaap.org.uk/images/mup-event-summary.pdf (last accessed 14 January 2016). Richardson, E.A., Hill, S.E., Mitchell,R., Pearce, J., & Shortt, N.K. (2015). Is local alcohol outlet density related to alcohol-related morbidity and mortality in Scottish cities? Health & Place, 33, 172-180. 24 Riessman, C. (1993). Narrative Analysis. London: Sage. Robinson, M., Geue, C., Lewsey, J., Mackay, D., McCartney, G., Curnock, E., Beeston, C. (2013). Monitoring and Evaluating Scotland's Alcohol Strategy: The impact of the Alcohol Act on off-trade alcohol sales in Scotland: Edinburgh: NHS Health Scotland. Robinson, M., Beeston, C., McCartney, G., Craig, N. (2015). Monitoring and Evaluating Scotland's Alcohol Strategy: Annual update of alcohol sales and price band analyses. Edinburgh: NHS Health Scotland. Scottish Government (2009). Changing Scotland's relationship with alcohol: a framework for action: Edinburgh: Health and Social Care Directorate. Scottish Government (2012). Introduction to SIMD. Edinburgh: Scottish Government. Retrieved from http://simd.scotland.gov.uk/publication-2012/ (last accessed 14 January 2016). Scottish Government (2015a). Minimum unit pricing. Retrieved from http://www.scotland.gov.uk/Topics/Health/Services/Alcohol/minimum-pricing (last accessed 12 January 2016(. Scottish Government (2015b). Scottish Liquor Licensing Statistics 2014-2015. Retrieved from http://www.gov.scot/Topics/Statistics/Browse/Crime-Justice/PubLiquor (last accessed 14 January 2016). 25 Scottish Parliament (2005). Licensing (Scotland) Act 2005. Edinburgh: Scottish Parliament. Scottish Parliament (2010). Alcohol etc. (Scotland) Act 2010. Edinburgh: Scottish Parliament. Scottish Parliament (2012). Alcohol (Minimum Pricing) (Scotland) Act. Edinburgh: Scottish Parliament. Scottish Parliament (2015). Welfare Reform Committee 1st Report, 2015 (Session 4): The Cumulative Impact of Welfare Reform on Households in Scotland. Edinburgh: Scottish Parliament. Sheron, N. (2014). Alcohol and Liver Disease in Europe. In Proceedings of Scotland the Brave! - Alcohol Policy in Scotland, 5 September, 2014, Brussels. Retrieved from http://www.shaap.org.uk/images/mup-event-summary.pdf (last accessed 14 January 2016). Shipton, D., & Whyte, B. (2011). Mental Health in Focus: a profile of mental health and wellbeing in Greater Glasgow & Clyde. Glasgow: Glasgow Centre for Population Health. Retrieved from http://www.gcph.co.uk/assets/0000/2748/Mental_Health_in_Focus_15_11_11.pdf (last accessed 14 January 2016).pub4623pu

Final Report for The Lydia Osteoporosis Project

Sharing Research and Education Focused on Moving and Handling and Older People with Osteoporosis in Acute Settingssch_nurAge UK www.ageuk.org.uk accessed 30th June 2016 Biggs J and Tang C 2011 Teaching for Quality Learning at University (Society for Research into Higher Education) SRHE and Open University Press Imprint, Maidenhead, UK. Blaikie, N. 2009 Designing Social Research. Polity Press, Cambridge, UK. Colon-Emeric, CS., Lyles, KW., House, P., Levine, DA., Schenck, AP., et al. 2007 Randomised trial to improve fracture prevention in nursing home residents American Journal of Medicine 120 (10) 886 -892 Coulter Smith M A, O'May F, Tropea S, Berg J 2016 Framing moving and handling as a complex intervention in the acute care of older adults with osteoporosis: A qualitative study. Journal of Clinical Nursing. Accepted for publication 19th April 2016. Wiley Open Access. Unique ID: 5511802- 1606658. Cox, H., Puffer, S., Morton, V. et al. 2008 Educating nursing home staff on fracture prevention: a cluster randomised trial Age and Ageing 37 167-172 Foss, NB., Pal, H., Kehlet, H. 2005 In hospital hip fractures: prevalence, risk factors, and outcome. Research Letter. Age Ageing 34, (6) 642-645. Doi:10.1093/ ageing/alfi198 Giangregorio, L., Fisher, P., Papaioannou, A., Adachi, JD. 2007 Osteoporosis knowledge and information needs in healthcare professionals caring for patients with fragility fractures Orthopaedic Nursing 26 (1) 27 - 35 Haentjens P, Magaziner J, Col_n-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S 2010 Meta-analysis: Excess Mortality After Hip Fracture Among Older Women and Men. Ann. Intern. Med. 152, (6), 380-390. doi: 10.7326/0003-4819-152-6-201003160- 00008. Harvey, G., & Kitson, A. 2015 Implementing Evidence Based Practice in Healthcare. A Facilitation Guide. Routledge, London. Hignett, S. 2003 Systematic review of patient handling activities starting in lying, sitting and standing positions. Journal Advanced Nursing 41 (6) 545-552 Hignett, S., Crumpton, E., Ruszola S. et al. 2004 Evidence-Based Patient Handling. Tasks, Equipment and Interventions Routledge, London Hippisley-Cox, J., Coupland, C. 2012 Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study. BMJ. 344, e3427. doi: 10.1136/bmj.e3427. International Osteoporosis Foundation (IOF) 2015 http://www.iofbonehealth.org/factsstatistics Accessed 21st December 2015 International Osteoporosis Foundation 2010 The Breaking Spine http://www.iofbonehealth.org/ publications/the-breaking-spine.html Accessed 2nd March 2011 Jonassen, D., & Land, S. 2012 Theoretical Foundations of Learning Environments 2nd edition Oxon, Routledge Joop, PW., van den Bergh., Tineke ACM van Geel., Willem, FL., et al. 2010 Assessment of Individual Fracture Risk: FRAX and Beyond Current Osteoporosis Reports 8 131-137 Kanis, JA., McCloskey, EV., Johansson, H., Cooper, C., Rizzoli , R., Reginster, JY. 2013 European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 24, 23-57 doi 10.1007/ s00198-012-2074-y Kanis, JA. , Johnell, O., Oden, A. et al. 2008 European guidance for the diagnosis and management of osteoporosis in postmenopausal women Osteoporosis International 19 399-428 Kanis, JA. 2007 on behalf of World Health Organization Scientific Group. Assessment of osteoporosis at the primary health care level. Technical report. UK: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield; 2007. Available from https://www.shef.ac.uk/ FRAX/pdfs/WHO_Technical_Report.pdf Accessed 6th December 2015 Kanis, JA, Borgstrom, F., De Laet, C., et al. 2005 Assessment of fracture risk Osteoporosis International 16 581-589 Kneafsey, R., Clifford, C., Greenfield, S. 2013 What is the nursing team involvement in maintaining and promoting the mobility of older adults in hospital? A grounded theory study International Journal of Nursing Studies 50 1617-1629 http://dx.doi.org/10.1016/j. ijnurstu.2013.04.007 Kneafsey, R., & Haigh, C. 2009 Moving and handling rehabilitation patients: A survey of nurses' views International Journal of Therapy & Rehabilitation 16 (8) 431- 440 McCormack, B. 2015 Action research in complex interventions Chpt. 31. In Richards D A., & Rahm Hallberg I. Eds. 2015 Complex Interventions In Health. An Overview of Research Methods. Routledge, London McLellan, AR., Reid, DM., Forbes, K., et al. 2004 Effectiveness of Strategies for the Secondary Prevention of Osteoporotic Fractures in Scotland Executive Summary CEPS: 99/03 NHS Quality Improvement Scotland Mezirow, J. 2009 An overview on transformative learning. In: Illeris, K. ed. Contemporary Theories of Learning. Oxon: Routledge. p. 90 Moon, JA. 2004 A Handbook of Reflective and Experiential Learning. Theory and Practice London, New York: Routledge Moorchilot, R., Masud, T. 2010 The role of fracture prediction in managing osteoporosis Geriatric Medicine 40 (12) 671-2, 674-5 Mortiboys, A. 2012. Teaching with Emotional Intelligence: A Step-by-step Guide for Higher and Further Education Professionals. Oxon: Routledge National Osteoporosis Society (NOS) 2015 http://www.nos.org.uk accessed 29th June 2016 National Osteoporosis Guidelines Group (NOGG 2000) http://www.shef.ac.uk/NOGG/ accessed 2nd November 2010 NICE 2008 Osteoporosis: Assessment of fracture risk and the prevention of osteoporotic fractures in individuals at high risk National collaborating centre for nursing and supportive care Osteoporosis Evidence Review NICE accessed March 2011 NICE 2004 Technologies for the prevention and treatment of osteoporosis and prevention of osteoporotic fractures in postmenopausal women http://www.nice.org.uk/guidance/index. jsp?action=article&r=true&o=32980 accessed March 2011 QMU 2011 QMU Research Code of Practice. Queen Margaret University, Edinburgh Reason, P., Bradbury, H. 2006 Eds. Handbook of Action Research. Sage. London Rizzoli, R., Branco, J., Brandi, M.L., Boonen, S., Bruyre, O., Cacoub, P., Cooper, C., Diez-Perez, A., Duder, J., Fielding, R.A., Harvey, N.C., Hiligsmann, M., Kanis, J.A., Petermans, J., Ringe, J.D., Tsouderos. Y., Weinman, J., Reginster, J.Y. 2014. Management of osteoporosis in the oldest old. Osteoporosis Int. 25 (11), 2507-2529. SIGN 2015 Scottish Intercollegiate Guideline Network Management of Osteoporosis. SIGN 142. Management of osteoporosis and the prevention of fragility fractures. A national clinical guideline RCP, Edinburgh Smith, J. (Ed) 2005 The Guide to the Handling of People. 5thEdition. Backcare in collaboration with RCN & National Back Exchange, Teddington Taylor, J., Hill, H., Kay, K. 2016 NS835. An integrated practice approach to mobility care for older people. Nursing Standard. 30 (29) 51-59 Tashakkori, A., & Teddlie, C. 1998 Mixed Methodology. Combining Qualitative and Quantitative Approaches. Applied Social Research Methods Series. Volume 46. Sage Publications, London Teddlie, C., & Tashakkori, A. 2009 Foundations of Mixed Methods Research. Integrating Quantitative and Qualitative Approaches in the Social and Behavioral Sciences. Sage, London. Van Merrinboer, J.J.G., & Kirschner P. A. 2013 Ten Steps to Complex Learning. A Systematic Approach to Four-component Instructional Design. 2nd ed. Routledge, London. Vered, I., Werner, P., Shemy, G., Stone, O. 2008 Nurses' knowledge and perceptions about osteoporosis: a questionnaire survey. International Journal of Nursing Studies 45 (6) 847 - 854 WHO 2008 FRAX tool http://www.shef.ac.uk/ FRAX/ accessed 30th June 2016pub4419pu

Contribution of Cell Elongation to the Biofilm Formation of Pseudomonas aeruginosa during Anaerobic Respiration

Pseudomonas aeruginosa, a gram-negative bacterium of clinical importance, forms more robust biofilm during anaerobic respiration, a mode of growth presumed to occur in abnormally thickened mucus layer lining the cystic fibrosis (CF) patient airway. However, molecular basis behind this anaerobiosis-triggered robust biofilm formation is not clearly defined yet. Here, we identified a morphological change naturally accompanied by anaerobic respiration in P. aeruginosa and investigated its effect on the biofilm formation in vitro. A standard laboratory strain, PAO1 was highly elongated during anaerobic respiration compared with bacteria grown aerobically. Microscopic analysis demonstrated that cell elongation likely occurred as a consequence of defective cell division. Cell elongation was dependent on the presence of nitrite reductase (NIR) that reduces nitrite (NO2−) to nitric oxide (NO) and was repressed in PAO1 in the presence of carboxy-PTIO, a NO antagonist, demonstrating that cell elongation involves a process to respond to NO, a spontaneous byproduct of the anaerobic respiration. Importantly, the non-elongated NIR-deficient mutant failed to form biofilm, while a mutant of nitrate reductase (NAR) and wild type PAO1, both of which were highly elongated, formed robust biofilm. Taken together, our data reveal a role of previously undescribed cell biological event in P. aeruginosa biofilm formation and suggest NIR as a key player involved in such process

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Involving Older People: lessons for Community Planning.

EdinburghThe study was commissioned by the Scottish Executive and CoSLA to provide information about the current ways in which older people are involved in the planning, delivery, monitoring and evaluation of public services throughout Scotland, and to draw some lessons for the future involvement of older people in the Community Planning process.NO DIVISIONpub511pu