Using chronic kidney disease trigger tools for safety and learning: a qualitative evaluation in East London primary care

Background An innovative programme to improve identification and management of chronic kidney disease (CKD) in primary care was implemented across three clinical commissioning groups (CCGs) in 2016. This included a falling estimated glomerular filtration rate (eGFR) trigger tool built from data within the electronic health record (EHR). This patient safety tool notifies GP practices when falling eGFR values are identified. By alerting clinicians to patients with possible CKD progression the tool invites clinical review, the option for specialist advice, and written reflection on management. Aim To identify practitioner perceptions of trigger tool use and value from interview data, and compare these with the written reflections on clinical management recorded within the tools. Method Eight semi-structured interviews with 6 GPs, 1 pharmacist and 1 practice manager were recorded and transcribed. Thematic analysis of the interview transcripts was undertaken using framework analysis. The free-text reflective comments recorded in the trigger tools of 1,921 cases were organised by referral category ‘yes’ and ‘no’, with each category stratified by age into ‘younger’ and ‘older’ cases. Subsequently the themes arising from the interviews were compared with the descriptive analysis of the reflective comments. Findings Three themes emerged from interviews: Getting started, Patient safety and Practitioner and Practice learning. Well organised practices found the tool was readily embedded into workflow and expressed greater motivation for using it. The trigger tool was seen to contribute to patient safety, and as a tool for learning about CKD management, both individually and as a practice. Reflective comments from 1,921 trigger tools were examined, these supported the theme of patient safety from the interviews. However the free text data, stratified by age, challenged the expectation that younger cases would have higher referral rates, driven by a higher level of risk for CKD progression. Conclusion Building electronic trigger tools from the EHR can identify patients with a falling eGFR prompting review of the eGFR trajectory and management plan. Interview and reflective data illustrated that practice use of the trigger tool supported the patient safety agenda and in addition encouraged team and individual learning about CKD management

Reviving the Design of Contemporary Masonry Vaults

Reviewing the brief background and characteristics of vaulting, construction and looking over the contemporary researches on it, this paper outlines the methods and disciplines of the workshop which tries to apply vault construction at present times regarding the current social and architectural requirements

Improving coding and primary care management for people with Chronic Kidney Disease: an observational controlled study in east London

Background: The UK national chronic kidney disease (CKD) audit in primary care shows diagnostic coding in the electronic health record for CKD averages 70%, with wide practice variation. Coding is associated with improvements to risk factor management; CKD cases coded in primary care have lower rates of unplanned hospital admission. Aim: To increase diagnostic coding of CKD (stages 3–5) and primary care management, including blood pressure to target and prescription of statins to reduce cardiovascular disease risk. Design and setting: Controlled, cross-sectional study in four East London clinical commissioning groups (CCGs). Method: Interventions to improve coding formed part of a larger system change to the delivery of renal services in both primary and secondary care in East London. Quarterly anonymised data on CKD coding, blood pressure values, and statin prescriptions were extracted from practice computer systems for 1-year pre- and post-initiation of the intervention. Results: Three intervention CCGs showed significant coding improvement over a 1 year period following the intervention (regression for post-intervention trend P<0.001). The CCG with highest coding rates increased from 76–90% of CKD cases coded; the lowest coding CCG increased from 52–81%. The comparison CCG showed no change in coding rates. Combined data from all practices in the intervention CCGs showed a significant increase in the proportion of cases with blood pressure achieving target levels (difference in proportion P<0.001) over the 2-year study period. Differences in statin prescribing were not significant. Conclusion: Clinically important improvements to coding and management of CKD in primary care can be achieved by quality improvement interventions that use shared data to track and monitor change supported by practice-based facilitation. Alignment of clinical and CCG priorities and the provision of clinical targets, financial incentives, and educational resource were additional important elements of the intervention

Effect of Helicobacter pylori eradication on glycaemia control in patients with type 2 diabetes mellitus and comparison of two therapeutic regimens

Background and study aims: The eradication rate of Helicobacter pylori (H. pylori) has been reported as being lower in patients with type 2 diabetes mellitus (DM) than in those without DM. The aim of the study was to assess the efficacy of the two H. pylori eradication regimens in patients without and with type 2 DM and to study the effect of H. pylori treatment on glycaemia control. Patients and Methods: A total of 93 consecutive type 2 DM (non-insulin users) and 98 non-diabetic age- and sex-matched patients were enrolled. Patients were randomly assigned to one of the two treatment protocols all given twice daily: (a) a 14-day quadruple therapy comprising of omeprazole 20mg, metronidazole 500mg, amoxicillin 1g and bismuth subcitrate 240mg (OMAB) and (b) a 14-day triple regimen comprising of omeprazole 20mg plus clarithromycin 500mg and amoxicillin 1g (OCA). Cure was defined as a negative 13C-urea breath test at least 6weeks after treatment. Results: The H. pylori eradication rate with the OCA regimen was 63% in patients with type 2 DM (non-insulin users) and 87.7% in the control group (p=0.017). The H. pylori eradication rate with the OMAB regimen was 38.2% in patients with type 2 DM and 55.1% in the control group (p&lt;0.001). Mean decrease of fasting plasma glucose and HbA1c level shows no statistically significant difference after H. pylori eradication. Conclusion: This study suggests that the eradication rate of H. pylori with OCA or OMAB treatment is lower in patients with type 2 diabetes than in non-diabetics and H. pylori treatment in patients with type 2 DM has no role in the control of the glycaemia. The triple therapy (OCA) is superior to the quadruple protocol (OMAB) in H. pylori eradication of both DM and non-DM cases. © 2013 Arab Journal of Gastroenterology

What are the expectations and experiences of a GMH research programme delivered in Bosnia-Herzegovina, Colombia and Uganda? A prospective longitudinal qualitative study

OBJECTIVES: Global health research collaborations between partners in high-income countries and low-income and middle-income countries (LMICs) aim to generate new evidence, strengthen research capacity, tackle health inequalities and improve outcomes. Previous evaluations of such programmes have identified areas for improvement but consisted only of retrospective experiences. We conducted the first prospective study to assess the initial expectations as well as the final experiences of participants of a global health research programme. DESIGN, SETTINGS AND PARTICIPANTS: This study adopted a prospective longitudinal qualitative study, 38 participants of a global mental health research programme with partners in Bosnia-Herzegovina, Colombia, Uganda and the (UK). The interviewees included senior investigators, coordinators and researchers. Framework analysis was used to analyse the data. OUTCOME MEASURES: Participants were interviewed about their initial expectations at the inception of the research programme and their final experiences at the end. RESULTS: Many of the original expectations were later reported as met or even exceeded. They included experiences of communication, relationships, developed research expertise, further research opportunities and extending networks. However, other expectations were not met or only partially met, mainly on developing local leadership, strengthening institutional research capacity and opportunities for innovation and for mutual learning. Around equity of partnership and ownership of research the views of participants in the UK tended to be more critical than those of partners in LMICs. CONCLUSIONS: The findings suggest that global health research programmes can achieve several of their aims, and that partners in LMICs feel equity has been established in the partnership despite the imbalance of the funding arrangement. Aims of global health research projects should have a realistic focus and be proportionate to the parameters of the funding arrangement. More resources and longer time scales may be required to address sustainable structural capacity and long-standing local leadership sufficiently

Make the right thing easy to do: using trigger tools for safety and learning in chronic kidney disease.

Innovating for Improvement grant from the Health Foundation

Non-Destructive Documentation Methods for Future Seismic and Damage Analysis of Modern Heritage Buildings using Contemporary Tools

This paper presents a comparative approach between a digital documentation workflow of a hyperbolic paraboloid heritage building using contemporary tools versus a traditional documentation technique. This documentation was undertaken to better understand the building’s structure, its evolution, and to assess the performance of this modern concrete structure for future seismic and damage analysis. Furthermore, this paper discusses the challenges related to producing a Heritage Building Information Model (HBIM) of this building using point cloud data in Autodesk’s Revit BIM-authoring software. This project states the importance of a parallel study between the traditional and the contemporary documentation methods; which led to discoveries about the current state of the extrados in the hyperbolic parabola after several earthquakes. Upon analyzing the HBIM and comparing it to the historical drawings, we discovered a gap between the moisture barrier membrane and the concrete shell. Visualizing the building in 3D provides a deeper and more accurate understanding of the currentstate of this pavilion and is one of many advantages of using digital technologies. The insights provided by digital documentation techniques and analyzing the historical images of the pavilion showed that the curvature of the pavilion had changed over time. The results that we found imply two hypotheses. First, the profile of the curvature had been modified due to earthquakes, and second that the modification was due to improper maintenance of the pavilion, namely, multiple additions of the membrane layers. This could not have been detected by solely relying on traditional documentation techniques

Prognostic factors for esophageal squamous cell Carcinoma-A Population-Based study in Golestan province, Iran, a high incidence area

Golestan Province in northern Iran is an area with a high incidence of esophageal squamous cell carcinoma (ESCC). We aimed to investigate prognostic factors for ESCC and survival of cases in Golestan, on which little data were available. We followed-up 426 ESCC cases participating in a population-based case-control study. Data were analyzed using the Kaplan-Meier method and the Cox proportional hazard models. Median survival was 7 months. Age at diagnosis was inversely associated with survival, but the association was disappeared with adjustment for treatment. Residing in urban areas (hazard ratio, HR = 0.70; 95 CI 0.54-0.90) and being of non-Turkmen ethnic groups (HR = 0.76; 95 CI 0.61-0.96) were associated with better prognosis. In contrast to other types of tobacco use, nass (a smokeless tobacco product) chewing was associated with a slightly poorer prognosis even in models adjusted for other factors including stage of disease and treatment (HR = 1.38; 95 CI 0.99-1.92). Opium use was associated with poorer prognosis in crude analyses but not in adjusted models. Almost all of potentially curative treatments were associated with longer survival. Prognosis of ESCC in Golestan is very poor. Easier access to treatment facilities may improve the prognosis of ESCC in Golestan. The observed association between nass chewing and poorer prognosis needs further investigations; this association may suggest a possible role for ingestion of nass constituents in prognosis of ESCC. © 2011 Aghcheli et al

Double Voter Perceptible Blind Signature Based Electronic Voting Protocol

Mu et al. have proposed an electronic voting protocol and claimed that it protects anonymity of voters, detects double voting and authenticates eligible voters. It has been shown that it does not protect voter\u27s privacy and prevent double voting. After that, several schemes have been presented to fulfill these properties. However, many of them suffer from the same weaknesses. In this paper, getting Asadpour et al. scheme as one of the latest one and showing its weaknesses, we propose a new voting scheme which is immune to the weaknesses of previous schemes without loosing efficiency. The scheme, is based on a special structure, which directly use the identity of voter, hides it in that structure and reveals it after double voting. We also, show that the security of this scheme depends on hardness of RSA cryptosystem, Discrete Logarithm problem and Representation problem