Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study

Background and Aims: Familial hypercholesterolaemia (FH) is a major cause of premature heart disease but remains unrecognised in most patients. This study investigated if a systematic primary care-based approach to identify and manage possible FH improves recommended best clinical practice. Methods: Pre- and post-intervention study in six UK general practices (population 45,033) which invited patients with total cholesterol >7.5 mmol/L to be assessed for possible FH. Compliance with national guideline recommendations to identify and manage possible FH (repeat cholesterol; assess family history of heart disease; identify secondary causes and clinical features; reduce total & LDL-cholesterol; statin prescribing; lifestyle advice) was assessed by calculating the absolute difference in measures of care pre- and six months post-intervention. Results: The intervention improved best clinical practice in 118 patients consenting to assessment (of 831 eligible patients): repeat cholesterol test (+75.4%, 95% CI 66.9-82.3); family history of heart disease assessed (+35.6%, 95% CI 27.0-44.2); diagnosis of secondary causes (+7.7%, 95% CI 4.1-13.9), examining clinical features (+6.0%, 95% CI 2.9-11.7). For 32 patients diagnosed with possible FH using Simon-Broome criteria, statin prescribing significantly improved (18.8%, 95% CI 8.9-35.3) with non-significant mean reductions in cholesterol post-intervention (total: -0.16 mmol/L, 95% CI -0.78-0.46; LDL: -0.12 mmol/L, 95% CI -0.81-0.57). Conclusions: Within six months, this simple primary care intervention improved both identification and management of patients with possible FH, in line with national evidence-based guidelines. Replicating and sustaining this approach across the country could lead to substantial improvement in health outcomes for these individuals with very high cardiovascular risk

Combo Night 2011

UNF Music Flagship Program Presents Combo Night Featuring UNF Jazz Studies Students Wednesday, October 5, 2011 UNF Fine Arts Center - Choir Room, 140

Strategies for identifying familial hypercholesterolaemia in non-specialist clinical settings

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The purpose of this review is to assess the effectiveness of interventions to systematically improve identification of FH in non-specialist settings compared to usual care (incidental approaches to identify FH in non-specialist settings)

RETHINKING DEVELOPMENT IN EAST NEW ORLEANS

With the present issue of climate change, dangerous flooding events will become an issue that many communities must grapple with. New Orleans is one such city with a long history of inundation. After Katrina, neighborhoods were devastated by a failure of the levee system. This caused many residents to reflect on the viability of a city in constant danger of flooding. Investigating how communities in the past handled flooding events will help inform a path forward. The Louisiana region has a rich history of building vernaculars and settlement patterns. Comparing the strategies used by deltaic communities that share similar issues to New Orleans can inform a settlement pattern that addresses the unique challenges that the city faces. This thesis aims to create a neighborhood plan that addresses the unique climatic factors of East New Orleans, while creating a more cohesive community within the disjointed settlements

Oral bisphosphonate use and total knee/hip implant survival: validation of results in an external population-based cohort.

OBJECTIVE: Aseptic loosening is the most common cause of revision arthroplasty. Bisphosphonates could minimize this through their antiresorptive effects. This study was undertaken to investigate the association between bisphosphonate use and implant survival. METHODS: A retrospective cohort study was conducted within the Danish nationwide registries (5.5 million residents). Using procedure codes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, we identified patients age ≥40 years undergoing total joint replacement in 1998-2007. We excluded users of disease-modifying antirheumatic drugs as well as patients with rheumatoid arthritis, Paget's disease, or hip fracture. Participants were classified as bisphosphonate users if they had been receiving treatment for ≥6 months. A time-varying exposure was used to avoid immortal time bias. Up to 6 bisphosphonate nonusers undergoing arthroplasty were matched to each bisphosphonate user, using propensity scores. Stratified Cox regression was performed to model implant survival according to bisphosphonate use. Further, we studied the associations of implant survival with duration of use, adherence (medication possession ratio), and timing of therapy initiation (preoperative/postoperative). RESULTS: Of 95,392 patients with a primary total joint replacement, 80,342 (84.2%) were eligible. We identified 1,590 bisphosphonate users (2.0%), and 1,558 of them (98.0%) were matched to 8,966 bisphosphonate nonusers. Twenty-seven of the 1,558 bisphosphonate users (1.73%) and 399 of the 8,966 matched nonusers (4.45%) underwent revision surgery during the study followup period (at a median 2.61 years after the first surgery [interquartile range 1.04-5.41 years]). Cox regression showed a reduced risk of revision surgery in bisphosphonate users (hazard ratio 0.41 [95% confidence interval 0.27-0.61]). This association was strongest in patients with the longest duration of treatment and/or the best adherence. CONCLUSION: Oral bisphosphonate users have a 59% reduced risk of revision surgery. This association is only present when bisphosphonates are started after arthroplasty surgery. Confirmation in randomized controlled trials is urgently needed

Acute effects of oestrogen receptor subtype-specific agonists on vascular contractility

This study shows for the first time that both the putatively selective oestrogen receptor α and oestrogen receptor β agonists PPT (4,4′,4″-(4-propyl-[(1)H]-pyrazole-1,3,5-triyl) tris-phenol) and DPN (2,3-bis(4-hydroxyphenyl)-propionitrile) can acutely relax precontracted isolated rat mesenteric arteries at pharmacological (i.e. μM) concentrations. When compared to responses observed to similar concentrations of 17β-oestrogen obtained on the same tissues, PPT had a significantly greater vasodilatory effect, while DPN had a significantly smaller effect. All responses were rapid being complete within 5 min exposure time. Thus, both PPT and DPN can acutely relax isolated mesenteric arteries with the relative potency of PPT>17β-oestrogen>DPN