Health economic burden that wounds impose on the National Health Service in the UK

OBJECTIVE: To estimate the prevalence of wounds managed by the UK's National Health Service (NHS) in 2012/2013 and the annual levels of healthcare resource use attributable to their management and corresponding costs. METHODS: This was a retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database. Records of 1000 adult patients who had a wound in 2012/2013 (cases) were randomly selected and matched with 1000 patients with no history of a wound (controls). Patients' characteristics, wound-related health outcomes and all healthcare resource use were quantified and the total NHS cost of patient management was estimated at 2013/2014 prices. RESULTS: Patients' mean age was 69.0 years and 45% were male. 76% of patients presented with a new wound in the study year and 61% of wounds healed during the study year. Nutritional deficiency (OR 0.53; p<0.001) and diabetes (OR 0.65; p<0.001) were independent risk factors for non-healing. There were an estimated 2.2 million wounds managed by the NHS in 2012/2013. Annual levels of resource use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million GP visits and 3.4 million hospital outpatient visits. The annual NHS cost of managing these wounds and associated comorbidities was pound5.3 billion. This was reduced to between pound5.1 and pound4.5 billion after adjusting for comorbidities. CONCLUSIONS: Real world evidence highlights wound management is predominantly a nurse-led discipline. Approximately 30% of wounds lacked a differential diagnosis, indicative of practical difficulties experienced by non-specialist clinicians. Wounds impose a substantial health economic burden on the UK's NHS, comparable to that of managing obesity ( pound5.0 billion). Clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS.Ye

Making the best use of new technologies in the National Diet and Nutrition Survey: a review

.Background Dietary assessment is of paramount importance for public health monitoring. Currently in the UK, the population’s diets are examined by the National Diet and Nutrition Survey Rolling Programme (NDNS RP). In the survey, diet is assessed by a four-day paper-based dietary diary, with accompanying interviews, anthropometric measurements and blood and urine sampling. However, there is growing interest worldwide in the potential for new technologies to assist in data collection for assessment of dietary intake. Published literature reviews have identified the potential of new technologies to improve accuracy, reduce costs, and reduce respondent and researcher burden by automating data capture and the nutritional coding process. However, this is a fast-moving field of research, with technologies developing at a rapid pace, and an updated review of the potential application of new technologies in dietary assessment is warranted. This review was commissioned to identify the new technologies employed in dietary assessment and critically appraise their strengths and limitations in order to recommend which technologies, if any, might be suitable to develop for use in the NDNS RP and other UK population surveys. Objectives The overall aim of the project was to inform the Department of Health of the range of new technologies currently available and in development internationally that have potential to improve, complement or replace the methods used in the NDNS RP. The specific aims were: to generate an itinerary of new and emerging technologies that may be suitable; to systematically review the literature and critically appraise new technologies; and to recommend which of these new technologies, if any, would be appropriate for future use in the NDNS RP. To meet these aims, the project comprised two main facets, a literature review and qualitative research. Literature review data sources The literature review incorporated an extensive search of peer-reviewed and grey literature. The following sources were searched: Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), Web of Science Core Collection, Ovid MEDLINE, Ovid MEDLINE In-Process, Embase, NHS EED (Economic Evaluation Database), National Cancer Institute (NCI) Dietary Assessment Calibration/Validation Register, OpenGrey, EPPI Centre (TRoPHI), conference proceedings (ICDAM 2012, ISBNPA 2013, IEEE Xplore, Nutrition Society Irish Section and Summer Meetings 2014), recent issues of journals (Journal of Medical Internet Research, International Journal of Medical Informatics), grants registries (ClinicalTrials.gov, BBSRC, report), national surveys, and mobile phone application stores. In addition, hand-searching of relevant citations was performed. The search also included solicitation of key authors in the field to enquire about Making the best use of new technologies in the NDNS: a review 4 as-yet unpublished articles or reports, and a Bristol Online Survey publicised via social media, society newsletters and meetings. Literature review eligibility criteria Records were screened for eligibility using a three-stage process. Firstly, keyword searches identified obviously irrelevant titles. Secondly, titles and abstracts were screened against the eligibility criteria, following which full-text copies of papers were obtained and, in the third stage of screening, examined against the criteria. Two independent reviewers screened each record at each stage, with discrepancies referred to a third reviewer. Eligibility criteria were pre-specified and agreed by the project Steering Group (Section 1.6). Eligible records included: studies involving technologies, new to the NDNS RP, which can be used to automate or assist the collection of food consumption data and the coding of foods and portion sizes, currently available or beta versions, public domain or commercial; studies that address the development, features, or evaluation of new technology; technologies appropriate for the requirements of the NDNS RP in terms of nutritional analysis, with capacity to collect quantifiable consumption data at the food level; primary sources of information on a particular technology; and journal articles published since the year 2000 or grey literature available from 2011 onwards. The literature search was not limited to Englishlanguage publications, which are included in the itinerary, although data were not extracted from non-English studies. Literature synthesis and appraisal New technologies were categorised into eleven types of technology, and an itinerary was generated of tools falling under each category type. Due to the volume of eligible studies identified by the literature searches, data extraction was limited to the literature focussing on selected exemplar tools of five technology categories (web-based diet diary, web-based 24- hour recall, handheld devices (personal digital assistants and mobile phones), nonautomated cameras to complement traditional methods, and non-automated cameras to replace traditional methods). For each category, at least two exemplars were chosen, and all studies involving the exemplar were included in data extraction and synthesis. Exemplars were selected on the basis of breadth of evidence available, using pre-specified criteria agreed by the Steering Group. Data were extracted by a single reviewer and an evidence summary collated for each exemplar. A quality appraisal checklist was developed to assess the quality of validation studies. The checklist was piloted and applied by two independent reviewers. Studies were not excluded on the basis of quality, but study quality was taken into account when judging the strength of evidence. Due to the heterogeneity of the literature, meta-analyses were not performed. References were managed and screened using the EPPI Reviewer 4 systematic review software. EPPI Reviewer was also used to extract data

Amelogenin an extracellular matrix protein in the treatment of venous leg ulcers and other hard to heal wounds. experimental and clinical evidence

Abstract: Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes. Studies with periodontal fibroblasts indicate that attachment to these structures increases the endogenous secretion of multiple growth factors and cell proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT) involving patients with hard-to-heal venous leg ulcers (VLUs) (ie, ulcers with a surface area ≥10 cm2 and duration of ≥6 months) showed that the application of amelogenin (Xelma®, Molnlycke Health Care, Gothenburg, Sweden) as an adjunct treatment to compression results in significant reduction in ulcer size, improvement in the state of ulcers, reduced pain, and a larger proportion of ulcers with low levels of exudate, compared with treatment with compression alone. Amelogenin therapy was also shown to be safe to use in that there were no significant differences in adverse events noted between patients treated with amelogenin plus compression and those treated with compression alone. Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in “real life” situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers

Perceptions of the policing and crime mapping ‘Trailblazers’, Home Office Research Report 67

The research involved interviews with key staff involved and focus groups with members of the public to explore their views and opinions on the initiatives. The research highlights considerable public curiosity, and to an extent an appetite, for crime and criminal justice information. However a key message from the research was that providing more information should not be an end in itself. Information needs to be relevant, useable, of high quality and tailored to suit its purpose, whether that is crime prevention or holding the police to account

Amelogenin, an extracellular matrix protein, in the treatment of venous leg ulcers and other hard-to-heal wounds: Experimental and clinical evidence

Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes. Studies with periodontal fibroblasts indicate that attachment to these structures increases the endogenous secretion of multiple growth factors and cell proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT) involving patients with hard-to-heal venous leg ulcers (VLUs) (ie, ulcers with a surface area ≥10 cm2 and duration of ≥6 months) showed that the application of amelogenin (Xelma®, Molnlycke Health Care, Gothenburg, Sweden) as an adjunct treatment to compression results in significant reduction in ulcer size, improvement in the state of ulcers, reduced pain, and a larger proportion of ulcers with low levels of exudate, compared with treatment with compression alone. Amelogenin therapy was also shown to be safe to use in that there were no significant differences in adverse events noted between patients treated with amelogenin plus compression and those treated with compression alone. Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in “real life” situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers

Dynamical behaviour of digital filters subject to 2's complement arithmetic nonlinearity

The thesis investigates a two-dimensional nonlinear map describing a second-order direct form digital filter constrained to operate with 2’s complement arithmetic. Attention is primarily directed towards the lossless case in which the filter parameters are on the lower boundary of the linear stability region. An effective tool for studying the dynamics of the map is the association of an infinite symbolic sequence with each orbit. Identification of the admissible periodic sequences is a fundamental theme. A comprehensive answer is given for when string fragments +0... 0+, and related patterns, appear within some admissible sequence. Infinite families of admissible periodic sequences are exhibited as analytic solutions to the trigonometric formulation of Chua and Lin’s admissibility criterion. The role of the filter parameter a = 2cos θ in determining admissibility is emphasised. Examples demonstrate that a periodic sequence may be admissible over several disjoint parameter intervals. \ud Strategies are developed that permit powerful computer searches for admissible periodic sequences. Tables are included listing the periodic sequences admissible for fixed values of the parameter, up to period 200. Parameter values for the tabulation progress by steps of 0.05 across the entire range (0,π). A complete list, covering all parameter values, of the admissible periodic sequences up to period 20 is presented; associated with each sequence is its interval of admissibility. A classification is undertaken of all periodic sequences with an interval of admissibility having left end-point θ = 0. For odd period sequences it is definitive; in the even case a partial classification is achieved, definitive when the period is twice a prime. An investigation of comparable scope is presented for admissibility around θ = π/2 The topological dynamics of a one-dimensional reduction of the filter map is explored. Orbits are attracted to an invariant set, itself a disjoint union of intervals, that becomes increasingly fragmented as the parameter a approaches 1

Flexible New Deal evaluation: customer survey and qualitative research findings

by Sandra Vegeris, Lorna Adams, Katie Oldfield, Christine Bertram, Rosemary Davidson, Lucia Durante, Catherine Riley and Kim Vowden This report presents qualitative and quantitative research findings from an evaluation of the Flexible New Deal (FND), Phase 1 of which was introduced in October 2009 in 28 Jobcentre Plus districts in England, Scotland and Wales. The research consisted of qualitative research into customer and provider experiences of FND delivery and a quantitative survey of customer experiences of FND in Phase 1 areas compared with customers at the same point in their claims experiencing the former Jobseeker’s Allowance (JSA) regime and New Deals in Phase 2 areas. Comparisons between the two areas provide an indication of FND services in contrast to JSA/New Deal services but they do not constitute an impact assessment. This is the fourth in a series of evaluation reports aiming to understand experiences of the Jobseekers Regime and Flexible New Deal (JRFND) from the point of view of customers, Jobcentre Plus staff and provider staff, and establish the extent to which JRFND leads to additional customer employment outcomes