Developing evidence-informed, employer-led workplace health: Final report

What do we want to know? We sought to understand whether workplace health programmes (WHPs) are effective for improving health and business outcomes, and to identify the characteristics of WHPs that are thought to influence their success. To address these issues, we undertook a systematic review of three sources of evidence: systematic reviews examining intervention effectiveness; research on stakeholders’ views and experiences; and key workplace health policy documents. / What did we find? We identified 24 systematic reviews of WHPs which examined statistically the impact on a variety of outcomes, including mental health, weight management, absenteeism (and its costs), work ability and job stress. The reviews demonstrated that workplace health interventions are effective in improving health and business outcomes, and that the magnitude of effects on those outcomes is modest. Evidence from 10 views studies and 17 policy documents were integrated with evidence from systematic reviews to identify key characteristics of WHPs. Four characteristics were identified across each of the three evidence sources, suggesting that they could be implemented to good effect: financial commitment, ease of uptake, accessibility, and structures to promote social support. Five characteristics were identified in systematic reviews and views studies but have yet to be addressed by policy recommendations; these included the extent of policy integration, the importance of the implementer’s role within the company, the content of an intervention, whether the intervention is tailored or individualised, and issues related to acceptability. Four characteristics were identified as important in views studies or policy documents but had not been examined in systematic reviews, suggesting a need for future evaluation. These included managerial support, organisational support, channels of communication and the provision of tailored advice. The provider approach and the use of web-based technologies were identified in views research only. Each of these characteristics can be implemented in a variety of ways, suggesting creative possibilities for the ways in which businesses could integrate them into employer-led workplace health. / What are the conclusions? The findings suggest that employers can derive benefits from establishing WHPs, both for the business and with respect to their employees’ health. Interventions that are supported by organisational policy, focus their content on specific health issues and engage employees have been shown to be effective and are supported by stakeholder research and policy documents. Employers may find additional benefit if they also include specific characteristics related to the context in which a WHP intervention takes place, is implemented or is received by participants. The impacts of many WHP characteristics on health and business outcomes have yet to be evaluated and should be integrated into future WHP intervention evaluations. / How did we get these results? Comprehensive searching of electronic databases and websites was carried out to identify the three relevant datasets. Using framework synthesis, we combined evidence from the systematic reviews, views studies and policy documents by using a framework of characteristics potentially influencing workplace health effectiveness. Data analysis themes were then organised to produce tabular and narrative summaries of key characteristics of WHPs to produce an overall narrative

Incidence and progression of diabetic retinopathy within a private diabetes mellitus clinic in South Africa

Objective: The study objective was to examine the influence of glycaemic control and ethnic variations on the incidence and progression of diabetic retinopathy (DR).Design, subjects and setting: Eight hundred and ninety-two persons with type 1 diabetes mellitus, and 1 998 persons with type 2 diabetes mellitus, who were enrolled in a private diabetes mellitus management programme in South Africa, participated in the study. Survival analyses were conducted to assess the relationship between the risk factors and the incidence of DR and referable DR, and the progression of DR.Outcome measures: Cumulative incidence of diabetic retinopathy and referable diabetic retinopathy.Results: The seven-year cumulative incidence of DR and referable DR was 536 and 50 cases per 1 000 persons with type 1 diabetes mellitus without DR at baseline, and 351 and 47 cases per 1 000 persons with type 2 diabetes mellitus. The seven-year cumulative incidence of referable DR was 332 cases per 1 000 persons with type 1 diabetes mellitus with background DR at baseline, and 360 cases with type 2 diabetes mellitus, representing a seven- and eightfold increase compared to no DR at baseline. After controlling for known risk factors for DR, a high baseline haemoglobin A1c (HbA1c) and non-Caucasian ethnicity were associated with the incidence of referable DR in patients with type 1 and type 2 diabetes mellitus.Conclusion: It was revealed in the first study to report on the incidence and progression of DR in South Africa that a high baseline HbA1c, ethnicity, and the presence of background DR increased the risk of the development of referable DR.Keywords: diabetes mellitus, diabetic retinopathy, epidemiology, incidence, risk factors, South Afric

A new survival model for hyperthermic intraperitoneal chemotherapy (HIPEC) in tumor-bearing rats in the treatment of peritoneal carcinomatosis

BACKGROUND: Cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in patients with peritoneal carcinomatosis of colorectal origin. Animal models are important in the evaluation of new treatment modalities. The purpose of this study was to devise an experimental setting which can be routinely used for the investigation of HIPEC in peritoneal carcinomatosis. METHODS: A new peritoneal perfusion system in tumor bearing rats were tested. For this purpose CC531 colon carcinoma cells were implanted intraperitoneally in Wag/Rija rats. After 10 days of tumor growth the animals were randomized into three groups of six animals each: group 1: control (n = 6), group 2: HIPEC with mitomycin C in a concentration of 15 mg/m(2 )(n = 6), group III: mitomycin C i.p. as monotherapy in a concentration of 10 mg/m(2 )(n = 6). After 10 days, total tumor weight and the extent of tumor spread, as classified by the modified Peritoneal Cancer Index (PCI), were assessed by autopsy of the animals. RESULTS: No postoperative deaths were observed. Conjunctivitis, lethargy and loss of appetite were the main side effects in the HIPEC group. No severe locoregional or systemic toxity was observed. All control animals developed massive tumor growth. Tumor load was significantly reduced in the treatment group and was lowest in group II. CONCLUSION: The combination of hyperthermia with MMC resulted in an increased tumoricidal effect in the rat model. The presented model provides an opportunity to study the mechanism and effect of hyperthermic intraperitoneal chemotherapy and new drugs for this treatment modality

Projections of the healthcare costs and disease burden due to hepatitis C infection under different treatment policies in Malaysia, 2018-2040

The World Health Organisation (WHO) has set ambitious goals to reduce the global disease burden associated with, and eventually eliminate, viral hepatitis

Antibiotic usage in chronic rhinosinusitis: analysis of national primary care electronic health records

Background : The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed. Methods : We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink) from consenting general practices, with (2) hospital care administrative records (Hospital Episode Statistics, HES recorded using ICD-10). Results : From the total of 88,317 cases of CRS identified, 40,462 (46%) had an antibiotic prescription within 5 days of their first CRS diagnosis. Of patients receiving a first line antibiotic within 5 days of CRS diagnosis, over 80%, in each CRS group, received a subsequent prescription for an antibiotic. Within 5 years of diagnosis, 9% are estimated to have had 5 or more antibiotics within 5 days of a CRS-related consultation. With data spanning almost 20 years, it was possible to discern trends in antibiotics prescriptions, with a clear increasing trend towards macrolide and tetracycline prescribing evident. Conclusions : While antibiotics may have been prescribed for acute exacerbations, we have found high rates of repeated antibiotic prescription in some patients with CRS in primary care. There is a need for stronger evidence on the role of antibiotics in CRS management

Antibiotic usage in chronic rhinosinusitis: analysis of national primary care electronic health records

BACKGROUND: The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed. METHODS: We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink) from consenting general practices, with (2) hospital care administrative records (Hospital Episode Statistics, HES recorded using ICD-10). RESULTS: From the total of 88,317 cases of CRS identified, 40,462 (46%) had an antibiotic prescription within 5 days of their first CRS diagnosis. Of patients receiving a first line antibiotic within 5 days of CRS diagnosis, over 80%, in each CRS group, received a subsequent prescription for an antibiotic. Within 5 years of diagnosis, 9% are estimated to have had 5 or more antibiotics within 5 days of a CRS-related consultation. With data spanning almost 20 years, it was possible to discern trends in antibiotics prescriptions, with a clear increasing trend towards macrolide and tetracycline prescribing evident. CONCLUSIONS: While antibiotics may have been prescribed for acute exacerbations, we have found high rates of repeated antibiotic prescription in some patients with CRS in primary care. There is a need for stronger evidence on the role of antibiotics in CRS management

The impact of iron overload and its treatment on quality of life: results from a literature review

BACKGROUND: To assess the literature for the impact of iron overload and infusion Iron Chelation Therapy (ICT) on patients' quality of life (QoL), and the availability of QoL instruments for patients undergoing infusion ICT. Also, to obtain patients' experiences of having iron overload and receiving infusion ICT, and experts' clinical opinions about the impact of treatment on patients' lives. METHODS: A search of studies published between 1966 and 2004 was conducted using Medline and the Health Economic Evaluation Database (HEED). Qualitative results from patient and expert interviews were analysed. Hand searching of relevant conference abstracts completed the search. RESULTS: Few studies measuring the impact of ICT with deferoxamine (DFO) on patients QoL were located (n = 15). QoL domains affected included: depression; fatigue; dyspnoea; physical functioning; psychological distress; decrease in QoL during hospitalization. One theme in all articles was that oral ICT should improve QoL. No iron overload or ICT-specific QoL instruments were located in the articles. Interviews revealed that the impact of ICT on patients with thalassemia, sickle cell disease, and myelodysplastic syndromes is high. CONCLUSION: A limited number of studies assessed the impact of ICT or iron overload on QoL. All literature suggested a need for easily administered, efficacious and well tolerated oral iron overload treatments, given the impact of current ICT on adherence. Poor adherence to ICT was documented to negatively impact survival. Further research is warranted to continue the qualitative and quantitative study of QoL using validated instruments in patients receiving ICT to further understanding the issues and improve patients QoL

What has finite element analysis taught us about diabetic foot disease and its management?:a systematic review

Over the past two decades finite element (FE) analysis has become a popular tool for researchers seeking to simulate the biomechanics of the healthy and diabetic foot. The primary aims of these simulations have been to improve our understanding of the foot's complicated mechanical loading in health and disease and to inform interventions designed to prevent plantar ulceration, a major complication of diabetes. This article provides a systematic review and summary of the findings from FE analysis-based computational simulations of the diabetic foot.A systematic literature search was carried out and 31 relevant articles were identified covering three primary themes: methodological aspects relevant to modelling the diabetic foot; investigations of the pathomechanics of the diabetic foot; and simulation-based design of interventions to reduce ulceration risk.Methodological studies illustrated appropriate use of FE analysis for simulation of foot mechanics, incorporating nonlinear tissue mechanics, contact and rigid body movements. FE studies of pathomechanics have provided estimates of internal soft tissue stresses, and suggest that such stresses may often be considerably larger than those measured at the plantar surface and are proportionally greater in the diabetic foot compared to controls. FE analysis allowed evaluation of insole performance and development of new insole designs, footwear and corrective surgery to effectively provide intervention strategies. The technique also presents the opportunity to simulate the effect of changes associated with the diabetic foot on non-mechanical factors such as blood supply to local tissues.While significant advancement in diabetic foot research has been made possible by the use of FE analysis, translational utility of this powerful tool for routine clinical care at the patient level requires adoption of cost-effective (both in terms of labour and computation) and reliable approaches with clear clinical validity for decision making

Identification of pathologically insignificant prostate cancer is not accurate in unscreened men.

BACKGROUND: Identification of men harbouring insignificant prostate cancer (PC) is important in selecting patients for active surveillance. Tools have been developed in PSA-screened populations to identify such men based on clinical and biopsy parameters. METHODS: Prospectively collected case series of 848 patients was treated with radical prostatectomy between July 2007 and October 2011 at an English tertiary care centre. Tumour volume was assessed by pathological examination. For each tool, receiver operator characteristics were calculated for predicting insignificant disease by three different criteria and the area under each curve compared. Comparison of accuracy in screened and unscreened populations was performed. RESULTS: Of 848 patients, 415 had Gleason 3+3 disease on biopsy. Of these, 32.0% had extra-prostatic extension and 50.2% were upgraded. One had positive lymph nodes. Two hundred and six (24% of cohort) were D'Amico low risk. Of these, 143 had more than two biopsy cores involved. None of the tools evaluated has adequate discriminative power in predicting insignificant tumour burden. Accuracy is low in PSA-screened and -unscreened populations. CONCLUSIONS: In our unscreened population, tools designed to identify insignificant PC are inaccurate. Detection of a wider size range of prostate tumours in the unscreened may contribute to relative inaccuracy