An evaluation of Birmingham Own Health telephone care management service among patients with poorly controlled diabetes. A retrospective comparison with the General Practice Research Database.

BACKGROUND: Telephone-based care management programmes have been shown to improve health outcomes in some chronic diseases. Birmingham Own Health is a telephone-based care service (nurse-delivered motivational coaching and support for self-management and lifestyle change) for patients with poorly controlled diabetes, delivered in Birmingham, UK. We used a novel method to evaluate its effectiveness in a real-life setting. METHODS: Retrospective cohort study in the UK. 473 patients aged ≥ 18 years with diabetes enrolled onto Birmingham Own Health (intervention cohort) and with > 90 days follow-up, were each matched by age and sex to up to 50 patients with diabetes registered with the General Practice Research Database (GPRD) to create a pool of 21,052 controls (control cohort). Controls were further selected from the main control cohort, matching as close as possible to the cases for baseline test levels, followed by as close as possible length of follow-up (within +/- 30 days limits) and within +/- 90 days baseline test date. The aim was to identify a control group with as similar distribution of prognostic factors to the cases as possible. Effect sizes were computed using linear regression analysis adjusting for age, sex, deprivation quintile, length of follow-up and baseline test levels. RESULTS: After adjusting for baseline values and other potential confounders, the intervention showed significant mean reductions among people with diabetes of 0.3% (95% CI 0.1, 0.4%) in HbA1c; 3.5 mmHg (1.5, 5.5) in systolic blood pressure, 1.6 mmHg (0.4, 2.7) in diastolic blood pressure and 0.7 unit reduction (0.3, 1.0) in BMI, over a mean follow-up of around 10 months. Only small effects were seen on average on serum cholesterol levels (0.1 mmol/l reduction (0.1, 0.2)). More marked effects were seen for each clinical outcome among patients with worse baseline levels. CONCLUSIONS: Despite the limitations of the study design, the results are consistent with the Birmingham Own Health telephone care management intervention being effective in reducing HbA1c levels, blood pressure and BMI in people with diabetes, to a degree comparable with randomised controlled trials of similar interventions and clinically important. The effects appear to be greater in patients with poorer baseline levels and the intervention is effective in the most deprived populations.

Long-term effects of epidural analgesia in labor: a randomized controlled trial comparing high dose with two mobile techniques.

BACKGROUND: Epidural analgesia provides the most effective pain relief in labor, but it is not known if it causes adverse long-term effects. The objective of this study was to assess the long-term effects of two mobile epidural techniques relative to high-dose epidural analgesia in a randomized controlled trial. METHODS: A total of 1,054 nulliparous women were randomized to traditional high-dose epidural, combined spinal epidural, or low-dose infusion. Women in all groups were followed-up at 12 months postpartum by postal questionnaire to assess long-term symptoms. The primary long-term outcome was backache occurring within 3 months of the birth persisting for longer than 6 weeks. Secondary outcomes were frequent headaches and fecal and urinary stress incontinence. RESULTS: No significant differences were found in long-term backache after combined spinal epidural or low-dose infusion relative to high-dose epidural. Significantly less headache occurred in combined spinal epidural analgesia than high-dose epidural (OR: 0.57, 95% CI: 0.36-0.92), but no difference was found for low-dose infusion. Significantly less fecal incontinence (OR: 0.51, 95% CI: 0.30-0.87) and stress incontinence (OR: 0.65, 95% CI: 0.42-1.00) occurred with low-dose infusion. CONCLUSION: Trial evidence showed no long-term disadvantages and possible benefits of low-dose mobile relative to high-dose epidural analgesia.

The Spectral Game: leveraging Open Data and crowdsourcing for education.

We report on the implementation of the Spectral Game, a web-based game where players try to match molecules to various forms of interactive spectra including 1D/2D NMR, Mass Spectrometry and Infrared spectra. Each correct selection earns the player one point and play continues until the player supplies an incorrect answer. The game is usually played using a web browser interface, although a version has been developed in the virtual 3D environment of Second Life. Spectra uploaded as Open Data to ChemSpider in JCAMP-DX format are used for the problem sets together with structures extracted from the website. The spectra are displayed using JSpecView, an Open Source spectrum viewing applet which affords zooming and integration. The application of the game to the teaching of proton NMR spectroscopy in an undergraduate organic chemistry class and a 2D Spectrum Viewer are also presented.

The JSpecView Project: an Open Source Java viewer and converter for JCAMP-DX, and XML spectral data files.

The JSpecView Open Source project began with the intention of providing both a teaching and research tool for the display of JCAMP-DX spectra. The development of the Java source code commenced under license in 2001 and was released as Open Source in March 2006. The scope was then broadened to take advantage of the XML initiative in Chemistry and routines to read and write AnIML and CMLspect documents were added.JSpecView has the ability to display the full range of JCAMP-DX formats and protocols and to display multiple spectra simultaneously. As an aid for the interpretation of spectra it was found useful to offer routines such that if any part of the spectral display is clicked, that region can be highlighted and the (x, y) coordinates returned. This is conveniently handled using calls from JavaScript and the feedback results can be used to initiate links to other applets like Jmol, to generate a peak table, or even to load audio clips providing helpful hints.Whilst the current user base is still small, there are a number of sites that already feature the applet. A tutorial video showing how to examine NMR spectra using JSpecView has appeared on YouTube and was formatted for replay on iPods and it has been incorporated into a chemistry search engine.

Chemical Markup, XML, and the World Wide Web. 7. CMLSpect, an XML vocabulary for spectral data.

CMLSpect is an extension of Chemical Markup Language (CML) for managing spectral and other analytical data. It is designed to be flexible enough to contain a wide variety of spectral data. The paper describes the CMLElements used and gives practical examples for common types of spectra. In addition it demonstrates how different views of the data can be expressed and what problems still exist.

Persistent urinary incontinence and delivery mode history: a six-year longitudinal study.

OBJECTIVE: To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery. DESIGN: Longitudinal study. SETTING: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). POPULATION: Women (4214) who returned postal questionnaires three months and six years after the index birth. METHODS: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery mode history. MAIN OUTCOME MEASURES: Urinary incontinence-persistent (at three months and six years after index birth) and long term (at six years after index birth). RESULTS: The prevalence of persistent urinary incontinence was 24%. Delivering exclusively by caesarean section was associated with both less persistent (OR=0.46, 95% CI 0.32-0.68) and long term urinary incontinence (OR=0.50, 95% CI 0.40-0.63). Caesarean section birth in addition to vaginal delivery, however, was not associated with significantly less persistent incontinence (OR 0.93, 95% CI 0.67-1.29). There were no significant associations between persistent or long term urinary incontinence and forceps or vacuum extraction delivery. Other significantly associated factors were increasing number of births and older maternal age. CONCLUSIONS: The risk of persistent and long term urinary incontinence is significantly lower following caesarean section deliveries but not if there is another vaginal birth. Even when delivering exclusively by caesarean section, the prevalence of persistent symptoms (14%) is still high.

Incidence of cancers following orthotopic liver transplantation in a single center: comparison with national cancer incidence rates for England and Wales.

BACKGROUND: The incidence of de novo cancers is increased in liver allograft recipients but there are few data assessing the extent of the increased risk compared with a matched population. METHODS: A retrospective study of 1,778 adults transplanted between January 1982 and March 2004, followed for a median of 65 months. The observed cancer incidence was compared with age-, sex-, and calendar year-matched expected cancer rates in England and Wales population. RESULTS: In all, 141 (7.9%) developed a new cancer. There was an increase in the incidence of all tumors compared with that expected (Standardized Incidence Ratio (SIR) 207, 95% CI 174-244, P < 0.001); the greatest increase was seen in lymphoid tumors (SIR 1026, 95% CI 608-1621, P < 0.001), skin cancers (SIR 580, 95% CI 432-763, P < 0.001), and cancer of the large bowel (SIR 496, 95% CI 290-774, P < 0.001). Large bowel cancer was more common in those patients with ulcerative colitis than those without (SIR 2727 vs. 347) and in older patients. Females had a greater risk of lung cancer than males (SIR 336 vs. 56). CONCLUSIONS: There is an increased incidence of tumors following liver transplantation. Although the absolute risk of cancer is low, we found that the increase in risk is greater in the younger aged recipients than the older ones. Increased awareness of colon cancer is needed especially in older patients and those with ulcerative colitis. There should be awareness for the high lung cancer incidence in females. Increased surveillance for breast and cervical cancer is not necessary.