Changing Current Practice in Urology: Improving Guideline Development and Implementation Through Stakeholder Engagement.

Effective stakeholder integration for guideline development should improve outcomes and adherence to clinical practice guidelines.

The feasibility of determining the effectiveness and cost-effectiveness of medication organisation devices compared with usual care for older people in a community setting: systematic review, stakeholder focus groups and feasibility randomised controlled trial.

Background: Medication organisation devices (MODs) provide compartments for a patient's medication to be organised into the days of the week and the recommended times the medication should be taken.

Aim: To define the optimal trial design for testing the clinical effectiveness and cost-effectiveness of MODs.

Design: The feasibility study comprised a systematic review and focus groups to inform a randomised controlled trial (RCT) design.

Safety evaluation of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) for allergic rhinitis.

Introduction: As a chronic disease, allergic rhinitis (AR) requires regular use of allergy medications for the effective management of symptoms. It is therefore imperative that AR treatments not only provide adequate symptom control but are also well tolerated.

Areas Covered: MP29-02 (Dymista, Meda, Solna, Sweden) is the first new class of AR medication (WHO ATC R01AD58) since the introduction of intranasal corticosteroids (INS) almost 50 years ago.

Association between miscarriage and cardiovascular disease in a Scottish cohort.

Objective: To assess if miscarriage, whether consecutive or not, is associated with an increased risk of subsequent cardiovascular disease.

Methods: A cohort study was performed using women with at least one miscarriage or live birth recorded from 1950 to 2010 in the Aberdeen Maternity and Neonatal Databank. The exposed groups consisted of women with non-consecutive, two consecutive or three or more consecutive miscarriages; the unexposed group consisted of all women with at least one live birth and no miscarriages.

Guidance on handheld inhalers in asthma and COPD guidelines.

Background: Inhaled therapy is the cornerstone of pharmacotherapy in patients with asthma and chronic obstructive pulmonary disease (COPD). Appropriate inhalation device selection is as important as drug choice but device-specific guidance appears to be lacking.

Methods: To quantify the level of inhalation-device recommendations in clinical guidelines, a review was conducted by hand-searching national and international asthma and COPD guidelines (Global Initiative for Asthma [GINA] and Global initiative for chronic Obstructive Lung Disease [GOLD] guidelines) and an international guideline on device selection (the American College of Chest Physicians/American College of Asthma, Allergy, and Immunology [ACCP/ACAAI]).

Are educational interventions to prevent catheter-related bloodstream infections in intensive care unit cost-effective?

Background: There is increasing interest in evidence-based educational interventions in central venous catheter care. It is unclear how effective these are at reducing the risk of bloodstream infections from the use of intravascular catheters (catheter-BSIs) and the associated costs and health benefits.

Aim: To estimate the additional costs and health benefits from introducing such interventions and the costs associated with catheter-BSIs.

Real-world perceptions of inhaled corticosteroid/long-acting β2-agonist combinations in the treatment of asthma.

Prescribing data for Europe show a shift from inhaled corticosteroids (ICSs) prescribed alone or in free combination with long-acting β(2)-agonists (LABAs) to fixed-dose single-inhaler combinations of these agents. However, existing guidelines provide little advice on selecting a specific ICS/LABA combination therapy for the treatment of asthma. European survey data indicate that the factors physicians take into account when making prescribing decisions are broadly in line with those considered to be important by experts in a Delphi process: the availability of a range of doses, the efficacy of the combination, the long-term safety and tolerability of the ICS and LABA components, the potency of the ICS and the speed of onset of the LABA.

A qualitative study of stakeholder views of a community-based anticipatory care service for patients with COPD.

Background: The need to consider anticipatory preventive care for people with chronic obstructive pulmonary disease (COPD) has been highlighted in UK guidelines and policy.

Aims: To explore stakeholder views of the utility and design of a community-based anticipatory care service (CBACS) for COPD.

Methods: This was a qualitative study using focus groups and in-depth interviews in North-East Scotland.

Hypertensive disorders of pregnancy and future health and mortality: A record linkage study.

The objective of this register-based cohort study was to examine the relationship between hypertensive disorders of pregnancy and future hospital discharges from specified causes including cardiovascular disease, incident cancer registrations and mortality. From the Aberdeen Maternity and Neonatal Databank we identified 34,854 women who were born on or before 31st December 1967 and who had (i) preeclampsia/eclampsia, (ii) gestational hypertension or (iii) normal blood pressure in their first pregnancy. Hospital discharges from selected causes including cardiovascular disease, cancer registrations and deaths in these women were identified from the Scottish Morbidity Records.

Physicians' attitudes towards combination therapy with inhaled corticosteroids and long-acting β-agonists: an observational study in UK specialist care.

Purpose: Recent real-world studies have demonstrated that asthma control remains suboptimal in many patients. The aim of this study was to evaluate physicians' perceptions of the effectiveness of combination therapy with an inhaled corticosteroid (ICS) and a long-acting β-agonist (LABA) in routine clinical practice.

Methods: In November 2009, UK respiratory specialists were invited by medeConnect Healthcare Insight to complete a survey on the effectiveness of different single- or dual-inhaler combinations of an ICS and a LABA in the context of asthma management.

Reassessing the evidence hierarchy in asthma: evaluating comparative effectiveness.

Classical randomized controlled trials are the gold standard in medical evidence because of their high internal validity. However, their necessarily strict design can limit their external validity and the ability to extrapolate these data to real world patients. Therefore, alternatively designed studies may play a complementary role in evaluating the comparative effectiveness of therapies in nonidealized patients in more naturalistic, real world settings.

European differences in cancer survival: report of an international symposium of general practitioners from three countries exploring primary and secondary care delay.

Background: There are several potential delays in the cancer diagnostic pathway: patient delay, primary care delay and secondary care delay. People in the UK have poorer five-year survival from many cancers compared with people in European countries with similar healthcare systems. The reasons for this are not clear, although it has been postulated that UK patients may present with cancer at a later stage.

Cost-utility analysis of indacaterol in Germany: a once-daily maintenance bronchodilator for patients with COPD.

Introduction: Indacaterol is a novel inhaled once-daily long-acting beta(2)-agonist (LABA) for the maintenance treatment of COPD that has been compared to existing inhaled monotherapies on a number of symptomatic endpoints in clinical studies. With constrained healthcare budgets, the objective of this analysis was to evaluate the cost-effectiveness of indacaterol 150 μg, the approved starting dose for maintenance therapy, from a German heath service perspective against the most widely used bronchodilator tiotropium, and the twice-daily LABA, salmeterol.

Methods: A Markov model was developed with the following main health states: Mild, Moderate, Severe, and Very Severe COPD, based on pre-bronchodilator FEV(1) measures reported in the indacaterol clinical trials, and death.

Asthma and psychological dysfunction.

Despite effective treatment, asthma outcomes remain suboptimal. Anxiety and depression occur more commonly in people with asthma than expected, and are associated with poor asthma outcomes. The direction of the relationship and the mechanisms underlying it are uncertain.

Is the oral contraceptive pill associated with fracture in later life? New evidence from the Royal College of General Practitioners Oral Contraception Study.

Background: Several studies, including an earlier analysis from the Royal College of General Practitioners (RCGP) Oral Contraception Study, have suggested that ever users of oral contraceptives have an increased risk of fracture when compared with never users. In this paper, we examined a subset of women in the RCGP study living in Scotland to determine whether this risk has persisted.

Study Design: A nested case-control study was carried out using data collected prospectively for the RCGP Oral Contraception Study.

Device type and real-world effectiveness of asthma combination therapy: an observational study.

Background: Selection of inhaler device type appears to influence real-world effectiveness of inhaled corticosteroids (ICS), but data are lacking on the role of inhaler device in ICS and long-acting β2-agonist (LABA) combination therapy for asthma.

Methods: This retrospective matched cohort study compared 1-year asthma outcomes for UK patients initiating fixed-dose combination (FDC) fluticasone-salmeterol delivered by pressurised metered-dose inhaler (pMDI) versus dry powder inhaler (DPI). Patients with asthma aged 4-80 years receiving a first prescription for FDC fluticasone-salmeterol by pMDI or DPI were matched on baseline demographic and asthma severity measures.

Modifiable and fixed factors predicting quality of life in people with colorectal cancer.

Background: People with colorectal cancer have impaired quality of life (QoL). We investigated what factors were most highly associated with it.

Methods: Four hundred and ninety-six people with colorectal cancer completed questionnaires about QoL, functioning, symptoms, co-morbidity, cognitions and personal and social factors.

Revisiting the symptom iceberg in today's primary care: results from a UK population survey.

Background: Recent changes in UK primary care have increased the range of services and healthcare professionals available for advice. Furthermore, the UK government has promoted greater use of both self-care and the wider primary care team for managing symptoms indicative of self-limiting illness. We do not know how the public has been responding to these strategies.

Toward shared care for people with cancer: developing the model with patients and GPs.

Background: The number of people surviving cancer for extended periods is increasing. Consequently, due to workload and quality issues, there is considerable interest in alternatives to traditional secondary care-led cancer follow-up.

Objective: To explore the views of potential recipients of shared follow-up of cancer.

Comparing asthma treatment in elderly versus younger patients.

A randomised 6-month study compared two maintenance doses of budesonide/formoterol (Symbicort® Turbuhaler® (h) maintenance and reliever therapy (Symbicort SMART®), 160/4.5 μg 1 × 2 and 2 × 2, in 8053 asthmatics with symptoms despite treatment with inhaled corticosteroids ± inhaled long-acting β2-agonists. This analysis compared response to the two treatments in elderly patients, ≥ 65 years, with that in younger patients.

The menopause 'It's somewhere between a taboo and a joke'. A focus group study.

Objectives: To explore the menopause from the perspective of women in the community, with specific emphasis on their experience of menopausal symptoms, management strategies and support post the Women's Health Initiative trial.

Methods: Four focus groups were conducted with 14 middle-aged women living in the Grampian region of Scotland. The groups lasted up to 2 hours and were analyzed using the framework approach.

A mixed-methods study identifying and exploring medical students' views of the UKCAT.

Background: The United Kingdom Clinical Aptitude Test (UKCAT) is used by 23 UK medical schools. Research to date has focused on validity and utility but it is also critical to examine selection processes from the applicant's perspective.

Methods: This was a mixed-methods study using a paper-based survey and focus groups with first year medical students in Scotland in 2009-2010.

Epidemiology of the contraceptive pill and venous thromboembolism.

Current users of combined oral contraceptives have an increased risk of venous thromboembolism. The risk appears to be higher during the first year of use and disappears rapidly once oral contraception is stopped. There is a strong interaction between hereditary defects of coagulation, combined oral contraceptive use and venous thromboembolism.

Epidemiology of neuropathic pain.

Epidemiology is an essential clinical tool in designing and evaluating management and prevention strategies, and is particularly relevant to neuropathic pain. Despite its relevance to neuropathic pain however, there is a paucity of accurate information on its prevalence, distribution and determinants, for several reasons. In many ways, it is appropriate to study neuropathic pain merely as a symptom or a pain mechanism rather than a specific disease.