Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial.

Study Question: How effective is supported computerised cognitive behaviour therapy (cCBT) as an adjunct to usual primary care for adults with depression?

Methods: This was a pragmatic, multicentre, three arm, parallel randomised controlled trial with simple randomisation. Treatment allocation was not blinded. Participants were adults with symptoms of depression (score ≥ 10 on nine item patient health questionnaire, PHQ-9) who were randomised to receive a commercially produced cCBT programme ("Beating the Blues") or a free to use cCBT programme (MoodGYM) in addition to usual GP care.

Patients' views about taking a polypill to manage cardiovascular risk: a qualitative study in primary care.

Background: A 'polypill' containing a combination of antihypertensives and statins could prevent up to 80% of cardiovascular disease (CVD) events.

Aim: To investigate patients' opinions about the use of a polypill for CVD prevention.

Design And Setting: Qualitative study of 17 patients from seven primary care practices in Birmingham, UK.

The REFER (REFer for EchocaRdiogram) protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design.

Background: Heart failure is a major cause of mortality and morbidity. As mortality rates are high, it is important that patients seen by general practitioners with symptoms suggestive of heart failure are identified quickly and treated appropriately. Identifying patients with heart failure or deciding which patients need further tests is a challenge.

A randomised trial of nicotine assisted reduction to stop in pharmacies - the RedPharm study.

Background: Public policy and clinical treatment in tobacco addiction in the UK has focused on cessation: an abrupt attempt to stop all cigarettes. However, recent evidence suggests that allowing more gradual withdrawal from tobacco or even permanent partial substitution by nicotine replacement therapy (NRT) could lead to net benefits to public health. No jurisdiction has introduced smoking reduction programmes in normal clinical care and the best methods for their implementation is uncertain.

Does self-management of oral anticoagulation therapy improve quality of life and anxiety?

Background: Research related to service requirements for anticoagulation management has focussed on clinical and health economic outcomes and paid little attention to the impact of treatment and service delivery on patients' quality of life. This was the first large UK study to evaluate the effect of patient self-management (PSM) of oral anticoagulation on treatment-related quality of life (TRQoL) and anxiety in comparison with routine care (RC) and to explore the effect of level of therapeutic control on TRQoL and anxiety across and within each model of care.

Methods: A quantitative survey, set in primary care in the West Midlands.

Vaginal vault cytology tests: analysis of a decade of data from a UK tertiary centre.

Objectives: To examine temporal trends in the use of vault cytology tests in primary and secondary care and the demographics of those women tested.

Methods: Retrospective analysis of routinely collected data concerning women who had a vault cytology test processed during a 10-year period (1 April 1995 to 31 March 2005) at Birmingham Women's NHS Foundation Trust.

Results: A total of 8457 vault cytology tests from 3164 women (range 1-17 tests, median = 2) were processed, representing approximately 2% of the cervical cytology workload of the Department of Cytopathology at Birmingham Women's Hospital.

Rehabilitation interventions for foot drop in neuromuscular disease.

Background: "Foot drop" or "Floppy foot drop" is the term commonly used to describe weakness or contracture of the muscles around the ankle joint. It may arise from many neuromuscular diseases.

Objectives: To conduct a systematic review of randomised trials for the treatment of foot drop resulting from neuromuscular disease.

Statins in heart failure: retrospective cohort study using routine primary care data.

Introduction: Studies suggest no benefit from statins in heart failure (HF), but many individuals in primary care are prescribed statins before HF diagnosis. This study aimed to assess the effect of a statin prescription prior to HF diagnosis on survival in an incident HF population.

Material And Methods: Cases of HF diagnosed between 1995 and 2004 in 315 UK primary care practices were identified from electronic case records and followed up for 2 years from diagnosis.

Self-testing for cancer: a community survey.

Background: Cancer-related self-tests are currently available to buy in pharmacies or over the internet, including tests for faecal occult blood, PSA and haematuria. Self-tests have potential benefits (e.g.

The From The Heart study: a global survey of patient understanding of cholesterol management and cardiovascular risk, and physician-patient communication.

Objectives: Cardiovascular disease (CVD) is the leading cause of mortality worldwide. A high level of low-density lipoprotein cholesterol (LDL-C) is a major CVD risk factor. Guidelines recommend effective cholesterol management and set LDL-C goals, yet deficiencies exist in physician implementation of these recommendations and in patient uptake of the advice.

How representative of primary care are research active practices? Cross-sectional survey.

Background: There has been a continued trend towards undertaking primary care-based research but the characteristics and generalizability of practices that participate in such research are not well known.

Objective: To compare research active and non-active practices in terms of practice demographics, disease prevalence and quality scores from the Quality and Outcomes Framework.

Design: Cross-sectional survey using publicly available data.

Prognosis of all-cause heart failure and borderline left ventricular systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES).

Aims: Heart failure (HF) is reported to have an essentially malignant prognosis that can be modified by several interventions. Most outcome data on HF are available from randomized controlled treatment trials and longitudinal epidemiological studies. However, for a number of reasons, neither type of study have, to date, provided generalizable data on HF mortality.

Rehabilitation interventions for foot drop in neuromuscular disease.

Background: "Foot drop" or "Floppy foot drop" is the term commonly used to describe weakness or contracture of the muscles around the ankle joint. It may arise from many neuromuscular diseases.

Objectives: To conduct a systematic review of randomised trials of treatment for footdrop resulting from neuromuscular disease.

Confidential reporting of patient safety events in primary care: results from a multilevel classification of cognitive and system factors.

Objective: To classify events of actual or potential harm to primary care patients using a multilevel taxonomy of cognitive and system factors.

Methods: Observational study of patient safety events obtained via a confidential but not anonymous reporting system. Reports were followed up with interviews where necessary.

The Short-Form Leeds Dyspepsia Questionnaire validation study.

Background: Assessment of symptoms should be the primary outcome measure in dyspepsia clinical trials. This requires a reliable, valid and responsive questionnaire that measures the frequency and severity of dyspepsia. The Leeds Dyspepsia Questionnaire fulfils these characteristics, but is long and was not designed for self-completion, so a shorter questionnaire was developed (the Short-Form Leeds Dyspepsia Questionnaire).

Gender differences among medical students in attitudes to learning about complementary and alternative medicine.

Objectives: To explore gender differences in attitudes to CAM among Year 1, 2 and 3 medical students.

Design: Survey; seven-item self-administered questionnaire.

Setting: Plenary lectures at the start of semester 2 of the academic year at the University of Birmingham Medical School.

Clinicians didn't reliably distinguish between different causes of cardiac death using case histories.

Background And Objectives: Routine statistics and epidemiologic studies often distinguish between types of cardiac death. Our aim was to assess agreement between doctors on cause of death given identical clinical information, and to assess agreement between a physician panel and the original cause of death as coded on national statistics.

Methods: Clinical information and autopsy reports on 400 cardiac deaths were randomly selected from a defined population in the West Midlands, UK.

Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction -- a systematic review and meta-analysis.

Background: Randomised controlled trials generally suggest that cardiac resynchronisation improves outcomes in patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. Our objective was to provide a valid synthesis of the effects of CRT on mortality, major morbidity, quality of life and implantation success rates.

Methods: Systematic overview and meta-analysis of randomised trials, both blinded and open, comparing cardiac resynchronisation with control.

Effective management of dyslipidaemia among patients with cardiovascular risk: updated recommendations on identification and follow-up.

The identification of modifiable risk factors for coronary heart disease (CHD) and therapies for their management has led to the development of many national and international guidelines. However, despite the general acceptance and use of such guidelines, CHD, the principal manifestation of cardiovascular disease (CVD), remains the leading cause of mortality worldwide, with dyslipidaemia one of the most important modifiable risk factors. Many patients remain unidentified and untreated or, if receiving treatment, do not reach guideline targets.

Methicillin-resistant Staphylococcus aureus: awareness and perceptions.

The purpose of this study was to investigate levels of awareness and the perceived risk of contracting methicillin-resistant Staphylococcus aureus (MRSA) amongst patients/visitors and employees of the UK National Health Service (NHS). Differences between the two cohorts were also investigated, particularly sources of information about MRSA. In March 2005, a piloted questionnaire was circulated to 50 patients/visitors and 100 NHS employees (25 doctors, 25 nurses, 25 domestics and 25 porters).

Can combining different risk interventions into a single formulation contribute to improved cardiovascular disease risk reduction? Rationale and design for an international, open-label program to assess the effectiveness of a single pill (amlodipine/atorvastatin) to attain recommended target levels for blood pressure and lipids (The JEWEL Program).

Background: In order to prevent cardiovascular events, it is essential to effectively manage overall risk of cardiovascular disease. However, despite guideline recommendations to this effect, current management of the major, modifiable cardiovascular risk factors such as hypertension and dyslipidemia is disconnected and patient adherence to therapy is poor. This is particularly important for patients with multiple cardiovascular risk factors, who are often prescribed multiple medications.

Reducing cardiovascular risk in diabetes: beyond glycemic and blood pressure control.

Patients with diabetes mellitus have a much higher rate of cardiovascular disease (CVD) than the general population, and, in addition to glycaemia and hypertension, dyslipidemia has emerged as an important modifiable cardiovascular risk factor in these patients. In most patients with type 2 diabetes, the major features of dyslipidemia are increased triglyceride levels, decreased high-density lipoprotein cholesterol (HDL-C) levels, and changes in the composition and level of low-density lipoprotein cholesterol (LDL-C). Clinical trials evaluating both primary and secondary prevention of CVD demonstrate that lipid-lowering therapy results in a substantial reduction of cardiovascular risk in patients with type 2 diabetes.

The diagnosis of heart failure in European primary care: The IMPROVEMENT Programme survey of perception and practice.

Objective: To examine European primary care physicians (PCPs) views on diagnosis of heart failure and compare perceptions with actual practice.

Design: Semi-structured PCP interviews and case note review on a random sample of heart failure patients.

Participants: 1363 primary care physicians from 14 countries and 11,062 patient notes.