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Konrad Jamrozik is professor of primary care epidemiology, Imperial College, London, and visiting professor in public health, School of Population Health, University of Western Australia, Perth. ...doi:10.1136/bmj.328.7442.759 pmid:15044295 pmcid:PMC381333 fatcat:4i5pqxdmlrhlbfc4myfsnetx44
ABC of smoking cessation Policy priorities for tobacco control Konrad Jamrozik Although many countries have implemented strategies for reducing tobacco use at individual and population level, no country ... Konrad Jamrozik is professor of primary care epidemiology, Imperial College, London, and visiting professor in public health, School of Population Health, University of Western Australia, Perth. ...doi:10.1136/bmj.328.7446.1007 pmid:15105328 pmcid:PMC404508 fatcat:666edjhyi5gx3jmfgjfsb7e4va
Population-based studies, as well as clinicians, often rely on self-report and hospital records to obtain a history of stroke. This study aimed to compare the validity of the diagnosis of stroke by self-report and by hospital coding according to their cross-sectional association with prevalent vascular risk factors, and longitudinal association with recurrent stroke and major cardiovascular outcomes in a large cohort of older Australian men. Methods Between 1996 and 1999, 11,745 older men weredoi:10.1159/000358583 pmid:24686404 fatcat:n3xq6sclendifoaqdwzdrotmru
more »... urveyed for a selfreported history of stroke as part of the Health in Men Study (HIMS). Previous hospitalization for stroke was obtained with consent from linked medical records via the Western Australian Data Linkage System (WADLS). Subjects were followed by WADLS until December 31, 2010 for hospitalization for stroke, cardiovascular events, and all-cause mortality. The primary outcome was hospitalisation for stroke during follow-up. Secondary outcomes included incident vascular events and composite vascular endpoints. Results: At baseline, a history of stroke was reported by 903 men (7.7%), previous hospitalisation for stroke was recorded in 717 (6.1%), both self-report and hospitalisation in 467 (4.0%), and no history of stroke in 10,696 men (91.1%). Prevalent cardiovascular disease and peripheral arterial disease were more common among men with previous hospitalisation for stroke than a history of self reported stroke (p<0.001). In longitudinal analyses, incident aortic aneurysm was also more common among men with baseline history of hospitalization for stroke (adjusted hazard ratio [HR]: 1.71 95% CI 1.12-2.60) than among men with self-reported stroke (HR: 0.88 95% CI 0.56-1.36) compared to men with no history of stroke. With regards to the primary outcome, the rate of hospitalisation for stroke during follow-up was significantly higher among men with self-reported stroke (HR: 2.44, 95% CI: 2.03 to 2.94), hospital-coded stroke (adjusted HR 3.02, 2.42 to 3.78) and both self-reported and hospital-coded stroke (adjusted HR 3.33; 2.82 to 3.92) compared to participants with no previous stroke. Time to recurrent stroke was similar among different methods of initial stroke diagnosis (p=0.067). Conclusions: Self-reported stroke and hospital-coded stroke have similar prognostic value for predicting the risk of recurrent stroke. This supports the use of these ways of assessing a history of stroke for the clinical purposes of secondary prevention and for further epidemiological studies. Word Count (abstract): 366
AGH Drilling Oil Gas
FASTER cost-effectiveness analysis 2 STRUCTURTED ABSTRACT Study design Cost-effectiveness analysis alongside a factorial randomized controlled trial. Objective To assess the cost-effectiveness of a rehabilitation (rehab) program and/or an education booklet each compared with usual care for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery. Summary of Background Data There is little knowledge about the cost-effectiveness of postoperativedoi:10.1097/brs.0b013e31821cba1f pmid:21505377 fatcat:nngpfizglncqjbtpv2syyswz64
more »... nagement of patients following spinal surgery. Methods Three hundred and thirty-eight patients were recruited into the study between June 2005 and March 2009. Patients were randomized to rehab only, booklet only, rehab plus booklet, or usual care only. Interactions between booklet and rehab were non-significant, hence we compare booklet versus no booklet and rehab versus no rehab. We adopt an English National Health Service (NHS) and personal social services perspective. Data on outcomes and costs are based on patient level data from the trial. A one year time horizon was used. Outcomes were measured in terms of quality-adjusted life years (QALYs). Health-related quality of life was reported by patients using the EQ-5D. A comprehensive range of health service contacts were included in the cost analysis. Results There were no significant differences in costs or outcomes associated with either intervention. Mean incremental costs and mean QALYs gained per patient of booklet versus no booklet were -£87 (95% CI, -£1221 to £1047) and -0.023 (95% CI, -0.068 to 0.023), respectively. Figures for rehab versus no rehab were £160 (95% CI, -£984 to £1304) and 0.002 (95% CI, -0.044 to 0.048), respectively. Neither intervention was cost-effective when compared with the threshold range commonly used to judge whether or not an intervention is cost-effective in the English NHS. Conclusions Cost-effectiveness evidence does not support use of booklet over no booklet or rehab over no rehab for the postoperative management of patients following spinal surgery. FASTER cost-effectiveness analysis 3 KEY WORDS Cost-effectiveness; postoperative management; rehabilitation; education; spinal surgery; factorial design; randomized controlled trial KEY POINTS There is little knowledge about the cost-effectiveness of postoperative management of patients following spinal surgery. We undertook a cost-effectiveness analysis of a rehabilitation programme and an education booklet for the postoperative management of patients undergoing spinal surgery. We found that there were no significant differences in costs or benefits associated with either intervention compared with not receiving that intervention. Neither intervention was cost-effective when compared with the threshold range commonly used to judge whether or not an intervention is cost-effective in the English NHS. FASTER cost-effectiveness analysis 4 MINI ABSTRACT We undertook a cost-effectiveness analysis of a rehabilitation programme and an education booklet for the postoperative management of patients following spinal surgery. There were no significant differences in costs or benefits with either intervention, and neither was cost-effective when compared with the cost-effectiveness threshold commonly used in the English NHS.
Age and Ageing
the National Service Framework for Older People mandates the introduction of 'intermediate care services' to reduce emergency admissions to hospital from the population aged 75 years or more. We evaluated the predictive performance of one of the screening instruments used to identify older people who might most benefit from such services. Methods: using multiple logistic regression, we compared responses to the six-item, self-administered Sherbrooke Questionnaire with subsequent patterns ofdoi:10.1093/ageing/afi020 pmid:15644408 fatcat:3hv7625ccjeodbg5wf2324aqp4
more »... gency attendance and admission to hospital among the elderly population of one borough in West London. Results: excess risk of both emergency attendance and admission became significant when two or more risk factors were present, and rose progressively with each additional factor, regardless of their nature. With each additional year of age, risks of emergency attendance and admission to hospital increased by 8% (95% CI = 6-10) and 9% (95% CI = 7-12), respectively. There were also significant independent risks associated with reporting memory problems (typical odds ratio (OR) 1.41, 95% CI = 1.14-1.75) and taking three or more medications (OR 1.65, 95% CI = 1.34-2.02), as well as large risks associated with attendance or admission in the year before screening. Conclusion: the Sherbrooke Questionnaire is a good measure of likely need for emergency visits to hospital among the elderly. However, programmes attempting to reduce such events should also take into account the individual's recent history of emergency attendance at hospital.
There is some evidence from a Cochrane review that rehabilitation following spinal surgery may be beneficial. Methods: We conducted a survey of current post-operative practice amongst spinal surgeons in the United Kingdom in 2002 to determine whether such interventions are being included routinely in the post-operative management of spinal patients. The survey included all surgeons who were members of either the British Association of Spinal Surgeons (BASS) or the Society for Back Paindoi:10.1186/1471-2474-7-47 pmid:16737522 pmcid:PMC1481518 fatcat:fzqe3gspmjcsnjy3bz2kfcq4eq
more »... Data on the characteristics of each surgeon and his or her current pattern of practice and post-operative care were collected via a reply-paid postal questionnaire. Results: Usable responses were provided by 57% of the 89 surgeons included in the survey. Most surgeons (79%) had a routine post-operative management regime, but only 35% had a written set of instructions that they gave to their patients concerning this. Over half (55%) of surgeons do not send their patients for any physiotherapy after discharge, with an average of less than two sessions of treatment organised by those that refer for physiotherapy at all. Restrictions on lifting, sitting and driving showed considerable inconsistency both between surgeons and also within the recommendations given by individual surgeons. Conclusion: Demonstrable inconsistencies within and between spinal surgeons in their approaches to post-operative management can be interpreted as evidence of continuing and significant uncertainty across the sub-speciality as to what does constitute best care in these areas of practice. Conducting further large, rigorous, randomised controlled trials would be the best method for obtaining definitive answers to these questions.
Evaluating Curriculum Changes in Undergraduate Cancer Education DARREN STARMER, BN, KONRAD JAMROZIK, MBBS, DPHIL, MICHAEL BARTON, MBBS, FRANZCR, SHARON MILES, BAPPSC Abstract—Background. ... Barton MB, Tattersall MH, Butow P, Crossing S, Jamrozik K, Jalaludin B, Atkinson C, Miles S. ...doi:10.1207/s15430154jce1903_9 pmid:15458870 fatcat:l5njenonhrgbbio5xlqiw4fvt4
Lecture Notes in Computer Science
Unit test generation tools typically aim at one of two objectives: to explore the program behavior in order to exercise automated oracles, or to produce a representative test set that can be used to manually add oracles or to use as a regression test set. Dynamic symbolic execution (DSE) can efficiently explore all simple paths through a program, exercising automated oracles such as assertions or code contracts. However, its original intention was not to produce representative test sets.doi:10.1007/978-3-642-38916-0_9 fatcat:pzijqtsdubev5mh5u6g7lvrd2m
more »... h DSE tools like Pex can retain subsets of the tests seen during the exploration, customer feedback revealed that users expect different values than those produced by Pex, and sometimes also more than one value for a given condition or program path. This threatens the applicability of DSE in a scenario without automated oracles. Indeed, even though all paths might be covered by DSE, the resulting tests are usually not sensitive enough to make a good regression test suite. In this paper, we present augmented dynamic symbolic execution, which aims to produce representative test sets with DSE by augmenting path conditions with additional conditions that enforce target criteria such as boundary or mutation adequacy, or logical coverage criteria. Experiments with our Apex prototype demonstrate that the resulting test cases can detect up to 30% more seeded defects than those produced with Pex. 4 A preliminary version of this paper was published as a short paper discussing the idea for mutation and boundary analysis without evaluation in 
Objective To estimate deaths from passive smoking in employees of the hospitality industry as well as in the general workforce and general population of the United Kingdom. Design Calculation, using the formula for population attributable proportion, of deaths likely to have been caused by passive smoking at home and at work in the UK according to occupation. Sensitivity analyses to examine impact of varying assumptions regarding prevalence and risks of exposure. Setting National UK databasesdoi:10.1136/bmj.38370.496632.8f pmid:15741188 pmcid:PMC556069 fatcat:5sjvvilg4zaqblqn6466gqsudy
more »... causes of death, employment, structure of households, and prevalences of active and passive smoking. Main outcome measures Estimates of deaths due to passive smoking according to age group ( < 65 or ≥ 65) and site of exposure (domestic or workplace). Results Across the United Kingdom as a whole, passive smoking at work is likely to be responsible for the deaths of more than two employed people per working day (617 deaths per year), including 54 deaths in the hospitality industry each year. Each year passive smoking at home might account for another 2700 deaths in persons aged 20-64 years and 8000 deaths among people aged ≥ 65. Conclusion Exposure at work might contribute up to one fifth of all deaths from passive smoking in the general population aged 20-64 years, and up to half of such deaths among employees of the hospitality industry. Adoption of smoke free policies in all workplaces and reductions in the general prevalence of active smoking would lead to substantial reductions in these avoidable deaths.
Age and Ageing
Study objective: UK government policy mandates the introduction of 'intermediate care services' to reduce emergency admissions to hospital from the population aged 75 years or more. We evaluated one of these initiatives-the Keep Well At Home (KWAH) Project-in a West London Primary Care Trust. Design: KWAH involves a two-phase screening process, including a home visit by a community nurse. We employed cohort methods to determine whether KWAH resulted in fewer emergency attendances and admissionsdoi:10.1093/ageing/afi055 pmid:15764623 fatcat:ou24qysqubft7ahlwdqj44pgsa
more »... to hospital in the target population, from October 1999 to December 2002. Results: estimated levels of coverage in the two phases of screening were 61 and 32%, respectively. The project had not maintained records of which additional health and social care services had been delivered following screening. The rates of emergency admissions to hospital in the 9 months before screening were similar in practices that did and did not join the project (rate ratio (RR) = 1.05; 95% CI 0.95-1.17), suggesting absence of volunteer bias. Over the first 37 months of the project, there was no significant impact on either attendances at Accident & Emergency departments (RR = 1.02; 95% CI 0.97-1.06) or emergency admissions of elderly patients (RR = 0.98; 95% CI 0.93-1.05). Conclusion: the KWAH Project has been ineffective in reducing emergency admissions among the elderly. Significant questions arise in relation to selection of the screening instruments, practicality of achieving higher coverage of the eligible population, and creation of a new postcode lottery. Abstract Background: cognitive impairment is an important part of the diagnostic criteria for dementia. The Mini-Mental State Examination (MMSE) is recommended to test for cognitive impairment and to monitor medication response. Objectives: we examined the prevalence of cognitive impairment in the UK and assessed associations with cognitive impairment. Design: cross-sectional survey as part of a cluster randomised trial. Subjects: representative sample of people aged 75 years and over. Methods: all subjects had a detailed baseline health assessment including the MMSE. Results: a total of 15,051 subjects completed the assessment (71.9%). Almost two-thirds of subjects were female (61.5%) and almost half were aged between 75 and 79 years (47.0%). The prevalence of cognitive impairment was 18.3% (95% confidence intervals (CI) = 16.0-20.9) at a cut-off of 23/24, and 3.3% (95% CI = 2.8-4.0) at 17/18. Those with impairment (MMSE 23/24) were significantly more likely to have hearing (odds ratio (OR) 1.7), vision (OR 1.7) and urinary incontinence problems (OR 1.3), have two or more falls in the previous 6 months (OR 1.4), and report poorer health (OR 1.9). Almost half the participants lived alone (n = 7,073; 47.0%) and of these almost one-fifth were impaired (MMSE 23/ 24; 19.4%).
Objective To assess the level of compliance with the new law in the United Kingdom mandating penalties for using a hand held mobile phone while driving, to compare compliance with this law with the one on the use of seat belts, and to compare compliance with these laws between drivers of four wheel drive vehicles and drivers of normal cars. Design Observational study with two phases-one within the "grace" period, the other starting one week after penalties were imposed on drivers using suchdoi:10.1136/bmj.38848.627731.2f pmid:16798755 pmcid:PMC1489223 fatcat:3e2ewzyt5bbjbfwwfuzrokjmte
more »... phones. Setting Three busy sites in London. Participants Drivers of 38 182 normal cars and 2944 four wheel drive vehicles. Main outcome measures Proportions of drivers seen to be using hand held mobile phones and not using seat belts. Results Drivers of four wheel drive vehicles were more likely than drivers of other cars to be seen using hand held mobile phones (8.2% v 2.0%) and not complying with the law on seat belts (19.5% v 15.0%). Levels of non-compliance with both laws were slightly higher in the penalty phase of observation, and breaking one law was associated with increased likelihood of breaking the other. Conclusions The level of non-compliance with the law on the use of hand held mobile phones by drivers in London is high, as is non-compliance with the law on seat belts. Drivers of four wheel drive vehicles were four times more likely than drivers of other cars to be seen using hand held mobile phones and slightly more likely not to comply with the law on seat belts.
Objective-To assess the relationship between infrarenal aortic diameter and subsequent all-cause mortality in men aged 65 years or older. Methods and Results-Aortic diameter was measured using ultrasound in 12 203 men aged 65 to 83 years as part of a trial of screening for abdominal aortic aneurysms. A range of cardiovascular risk factors was also documented. Mortality over the next 3 to 7 years was assessed using record linkage. Initial aortic diameter was categorized into 10 intervals, anddoi:10.1161/01.atv.0000131261.12051.7f pmid:15130915 fatcat:sdqt4bh25ne2fojydxkq4d5pyu
more »... relationship between increasing diameter and subsequent mortality was explored using Cox proportional hazard models. Median diameter increased from 21.4 mm in the youngest men to 22.1 mm in the oldest men. The cumulative all-cause mortality increased in a graded fashion with increasing aortic diameter. Using the diameter interval 19 to 22 mm as the reference, the adjusted hazard ratio for all-cause mortality increased from 1.26 (95% CI: 1.09, 1.44; Pϭ0.001) for aortic diameters of 23 to 26 mm to 2.38 (95% CI: 1.22, 4.61; Pϭ0.011) for aortic diameters of 47 to 50 mm. Analysis of causes of death indicated that cardiovascular disease was an important contributor to this increase. Conclusion-Infrarenal aortic diameter is an independent marker of subsequent all-cause mortality. (Arterioscler Thromb
Aim: To assess trends in admissions of patients with heart failure (HF) to all hospitals in Australia between 1996-1997 and 2003-2004. Methods and results: We carried out a retrospective analysis of the official population-based National Hospital Morbidity Data in Australia. Although the absolute number of separations with a principal diagnosis of HF remained stable, the age-and sex-standardized separation rate for HF recorded as principal diagnosis decreased from 2.0 per 1000 population indoi:10.1016/j.ejheart.2006.06.007 pmid:17023205 fatcat:htvr2pjp45dmpa3rfdi3rhe73e
more »... -1997 to 1.6 per 1000 population in . The corresponding values for HF recorded in any diagnostic position were 7.7 and 4.7 per 1000 population. Men had higher in-hospital mortality than women (8.9% versus 8.1%, p b 0.001) and also a larger decrease in this measure over the study period (21.9% versus 14.4%). While the geometric mean length of stay for HF as principal diagnosis fell from 5.4 days in 1996-1997 to 4.9 days in 2003-2004, the proportion of bed-days related to such diagnoses relative to total bed days attributed to circulatory diseases increased from 12.8% to 13.7% (p b 0.001). Conclusion: There were no increase in number of admissions involving HF and standardized rates of hospital separations with HF fell in Australia between 1996 and 2004. The explanation for the observed declines in in-hospital case fatality and the separation rates should be sought in whole-of-community studies.
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