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Crooks CJ, West J, Morling JR, Simmonds M, Juurlink I, Cruickshank S, Briggs S, Hammond-Pears S, Shaw D, Card TR, Fogarty AW. Pulse oximetry has limited utility in identifying potential patients for long-term oxygen therapy. Int J Tuberc Lung Dis 2024; 28:253-255. [PMID: 38659138 DOI: 10.5588/ijtld.23.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- C J Crooks
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK
| | - J West
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK, East Midlands Academic Health Science Network, University of Nottingham, Nottingham, UK
| | - J R Morling
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - M Simmonds
- Nottingham University Hospitals NHS Trust, UK
| | - I Juurlink
- Nottingham University Hospitals NHS Trust, UK
| | | | - S Briggs
- Nottingham University Hospitals NHS Trust, UK
| | - S Hammond-Pears
- Nottingham University Hospitals NHS Trust, UK, East Midlands Academic Health Science Network, University of Nottingham, Nottingham, UK
| | - D Shaw
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham
| | - T R Card
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - A W Fogarty
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Taylor MJ, Morling JR, Lee A. Why we must anticipate a range of possible consequences of upcoming vape-related legislation changes in the United Kingdom. Public Health 2024; 230:231-232. [PMID: 38519286 DOI: 10.1016/j.puhe.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/24/2024]
Affiliation(s)
- M J Taylor
- University of Nottingham, Nottingham, UK.
| | | | - A Lee
- The University of Sheffield, Sheffield, UK
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Lee ACK, Morling JR. The looming global workforce crisis in primary care. Public Health 2024; 229:63-64. [PMID: 38402664 DOI: 10.1016/j.puhe.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
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Bailey JA, Morton AJ, Jones J, Chapman CJ, Oliver S, Morling JR, Patel H, Humes DJ, Banerjea A. 'Low' faecal immunochemical test (FIT) colorectal cancer: a 4-year comparison of the Nottingham '4F' protocol with FIT10 in symptomatic patients. Colorectal Dis 2024; 26:309-316. [PMID: 38173125 DOI: 10.1111/codi.16848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 01/05/2024]
Abstract
AIM The aim of this work was to evaluate colorectal cancer (CRC) outcomes after 'low' (sub-threshold) faecal immunochemical test (FIT) results in symptomatic patients tested in primary care. METHOD This work comprised a retrospective audit of 35 289 patients with FIT results who had consulted their general practitioner with lower gastrointestinal symptoms and had subsequent CRC diagnoses. The Rapid Colorectal Cancer Diagnosis pathway was introduced in November 2017 to allow incorporation of FIT into clinical practice. The local '4F' protocol combined FIT results with blood tests and digital rectal examination (DRE): FIT, full blood count, ferritin and finger [DRE]. The outcome used was detection rates of CRC, missed CRC and time to diagnosis in local 4F protocols for patients with a subthreshold faecal haemoglobin (fHb) result compared with thresholds of 10 and 20 μg Hb/g faeces. RESULTS A single threshold of 10 μg Hb/g faeces identifies a population in whom the risk of CRC is 0.2%, but this would have missed 63 (10.5%) of 599 CRCs in this population. The Nottingham 4F protocol would have missed fewer CRCs [42 of 599 (7%)] despite using a threshold of 20 μg Hb/g faeces for patients with normal blood tests. Subthreshold FIT results in patients subsequently diagnosed with a palpable rectal tumour yielded the longest delays in diagnosis. CONCLUSION A combination of FIT with blood results and DRE (the 4F protocol) reduced the risk of missed or delayed diagnosis. Further studies on the impact of such protocols on the diagnostic accuracy of FIT are expected. The value of adding blood tests to FIT may be restricted to specific parts of the fHb results spectrum.
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Affiliation(s)
- J A Bailey
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Queens Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - A J Morton
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Queens Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - J Jones
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C J Chapman
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Oliver
- NHS Nottingham and Nottinghamshire Integrated Care Board, Nottingham, UK
| | - J R Morling
- NHS Nottingham and Nottinghamshire Integrated Care Board, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK
| | - H Patel
- NHS Nottingham and Nottinghamshire Integrated Care Board, Nottingham, UK
| | - D J Humes
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - A Banerjea
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Smith K, Lee ACK, Morling JR. When public health and healthcare messaging collide: unintended consequences. Public Health 2024; 226:157-158. [PMID: 38071947 DOI: 10.1016/j.puhe.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Affiliation(s)
- K Smith
- NHS England-North East and Yorkshire, UK
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Knight H, Jia R, Ayling K, Blake H, Morling JR, Villalon AM, Corner J, Denning C, Ball J, Bolton K, Figueredo G, Morris D, Tighe P, Vedhara K. The changing vaccine landscape: rates of COVID-19 vaccine acceptance and hesitancy in young adults during vaccine rollout. Perspect Public Health 2023; 143:220-224. [PMID: 35575215 PMCID: PMC10467000 DOI: 10.1177/17579139221094750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Development and rollout of vaccines offers the best opportunity for population protection against the SARS-CoV-2 (COVID-19) virus. However, hesitancy towards the vaccines might impede successful uptake in the United Kingdom, particularly in young adults who demonstrate the highest rates of hesitancy. This prospective study explored COVID-19 vaccine hesitancy in young adults and whether the reasons behind these attitudes changed during the initial stages of the United Kingdom's vaccine rollout. METHOD Data on vaccination intention were collected from a British university student cohort at three time points: October 2020, February 2021, and March 2021. This online survey included items on intention to receive a vaccine and a free-text response for the reasons behind this intention. Cochran's Q tests examined changes in rates of hesitancy and acceptance over time and free-text responses were analysed thematically. RESULTS At baseline, 893 students provided data, with 476 participants completing all three time points. Hesitancy declined over time, with 29.4% of participants expressing hesitancy at baseline, reducing to 9.1% at wave 2 and 5.9% at wave 3. The most commonly endorsed themes for those willing to accept a vaccine were self-protection against COVID-19 and pro-social reasons, including protecting the population or unspecific others, and ending the pandemic/returning to normal life. The most commonly endorsed hesitancy themes related to 'confidence' in the vaccines and potential personal risk, including insufficient testing/scientific evidence, concern about side effects, and long-term effects. These reasons remained the most commonly endorsed at both waves 2 and 3. CONCLUSIONS While a decline in hesitancy was observed over time, the key reasons behind both vaccine acceptance and hesitancy remained consistent. Reasons behind hesitancy aligned with those of the general public, providing support for the use of generalist interventions. Pro-social reasons frequently underpinned vaccine acceptance, so cohort-specific interventions targeting those factors may be of benefit.
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Affiliation(s)
- H Knight
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - R Jia
- School of Medicine, University of Nottingham, Nottingham, UK
| | - K Ayling
- School of Medicine, University of Nottingham, UK
| | - H Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - JR Morling
- School of Medicine, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - AM Villalon
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - J Corner
- University Executive Board, University of Nottingham, Nottingham, UK
| | - C Denning
- Biodiscovery Institute, University Park, University of Nottingham, Nottingham, UK
| | - J Ball
- Biodiscovery Institute, University Park, University of Nottingham, Nottingham, UK
| | - K Bolton
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
| | - G Figueredo
- School of Computer Sciences, University of Nottingham, Nottingham, UK
| | - D Morris
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - P Tighe
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - K Vedhara
- School of Medicine, University of Nottingham, Nottingham, UK
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Crooks CJ, West J, Morling JR, Simmonds M, Juurlink I, Briggs S, Cruickshank S, Hammond-Pears S, Shaw D, Card TR, Fogarty AW. Differential pulse oximetry readings between ethnic groups and delayed transfer to intensive care units. QJM 2023; 116:63-67. [PMID: 36066450 PMCID: PMC9928225 DOI: 10.1093/qjmed/hcac218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pulse oximeters are widely used to monitor blood oxygen saturations, although concerns exist that they are less accurate in individuals with pigmented skin. AIMS This study aimed to determine if patients with pigmented skin were more severely unwell at the period of transfer to intensive care units (ICUs) than individuals with White skin. METHODS Using data from a large teaching hospital, measures of clinical severity at the time of transfer of patients with COVID-19 infection to ICUs were assessed, and how this varied by ethnic group. RESULTS Data were available on 748 adults. Median pulse oximetry demonstrated similar oxygen saturations at the time of transfer to ICUs (Kruskal-Wallis test, P = 0.51), although median oxygen saturation measurements from arterial blood gases at this time demonstrated lower oxygen saturations in patients classified as Indian/Pakistani ethnicity (91.6%) and Black/Mixed ethnicity (93.0%), compared to those classified as a White ethnicity (94.4%, Kruskal-Wallis test, P = 0.005). There were significant differences in mean respiratory rates in these patients (P < 0.0001), ranging from 26 breaths/min in individuals with White ethnicity to 30 breaths/min for those classified as Indian/Pakistani ethnicity and 31 for those who were classified as Black/Mixed ethnicity. CONCLUSIONS These data are consistent with the hypothesis that differential measurement error for pulse oximeter readings negatively impact on the escalation of clinical care in individuals from other than White ethnic groups. This has implications for healthcare in Africa and South-East Asia and may contribute to differences in health outcomes across ethnic groups globally.
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Affiliation(s)
- C J Crooks
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - J West
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
- East Midlands Academic Health Science Network, University of Nottingham, Nottingham NG7 2TU, UK
| | - J R Morling
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - M Simmonds
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - I Juurlink
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - S Briggs
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - S Cruickshank
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - S Hammond-Pears
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- East Midlands Academic Health Science Network, University of Nottingham, Nottingham NG7 2TU, UK
| | - D Shaw
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - T R Card
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - A W Fogarty
- Address correspondence to Dr A.W. Fogarty, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham City Hospital, Nottingham NG5 1PB, UK.
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Knight H, Jia R, Ayling K, Bradbury K, Baker K, Chalder T, Morling JR, Durrant L, Avery T, Ball JK, Barker C, Bennett R, McKeever T, Vedhara K. Understanding and addressing vaccine hesitancy in the context of COVID-19: development of a digital intervention. Public Health 2021; 201:98-107. [PMID: 34801843 PMCID: PMC8520885 DOI: 10.1016/j.puhe.2021.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/29/2021] [Accepted: 10/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) was identified in late 2019, spreading to over 200 countries and resulting in almost two million deaths worldwide. The emergence of safe and effective vaccines provides a route out of the pandemic, with vaccination uptake of 75-90% needed to achieve population protection. Vaccine hesitancy is problematic for vaccine rollout; global reports suggest only 73% of the population may agree to being vaccinated. As a result, there is an urgent need to develop equitable and accessible interventions to address vaccine hesitancy at the population level. STUDY DESIGN & Method: We report the development of a scalable digital intervention seeking to address COVID-19 vaccine hesitancy and enhance uptake of COVID-19 vaccines in the United Kingdom. Guided by motivational interviewing (MI) principles, the intervention includes a series of therapeutic dialogues addressing 10 key concerns of vaccine-hesitant individuals. Development of the intervention occurred linearly across four stages. During stage 1, we identified common reasons for COVID-19 vaccine hesitancy through analysis of existing survey data, a rapid systematic literature review, and public engagement workshops. Stage 2 comprised qualitative interviews with medical, immunological, and public health experts. Rapid content and thematic analysis of the data provided evidence-based responses to common vaccine concerns. Stage 3 involved the development of therapeutic dialogues through workshops with psychological and digital behaviour change experts. Dialogues were developed to address concerns using MI principles, including embracing resistance and supporting self-efficacy. Finally, stage 4 involved digitisation of the dialogues and pilot testing with members of the public. DISCUSSION The digital intervention provides an evidence-based approach to addressing vaccine hesitancy through MI principles. The dialogues are user-selected, allowing exploration of relevant issues associated with hesitancy in a non-judgmental context. The text-based content and digital format allow for rapid modification to changing information and scalability for wider dissemination.
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Affiliation(s)
- H Knight
- University of Nottingham, School of Medicine, Nottingham, UK
| | - R Jia
- University of Nottingham, School of Medicine, Nottingham, UK
| | - K Ayling
- University of Nottingham, School of Medicine, Nottingham, UK
| | - K Bradbury
- National Institute for Health Research (NIHR) ARC Wessex, UK; University of Southampton, Department of Psychology, Southampton, UK
| | - K Baker
- National Institute for Health Research (NIHR) ARC Wessex, UK
| | - T Chalder
- Kings College London, Department of Psychological Medicine, London, UK
| | - J R Morling
- University of Nottingham, School of Medicine, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - L Durrant
- University of Nottingham, School of Medicine, Nottingham, UK
| | - T Avery
- University of Nottingham, School of Medicine, Nottingham, UK
| | - J K Ball
- University of Nottingham, School of Life Sciences, Nottingham, UK
| | - C Barker
- National Institute for Health Research (NIHR) ARC Wessex, UK
| | | | - T McKeever
- University of Nottingham, School of Medicine, Nottingham, UK
| | - K Vedhara
- University of Nottingham, School of Medicine, Nottingham, UK.
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Abstract
OBJECTIVES This study aimed to review the trends in adult national screening programme performance in England before and during the COVID-19 pandemic and consider the future implications. STUDY DESIGN This was a quantitative, longitudinal study. METHODS Publicly available data on quarterly uptake of the five adult screening programmes in England were obtained from Public Health England. Trends from 2017 to 2021 were reviewed and discussed. RESULTS From 2019 to 2020 Q4, there were substantial reductions in performance in four of the five national screening programmes that were not in keeping with recent trends. CONCLUSION The reductions in screening performance coincide with the arrival of the COVID-19 pandemic in England and may be explained by the temporary suspension of national screening programmes, and the inability or unwillingness of invitees to partake in screening once the programmes had been restored. Because of the delay in publication of the analysed data, further COVID-19 lockdowns in recent months make it probable that the current true screening performance figures are substantially lower than those presented in this article. The impact on screening programme performance is likely to be detrimental to patient outcomes, meaning remedial action is urgently required.
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Affiliation(s)
- R C Armitage
- School of Medicine, Division of Epidemiology & Public Health, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - J R Morling
- School of Medicine, Division of Epidemiology & Public Health, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK; School of Medicine, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, NG7 2UH, UK
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Knight J, Day M, Lee ACK, Morling JR. COVID-19: transferring learning from the pandemic response to non-communicable disease control. Public Health 2021; 197:A1-A2. [PMID: 34535216 PMCID: PMC8437800 DOI: 10.1016/j.puhe.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - M Day
- Public Health England, UK
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Bhopal R, Lee A, Morling J. COVID-19-why open and honest public dialogue is needed: Porter's reflections on the ethical dilemmas of age rather than geographical based lockdowns are noteworthy. Public Health 2021; 196:e2-e3. [PMID: 33845985 PMCID: PMC7833592 DOI: 10.1016/j.puhe.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - A Lee
- University of Sheffield, UK.
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Bailey JA, Khawaja A, Andrews H, Weller J, Chapman C, Morling JR, Oliver S, Castle S, Simpson JA, Humes DJ, Banerjea A. GP access to FIT increases the proportion of colorectal cancers detected on urgent pathways in symptomatic patients in Nottingham. Surgeon 2021; 19:93-102. [PMID: 32327303 DOI: 10.1016/j.surge.2020.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/13/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Service evaluation of GP access to Faecal Immunochemical Test (FIT) for colorectal cancer (CRC) detection in Nottinghamshire and use of FIT for "rule out", "rule in" and "first test selection". DESIGN Retrospective audit of FIT results, CRC outcomes and resource utilisation before and after introduction of FIT in Primary Care in November 2017. Data from the new pathway up to December 2018 was compared with previous experience. RESULTS Between November 2017 and December 2018, 6747 GP FIT test requests yielded 5733 FIT results, of which 4082 (71.2%) were <4.0 μg Hb/g faeces, 579 (10.1%) were 4.0-9.9 μg Hb/g faeces, 836 (14.6%) were 10.0-149.9 μg Hb/g faeces, and 236 (4.1%) were ≥150.0 μg Hb/g faeces. The proportion of "rule out" results <4.0 μg Hb/g faeces was significantly higher than in the Getting FIT cohort (71.2% vs 60.4%, Chi squared 42.8, p < 0.0001) and the proportion of "rule in" results ≥150.0 μg Hb/g faeces was significantly lower (4.1% vs 8.1%, Chi squared 27.3,P < 0.0001). There was a 33% rise in urgent referrals across Nottingham overall during the evaluation period. 2 CRC diagnoses were made in 4082 patients who had FIT<4.0 μg Hb/g faeces. 58.4% of new CRC diagnoses associated with a positive FIT were early stage cancers (Stage I and II). The proportion of all CRC diagnoses that follow an urgent referral s rose after introduction of FIT. CONCLUSIONS FIT allows GP's to select a more appropriate cohort for urgent investigation without a large number of missed diagnoses. FIT appears to promise a "stage migration" effect which may ultimately improve CRC outcomes.
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Affiliation(s)
- J A Bailey
- Nottingham Colorectal Service, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - A Khawaja
- Nottingham Colorectal Service, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - H Andrews
- Nottingham Colorectal Service, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J Weller
- Nottingham Colorectal Service, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - C Chapman
- Eastern Hub, Bowel Cancer Screening Programme, A Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J R Morling
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, NG7 2UH, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, NG5 1PB, UK
| | - S Oliver
- Nottingham City Clinical Commissioning Group, Nottingham, UK
| | - S Castle
- Nottingham City Clinical Commissioning Group, Nottingham, UK
| | - J A Simpson
- Nottingham Colorectal Service, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - D J Humes
- Nottingham Colorectal Service, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK; NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, NG7 2UH, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, NG5 1PB, UK
| | - A Banerjea
- Nottingham Colorectal Service, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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Bailey JA, Weller J, Chapman CJ, Ford A, Hardy K, Oliver S, Morling JR, Simpson JA, Humes DJ, Banerjea A. Faecal immunochemical testing and blood tests for prioritization of urgent colorectal cancer referrals in symptomatic patients: a 2-year evaluation. BJS Open 2021; 5:6162967. [PMID: 33693553 PMCID: PMC7947575 DOI: 10.1093/bjsopen/zraa056] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A novel pathway incorporating faecal immunochemical testing (FIT) for rapid colorectal cancer diagnosis (RCCD) was introduced in 2017. This paper reports on the service evaluation after 2 years of pathway implementation. METHODS The RCCD protocol was based on FIT, blood results and symptoms to stratify adult patients in primary care. Two-week-wait (2WW) investigation was indicated for patients with rectal bleeding, rectal mass and faecal haemoglobin (fHb) level of 10 µg Hb/g faeces or above or 4 µg Hb/g faeces or more in the presence of anaemia, low ferritin or thrombocytosis, in all other symptom groups. Patients with 100 µg Hb/g faeces or above had expedited investigation . A retrospective audit of colorectal cancer detected between 2017 and 2019 was conducted, fHb thresholds were reviewed and critically assessed for cancer diagnoses. RESULTS In 2 years, 14788 FIT tests were dispatched with 13361 (90.4 per cent) completed returns. Overall, fHb was less than 4 µg Hb/g faeces in 9208 results (68.9 per cent), 4-9.9 µg Hb/g in 1583 (11.8 per cent), 10-99.9 µg Hb/g in 1850 (13.8 per cent) and 100 µg Hb/g faeces or above in 720 (5.4 per cent). During follow-up (median 10.4 months), 227 colorectal cancers were diagnosed. The cancer detection rate was 0.1 per cent in patients with fHb below 4 µg Hb/g faeces, 0.6 per cent in those with fHb 4-9.9 µg Hb/g faeces, 3.3 per cent for fHb 10-99.9 µg Hb/g faeces and 20.7 per cent for fHb 100 µg Hb/g faeces or above. The detection rate in the cohort with 10-19.9 µg Hb/g faeces was 1.4 per cent, below the National Institute for Health and Care Excellence threshold for urgent referral. The colorectal cancer rate in patients with fHb below 20 µg Hb/g faeces was less than 0.3 per cent. CONCLUSION Use of FIT to "rule out" urgent referral from primary care misses a small number of cases. The threshold for referral may be adjusted with blood results to improve stratification .
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Affiliation(s)
- J A Bailey
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Weller
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C J Chapman
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Ford
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Hardy
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Oliver
- Nottingham City Clinical Commissioning Group, Nottingham,UK
| | - J R Morling
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - J A Simpson
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J Humes
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK,National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK,Correspondence to: Nottingham Colorectal Service, E Floor West Block, Queen’s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK (e-mail: )
| | - A Banerjea
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Bailey JA, Ibrahim H, Bunce J, Chapman CJ, Morling JR, Simpson JA, Humes DJ, Banerjea A. Quantitative FIT stratification is superior to NICE referral criteria NG12 in a high-risk colorectal cancer population. Tech Coloproctol 2021; 25:1151-1154. [PMID: 34263362 PMCID: PMC8279105 DOI: 10.1007/s10151-021-02466-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines for urgent investigation of colorectal cancer (CRC) are based on age and symptom-based criteria. This study aims to compare the diagnostic value of clinical features and faecal immunochemical test (FIT) results to identify those at a higher risk of CRC, thereby facilitating effective triage of patients. METHODS We undertook a review of all patients referred for investigation of CRC at our centre between September 2016 and June 2018. Patients were identified using a prospectively recorded local database. We performed a logistic regression analysis of factors associated with a diagnosis of CRC. RESULTS One-thousand-and-seven-hundred-eighty-four patients with FIT results were included in the study. Change in bowel habit (CIBH) was the most common referring clinical feature (38.3%). Patients diagnosed with CRC were significantly older than those without malignancy (74.0 years vs 68.9 years, p = 0.0007). Male patients were more likely to be diagnosed with CRC than females (6.5% vs 2.5%, Chi-squared 16.93, p < 0.0001). CRC was diagnosed in 3.5% (24/684) with CIBH compared to 8.1% (6/74) with both CIBH and iron deficiency anaemia. No individual or combination of referring clinical features was associated with an increased diagnosis of CRC (Chi-squared, 8.03, p = 0.155). Three patients with negative FIT results (< 4 µg Hb/g faeces) were diagnosed with CRC (3/1027, 0.3%). The highest proportion of cancers detected was in the ≥ 100 µg Hb/g faeces group (55/181, 30.4%). CONCLUSION In a multivariate model, FIT outperforms age, sex and all symptoms prompting referral. FIT has greater stratification value than any referral symptoms. FIT does have value in patients with iron deficiency anaemia.
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Affiliation(s)
- J A Bailey
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - H Ibrahim
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Bunce
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C J Chapman
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J R Morling
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Division of Epidemiology and Public Health, School of Medicine, University of NottinghamCity Hospital, Nottingham, UK
| | - J A Simpson
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J Humes
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Division of Epidemiology and Public Health, School of Medicine, University of NottinghamCity Hospital, Nottingham, UK
| | - A Banerjea
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Affiliation(s)
- A Lee
- University of Sheffield, UK.
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Affiliation(s)
- A C K Lee
- The University of Sheffield, United Kingdom.
| | - J Morling
- The University of Nottingham, United Kingdom
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Affiliation(s)
- R Merrick
- Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - S Walsh
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - J Ford
- Institute of Public Health, University of Cambridge, Cambridge, UK
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Chapman C, Thomas C, Morling J, Tangri A, Oliver S, Simpson JA, Humes DJ, Banerjea A. Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham. Colorectal Dis 2020; 22:679-688. [PMID: 31876975 DOI: 10.1111/codi.14944] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/29/2019] [Indexed: 12/29/2022]
Abstract
AIM We introduced primary care access to faecal immunochemical testing (FIT) as a stratification tool for symptomatic patients considered to be at risk of colorectal cancer (CRC) prior to urgent referral. We aimed to evaluate clinical and pathway outcomes during the first 6 months of this novel approach. METHOD FIT was recommended for all patients who consulted their general practitioner with lower gastrointestinal symptoms other than rectal bleeding and rectal mass. We undertook a retrospective audit of the results of FIT, related clinical outcomes and resource utilization on prospectively logged cases between November 2017 and May 2018. RESULTS Of the 1862 FIT kits dispatched by post 91.4% were returned, with a median return time of 7 days (range 2-110 days); however, 1.3% of returned kits could not be analysed. FIT results ≥ 150.0 μg haemoglobin (Hb)/g faeces identified patients with a significantly higher risk of CRC (30.9% vs 1.4%, chi-square 167.1, P < 0.0001). FIT results ≥ 10.0 μg Hb/g faeces identified patients with significantly higher risk of significant noncancer bowel pathology (24.1% vs 4.9%, chi-square 73.6, P < 0.0001) and FIT results < 4.0 μg Hb/g faeces identified a group more likely to have non-CRC pathology (5.1% vs 2.4%, chi-square 3.9, P < 0.05). The CRC detection rate in 531 patients investigated after a FIT result of < 4.0 μg Hb/g faeces was 0.2%. In 899 investigated patients, a FIT result with a threshold of 4.0 μg Hb/g faeces had sensitivity 97.2% (85.5-99.9% CI), specificity 61.4% (58.1-64.7% CI), negative predictive value 99.8% (98.7-100.0% CI) and positive predictive value 9.5% (8.7-10.4% CI). CONCLUSION A symptomatic pathway incorporating FIT is feasible and appears more clinically effective than pathways based on age and symptoms alone.
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Affiliation(s)
- C Chapman
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Thomas
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Morling
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - A Tangri
- Riverlyn Medical Centre, Nottingham, UK
| | - S Oliver
- Nottingham City Clinical Commissioning Group, Nottingham, UK
| | - J A Simpson
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J Humes
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - A Banerjea
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Morling J, Sim F, Mackie P. Prevention: of what, in whom, and how? Public Health 2019; 169:A1-A2. [DOI: 10.1016/j.puhe.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Objective To understand the usage and acceptability of a faecal collection device amongst participants in the National Health Service Bowel Cancer Screening Programme, with the aim of influencing future uptake. Setting Participants completing faecal occult blood test retests as part of the routine Bowel Cancer Screening Programme in Eastern England. Methods A faecal collection device and questionnaire were sent to all potential retest participants during a one-month period to collect information on prior stool collection methods and ease of use and usefulness of the enclosed faecal collection device. Results Out of 1087 participants invited, 679 (62.5%) returned their questionnaire. Of these, 429 (63.2%) trialled the faecal collection device at least once, 163 (38.4%) found the device made collecting their sample easier than previously, 189 (44.6%) found it made collection more difficult and 72 (17.0%) said it made no difference. Similar numbers reported finding that the faecal collection device made collecting the sample more pleasant (130, 31.5%), less pleasant (103, 25.0%) and no different (179, 43.4%) compared with previous collection without a faecal collection device. Conclusion Although a small proportion of participants found the faecal collection device helpful, a considerable majority did not or did not use it at all. Offering faecal collection devices is unlikely to produce a substantial increase in bowel cancer screening uptake.
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Affiliation(s)
- JR Morling
- Bowel Cancer Screening Programme (Eastern Hub), Queens Medical Centre, Nottingham, UK
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - AN Barke
- Bowel Cancer Screening Programme (Eastern Hub), Queens Medical Centre, Nottingham, UK
| | - CJ Chapman
- Bowel Cancer Screening Programme (Eastern Hub), Queens Medical Centre, Nottingham, UK
| | - RF Logan
- Bowel Cancer Screening Programme (Eastern Hub), Queens Medical Centre, Nottingham, UK
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Gifford FJ, Morling JR, Fallowfield JA. Systematic review with meta-analysis: vasoactive drugs for the treatment of hepatorenal syndrome type 1. Aliment Pharmacol Ther 2017; 45:593-603. [PMID: 28052382 DOI: 10.1111/apt.13912] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/13/2016] [Accepted: 12/02/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatorenal syndrome type 1 (HRS1) is a functional, rapidly progressive, potentially reversible form of acute kidney injury occurring in patients with cirrhosis. Characterised by intense renal arterial vasoconstriction, it carries a very poor prognosis. There is a significant unmet need for a widely approved, safe and effective pharmacological treatment. AIM To re-evaluate efficacy and safety of pharmacological treatments for HRS1, in the light of recently published randomised controlled trials (RCTs). METHODS MEDLINE (OvidSP), EMBASE, PubMed and Cochrane registers were searched for RCTs reporting efficacy and adverse events related to pharmacological treatment of HRS1. Search terms included: 'hepatorenal syndrome', 'terlipressin', 'noradrenaline', 'octreotide', 'midodrine', 'vasopressin', 'dopamine', 'albumin' and synonyms. Comparison of vasoactive drugs vs. placebo/no treatment, and two active drugs were included. Meta-analysis was performed for HRS1 reversal, creatinine improvement, mortality and adverse events. RESULTS Twelve RCTs enrolling 700 HRS1 patients were included. Treatment with terlipressin and albumin led to HRS1 reversal more frequently than albumin alone or placebo (RR: 2.54, 95% CI: 1.51-4.26). Noradrenaline was effective in reversing HRS1, but trials were small and nonblinded. Overall, there was mortality benefit with terlipressin (RR: 0.79, 95% CI: 0.63-1.01), but sensitivity analysis including only trials with low risk of selection bias weakened this relationship (RR: 0.87, 95% CI: 0.71-1.06). Notably, there was a significant risk of adverse events with terlipressin therapy (RR: 4.32, 95% CI: 0.75-24.86). CONCLUSIONS Terlipressin treatment is superior to placebo for achieving HRS1 reversal, but mortality benefit is less clear. Terlipressin is associated with significant adverse events, but infusion regimens may be better tolerated. There is continued need for safe and effective treatment options for hepatorenal syndrome.
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Affiliation(s)
- F J Gifford
- Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J R Morling
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - J A Fallowfield
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
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Morling JR, Grant R, Brewster DH. Completeness of primary intracranial tumour recording in the Scottish Cancer Registry 2011-2012. Public Health 2016; 140:278-281. [PMID: 27370699 DOI: 10.1016/j.puhe.2016.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/04/2016] [Accepted: 05/31/2016] [Indexed: 11/16/2022]
Affiliation(s)
- J R Morling
- Information Services Division, NHS National Services Scotland, 1 Gyle Square, South Gyle Crescent, Edinburgh EH12 9EB, UK.
| | - R Grant
- Department of Neurosciences, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - D H Brewster
- Information Services Division, NHS National Services Scotland, 1 Gyle Square, South Gyle Crescent, Edinburgh EH12 9EB, UK
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Morling JR, Fallowfield JA, Guha IN, Williamson RM, Ali M, Glancy S, Strachan MWJ, Price JF. Clinically significant chronic liver disease in people with Type 2 diabetes: the Edinburgh Type 2 Diabetes Study. QJM 2016; 109:249-56. [PMID: 26454513 PMCID: PMC4815616 DOI: 10.1093/qjmed/hcv191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/05/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Type 2 diabetes is an independent risk factor for chronic liver disease, however disease burden estimates and knowledge of prognostic indicators are lacking in community populations. AIMS To describe the prevalence and incidence of clinically significant chronic liver disease amongst community-based older people with Type 2 diabetes and to determine risk factors which might assist in discriminating patients with unknown prevalent or incident disease. DESIGN Prospective cohort study. METHODS Nine hundred and thirty-nine participants in the Edinburgh Type 2 Diabetes Study underwent investigation including liver ultrasound and non-invasive measures of non-alcoholic steatohepatitis (NASH), hepatic fibrosis and systemic inflammation. Over 6-years, cases of cirrhosis and hepatocellular carcinoma were collated from multiple sources. RESULTS Eight patients had known prevalent disease with 13 further unknown cases identified (prevalence 2.2%) and 15 incident cases (IR 2.9/1000 person-years). Higher levels of systemic inflammation, NASH and hepatic fibrosis markers were associated with both unknown prevalent and incident clinically significant chronic liver disease (allP < 0.001). CONCLUSIONS Our study investigations increased the known prevalence of clinically significant chronic liver disease by over 150%, confirming the suspicion of a large burden of undiagnosed disease. The disease incidence rate was lower than anticipated but still much higher than the general population rate. The ability to identify patients both with and at risk of developing clinically significant chronic liver disease allows for early intervention and clinical monitoring strategies. Ongoing work, with longer follow-up, including analysis of rates of liver function decline, will be used to define optimal risk prediction tools.
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Affiliation(s)
- J R Morling
- From the Centre for Population Health Sciences, University of Edinburgh, Old Medical Buildings, Teviot Place, Edinburgh EH8 9AG, UK
| | - J A Fallowfield
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - I N Guha
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK
| | | | - M Ali
- Department of Metabolic Medicine, Edinburgh, UK
| | - S Glancy
- Department of Radiology, Western General Hospital, Edinburgh, UK
| | | | - J F Price
- From the Centre for Population Health Sciences, University of Edinburgh, Old Medical Buildings, Teviot Place, Edinburgh EH8 9AG, UK
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Jenks SJ, Conway BR, Hor TJ, Williamson RM, McLachlan S, Robertson C, Morling JR, Strachan MWJ, Price JF. Hepatic steatosis and non-alcoholic fatty liver disease are not associated with decline in renal function in people with Type 2 diabetes. Diabet Med 2014; 31:1039-46. [PMID: 24684407 DOI: 10.1111/dme.12456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/18/2014] [Accepted: 03/26/2014] [Indexed: 12/13/2022]
Abstract
AIMS We aimed to determine whether the presence of hepatic steatosis and/or non-alcoholic fatty liver disease was associated with decline in renal function or onset of microalbuminuria in a cohort of people with Type 2 diabetes, including those managed in both primary and secondary care. METHODS Nine hundred and thirty-three patients from the Edinburgh Type 2 Diabetes Study, a cohort of Scottish men and women aged 60-74 years with Type 2 diabetes, underwent assessment for hepatic steatosis by liver ultrasonography 1 year after recruitment. Non-alcoholic fatty liver disease was defined as the presence of steatosis following exclusion of secondary causes of liver disease. Patients were followed for 4 years and decline in renal function was assessed by the change in estimated glomerular filtration rate over time. RESULTS Of the 933 subjects, 530 had hepatic steatosis and, of those with hepatic steatosis, 388 had non-alcoholic fatty liver disease. Neither hepatic steatosis nor non-alcoholic fatty liver disease were significantly associated with rate of decline in renal function, with the mean rate of decline in estimated glomerular filtration rate being -1.55 ml min(-1) 1.73 m(-2) per year for participants with hepatic steatosis compared with -1.84 ml min(-1) 1.73 m(-2) for those without steatosis (P = 0.19). Similar results were obtained when the analysis was restricted to participants with and without non-alcoholic fatty liver disease (-1.44 vs. -1.64 ml min(-1) 1.73 m(-2) per year, respectively; P = 0.44). Additionally, neither hepatic steatosis nor non-alcoholic fatty liver disease were associated with the onset or regression of albuminuria during follow-up (all P ≥ 0.05). CONCLUSIONS The presence of hepatic steatosis/non-alcoholic fatty liver disease was not associated with decline in renal function during a 4-year follow-up in our cohort of older people with Type 2 diabetes.
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Affiliation(s)
- S J Jenks
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
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Abstract
AIMS To determine the prevalence and distribution of abnormal plasma liver enzymes in a representative sample of older adults with Type 2 diabetes. METHODS Plasma concentrations of alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase were measured in a randomly selected, population-based cohort of 1066 men and women aged 60-75 years with Type 2 diabetes (the Edinburgh Type 2 Diabetes Study). RESULTS Overall, 29.1% (95% CI 26.1-31.8) of patients had one or more plasma liver enzymes above the upper limit of the normal reference range. Only 10.1% of these patients had a prior history of liver disease and a further 12.4% reported alcohol intake above recommended limits. Alanine aminotransferase was the most commonly raised liver enzyme (23.1% of patients). The prevalence of abnormal liver enzymes was significantly higher in men (odds ratio 1.40, 95% CI 1.07-1.83), in the youngest 5-year age band (odds ratio 2.02, 95% CI 1.44-2.84), in patients with diabetes duration < 5 years (odds ratio 1.38, 95% CI 1.01-1.90), plasma HbA(1c) ≥ 58 mmol/mol (7.5%) (odds ratio 1.43, 95% CI 1.09-1.88), obese BMI (odds ratio 2.84, 95% CI 1.59-3.06) and secondary care management for their diabetes (odds ratio 1.40, 95% CI 1.05-1.87). However, all these factors combined accounted for only 7.6% of the variation in liver enzyme abnormality. CONCLUSIONS The prevalence of elevated liver enzymes in people with Type 2 diabetes is high, with only modest variation between clinically defined patient groups. Further research is required to determine the prognostic value of raised, routinely measured liver enzymes to inform decisions on appropriate follow-up investigations.
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Affiliation(s)
- J R Morling
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
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Abstract
OBJECTIVES To quantify the out-of-hours experience obtained by public health trainees in Scotland and to assess whether this is sufficient to meet the Faculty of Public Health guidelines. STUDY DESIGN Prospective survey. METHODS All public health trainees in Scotland were invited to participate in a prospective survey of out-of-hours experience. Data were collected from March 2009 to March 2010. The variation in the experience between trainees was compared according to the size, urban/rural mix, and deprivation of the population for which they were responsible. The variation in the experiences gained were then compared to the requirements of the Faculty of Public Health. RESULTS 18 trainees participated from 6 areas, collecting data on 391 shifts and a total of 276 calls. For every 50 shifts the median number of notifications of probable meningococcus was 3.7 and the median number of chemical incidents and Escherichia coli O157 notifications was 0.0. This variation is difficult to interpret because some trainees collected data for only a short period. The variation between trainees was not significantly related to population size, deprivation or rurality. Pooling the data from all trainees, there was a mean of 2.9 probable meningococcus notifications, 2.4 E coli O157 calls, and 0.3 chemical incident calls per 50 shifts. CONCLUSIONS There is a large and unpredictable degree of variation in the on-call experience of Scottish trainees. The minimum recommended number of on-call shifts may not be adequate to ensure a high proportion of trainees are prepared for unsupervised on-call.
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Morling J, Williamson R, Strachan M, Price J, Glancy S, Nee L. P2-201 Changes in aminotransferases indicate changes in hepatosteatosis in people with type 2 diabetes: the Edinburgh type 2 diabetes study. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Katikireddi SV, Morling J, Bhopal R. P2-131 Falling prevalence of impaired glucose tolerance in south Asian populations. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976i.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Morling J, Williamson R, Strachan M, Price J, Nee L, Glancy S. P2-202 Thiazolidinediones are associated with regression of hepatosteatosis in people with type 2 diabetes: the Edinburgh type 2 diabetes study. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mackie P, Morling J. Corrigendum to “Commissioning prison health: Opportunities and challenges for creating a new prison public health system in Scotland” [Public Health123(2009) 434–437]. Public Health 2010. [DOI: 10.1016/j.puhe.2010.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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