Glycated hemoglobin, body weight and blood pressure in type 2 diabetes patients initiating dapagliflozin treatment in primary care:a retrospective study

Introduction - The present study aimed to describe characteristics of patients with type 2 diabetes (T2D) in UK primary care initiated on dapagliflozin, post-dapagliflozin changes in glycated hemoglobin (HbA1c), body weight and blood pressure, and reasons for adding dapagliflozin to insulin. Methods - Retrospective study of patients with T2D in the Clinical Practice Research Datalink with first prescription for dapagliflozin. Patients were included in the study if they: (1) had a first prescription for dapagliflozin between November 2012 and September 2014; (2) had a Read code for T2D; (3) were registered with a practice for at least 6 months before starting dapagliflozin; and (4) remained registered for at least 3 months after initiation. A questionnaire ascertained reason(s) for adding dapagliflozin to insulin. Results - Dapagliflozin was most often used as triple therapy (27.7%), dual therapy with metformin (25.1%) or added to insulin (19.2%). Median therapy duration was 329 days [95% confidence interval (CI) 302–361]. Poor glycemic control was the reason for dapagliflozin initiation for 93.1% of insulin-treated patients. Avoiding increases in weight/body mass index and insulin resistance were the commonest reasons for selecting dapagliflozin versus intensifying insulin. HbA1c declined by mean of 9.7 mmol/mol (95% CI 8.5–10.9) (0.89%) 14–90 days after starting dapagliflozin, 10.2 mmol/mol (95% CI 8.9–11.5) (0.93%) after 91–180 days and 12.6 mmol/mol (95% CI 11.0–14.3) (1.16%) beyond 180 days. Weight declined by mean of 2.6 kg (95% CI 2.3–2.9) after 14–90 days, 4.3 kg (95% CI 3.8–4.7) after 91–180 days and 4.6 kg (95% CI 4.0–5.2) beyond 180 days. In patients with measurements between 14 and 90 days after starting dapagliflozin, systolic and diastolic blood pressure decreased by means of 4.5 (95% CI −5.8 to −3.2) and 2.0 (95% CI −2.9 to −1.2) mmHg, respectively from baseline. Similar reductions in systolic and diastolic blood pressure were observed after 91–180 days and when follow-up extended beyond 180 days. Results were consistent across subgroups. Conclusion - HbA1c, body weight and blood pressure were reduced after initiation of dapagliflozin in patients with T2D in UK primary care and the changes were consistent with randomized clinical trials.

A retrospective study examining the nature, contributory factors and predictors of dispensing errors in community pharmacy

Introduction: Since 2005, the workload of community pharmacists in England has increased with a concomitant increase in stress and work pressure. However, it is unclear how these factors are impacting on the ability of community pharmacists to ensure accuracy during the dispensing process. This research seeks to extend our understanding of the nature, outcome, and predictors of dispensing errors. Methodology: A retrospective analysis of a purposive sample of incident report forms (IRFs) from the database of a pharmacist indemnity insurance provider was conducted. Data collected included; type of error, degree of harm caused, pharmacy and pharmacist demographics, and possible contributory factors. Results: In total, 339 files from UK community pharmacies were retrieved from the database. The files dated from June 2006 to November 2011. Incorrect item (45.1%, n = 153/339) followed by incorrect strength (24.5%, n = 83/339) were the most common forms of error. Almost half (41.6%, n = 147/339) of the patients suffered some form of harm ranging from minor harm (26.7%, n = 87/339) to death (0.3%, n = 1/339). Insufficient staff (51.6%, n = 175/339), similar packaging (40.7%, n = 138/339) and the pharmacy being busier than normal (39.5%, n = 134/339) were identified as key contributory factors. Cross-tabular analysis against the final accuracy check variable revealed significant association between the pharmacy location (P < 0.024), dispensary layout (P < 0.025), insufficient staff (P < 0.019), and busier than normal (P < 0.005) variables. Conclusion: The results provide an overview of some of the individual, organisational and technical factors at play at the time of a dispensing error and highlight the need to examine further the relationships between these factors and dispensing error occurrence.

Investigation of assessment methods for final year optometry undergraduates

This retrospective study was designed to investigate the factors that influence performance in examinations comprised of multiple-choice questions (MCQs), short-answer questions (SAQs), and essay questions in an undergraduate population. Final year optometry degree examination marks were analyzed for two separate cohorts. Direct comparison found that students performed better in MCQs than essays. However, forward stepwise regression analysis of module marks compared with the overall score showed that MCQs were the least influential, and the essay or SAQ mark was a more reliable predictor of overall grade. This has implications for examination design.

Clinical characteristics of unilateral myopic anisometropia in a juvenile optometric practice population

Purpose: A retrospective study of longitudinal case histories, undertaken to establish the clinical and statistical characteristics of unilateral myopic anisometropia (UMA) amongst the juvenile and adolescent population at an optometric practice, is reported. UMA was defined as that specific refractive state where an unequivocally myopic eye is paired with a 'piano' [spherical equivalent refraction, (SER) = ±0.25 Dioptres (D)] companion eye. Methods: The clinical records of all patients aged <19 years on file at an established independent optometric practice were categorised as 'myopic' (SER ≤-0.50 D), 'hypermetropie' (≥+0.75 D) or 'emmetropic' (≥-0.37≤+0.62 D). Subsequently all juvenile patients matching the UMA criterion, together with a case-matched group of bilaterally myopic individuals, were selected as the comparative study populations. Results: A total of 14.4% (n = 21 of 146) of the juvenile myopic case histories were identified as cases of UMA. More than half of these UMA cases emerged between the ages of 11.5 and 13.5 years. There was a marked female gender bias. The linear gradient of the age-related mean refractive trend in the myopic eye of the UMA population was not statistically significantly different (p > 0.1) to that fitted to the ametropic progression recorded in either eye of the case-matched population of young bilateral myopes; uniquely the slope associated with the companion eye of UMA cases was statistically significantly (p < 0.025) less steep. Compared with bilateral myopes fewer cases of UMA required a refractive correction to relieve visual or asthenopic symptoms, and this initial correction was dispensed on average 1 year later (at age 12.7 years) in UMA patients. Conclusions: Individuals identified as demonstrating clinically-defined UMA can be considered as distinct but functionally normal cases on the continuum of human refractive error. However, any unilaterally-acting determining factor(s) underlying the genesis of the condition remain obscure. © 2004 The College of Optometrists.

Predicting changes in measured introcular pressure with non-contact tonometry after LASIK

Purpose: Optometrists are becoming more integrally involved in the diagnosis of and care for glaucoma patients in the UK. The correlation of apparent change in non contact tonometry (NCT) IOP measurement and change in other ocular parameters such as refractive error, corneal curvature, corneal thickness and treatment zone size (data available to optometrists after LASIK) would facilitate care of these patients. Setting: A UK Laser Eye Clinic. Methods: This is a retrospective study study of 200 sequential eyes with myopia with or without astigmatism which underwent LASIK using a Hansatome and an Alcon LADARvision 4000 excimer laser. Refraction keratometry, pachymetry and NCT IOP mesurements were taken before treatmebnt and agian 3 months after treatment. The relationship between these variables anfd teh treatment zones were studied using stepwise multiple regression analysis. Results: There was a mean difference of 5.54mmHg comnparing pre and postoperative NCT IOP. IOP change correlates with refractive error change (P < 0.001), preoperative corneal thickness (P < 0.001) and treatment zone size (P = 0.047). Preoperative corneal thickness correlates with preoperative IOP (P < 0.001) and postoperative IOP (P < 0.001). Using these correlations, the measured difference in NCT IIOP can be predicted preoperatively or postoperatively using derived equations.Conclusion: There is a significant reduction in measured NCT IOP after LASIK. The amount of reduction can be calculated using data acquired by optometrists. This is helpful for opthalmologists and optometrists who co-manage glaucoma patients who have had LASIK or with glaucoma pateints who are consideraing having LASIK.

Decompression illness and its regulation in contemporary UK tunnelling : an engineering perspective:an engineering perspective

This thesis records the findings of a retrospective study of decompression illness (DCI) in the UK compressed air tunnelling industry since the mid-1980s. The thesis describes how the study arose, its scope and objectives, along with an overview of tunnelling and shaft-sinking. The development of compressed air working techniques is reviewed along with a description of decompression practice and DCI, and an outline of relevant legislation and guidance. The acquisition and manipulation of data to form a number of databases and spreadsheets on which the analysis was performed is discussed. That analysis examined measures of DCI incidence and quantified that incidence using these measures. Also considered is the variation in tolerance and susceptibility to DCI in the workforce, and the phenomenon of acclimatisation. An examination of the extent to which men worked on multiple contracts and the variation in their susceptibility to DCI on these contracts is included. Options are then considered for reducing the incidence of DCI. The first retained air-only decompression through the application of restrictions on exposure. The second related to the use of oxygen decompression. Finally the adequacy of the existing Regulations and Guidance is considered and recommendations made for possible changes to them, arising from the study. The main conclusions are that a number of measures of DCI incidence were identified, some more appropriate than others and that the incidence of DCI when so measured was high, disproportionately so in shift workers. No reasonably practicable restrictions on exposure were identified which would have allowed the retention of air-only decompression. Oxygen decompression looked promising but had yet to be used sufficiently extensively to generate enough data for analysis. Recommendations included one that an alternative technique for monitoring the effectiveness of decompression should be developed. The thesis ends with recommendations for further research.

Retinal thickness in pregnant women with diabetes

Poster section Design. Retrospective study. Purpose. To assess whether there are changes in foveal thickness (FT) and total macular volume (TMV) in pregnancy in diabetic subjects. Methods. The audit consisted of pregnant women with diabetes, with no maculopathy, who completed their antenatal care at Birmingham Heartlands Hospital. The Zeiss Stratus Optical coherence tomography (OCT) was performed on patients attending diabetic retinopathy (DR) screening at intervals throughout their pregnancy. To be included in the audit patients had to have at least one OCT scan during their pregnancy. Results. Altogether there were 8 type 1 and 22 type 2 patients with mean diabetes duration of 6 years (range 1-20). Mean gestation at DR screening with OCT during the first trimester was 9.7 weeks (6-13) (n=22). The mean and standard deviation for FT for the right was 179.1 µm ± 21.49 and for the left eye was 187.3 µm ± 23.55. The mean TMV was right 6.43 µm ± 0.35 and left 6.50 µm ± 0.39. The mean gestation at DR screening with OCT during the second trimester was 23.4 weeks (18-26) (n=25). The mean FT for the right was 191.4 µm ± 22.70 and the left 195.6 µm ± 24.77. The mean TMV was right 6.74 µm ± 0.45 and left 6.91 µm ± 0.35. The gestation of DR screening with OCT during the third trimester was 31.1 weeks (27-36) (n=15). The mean FT for the right was 181.5 µm ± 24.84 and for the left 193.1 µm ± 28.55. The mean TMV was right 6.80 µm ± 0.40 and left 6.84 µm ± 0.31. There were no significant differences in FT over the 3 trimesters. The TMV showed a significant difference when comparing the first and second trimesters (p<0.05). However, there was no significant statistical difference in TMV in the second and third trimesters. None of the patients showed any macula edema on the OCT. Conclusions. The results suggest there is no significant change in foveal thickness in pregnancy in diabetic subjects. There was a significant statistical difference in total macular volume in the second trimester; however, this would not be clinically significant. This is an important observation proven by the OCT which has not been previously studied.

Predicting university success in psychology:are subject-specific skills important?

The relationship between previous academic achievement and subsequent success at university was explored in a retrospective study of 56 UK psychology students. It was found that the subjects studied at A-level, and the grades obtained, did not predict performance at university. In contrast, GCSE grades, in particular those achieved in Science and English, were significant predictors of final year marks. Once at university, first and second year results had an incremental ability to predict final year performance, with an additional effect of undertaking a work placement. The implications of the results are discussed within the context of recent literature relating to cognitive and non-cognitive predictors of academic performance.

An analysis of penalty kicks in elite football post 1997

The penalty kick in football is a seemingly simplistic play; however, it has increased in complexity since 1997 when the rules changed allowing goalkeepers to move laterally along their goal line before the ball was kicked. Prior to 1997 goalkeepers were required to remain still until the ball was struck. The objective of this study was to determine the importance of the penalty kick in the modern game of football. A retrospective study of the 2002, 2006 and 2010 World Cup and the 2000, 2004 and 2008 European Championship tournaments was carried out, assessing the importance of the penalty kick in match play and shootouts and the effect of the time of the game on the shooter's success rate. This study demonstrated the conversion rate of penalties was 73% in shootouts and 68% in match play. Significantly more penalties were awarded late in the game: twice as many penalties in the second half than the first and close to four times as many in the fourth quarter vs. the first. Teams awarded penalty kicks during match play won 52%, drew 30% and lost 18% of the time; chances of winning increased to 61% if the penalty was scored, but decreased to 29% if missed. Teams participating in either the World Cup or European Championship final match had roughly a 50% chance of being involved in a penalty shootout during the tournament. Penalty shots and their outcome significantly impact match results in post 1997 football.

Clinical characteristics of patients with epilepsy in a specialist neuropsychiatry service

Neuropsychiatry services provide specialist input into the assessment and management of behavioral symptoms associated with a range of neurological conditions, including epilepsy. Despite the centrality of epilepsy to neuropsychiatry and the recent expansion of neuropsychiatry service provision, little is known about the clinical characteristics of patients with epilepsy who are routinely seen by a specialist neuropsychiatry service. This retrospective study filled this gap by retrospectively evaluating a naturalistic series of 60 consecutive patients with epilepsy referred to and assessed within a neuropsychiatry setting. Fifty-two patients (86.7%) had active epilepsy and were under the ongoing care of the referring neurologist for seizure management. The majority of patients (N = 42; 70.0%) had a diagnosis of localization-related epilepsy, with temporal lobe epilepsy as the most common epilepsy type (N = 37; 61.7%). Following clinical assessment, 39 patients (65.0%) fulfilled formal diagnostic criteria for at least one psychiatric disorder; nonepileptic attack disorder (N = 37; 61.7%), major depression (N = 23; 38.3%), and generalized anxiety disorder (N = 16; 26.7%) were the most commonly diagnosed comorbidities. The clinical characteristics of patients seen in specialist neuropsychiatry settings are in line with the results from previous studies in neurology clinics in terms of both epilepsy and psychiatric comorbidity. Our findings confirm the need for the development and implementation of structured care pathways for the neuropsychiatric aspects of epilepsy, with focus on comorbid nonepileptic attacks and affective and anxiety symptoms. This is of particular importance in consideration of the impact of behavioral symptoms on patients' health-related quality of life.

Use of flucinolone acetonide for patients with diabetic macular oedema:patient selection criteria and early outcomes in real world setting

Introduction: Fluocinolone acetonide slow release implant (Iluvien®) was approved in December 2013 in UK for treatment of eyes which are pseudophakic with DMO that is unresponsive to other available therapies. This approval was based on evidence from FAME trials which were conducted at a time when ranibizumab was not available. There is a paucity of data on implementation of guidance on selecting patients for this treatment modality and also on the real world outcome of fluocinolone therapy especially in those patients that have been unresponsive to ranibizumab therapy. Method: Retrospective study of consecutive patients treated with fluocinolone between January and August 2014 at three sites were included to evaluate selection criteria used, baseline characteristics and clinical outcomes at 3-month time point. Results: Twenty two pseudophakic eyes of 22 consecutive patients were included. Majority of patients had prior therapy with multiple intravitreal anti-VEGF injections. Four eyes had controlled glaucoma. At baseline mean VA and CRT were 50.7 letters and 631 μm respectively. After 3 months, 18 patients had improved CRT of which 15 of them also had improved VA. No adverse effects were noted. One additional patient required IOP lowering medication. Despite being unresponsive to multiple prior therapies including laser and anti-VEGF injections, switching to fluocinolone achieved treatment benefit. Conclusion: The patient level selection criteria proposed by NICE guidance on fluocinolone appeared to be implemented. This data from this study provides new evidence on early outcomes following fluocinolone therapy in eyes with DMO which had not responded to laser and other intravitreal agents.