The SPHERE Study: Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]

Background: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines.

Methods: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

Fuzzy Coding of Genetic Algorithms

A well-cited paper suggesting fuzzy coding as an alternative to the conventional binary, grey and floating-point representations used in genetic algorithms.

A recursive rule base adjustment algorithm for a fuzzy logic controller

This paper introduces a recursive rule base adjustment to enhance the performance of fuzzy logic controllers. Here the fuzzy controller is constructed on the basis of a decision table (DT), relying on membership functions and fuzzy rules that incorporate heuristic knowledge and operator experience. If the controller performance is not satisfactory, it has previously been suggested that the rule base be altered by combined tuning of membership functions and controller scaling factors. The alternative approach proposed here entails alteration of the fuzzy rule base. The recursive rule base adjustment algorithm proposed in this paper has the benefit that it is computationally more efficient for the generation of a DT, and advantage for online realization. Simulation results are presented to support this thesis. (c) 2005 Elsevier B.V. All rights reserved.