Craig A.,Enterprise House |
Institution of Chemical Engineers Symposium Series | Year: 2016
This paper explains how following major changes to the make-up of the business INEOS Enterprises revamped its Safety Management System, both to better comply with various INEOS central SHE systems and to ensure a more robust formal competence assessment process for some of the key roles at each of its sites. The paper describes challenges which had to be addressed by the new system, the system that was developed and lessons learned during its application over the last 2 years. © 2016 IChemE.
Wilke T.,University of Wismar |
Mueller S.,University of Wismar |
Groth A.,University of Wismar |
Berg B.,University of Wismar |
And 5 more authors.
Journal of Diabetes and Metabolic Disorders | Year: 2016
Background: We compared all-cause mortality, major macrovascular events (MACE) and diabetes-related hospitalizations in T2DM-incident patients newly treated with metformin (MET) versus sulphonylureas (SU) monotherapy and in T2DM-prevalent patients newly treated with MET+SU versus MET+DPP4-inhibitor combination therapy. Methods: We analysed anonymized data obtained from a German health fund. Patients were included when they had started MET versus SU therapy or MET+SU versus MET+DPP4 therapy between 01/07/2010 and 31/12/2011. Observation started with the first MET/SU prescription or the first prescription of the second agent of a MET+SU/MET+DPP4 combination therapy. Follow-up time lasted until the end of data availability (a minimum of 12 months), death or therapy discontinuation. Results: In total, 434,291 T2DM-prevalent and 35,661 T2DM-incident patients were identified. Of the identified T2DM-incident patients, 904/7,874 started SU/MET monotherapy, respectively, with a mean age of 70.1/61.4 years (54.6/50.3 % female, Charlson Comorbidity Index (CCI) 1.4/2.2; 933/7,350 observed SU/MET patient years). 4,157/1,793 SU+MET/DPP4+MET therapy starters had a mean age of 68.1/62.2 years (53.4/50.8 % female, CCI 2.8/2.6; 4,556/1,752 observed SU+MET/ DPP4+MET patient years). In a propensity score matched (PSM) comparison, the HRs (95 % CIs) associated with SU monotherapy compared to MET monotherapy exposure were 1.4 (0.9-2.3) for mortality, 1.4 (0.9-2.2) for MACE, 4.1 (1.5-10.9) for T2DM hospitalizations and 1.6 (1.2-2.3) for composite event risk. In a multivariable Cox regression model, SU monotherapy was associated with higher mortality (aHR 2.0; 1.5-2.6), higher MACE (aHR 1.3; 1.0-1.7) and higher T2DM hospitalizations (aHR 2.8; 1.8-4.4), which corresponded with a higher composite event risk (aHR 1.8; 1.5-2.1). No significant differences in event rates were observed in the PSM comparison between DPP4+MET/SU+MET combination therapy starters and in the multivariable Cox regression analysis. Conclusions: Our results show that SU monotherapy may be associated with increased mortality, MACE and T2DM hospitalizations, compared to MET monotherapy. When considering SU therapy, the associated cardiovascular risk should also be taken into account. © 2016 Wilke et al.
Twiss J.,Enterprise House |
Meads D.M.,Enterprise House |
Preston E.P.,Enterprise House |
Crawford S.R.,Enterprise House |
McKenna S.P.,Enterprise House
Journal of Investigative Dermatology | Year: 2012
The Dermatology Life Quality Index (DLQI) is a widely used health-related quality of life measure. However, little research has been conducted on its dimensionality. The objectives of the current study were to apply Rasch analysis to DLQI data to determine whether the scale is unidimensional, to assess its measurement properties, test the response format, and determine whether the measure exhibits differential item functioning (DIF) by disease (atopic dermatitis versus psoriasis), gender, or age group. The results show that there were several problems with the scale, including misfitting items, DIF by disease, age, and gender, disordered response thresholds, and inadequate measurement of patients with mild illness. As the DLQI did not benefit from the application of Rasch analysis in its development, it is argued that a new measure of disability related to dermatological disease is required. Such a measure should use a coherent measurement model and ensure that items are relevant to all potential respondents. The current use of the DLQI as a guide to treatment selection is of concern, given its inadequate measurement properties. © 2012 The Society for Investigative Dermatology.
PubMed | Enterprise House
Type: Journal Article | Journal: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research | Year: 2010
The Herpes Outbreak Impact Questionnaire (HOIQ) and Herpes Symptom Checklist (HSC) are patient-completed questionnaires for assessing genital herpes outbreaks. This report describes the validation of paper-and-pencil versions of the scales and responsiveness assessments in an Australian clinical trial.Acceptability of the language of the original UK versions was tested with Australians. The HOIQ and HSC were then field-tested with patients. The new versions were validated using patients daily responses to the questionnaires in a famciclovir study.The HOIQ and HSC were readily adapted into Australian English and were acceptable to patients. Psychometric sample: N = 151; 81 (54%) male; mean age 39.9 +/- 11.6 years; mean outbreaks 5.1 +/- 3.0 per year. Internal consistency was good (alphas at outbreak 1 ranged 0.84-0.90 HOIQ and 0.73-0.87 HSC). Rasch analysis showed item stability over time. Correlations between HOIQ and HSC ranged from 0.46 to 0.60. Both scales distinguished outbreak healing presence or absence at day 6 (P = 0.001), and the HOIQ scale distinguished between symptom severity groups (P < 0.001). Scale scores declined significantly over study duration, exhibiting large effect sizes.The paper-and-pencil HOIQ and HSC were reliable, valid, and responsive in a clinical trial setting. These instruments are recommended for use in clinical studies.
PubMed | Enterprise House
Type: Historical Article | Journal: Transfusion medicine (Oxford, England) | Year: 2012
Blood transfusion, that is the transference of blood from the circulation of one individual to that of another for practical therapeutic purposes, is of relatively recent origin. Although it only became a routine practical possibility during and shortly after the Second World War, the concept of the infusion of blood has a much longer history. Practical transfusion has to some degree paralleled and in many instances been the consequence of developments in other sciences. However, the early history of blood transfusion is to some extent one of mysticism, professional rivalries, disregard of published work and a desire to maintain the status quo with regard to established medical procedure. This article summarises some of the major aspects relating to the early history of blood transfusion.