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Swansea, United Kingdom

Bowden S.,University of Cardiff | Poynton M.H.,Imperial College London | White P.L.,Public Health Wales
Journal of Infection | Year: 2013

Objectives: The aim of this study was to assess the clinical utility of enhanced diagnostics on the management of invasive fungal disease in high risk patients within an integrated care pathway and to audit compliance and efficacy of antifungal prophylaxis. Methods: A cohort of 549 high risk haematology and stem-cell transplant recipients was followed over a 5 year period. The routine standard of care involved the use of antimould prophylaxis and a neutropenic care pathway utilizing twice weekly antigen and PCR testing. Results: Prophylaxis with itraconazole was poorly tolerated and therapeutic levels could not be maintained. Antigen testing and PCR showed good clinical utility in the management of invasive aspergilosis with high sensitivity (98%) and negative predictive value (99.6%) when both tests were used together, allowing a diagnosis IA to be excluded and obviating the need for empirical antifungal agents. When used serially, multiple positive PCR and antigen test results enabled accurate diagnosis of IA with a specificity of 95% and a positive likelihood ratio of 11. Biomarkers preceded clinical signs in 85% of proven and probable invasive disease. Conclusion: The combination of both tests showed optimum clinical utility for the diagnosis and management of IA in this high risk group. © 2013 The British Infection Association. Source

Bradley P.M.,Public Health Wales | Lindsay B.,University of East Anglia | Fleeman N.,University of Liverpool
Cochrane Database of Systematic Reviews | Year: 2016

Background: Researchers have criticised epilepsy care for adults for its lack of impact, stimulating the development of various service models and strategies to respond to perceived inadequacies. Objectives: To assess the effects of any specialised or dedicated intervention beyond that of usual care in adults with epilepsy. Search methods: For the latest update of this review, we searched the Cochrane Epilepsy Group Specialized Register (9 December 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 11), MEDLINE (1946 to June 2013), EMBASE (1988 to June 2013), PsycINFO (1887 to December 2013) and CINAHL (1937 to December 2013). In addition, we contacted experts in the field to seek information on unpublished and ongoing studies, checked the websites of epilepsy organisations and checked the reference lists of included studies. Selection criteria: We included randomised controlled trials, controlled or matched trials, cohort studies or other prospective studies with a control group, and time series studies. Data collection and analysis: Two review authors independently selected studies, extracted all data, and assessed the quality of all included studies. Main results: Our review included 18 different studies of 16 separate interventions, which we classified into seven distinct groups. Most of the studies have methodological weaknesses, and many results from other analyses within studies need to be interpreted with caution because of study limitations. Consequently, there is currently limited evidence for the effectiveness of interventions to improve the health and quality of life in people with epilepsy. It was not possible to combine study results in a meta-analysis because of the heterogeneity of outcomes, study populations, interventions and time scales across the studies. Authors' conclusions: Two intervention types, the specialist epilepsy nurse and self management education, have some evidence of benefit. However, we did not find clear evidence that other service models substantially improve outcomes for adults with epilepsy. It is also possible that benefits are situation specific and may not apply to other settings. These studies included only a small number of service providers whose individual competence or expertise may have had a significant impact on outcomes. At present it is not possible to advocate any single model of service provision. © 2016 The Cochrane Collaboration. Source

Atenstaedt R.L.,Public Health Wales
The Medico-legal journal | Year: 2010

Notifiable diseases in England and Wales include cholera, plague, relapsing fever, smallpox, typhus and food poisoning. S 26(1) of the Public Health (Control of Disease) Act 1984 Part II made it a criminal offence to place material which is known to have been exposed to infection from a notifiable disease or one of a number of additional diseases, and which has not been disinfected, in a dustbin. One such potential infection risk that is often placed in dustbins is the disposable nappy, particularly from children who are suffering from gastroenteritis. A literature review was undertaken using PubMed on the relationship between nappies and the transmission of infectious disease. The literature review did not reveal any evidence of notifiable disease transmission through discarded nappies in dustbins. As a result of a recent review, Part II of the Public Health (Control of Disease) Act 1984 has now been replaced by Part IIA by virtue of the Health and Social Care Act 2008, and so s 26(1) no longer applies. This is both an evidence-based decision and more importantly, decriminalizes thousands of parents who decide to discard their baby's nappy in the dustbin. Source

Brophy S.,University of Swansea | Jones K.H.,University of Swansea | Rahman M.A.,University of Swansea | Zhou S.-M.,University of Swansea | And 5 more authors.
American Journal of Gastroenterology | Year: 2013

OBJECTIVES:To examin. The incidence of Campylobacter and Salmonella infection in patients prescribed proton pump inhibitors (PPIs) compared with controls.METHODS:Retrospective cohort study using anonymous general practitioner (GP) data. Anonymised individual-level records fro. The Secure Anonymised Information Linkage (SAIL) system between 1990 and 2010 in Wales were selected. Data were available from 1,913,925 individuals including 358,938 prescribed a PPI. The main outcome measures examined included incidence of Campylobacter or Salmonella infection following a prescription for PPI.RESULTS:The rate of Campylobacter and Salmonella infections was already at 3.1-6.9 times that of non-PPI patients even before PPI prescription. The PPI group had an increased hazard rate of infection (after prescription for PPI) of 1.46 for Campylobacter and 1.2 for Salmonella, compared with baseline. However. The non-PPI patients also had an increased hazard ratio with time. In fact. The ratio of events i. The PPI group compared wit. The non-PPI group usin. The prior event rate ratio was 1.17 (95% CI 0.74-1.61) for Campylobacter and 1.00 (0.5-1.5) for Salmonella.CONCLUSIONS:People who go on to be prescribed PPIs have a greater underlying risk of gastrointestinal (GI) infection beforehand and they have a higher prevalence of risk factors before PPI prescription. The rate of diagnosis of infection is increasing with time regardless of PPI use, and there is no evidence that PPI is associated with an increase in diagnosed GI infection. It is likely that factors associated wit. The demographic profile o. The patient ar. The main contributors to increased rate of GI infection for patients prescribed PPIs. Source

Ward M.,Public Health Wales
Schweizerische Zeitschrift fur Sportmedizin und Sporttraumatologie | Year: 2014

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don't broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging "Exercise on Prescription" model where patients could be referred to community based exercise instructors for a structured "prescription" of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities. Source

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