Medical Centre

Google Scholar Citations Open To All - Google Scholar Blog I've been using Google Scholar Citations since it was launched earlier this year and have found it a very useful tool for tracking citations of my work. The service was launched with a limited number of users but has now been opened up. I'll be encouraging my colleagues in the Department of Primary Care & Public Health at Imperial College London to sign up for Google Scholar Citations. You can find out how to do this on the Google Scholar Blog .

The National Health Service (NHS) Health Check Programme aims to identify and manage patients in England aged 40-74 years with a 10-year cardiovascular disease (CVD) risk score over 20%. In an article published in the European Journal of Cardiovascular Prevention & Rehabilitation . Andrew Dalton and colleagues from the Department of Primary Care & Public Health at Imperial College London assessed the prevalence of high CVD risk in the English population, using the two CVD risk scores and the 20% cut off mandated in national policy, and the prevalence of risk factors within this population. They found that of those eligible for an NHS Health Check, 10.5% (2,012,000) had a risk score greater than 20% using the QRISK2 risk score; 22.0% (4,267,000) using Joint British Societies' (JBS2) score. To reduce risk in those at high CVD risk, we estimate the total costs of the Programme to be £176 million using QRISK2 or £378 million using JBS2. They concluded that a large number of ...

In a  recent article in the New Perspectives Part II Section of  the SGIM Forum , the newsletter of the US Society of General Internal Medicine, I discuss the NHS Health Checks Programme. The burden of cardiovascular disease, type 2 diabetes and kidney disease will increase, both in developed countries with ageing populations, and in developing and middle income countries that are undergoing economic and demographic transitions. These diseases all share risk factors that include smoking, hypertension, obesity, physical inactivity, and impaired glycemic status. Integrated approaches to their prevention, early identification and effective management could therefore have major public health and economic benefits, and help limit the impact of the predicted future rise in non-communicable diseases. For example, even very modest reductions in population risk factor prevalence could prove to be highly effective in reducing the impact of these diseases. Despite downward secul...

Childhood vaccines are among the most successful and cost-effective public health interventions available. Within England, vaccination coverage is lowest in deprived, urban areas with mobile populations, such as London. Barriers to immunisation can stem from parental concerns about risks, inadequate knowledge and provision by providers, and generalized system barriers involving the organization of the health system and access to services. In an article published recently in JRSM Short Reports , Nia Willaims and colleagues from the Department of Primary Care & Public Health at Imperial College London carried out a systematic literature review aimed at providing GPs with up-to-date, evidence-based guidelines on how to improve uptake rates of primary immunisations for children registered under their care. Forty-six studies were included for analysis, published between 1980 and 2009. A number of interventions were found to increase vaccination rates in children. These inclu...

Errors in journal articles are common. Most journals now have policies to correct errors in research articles. However, errors in other types of articles often remain uncorrected. I've listed below a few statements in BMJ articles that are either wrong or that are highly unlikely to be true but which remain uncorrected. The BMJ is probably no worse in this respect than other medical journals, but as a member of the BMA, I receive a weekly copy of the print edition and therefore spend more time reading it than other medical journals. This means that I am more likely to pick up errors in the BMJ than in other journals. The reported incidence [of polycystic ovary syndrome] varies between 3% and 15% of women of reproductive age. http://www.bmj.com/content/343/bmj.d6407.full An annual incidence of 15% would imply that after 10 years, a women of childbearing age would have around an 80% risk of developing PCOS. Even the 3% incidence figure would mean that a women of childbearing a...

On an average weekday in England, there are over1 million consultations with general practitioners. The limited data on errors and patient harm in primary care obstructs the development of strategies to improve patient safety. In an article published recently in Family Practice , Carmen Tsang and colleagues reported the results of a systematic review to determine the types of adverse events that are routinely recorded in primary care. They found that there is limited use of routinely collected data to measure adverse events in primary care despite large volumes of data generated in the electronic patient records now used by most general practitioners in the UK. 

Patient safety measures can be derived from routinely collected hospital data. Carmen Tsang and Colleagues from the Department of Primary Care & Public Health at Imperial College recently carried out a review of such measures, the results of which were published in the American Journal of Medical Quality . They found that many studies were frequently conducted in the United States between using Agency for Healthcare Research and Quality patient safety indicators. They concluded that these indicators need further development, refinement and validation. Patient safety indicators that can be used  in ambulatory care settings were also needed. 

A recent commentary published in the Lancet by Allyson Pollock and colleagues concluded that there is no evidence that competition for patients in the NHS saves lives or improves quality of care, Improvements in area such as survival following acute myocardial infarction are likely to be due to the development of cardiac networks that encourage collaboration between hospitals and the wider provision of services such as percutaneous coronary interventions (PCI). The article was widely quoted in the media, including in the Independent and Pulse . 

A newly published Cochrane systematic review by Nik Tuah and Colleagues reported that there is currently limited evidence that the transtheoretical model stages of change (TTM SOC) method is effective in producing weight loss. The transtheoretical model describes a step-by-step way in which people move from unhealthy behaviours to healthy ones. The five stages of change that the model anticipates are pre-contemplation, contemplation, preparation, action and maintenance. The BBC reported on the study and noted that behavioural change to promote weight loss was very difficult to achieve.

An article published recently in Pulse by Michael Soljak and I examined the use of patient reported outcome measures. Patient-reported outcome measures (PROMs) estimate the effectiveness of healthcare delivered to patients as perceived by the patients themselves. The recent Government White Paper, ‘Equity and excellence: Liberating the NHS',2 envisages an increase in the scope and coverage of PROMs in future, starting from April 2011. For providers, PROMs will provide important data for quality improvement, in the form of comparative, casemix-adjusted pre- to post-operative changes in scores. They will also have a role in commissioning. For example, PROMs might be used to identify procedures with little benefit, or subgroups of patients who do not benefit greatly from surgery. This could allow more effective targeting of resources to improve health gain.

Type 2 diabetes mellitus is increasing worldwide. Recent growth has been particularly dramatic in the states of The Co-operation Council for the Arab States of the Gulf (GCC), and these and other developing economies are at particular risk. In a systematic review published recently in PLoS One , Layla Alhyas and colleagues review the quality of control of type 2 diabetes in the GCC, and the nature and efficacy of interventions. They found the the quality of diabetes management to be sub-optimal. Assessment of the efficacy of interventions was difficult due to poor quality studies and a lack of data, but the findings of the review suggested that there was considerable scope to improve the quality of diabetes care in this region.

In an article published recently in the Canadian Association Medical Journal , Eszter Vamos and colleagues from Imperial College examined the association between size of general practice and the quality of diabetes management in England between 1997 and 2005. They found improvements in the recording of process of care measures, prescribing and achieving intermediate diabetes outcomes in all practice sizes during the study period. They concluded that size of practice was not strongly associated with the quality of diabetes management in primary care; and that pay for performance programmes appear to benefit both large and small practices to a similar extent.

A systematic review published recently by Layla Alhyas and colleagues in JRSM Short Reports examined the prevalence of risk factors for diabetes and its major complications in the Co-operation Council of the Arab States of the Gulf (GCC) region. They reported high prevalences of risk factors such as obesity, hyperglycaemia, hypertension and abnormal blood lipids. Enhanced management of these risk factors will be essential if escalation of diabetes-related problems is to be averted as industrialization, urbanization and changing population demographics continue in the countries in the Gulf region.

A recent paper by Jo Murray and colleagues published in JRSM Short Reports examined the impact of patients' use of the NHS Choices website on primary care consultations in England and Wales. They found that NHS Choices did alter healthcare-seeking behaviour, attitudes and knowledge among its users. Using NHS Choices appeared to result in reduced demand for primary care consultations among young, healthy users in particular. The authors concluded that the use of online medical services should be explored further.

In the UK, quality standards for chronic kidney disease (CKD) are set out in a National Service Framework and in pay-for-performance indicators. As CKD is largely asymptomatic in its early stages, it is therefore generally detected following routine renal function testing. In a paper published recently in Family Practice , Simon de Lusignan and colleagues examined which groups of patients were most likely to have renal function testing in primary care. The found that testing rates were highest in people with diabetes, and slightly higher in women than men. The results will help in the planning of the new NHS Health Check programme.

Many doctors will already be familiar with Google Scholar. Google have recently launched a new linked service, Google Scholar Citations, which provides a web-based tool for academics to monitor citations to their articles. Academics can check who is citing their publications, view citations over time and examine citation metrics. Academics can also make their profile public so that other people can view their citation metrics. The service was launched with a small number of users and I was fortunate enough to be selected as one of the early users. You can view my Google Scholar Citations page to see the data available. Amongst the metrics that can be viewed are the total number of citations and the h-index, along with a chart showing the number of citations per year. Detailed citation counts are also available for individual papers. Many universities already have updateable publication pages for their academics (as an example, see my Imperial College London Publications page). Google...

Ninety per cent of HIV infections in children under the age of 15 are caused by mother-to-child transmission of HIV during pregnancy, delivery and breastfeeding. In high-income countries introduction of prevention of mother-to-child HIV transmission (PMTCT) programmes substantially reduce the rate of transmission of HIV from mothers to infants. In a recent systematic review published in the Cochrane Database of Systematic Reviews , Lorraine Car and Colleagues examined the effectiveness of integrated PMTCT programmes compared to non-integrated and partially integrated care. They found very little evidence of evidence on this area and suggested that additional research is needed to allow clinicians and policy makers to make a definitive conclusion about the effectiveness of integration of PMTCT interventions with other health services.

In a letter published recently in the Lancet , Helen Atherton and I argue for a more pragmatic  approach to the use of social networking in healthcare. For example, we should be using current evidence on how social  networking might be used to improve communication with patients. This could involve considering the use of social networking in terms of wider clinical behaviour. Concerns about the eff ect of new  technology on the doctor–patient  relationship were probably being  expressed when telephones were first  introduced more than 100 years ago. Rather than viewing new technology as a threat, we should use the opportunities it offers to improve the efficiency and effectiveness of health systems and to improve people’s knowledge of their health and illnesses.

Access to health information allows people to take a more active role in their health care by making them more informed about their health and the management of their illnesses. The internet is an increasingly popular way for people to obtain this kind of health information, but there are many barriers that prevent people making full use of such information. In particular, people may lack the motivation or the skills to use the internet. In a recent systematic review published in the Cochrane Database of Systematic Reviews , Josip Car and colleagues examined whether teaching people to find, evaluate or use online health information (online health literacy) improves those skills and improves their health. They found only two studies met the inclusion criteria for the review. They concluded that there is limited evidence on which to draw conclusions about the effect of these interventions and that further high-quality research on this topic was necessary.

Electronic health databases that contain data obtained from health records generated by routine clinical practice are widely in biomedical research. Because of the large number of patients in such databases and long patient follow-up, these databases have unique characteristics that are very valuable for academic researchers. An article published recently in PLoS One describes the use of the United Kingdom's General Practice Research Database (GPRD). The authors identified 749 studies published between 1995 and 2009 based on the GPRD. The studies included authors from 22 countries published in 193 journals across 58 study fields The findings of the study illustrate how valuable the data collected in UK primary care by primary care teams is for research and public health.