探花直播 of Cambridge - Michael Sweeting

Keyhole surgery more effective than open surgery for ruptured aneurysm

cjb250 — Wed, 15 Nov 2017 09:32:25 +0000

This is the first randomised trial comparing the use of keyhole (endovascular) aneurysm repair versus traditional open surgery to repair ruptured aneurysm, with full midterm follow-up.

Abdominal aortic aneurysm is a swelling of the aorta 鈥� the main blood vessel that leads away from the heart, down through the abdomen to the rest of the body. If the artery wall ruptures, the risk of death is high, and emergency surgery is needed.

Three recent European randomised trials showed that keyhole repair does not reduce the high death rate up to three months after surgery compared with open repair. However, mid-term outcomes (three months to three years) of keyhole repair are still uncertain.

An international research team set out to assess three year clinical outcomes and cost effectiveness of a strategy of keyhole repair (whenever the shape of the aorta allows this) versus open repair for patients with suspected ruptured abdominal aortic aneurysm who were part of the IMPROVE trial.

Dr Michael Sweeting from the Department of Public Health and Primary Care at the 探花直播 of Cambridge, who was involved in the trial, says: 鈥淢ore than 1000 people a year in the UK require emergency surgery to repair a ruptured abdominal aortic aneurysm. Without repair, ruptured aneurysm is nearly always fatal. However, surgery is not without its own significant risks, so we are always looking at ways of reducing the risk to the patient. One option is keyhole surgery, but until now not enough was known about how its outcomes compare to regular, open surgery beyond one year after repair.鈥�

探花直播trial involved 613 patients from 30 vascular centres (29 in the UK 鈥� including at Addenbrooke鈥檚 Hospital, Cambridge - and one in Canada) with a clinical diagnosis of ruptured aneurysm, of whom 316 were randomised to a strategy of keyhole repair and 297 to open repair.

Deaths were monitored for an average of 4.9 years and were similar in both groups three months after surgery. At three years, there were fewer deaths in the keyhole group than in the open repair group, leading to lower mortality (48% vs 56%). However, after seven years there was no clear difference between the groups.

探花直播need for repeat surgery (鈥榬einterventions鈥�) related to the aneurysm occurred at a similar rate in both groups, with about 28% of each group needing at least one reintervention after three years.

Average quality of life was higher in the keyhole group in the first year, but by three years was similar across the groups. This early higher average quality of life, coupled with the lower mortality at three years, led to a gain in average quality adjusted life years or QALYs (a measure of healthy years lived) at three years in the keyhole versus the open repair group.

探花直播keyhole group also spent fewer days in hospital (14.4 versus 20.5 in the open repair group) and had lower overall costs (拢16,900 versus 拢19,500 in the open repair group).

探花直播researchers point to some study limitations, such as sample size and midterm data focusing on aneurysm-related events, which may have led to some bias. Nevertheless, they say compared with open repair, there are clear benefits associated with keyhole surgery.

鈥淭hese findings show that, in the first three years after repair, keyhole surgery can improve outcomes and quality of life for patients compared to open surgery, and is more cost effective and requires less time in hospital 鈥� important factors to consider for our stretched health services,鈥� adds Dr Sweeting.

Reference
Comparative clinical effectiveness and cost effectiveness of endovascular strategy v open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial. BMJ; 15 Nov 2017; DOI:

Adapted from a press release from 探花直播BMJ.

探花直播use of keyhole surgery to repair ruptured abdominal aortic aneurysm is both clinically and cost effective and should be adopted more widely, concludes a randomised trial published by 探花直播BMJ today.

More than 1000 people a year in the UK require emergency surgery to repair a ruptured abdominal aortic aneurysm. Without repair, ruptured aneurysm is nearly always fatal

Michael Sweeting

Arindam Chaudhuri

Abdominal aortic aneurysm

探花直播text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Type 2 diabetes successfully managed online

sc604 — Wed, 27 Sep 2017 23:01:03 +0000

探花直播results, published in BMJ Open, and funded by the National Institute for Health Research (NIHR), come from the first UK-based trial of its kind and show that patients using the HeLP-Diabetes programme have better diabetes control after 12 months.

鈥淒iabetes is an NHS priority, with around 4 million people in England living with type 2 diabetes. This self-management tool offers an evidence based and cost effective way to improve health outcomes, for patients both at the beginning and later on in their diagnosis, that could be offered as part of the current menu of self-management support,鈥� said Professor Elizabeth Murray of 探花直播 College London, the paper鈥檚 first author. 聽

Clinicians at Whittington Health and researchers from 探花直播 of Cambridge and UCL compared diabetes control and diabetes related stress in a randomised group of 374 patients from 21 general practices in England whose average age was just under 65 years. 185 patients used the HeLP-Diabetes programme developed at UCL, and a control group of 189 patients used information from a static, text-based website.

Anonymised clinical data were collected for a diabetes control molecule called glycated haemoglobin (HbA1c) and diabetes related stress data were collected via a patient self-report questionnaire where patients score themselves from 1 to 100 (higher scores indicating more stress) against 20 items focusing on areas that cause difficulty in everyday life.

Glycaemic control was chosen as an outcome measure as poorly controlled diabetes is associated with premature mortality and risk complications, such as cardiovascular disease. Participants made it a priority that disease related stress was also a primary outcome measure as around 40% of patients with diabetes have significant level of distress, severely impacting their quality of life.

探花直播mean baseline for HbA1c was 7.3% but by the end of the trial participants in the HeLP-Diabetes group had a lower HbA1c than those in the control group (7.22% and 7.46% respectively). It is considered that this reduction of 0.24% across a population level could translate into considerable population benefit as each 1% reduction in HbA1c is associated with a risk reduction of 21% for deaths related to diabetes and a 37% risk reduction for microvascular complications.

While there was no significant overall difference between groups for diabetes related stress, it was highlighted that the baseline for diabetes related stress was exceptionally low in the trial population group. However, patients that had diabetes for less than seven years showed a beneficial impact - suggesting that early intervention could be key.

鈥淭his is an important step forward in helping people living with type 2 diabetes to take control of their health,鈥� said Dr Michael Sweeting of Cambridge鈥檚 Department of Public Health and Primary Care, who was chief statistician in the trial. 鈥淏ased on the results from this trial, we can be confident in the value of online programmes to help people manage chronic conditions effectively.鈥�

鈥淎lthough historically group-based sessions have been a popular choice for health care providers, online programmes offer individuals the flexibility to access support that fits around their lifestyle. All the content in our programme was evidence based drawing on a range of diabetes management research including behavioural change, accessibility and usability, and promoting emotional wellbeing by drawing on principles of cognitive behavioural therapy and mindfulness,鈥� added Professor Murray.

鈥淕iving people the skills to look after their diabetes is at the heart of what we do. As well as helping develop the website, our patients were involved at the very start. It was wonderful to see how people accessing the HeLP-Diabetes programme, to help track and monitor their condition, were able to keep their diabetes in check. We hope to see this initiative made widely available, so that many more people with diabetes can benefit from this exciting new development,鈥� said Dr Maria Barnard, Lead Consultant in Diabetes, Whittington Health.

Reference:
Murray, Elizabeth et al. 鈥�Web-based self-management support for people with type 2 diabetes (HeLP-Diabetes): randomised controlled trial in English primary care鈥� BMJ Open (2017). DOI:聽10.1136/bmjopen-2017-016009

鈥婣dapted from a UCL press release.

People with type 2 diabetes could improve their health by using a new web-based self-management tool, according to new research.聽

Based on the results from this trial, we can be confident in the value of online programmes to help people manage chronic conditions effectively.

Michael Sweeting

stevepb

Diabetes

探花直播text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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