Gametocyte carriage in Plasmodium falciparum-infected travellers.

BACKGROUND: Gametocytes are the sexual stage of Plasmodium parasites. The determinants of gametocyte carriage have been studied extensively in endemic areas, but have rarely been explored in travellers with malaria. The incidence of gametocytaemia, and factors associated with gametocyte emergence in adult travellers with Plasmodium falciparum malaria was investigated at the Hospital for Tropical Diseases in London. METHODS: Clinical, parasitological and demographic data for all patients presenting with P. falciparum malaria between January 2001 and December 2011 were extracted from a prospective database. These data were supplemented by manual searches of laboratory records and patient case notes. RESULTS: Seven hundred and seventy three adult patients with laboratory-confirmed P. falciparum malaria were identified. Four hundred and sixty five (60%) were born in a country where malaria is endemic. Patients presented to hospital a median of four days into their illness. The median maximum parasite count was 0.4%. One hundred and ninety six patients (25%) had gametocytes; 94 (12%) on admission, and 102 (13%) developing during treatment. Gametocytaemia on admission was associated with anaemia and a lower maximum parasitaemia. Patients with gametocytes at presentation were less likely to have thrombocytopenia or severe malaria. Patients who developed gametocytes during treatment were more likely to have had parasitaemia of long duration, a high maximum parasitaemia and to have had severe malaria. There was no apparent association between the appearance of gametocytes and treatment regimen. CONCLUSIONS: The development of gametocytaemia in travellers with P. falciparum is associated with factors similar to those reported among populations in endemic areas. These data suggest that acquired immunity to malaria is not the only determinant of patterns of gametocyte carriage among patients with the disease

Benefits-Led IT: Building The Organisational Capability – A Longitudinal Perspective

Although the enterprise-wide benefits realisation capability has been touted as the most robust way in which organisations can counter the still too common incidence of information systems failing to deliver their promised value, there has been no research to explore the validity of this claim. Consequently, the aim of this paper is to present the results of a three year, action research study, which explicitly sought to establish just such a capability, within an Institute of Higher Education. The project commenced, in 2010, with a series of workshops, through which staff were introduced to the core components of this capability, namely a range of benefits-oriented competences and practices. This paper provides a longitudinal perspective, critically reviewing the adoption and impact of these competences and practices, over the past three years. The study has demonstrated that certain practices are enthusiastically embraced, as they are perceived to make a positive contribution to the realisation of benefits. However, it would be difficult to claim that a benefits realisation capability has been successfully created, as it is clear that there is still some reluctance to apply benefits practices in a consistent and extensive manner, across all areas of organisational activity. This paper concludes by exploring the lessons learned for organisations wishing to establish their own benefits realisation capabilities

The realisation of Benefits from IT Projects: Does Practice makes Perfect?

There is growing agreement that the potential benefits of implementing business technologies will not be realised through the relatively simple act of going live with a new software application. Indeed, there is clear evidence that organisations must explicitly plan for, and proactively manage, the realisation of benefits, if a new technology is to deliver real value to its host organisation. In particular, benefits need to be leveraged through carefully planned and co-ordinated programmes of organisational change, and on-going organisational adaptation. Inevitably these insights have encouraged academics, consultants and practitioners to develop tools and techniques to explicitly support the benefits realisation process. In this paper, we argue that the adoption of any such prescription, tools or panacea is unlikely to be sufficient, as benefits typically arise from the complex interplay between systems, people, contexts and processes, often over significant time-frames. We show, through the use of a public sector case study, that a more robust and effective solution to benefits realisation problem is likely to arise from the development of a capability to support the realisation of benefits, composed of practices, and we then question as to whether it‟s enacted through craftsmen

Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared to men in the general population: a cross-sectional study

Objectives: To determine the prevalence of knee pain, radiographic knee osteoarthritis (RKOA), total knee replacement (TKR) and associated risk factors in male ex-professional footballers compared to men in the general population (comparison group). Methods: 1207 male ex-footballers and 4085 men in the general population in the UK were assessed by postal questionnaire. Current knee pain was defined as pain in or around the knees on most days of the previous month. Presence and severity of RKOA were assessed on standardised radiographs using the Nottingham Line Drawing Atlas (NLDA) in a sub-sample of 470 ex-footballers and 491 men in the comparison group. The adjusted risk ratio (aRR) and risk difference (aRD) with 95% confidence interval (CI) in ex-footballers compared to the general population were calculated using the marginal model in Stata. Results: Ex-footballers were more likely than the comparison group to have current knee pain [aRR 1.91, 95%CI 1.77-2.06], RKOA [aRR 2.21, 95%CI 1.92-2.54] and TKR (aRR 3.61, 95%CI 2.90–4.50). Ex-footballers were also more likely to present with chondrocalcinosis [aRR 3.41, 95%CI 2.44-4.77]. Prevalence of knee pain and RKOA were higher in ex-footballers at all ages. However, even after adjustment for significant knee injury and other risk factors, there was more than a doubling of risk of these outcomes in footballers. Conclusions: The prevalence of all knee osteoarthritis outcomes (knee pain, RKOA and TKR) were 2-3 times higher in male ex-footballers compared to men in the general population group. Knee injury is the main attributable risk factor. Even after adjustment for recognised risk factors, knee osteoarthritis appear to be an occupational hazard of professional football

Futureproofing Medical Education Through Scenario Analysis: Instrumental Case Study

Abstract Developments in technology and climate change, as well as other "megatrends" are having lasting impacts in society and healthcare. A scenario analysis was conducted to explore the impact of megatrends on medical education. Three scenarios were developed for the year 2035, showing varying levels of technological integration and environmental focus. Implications for an updated curricula focus on health inequalities, digital health, and globalization effects.Abstract Developments in technology and climate change, as well as other "megatrends" are having lasting impacts in society and healthcare. A scenario analysis was conducted to explore the impact of megatrends on medical education. Three scenarios were developed for the year 2035, showing varying levels of technological integration and environmental focus. Implications for an updated curricula focus on health inequalities, digital health, and globalization effects

A Randomised Controlled Trial of a Facilitated Home-Based Rehabilitation Intervention in Patients with Heart Failure with Preserved Ejection Fraction and their Caregivers:The REACH-HFpEF Pilot Study

Abstract Introduction Home-based cardiac rehabilitation may overcome suboptimal rates of participation. The overarching aim of this study was to assess the feasibility and acceptability of the novel Rehabilitation EnAblement in CHronic Hear Failure (REACH-HF) rehabilitation intervention for patients with heart failure with preserved ejection fraction (HFpEF) and their caregivers. Methods and results Patients were randomised 1:1 to REACH-HF intervention plus usual care (intervention group) or usual care alone (control group). REACH-HF is a home-based comprehensive self-management rehabilitation programme that comprises patient and carer manuals with supplementary tools, delivered by trained healthcare facilitators over a 12 week period. Patient outcomes were collected by blinded assessors at baseline, 3 months and 6 months postrandomisation and included health-related quality of life (primary) and psychological well-being, exercise capacity, physical activity and HF-related hospitalisation (secondary). Outcomes were also collected in caregivers. We enrolled 50 symptomatic patients with HF from Tayside, Scotland with a left ventricular ejection fraction ≥45% (mean age 73.9 years, 54% female, 100% white British) and 21 caregivers. Study retention (90%) and intervention uptake (92%) were excellent. At 6 months, data from 45 patients showed a potential direction of effect in favour of the intervention group, including the primary outcome of Minnesota Living with Heart Failure Questionnaire total score (between-group mean difference −11.5, 95% CI −22.8 to 0.3). A total of 11 (4 intervention, 7 control) patients experienced a hospital admission over the 6 months of follow-up with 4 (control patients) of these admissions being HF-related. Improvements were seen in a number intervention caregivers' mental health and burden compared with control. Conclusions Our findings support the feasibility and rationale for delivering the REACH-HF facilitated home-based rehabilitation intervention for patients with HFpEF and their caregivers and progression to a full multicentre randomised clinical trial to test its clinical effectiveness and cost-effectiveness

The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction:the REACH-HF multicenter randomized controlled trial

Background: Cardiac rehabilitation (CR) improves health-related quality of life (HRQOL) and reduces hospitalizations in patients with heart failure (HF), but international uptake of CR for HF remains low.Design and methods: The aim of this multicenter randomized trial was to compare the REACH-HF (Rehabilitation EnAblement in CHronicHeart Failure) intervention, a facilitated self-care and homebased CR programme to usual care for adults with HF with reduced ejection fraction (HFrEF). The study primary hypothesis was that the addition of the REACH-HF intervention to usual care would improve disease-specific HRQOL (Minnesota Living with Heart Failure questionnaire [MLHFQ]) at 12 months compared with usual care alone.Results: The study recruited 216 participants, predominantly men (78%) with an average age of 70 years and mean left ventricular ejection fraction of 34%. Overall, 185 (86%) participants provided data for the primary outcome. At 12 months, there was a significant and clinically meaningful between-group difference in the MLHFQ score of –5.7 points (95% CI –10.6 to –0.7) in favor of the REACH-HF intervention group (p = 0.025). With exception of patient self-care (P < 0.001) there was no significant difference in other secondary outcomes including clinical events (P > 0.05) at follow up compared to usual care. The mean cost of the REACH-HF intervention was £418 per participant.Conclusions: The novel REACH-HF home-based facilitated intervention for HFrEF was clinically superior in disease-specific HRQoL at 12 months and offers an affordable alternative to traditional centre-based programs to address current low CR uptake rates for HF