Andrew Willis

The Effectiveness of Screening for Diabetes and Cardiovascular Disease Risk Factors in a Community Pharmacy Setting

Risk factors for cardiovascular disease including diabetes have seen a large rise in prevalence in recent years. This has prompted interest in prevention through the identifying individuals at risk of both diabetes and cardiovascular disease and has seen increased investment in screening interventions taking place in primary care. Community pharmacies have become increasingly involved in the provision of such interventions and this systematic review and meta-analysis aims to gather and analyse the existing literature assessing community pharmacy based screening for risk factors for diabetes and those with a high cardiovascular disease risk. Methods We conducted systematic searches of electronic databases using MeSH and free text terms from 1950 to March 2012. For our analysis two outcomes were assessed. They were the percentage of those screened who were referred for further assessment by primary care and the uptake of this referral. Results Sixteen studies fulfilled our inclusion criteria comprising 108,414 participants screened. There was significant heterogeneity for all included outcomes. Consequently we have not presented summary statistics and present forest plots with I2 and p values to describe heterogeneity. We found that all included studies suffered from high rates of attrition between pharmacy screening and follow up. We have also identified a strong trend towards higher rates for referral in more recent studies. Conclusions Our results show that pharmacies are feasible sites for screening for diabetes and those at risk of cardiovascular disease. A significant number of previously unknown cases of cardiovascular disease risk factors such as hypertension, hypercholesterolemia and diabetes are identified, however a significant number of referred participants at high risk do not attend their practitioner for follow up. Research priorities should include methods of increasing uptake to follow up testing and early intervention, to maximise the efficacy of screening interventions based in community pharmacies.

Primary prevention of cardiovascular disease using validated risk scores: a systematic review.

Objectives The high prevalence of cardiovascular disease (CVD) and the increased cost of treatment have prompted strategies for the primary prevention of CVD in the UK to move towards the use of validated CVD risk scores to identify individuals at the highest risk. There are no reviews evaluating the effectiveness of this strategy as a means of reducing CVD risk or mortality. This review summarizes current evidence for and against the use of validated CVD risk scores for the primary prevention of CVD. Design We utilized an in depth search strategy to search MEDLINE, EMBASE and the Cochrane database of clinical trials, expert opinions were sought and reference lists of identified studies and relevant reviews were checked. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies. Setting The majority of included trials were carried out in a primary care setting. 2 trials were carried out in North America, 2 in Scandinavia and 1 in the UK. Participants 31,651 participants in total were recruited predominantly from a primary care setting. Participants were aged 18-65 years old and were free from CVD at baseline. Main outcome measures Outcome measures used in the included studies were change in validated CVD risk score and CVD/All-cause mortality. Results We identified 16 papers which matched the inclusion criteria reporting 5 unique trials. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies. Only one study reported a significant difference in risk score at follow up and one study reported a significant difference in total mortality, however significant differences in individual risk factors were reported by the majority of identified studies. Conclusions This review demonstrates the potential for multifactorial interventions aimed at individuals selected by CVD risk scores for lowering CVD risk and mortality. However, the majority of studies in this area do not provide an intensity of intervention which is sufficient in significantly reducing CVD mortality or validated CVD risk.

Customer and staff perceptions of the role of closed circuit television in retail security

Closed circuit television (CCTV) is a relative newcomer to the security field. Its introduction on a wide scale required major technological developments in three areas — camera and optical design, including miniaturisation; electromechanical engineering to allow cameras to pan, tilt and zoom; and multi-camera and playback systems permitting sixteen or more camera pictures to be recorded on a single recorder, any one of which can be viewed as a live full-screen display (British Security Industry Association, 1988; 1990). CCTV reflects the refinement and commercial application of all the technology which lies behind the now familiar domestic video and camcorder.

Assessment of response rates and yields for Two opportunistic Tools for Early detection of Non-diabetic hyperglycaemia and Diabetes (ATTEND). A randomised controlled trial and cost-effectiveness analysis

AIMS To assess the opportunistic use in primary care of a computer risk score versus a self-assessment risk score for undiagnosed type 2 diabetes. METHODS We conducted a randomised controlled trial in 11 primary care practices in the UK. 577 patients aged 40-75years with no current diagnosis of type 2 diabetes were recruited to a computer based risk score (Leicester Practice Computer Risk Score (LPCRS)) or a patient self-assessment score (Leicester Self-Assessment Score (LSAS)). RESULTS The rate of self-referral blood tests was significantly higher for the LPCRS compared to the LSAS, 118.98 (95% CI: 102.85, 137.64) per 1000 high-risk patient years of follow-up compared to 92.14 (95% CI: 78.25, 108.49), p=0.022. Combined rate of diagnosis of type 2 diabetes and those at risk of developing the disease (i.e. impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)) was similar between the two arms, 15.12 (95% CI: 9.11, 25.08) per 1000 high-risk patient years for LPCRS compared to 14.72 (95% CI: 9.59, 22.57) for the LSAS, p=0.699. For the base case scenario the cost per new case of type 2 diabetes diagnosed was lower for the LPCRS compared to the LSAS, £168 (95% Credible Interval (CrI): 76, 364), and £352 (95% CrI: 109, 1148), respectively. CONCLUSIONS Compared to a self-assessment risk score, a computer based risk score resulted in greater attendance to an initial blood test and is potentially more cost-effective.

Sales and Security: Striking the Balance

This study reports an investigation of product theft in the electrical retail sector using an innovative methodology which involved tagging all small goods available for sale in ten stores (part of a national chain) over a two-week period. The study explores the number and value of goods sold and stolen by product type and location in the store. It adds an empirical dimension to the theoretical work of Clarke2 and others which identified the importance of opportunity in understanding offending behaviour and the potential for situational crime prevention in the retail sector.3 The study offers some evidence that location of product is associated with levels of loss and it also suggests that retailers can make an informed choice about an acceptable trade-off between sales and security.

The changing face of terrorism: implications for the retail sector

A safe shopping environment is an essential component of the quality of life in contemporary Britain. This chapter focuses on the public’s attitude towards the terrorist threat to safe shopping. There are three interrelated aspects. First, the extent to which members of the public fear that they will be exposed to terrorist attack whilst shopping. Second, public perceptions of the shopping areas and types of store which are most vulnerable to terrorist attack. Third, the extent to which various countermeasures are thought to be acceptable.

CCTV and the ‘High-Tech Fix’: Some Unanswered Questions

While there is a lack of reliable information to confirm the effectiveness of CCTV there is an over-abundance of data to show that the shopping public and others are strongly supportive of it. In the current study over nine in ten shoppers thought that CCTV was very acceptable or acceptable and over four in five managers thought it to be effective. These findings confirm the results of earlier studies. The general public is strongly in favour of the use of CCTV in shops to counter the threat of terrorism — at the 80 per cent level (Beck and Willis, 1993a, 1993b and 1994a); and there is as much or more support for CCTV as a general crime control measure in the retail sector (Beck and Willis, 1992, 1994b and 1995; Honess and Charman, 1992). Closed circuit television is decidedly not resented as an unwarranted, ‘big brother’ infringement of civil liberties.

Crime and Nuisance in Context

This book seeks to explore a neglected aspect of criminal victimisation — the various threats to safe shopping — and in so doing to open a new dimension in criminological study. Particular attention is given to a comparison between the crime and nuisance threats in two retail environments — the traditional town centre (the high street) and the nearby shopping centre or shopping mall. The crime prevention and risk management implications of the findings are discussed throughout, with a particular focus on the use and effectiveness of security measures — such as conventional policing, private security guards, closed circuit television (CCTV) and security shutters, as well as town-centre and shopping-centre man-agers’ views about crime prevention priorities. Whenever possible, the discussion and analysis moves beyond the bounds of town centres and shopping centres to draw out the wider implications for ‘safe shopping’. Some readers may care to start by turning to the concluding chapter. This can be read either as an overview of the findings and their significance or as a preview which might direct attention to chapters of special interest. The reader who proceeds chapter by chapter will find that the book is structured around a number of interrelated themes.

Regulating the Private Security Industry

The ‘rise and rise’ of private security, of which security guards in shopping centres is but one manifestation, has prompted the House of Commons (1995a and 1995b) Home Affairs Committee to establish an inquiry into the regulation of the private security industry. This question merits an extended discussion because of its implications for risk and security management in the retail sector generally, as well as because it raises specific points about guarding services in town centres and shopping centres.

Crime and Nuisance: The Customers’ Perspective

The public’s concerns about crime and nuisance whilst shopping were measured in four ways. First, shoppers were asked whether or not they were worried at all by crime whilst shopping — and, if so, to what extent they were worried. Secondly, shoppers were asked to rate the seriousness of 12 specific types of crime and nuisance which could give them cause for concern. Thirdly, the interviews explored whether or not shoppers avoided certain places in order to minimise the risks from crime and nuisance. Finally, all shoppers were asked direct questions about whether they had witnessed any form of criminal victimisation whilst shopping or whether they themselves had been the victim of a crime whilst shopping in the previous 12 months.