Bolaji Coker

Mild Traumatic Brain Injury in UK Military Personnel Returning From Afghanistan and Iraq: Cohort and Cross-sectional Analyses

Objectives:To assess (a) the prevalence of mild traumatic brain injury (mTBI) in UK military personnel deployed to Iraq and/or Afghanistan, (b) the risk factors associated with mTBI, and (c) the association between mTBI and subsequent postconcussion symptoms (PCS). Participants:A total of 4620 personnel deployed to Iraq and/or Afghanistan who completed a questionnaire between 2007 and 2009, of whom 2333 were also studied in 2005, participated in the study. Main Outcome Measures:Mild traumatic brain injury during deployment, as identified using a modified version of the Brief Traumatic Brain Injury Screen questionnaire; symptoms associated with PCS in the month before questionnaire completion. Results:The prevalence of mTBI was 4.4%, and the prevalence in those with a combat role was 9.5%. Having an mTBI was associated with current symptoms of posttraumatic stress disorder (adjusted odds ratio (AOR), 5.2; 95% confidence interval [CI], 2.3–11.4), alcohol misuse (AOR, 2.3; 95% CI, 1.4–3.7), and multiple physical symptoms (AOR, 2.6; 95% CI, 1.3–5.2). Only 3 of 9 symptoms remained associated with mTBI after adjustment. Psychological distress and alcohol misuse recorded before deployment were associated with subsequent mTBI. Conclusions:The prevalence of mTBI in UK military is lower than that in the US military. Symptoms of current posttraumatic stress disorder and alcohol misuse are associated with mTBI. Symptoms of mental disorder predated occurrence of mTBI. The majority PCS were not associated with mTBI.

Education, Self‐Management, and Upper Extremity Exercise Training in People With Rheumatoid Arthritis: A Randomized Controlled Trial

To evaluate the effectiveness of a brief supervised education, self‐management, and global upper extremity exercise training program, supplementing a home exercise regimen, for people with rheumatoid arthritis (RA; the Education, Self‐Management, and Upper Extremity Exercise Training in People with Rheumatoid Arthritis [EXTRA] program).

Education, self-management and upper limb eXercise Training in people with Rheumatoid Arthritis (the EXTRA Programme)

To evaluate the effectiveness of a brief supervised education, self‐management, and global upper extremity exercise training program, supplementing a home exercise regimen, for people with rheumatoid arthritis (RA; the Education, Self‐Management, and Upper Extremity Exercise Training in People with Rheumatoid Arthritis [EXTRA] program).

Predicting independent survival after stroke: a European study for the development and validation of standardised stroke scales and prediction models of outcome

Background Accurate prediction of stroke outcome is desirable for clinical management and provision of appropriate care, and potentially for stratification of patients into studies. Objectives To investigate the predictive properties of validated scales and severity measures, and their constituent variables, and to compare their prediction in six European populations. Methods We studied 2033 first-ever stroke patients in population-based stroke registers in France, Italy, Lithuania, the UK, Spain and Poland. Logistic models were used to predict independent survival at 3 and 12 months after stroke using a range of measures including the Six Simple Variable (SSV), Barthel index (BI) and the National Institute of Heath Stroke Scale (NIHSS). Predictions were compared within and between populations using receiver operating characteristic curves. A five-variable scale was developed and validated. Results Comparisons of BI with BI+age, and NIHSS with NIHSS+age, across populations showed that inclusion of age significantly improved prediction. Fairly equal predictions were obtained by three models: five variables, BI+age, and NIHSS+age. Better agreement between predicted and actual outcomes, and more precise estimates were obtained by the five variables model (age, verbal component of the Glasgow Coma Scale, arm power, ability to walk, and pre-stroke dependency). Conclusions Living alone before the stroke was not significantly associated with independent survival after the stroke. Five variables (excluding living alone, from the SSV) provided good prediction for all populations and subgroups. Further external validation for our estimates is recommended before utilisation of the model in practice and research.

Variations in acute stroke care and the impact of organised care on survival from a European perspective: the European Registers of Stroke (EROS) investigators

Background The need for stroke care is escalating with an ageing population, yet methods to estimate the delivery of effective care across countries are not standardised or robust. Associations between quality and intensity of care and stroke outcomes are often assumed but have not been clearly demonstrated. Objective To examine variations in acute care processes across six European populations and investigate associations between the delivery of care and survival. Methods Data were obtained from population-based stroke registers of six centres in France, Lithuania, UK, Spain, Poland and Italy between 2004 and 2006 with follow-up for 1 year. Variations in the delivery of care (stroke unit, multidisciplinary team and acute drug treatments) were analysed adjusting for case mix and sociodemographic factors using logistic regression methods. Unadjusted and adjusted survival probabilities were estimated and stratified by levels of Organised Care Index. Results Of 1918 patients with a first-ever stroke registered, 30.7% spent more than 50% of their hospital stay in a stroke unit (13.9–65.4%) among centres with a stroke unit available. The percentage of patients assessed by a stroke physician varied between 7.1% and 96.6%. There were significant variations after adjustment for confounders, in the organisation of care across populations. Significantly higher probabilities of survival (p<0.01) were associated with increased organisational care. Conclusions This European study demonstrated associations between delivery of care and stroke outcomes. The implementation of evidence-based interventions is suboptimal and understanding better ways to implement these interventions in different healthcare settings should be a priority for health systems.

Multicentre prospective survey of SeHCAT provision and practice in the UK.

Objective A clinical diagnosis of bile acid malabsorption (BAM) can be confirmed using SeHCAT (tauroselcholic (75selenium) acid), a radiolabelled synthetic bile acid. However, while BAM can be the cause of chronic diarrhoea, it is often overlooked as a potential diagnosis. Therefore, we investigated the use of SeHCAT for diagnosis of BAM in UK hospitals. Design A multicentre survey was conducted capturing centre and patient-level information detailing patient care-pathways, clinical history, SeHCAT results, treatment with bile acid sequestrants (BAS), and follow-up in clinics. Eligible data from 38 centres and 1036 patients were entered into a validated management system. Results SeHCAT protocol varied between centres, with no standardised patient positioning, and differing referral systems. Surveyed patients had a mean age of 50 years and predominantly women (65%). The mean SeHCAT retention score for all patients was 19% (95% CI 17.8% to 20.3%). However, this differed with suspected BAM type: type 1: 9% (95% CI 6.3% to 11.4%), type 2: 21% (95% CI 19.2% to 23.0%) and type 3: 22% (95% CI 19.6% to 24.2%). Centre-defined ‘abnormal’ and ‘borderline’ results represented over 50% of the survey population. BAS treatment was prescribed to only 73% of patients with abnormal results. Conclusions The study identified a lack of consistent cut-off/threshold values, with differing centre criteria for defining an ‘abnormal’ SeHCAT result. BAS prescription was not related in a simple way to the SeHCAT result, nor to the centre-defined result, highlighting a lack of clear patient care-pathways. There is a clear need for a future diagnostic accuracy study and a better understanding of optimal management pathways.