Paul Jarvis

Laminar flow reduces cases of surgical site infections in vascular patients

Introduction Numerous strategies are employed routinely in an effort to lower rates of surgical site infections (SSIs). A laminar flow theatre environment is generally used during orthopaedic surgery to reduce rates of SSIs. Its role in vascular surgery, especially when arterial bypass grafts are used, is unknown. Methods A retrospective review of a prospectively maintained database was undertaken for all vascular procedures performed by a single consultant over a one-year period. Cases were performed, via random allocation, in either a laminar or non-laminar flow theatre environment. Demographic data, operative data and evidence of postoperative SSIs were noted. A separate subgroup analysis was undertaken for patients requiring an arterial bypass graft. Univariate and multivariate logistical regression was undertaken to identify significant factors associated with SSIs. Results Overall, 170 procedures were analysed. Presence of a groin incision, insertion of an arterial graft and a non-laminar flow theatre were shown to be predictive of SSIs in this cohort. In the subgroup receiving arterial grafts, only a non-laminar flow theatre environment was shown to be predictive of an SSI. Conclusions This study suggests that laminar flow may reduce incidences of SSI, especially in the subgroup of patients receiving arterial grafts.

An analysis of the economic impact of smoking cessation in Europe

BackgroundThere is much evidence that smoking cessation interventions are both clinically and cost effective but these results relate only to the specific study populations involved in the studies. The present study aimed to compare and contrast results obtained when the effects of smoking cessation are modelled for several different European countries.MethodsLocal investigators collected data relating to several smoking related diseases. Costs and disease rates were then modelled up to 2030 for reductions in smoking of 3%, 15% and 30% using an epidemiological modelling tool, PREVENT.ResultsModels could not be constructed for some countries due to lack of data while for others substantial amounts of data had to be imputed. In all cases, disease rates fall when smoking cessation occurs. Overall costs initially fall before eventually rising as lives are saved and the population ages, leading to negative savings in some cases by the end of the modelled period. The speed and magnitude with which these effects occur are diverse for different countries.ConclusionsHealth and economic results for different countries vary significantly for the same reductions in smoking. This suggests that it may be inappropriate to assume that evidence from one country will produce similar health and economic effects if the same levels of smoking cessation were achieved in another country which has evident messages for health policy. Problems with obtaining data also highlight the difficulties associated with modelling such scenarios and underline the need for relevant data to be routinely collected in all countries.

Quality control in urodynamics and the role of software support in the QC procedure

This article aims to identify quality control (QC) best practice, to review published QC audits in order to identify how closely good practice is followed, and to carry out a market survey of the software features that support QC offered by urodynamics machines available in the UK.

The Nottingham Prognostic Index: five- and ten-year data for all-cause survival within a screened population.

INTRODUCTION The Nottingham Prognostic Index (NPI) is an established prognostication tool in the management of breast cancers (BCs). Latest ten-year survival data have demonstrated an improved outlook for each NPI category and the latest UK five- and ten-year survival from BC has been reported to be 85% and 77%, respectively. We compared survival of each NPI category for BCs diagnosed within the national breast screening service in Wales (Breast Test Wales (BTW)) to the latest data, and reviewed its validity in unselected cases within a screened population. METHODS All women screened between 1998 and 2001 within BTW were included. The NPI score for each cancer was calculated using the size, nodal status, and grade of the primary tumour. Survival data (all-cause) were calculated after ten years of follow-up. RESULTS In the three-year screening period, 199,082 women were screened. A total of 1,712 cancers were diagnosed, and 1,546 had data available for calculating the NPI. Overall five-year and ten-year survival was 94% and 82%, respectively. CONCLUSIONS Overall five-year and ten-year survival (all-cause) has improved even when compared with UK data for BC-specific survival. We found that the NPI remains valid for BC treatment, and that our data provide a reference for updating the all-cause survival of women diagnosed with BCs within a screened population.

The incidence and 10-year survival of interval breast cancers in Wales

AIM To evaluate the number of interval cancers (IC) within one screening cycle and the overall 10-year survival of IC, including its four main classifications, and compare that to screen-detected cancers (SDC). MATERIALS AND METHODS Within Breast Test Wales (BTW), all SDC between the years 1998 and 2001 were included. IC that occurred between 1998 and 2003 that had undergone screening between the years 1998 and 2001 were also included. These IC were classified into true interval (TI), false negative (FN), occult cancer (OCC), and unclassified cancer (UCC). BTW received notification of all deaths of women that had undergone screening; thus, the 10-year all-cause survival rate was calculated from the date of diagnosis and death. RESULTS During the study period, 199,082 women attended screening. Of these, 1020 (0.51%) women had SDC and 692 (0.38%) women developed IC. Of the 692 IC, 391 (57.8%) were TI, 120 (17.7%) were FN, 68 (10%) were OCC, and 98 (14.5%) were UCC; 15 (2.2%) were not classified. After a 10-year follow-up period, the 10-year survival rate (all-cause) for SDC was 81.6%, overall for all of IC was 72.4% (OR = 1.67, p < 0.001), TI was 77.5% (OR = 1.00, p = 0.99), FN was 55% (OR = 2.36, p < 0.001), OCC was 54.4% (OR = 3.17, p < 0.001), and UCC was 87.8% (OR = 0.61, p = 0.19). CONCLUSIONS The overall 10-year survival of IC was significantly different to SDC. However, within this, the prognosis of TI was similar to SDC, whereas FN and OCC had significantly worse long-term survival. Further research is required to identify the underlying cause of poor survival of FN and OCC.

The application of a new attribute selection technique to the forecasting of housing value using dependence modelling

This article introduces the J-score, a heuristic feature selection technique capable of selecting a useful subset of attributes from a dataset of potential inputs. The utility of the J-score is demonstrated through its application to a dataset containing historical information that may influence the house price index in the United Kingdom. After selecting a subset of features deemed appropriate by the J-score, a predictive model is trained using an artificial neural network. This model is then tested and the results compared with those from an alternative model, built using a subset of features suggested by the Gamma test, a non-linear analysis algorithm that is described. Other control subsets are also used for the assessment of the J-score model quality. The predictive accuracy of the J-score model relative to other models provides evidence that the J-score has good potential for further practical use in a variety of problems in the feature selection domain.

What can hashtags tell us about minority languages on Twitter? A comparison of #cymraeg, #frysk, and #gaeilge

ABSTRACT Researchers of minority language media are increasingly interested in the role of internet-based communication in language usage, maintenance, and revitalisation. This study explores the use of hashtags signifying the Welsh/Cymraeg, Frisian/Frysk, and Irish/Gaeilge languages on Twitter. Acknowledging the challenges of interpreting social media data, we focus on the hashtag and what it can tell us about the social and digital lives of minority languages. Specifically, we examine the agents using those hashtags, the topics they discuss, the languages used and the extent to which ambient communities may be formed through their use. Our analysis reveals different types of agents who are active and who have a variety of purposes in applying the minority language hashtag – sometimes to promote content in the minority language, more often to draw attention to content about those languages. Comparative analysis between the three language hashtags reveals statistically significant differences along a number of different dimensions, indicating that each minority language hashtag community has its own unique character. Through this comparative, platform-specific contribution we reach some generalisations concerning minority languages in the digital age, while also paying attention to the particularities of each language context and the exploitable features of social media for those languages.

Perceived inequalities in care and support for older women from Black and minority ethnic backgrounds in Wales: findings from a survey exploring dignity from service providers’ perspectives

ABSTRACT Objective: As part of a large mixed-method study aimed at capturing understandings of dignity, and care expectations of community dwelling older women from Black and minority ethnic (BME) backgrounds living in Wales, the aim of this paper is to compare service providers’ perceptions of their care and support provided to older people in general, and to older women from BME backgrounds in particular, with a focus on two dignity indicators: care and support needs, and effective communication. Design: A survey design was used. Results: A total of 124 responses from service providers in Wales were received. Perceived inequalities in care and support were found. Although most respondents reported that care and support provision was generally acceptable, more respondents believed that compared to older people in general, older women from BME backgrounds were seldom or never offered opportunities and support to express their needs, were involved in their own care, were provided appropriate information, had their key needs especially less visible needs (psychological and religious needs) been taken into account, or were communicated with effectively (all p < 0.05). In some cases, respondents tended to report more positively in areas related to their own practice. Conclusion: We suggest that learning from the views and perceptions of service providers, as well as older people and their families, remains key to developing services for the UKs increasingly diverse and ageing population. A better understanding of how inequalities may occur, their impact on older people and their families, and how they may be minimised can inform the development of high quality care for older people regardless of their ethnic and cultural backgrounds in Wales, other parts of the UK and beyond.

Older people and home care in Wales: findings from a survey of service users

Purpose – The purpose of this paper is to provide an account of a comprehensive and independent study of 1,029 older people who receive home care in Wales. The study aims to expand knowledge on the views of older people, a group who traditionally have struggled to make their voices heard. It asked older people about six specific components of home care: being listened to; having trained, knowledgeable and skilled care workers; having enough time to be cared for; receiving care from as few different workers as possible; receiving quality care; and being signposted to other sources of information. Design/methodology/approach – After an initial literature review and period of analysis, a thematic framework for home care was developed which contained the six components described above. A questionnaire was subsequently designed and distributed via the post to all home care services over 65 years old in four local authorities across Wales. A sample response rate of 26.7 per cent was achieved. Findings – The pap...

Using the Gamma Test in the Analysis of Classification Models for Time-Series Events in Urodynamics Investigations

Urodynamics is a clinical test in which time series data is recorded measuring internal pressure readings as the bladder is filled and emptied. Two sets of descriptive statistics based on various pressure events from urodynamics tests have been derived from time series data. The suitability of these statistics for use as inputs for event classification through neural networks is investigated by means of the gamma test. BFGS neural network models are constructed and their classification accuracy measured. Through a comparison of the results, it is shown that the gamma test can be used to predict the reliability of models before the neural network training phase begins.