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"Wadsworth, Andy"
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Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
AbstractObjectiveThe HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management.DesignUnmasked randomised controlled trial with automated ascertainment of primary endpoint.Setting76 general practices in the United Kingdom.Participants622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet.InterventionsParticipants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines.Main outcome measuresThe primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values.ResultsAfter one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction.ConclusionsThe HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded.Trial registrationISRCTN13790648.
Journal Article
Substance use among those attending an accident and emergency department
There were also univariate associations between reporting three or more injuries requiring medical attention in the previous year and both recent drug and heavy alcohol use (previous month drug use: odds ratio (OR) 1.78, 95% confidence interval (CI) 1.21 to 2.62; previous year drug use: OR 1.64, 95% CI 1.16 to 2.30; alcohol: OR 1.53, 95% CI 1.11 to 2.10).
Journal Article
Safety Culture, Advice and Performance
Preventing work-related injury and illness is of crucial importance to employees, industry and wider society. Corporate safety culture - which describes shared values in an organisation that influence its members' attitudes, values and beliefs in relation to safety - is now generally accepted as having a strong influence over workplace accidents and injuries. Occupational safety and health practitioners also have a significant role to play in improving health and safety at work, yet their specific contribution to safety performance has rarely been studied. The aim of this study, therefore, was to consider associations between corporate safety performance and both safety culture and occupational safety and health advice. UK organisations from various sectors of industry were recruited to take part in three questionnaire surveys measuring: safety climate, to give a snapshot of underlying safety culture; occupational safety and health practitioners' experiences; and safety performance. The results showed that the perception of organisational safety culture was consistently and independently associated with corporate safety performance. In addition, there were some independent associations between corporate safety performance and both the level of occupational safety and health practitioners' training and qualifications, and organisational receptiveness to advice. Overall, the study suggests that corporate safety culture is independently associated with corporate safety performance, and this association is apparent among organisations from a variety of industrial sectors. In addition, it points to safety advice in relation to safety performance as an area for further study.
Journal Article
Multimodal profiling of lung granulomas reveals cellular correlates of tuberculosis control
Mycobacterium tuberculosis lung infection results in a complex multicellular structure, the granuloma. In some granulomas, immune activity promotes bacterial clearance; in others, bacteria persist and grow. We identified correlates of bacterial control in cynomolgus macaque lung granulomas by co-registering longitudinal PET-CT imaging, single-cell RNA-sequencing, and measures of bacterial clearance. We find that bacterial persistence occurs in granulomas enriched for mast, endothelial, fibroblast and plasma cells, signaling amongst themselves via Type II immunity and wound healing pathways. In contrast, these interactions are largely absent in granulomas that drive bacterial control, which are often those that form later in the course of infection; these restrictive lesions are characterized by cellular ecosystems enriched for Type1-Type17, stem-like, and cytotoxic T cells engaged in pro-inflammatory signaling networks that involve diverse myeloid and non-immune cell populations. There is also a temporal aspect to bacterial control, in that granulomas that arise later in infection (in the context of an established immune response) share the functional characteristics of restrictive granulomas and are more capable of killing Mtb. Taken together, our results define the complex multicellular ecosystems underlying (lack of) granuloma resolution and highlight host immune targets that can be leveraged to develop new vaccine and therapeutic strategies for TB. Competing Interest Statement A.K.S. reports compensation for consulting and/or SAB membership from Merck, Honeycomb Biotechnologies, Cellarity, Cogen Therapeutics, Ochre Bio, and Dahlia Biosciences. CL: shareholder and consultant Honeycomb biotechnologies. TKH: shareholder and consultant nference, inc Footnotes * Analyses to define distinct intercellular signaling environments across granulomas with varying levels of bacterial burden, as well as accompanying text discussion
Paper
Stand up for lethargy
The way to avoid messy hands (Letters, September 1) and still impress friends, especially vegetarians and Jains, is to catch the fly as follows: with fly on flat surface get your cupped hand about 18 inches behind it and resting vertically on the surface so your hand is resting on the little finger and palm edge. Move...
Newspaper Article