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Articles by J. R. F Gladman
Total Records ( 3 ) for J. R. F Gladman
  J Gribbin , R Hubbard , J. R. F Gladman , C Smith and S. Lewis

Background: antihypertensive medications have long been implicated as a potential cause of falls in older people but, despite their widespread prescribing, the size of class-specific adverse effects remains unclear.

Aim: to determine the role of antihypertensive medications in older people with a recorded fall in primary care.

Design: case–control study.

Setting: UK general practices contributing data to The Health Improvement Network primary care database.

Methods: patients over 60 years of age with a first fall recorded between 2003 and 2006 were selected, and up to six controls per case matched by age, gender and general practice. We used conditional logistic regression to estimate odds ratios for ever exposure, and current/previous exposure to the main classes of antihypertensives, adjusting for co-morbidity. We also examined the effect of the time interval from first prescription to first fall.

Results: amongst our 9,682 cases, we found an increased risk of current prescribing of thiazides (odds ratio (OR) 1.25; 95% confidence interval 1.15–1.36). At 3 weeks after first prescribing the risk remained 4.28 (1.19–15.42). We found a reduced risk for current prescribing of beta blockers (OR 0.90; 0.85–0.96). There was no significant association with current prescribing of any other class of antihypertensive.

Conclusions: the study provides evidence that current prescribing of thiazides is associated with an increased risk of falling and that this is strongest in the 3 weeks following the first prescription.

  J Beavan , S. P Conroy , R Harwood , J. R. F Gladman , J Leonardi Bee , T Sach , T Bowling , W Sunman and C. Gaynor

Background: nasogastric tube (NGT) feeding is commonly used after stroke, but its effectiveness is limited by frequent dislodgement.

Objective: the objective of the study was to evaluate looped NGT feeding in acute stroke patients with dysphagia.

Methods: this was a randomised controlled trial of 104 patients with acute stroke fed by NGT in three UK stroke units. NGT was secured using either a nasal loop (n = 51) or a conventional adhesive dressing (n = 53). The main outcome measure was the proportion of prescribed feed and fluids delivered via NGT in 2 weeks post-randomisation. Secondary outcomes were frequency of NGT insertions, treatment failure, tolerability, adverse events and costs at 2 weeks; mortality; length of hospital stay; residential status; and Barthel Index at 3 months.

Results: participants assigned to looped NGT feeding received a mean 17% (95% confidence interval 5–28%) more volume of feed and fluids, required fewer NGTs (median 1 vs 4), and had fewer electrolyte abnormalities than controls. There was more minor nasal trauma in the loop group. There were no differences in outcomes at 3 months. Looped NGT feeding cost £88 more per patient over 2 weeks than controls.

Conclusion: looped NGT feeding improves delivery of feed and fluids and reduces NGT reinsertion with little additional cost.

  L Irvine , S. P Conroy , T Sach , J. R. F Gladman , R. H Harwood , D Kendrick , C Coupland , A Drummond , G Barton and T. Masud

Background: multifactorial falls prevention programmes for older people have been proved to reduce falls. However, evidence of their cost-effectiveness is mixed.

Design: economic evaluation alongside pragmatic randomised controlled trial.

Intervention: randomised trial of 364 people aged ≥70, living in the community, recruited via GP and identified as high risk of falling. Both arms received a falls prevention information leaflet. The intervention arm were also offered a (day hospital) multidisciplinary falls prevention programme, including physiotherapy, occupational therapy, nurse, medical review and referral to other specialists.

Measurements: self-reported falls, as collected in 12 monthly diaries. Levels of health resource use associated with the falls prevention programme, screening (both attributed to intervention arm only) and other health-care contacts were monitored. Mean NHS costs and falls per person per year were estimated for both arms, along with the incremental cost-effectiveness ratio (ICER) and cost effectiveness acceptability curve.

Results: in the base-case analysis, the mean falls programme cost was £349 per person. This, coupled with higher screening and other health-care costs, resulted in a mean incremental cost of £578 for the intervention arm. The mean falls rate was lower in the intervention arm (2.07 per person/year), compared with the control arm (2.24). The estimated ICER was £3,320 per fall averted.

Conclusions: the estimated ICER was £3,320 per fall averted. Future research should focus on adherence to the intervention and an assessment of impact on quality of life.

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