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Articles by R. Baker
Total Records ( 3 ) for R. Baker
  K. M Ho , M Burrell , S Rao and R. Baker
  Background

Venous thromboembolism is common after major trauma. Strategies to prevent fatal pulmonary embolism (PE) are widely utilized, but the incidence and risk factors for fatal PE are poorly understood.

Methods

Using linked data from the intensive care unit, trauma registry, Western Australian Death Registry, and post-mortem reports, the incidence and risk factors for fatal PE in a consecutive cohort of major trauma patients, admitted between 1994 and 2002, were assessed. Non-linear relationships between continuous predictors and risk of fatal PE were modelled by logistic regression.

Results

Of the 971 consecutive trauma patients considered in the study, 134 (13.8%) died after their injuries. Fatal PE accounted for 11.9% of all deaths despite unfractionated heparin prophylaxis being used in 44% of these patients. Fatal PE occurred in those who were older (mean age 51- vs 37-yr-old, P=0.01), with more co-morbidities (Charlson's co-morbidity index 1.1 vs 0.2, P=0.01), had a larger BMI (31.8 vs 24.5, P=0.01), and less severe head and systemic injuries when compared with those who died of other causes. Sites of injuries were not significantly related to the risk of fatal PE. Fatal PE occurred much later than deaths from other causes (median 18 vs 2 days, P=0.01), and the estimated attributable mortality of PE was 49% (95% confidence interval 36–62%).

Conclusions

Fatal PE appeared to be a potential preventable cause of late mortality after major trauma. Severity of injuries, co-morbidity, and BMI were important risk factors for fatal PE after major trauma.

  M. A. Stone , A. C. Burden , M. Burden , R. Baker and K. Khunti
 

Aims  To assess the acceptability of and satisfaction with near patient testing for glycated haemoglobin in primary care in patients and health professionals.

Methods  A questionnaire survey and qualitative study were nested within a randomized controlled trial conducted in eight general practices in Leicester-shire, UK. Satisfaction with diabetes care was compared in the intervention group (near patient test) and in the control subjects (usual laboratory test), using the Diabetes Clinic Satisfaction Questionnaire. Semistructured interviews were conducted with a purposive sample of patients and healthcare professionals and analysed using thematic coding and framework charting.

Results  Questionnaire data for 344 patients were analysed and interviews were conducted with 15 patients and 11 health professionals. Interviews indicated that the near patient test was highly acceptable to patients and staff and confirmed that there may be potential benefits such as time saving, reduced anxiety and impact on patient management and job satisfaction. However, both the survey and the interviews identified high pre-existing levels of satisfaction with diabetes care in both intervention and control group patients and survey results failed to confirm increased patient satisfaction as a result of rapid testing. Limited patient understanding of glycated haemoglobin testing was noted.

Conclusions  We were unable to confirm actual rather than potential advantages of the near patient test. Widespread adoption in primary care cannot be recommended without further evidence of benefit.

  S Lindsay , S Smith , P Bellaby and R. Baker
 

The aim of this study was to assess whether our online closed community heart care support group and information resource could sustain changes in health behaviour after the moderators withdrew their support. Heart patients (n = 108) living in a deprived area of Greater Manchester were recruited from general practitioners’ coronary heart disease registries. The sample for this randomized controlled trial was divided in half at random where half of the participants received password-protected access to our health portal and the other half did not. At 6 months follow-up (based on the moderated phase), there was a significant difference between the experimental group and the controls in terms of self-reported diet (eating bad foods less often). This change in behaviour was not sustained during the 3-month unmoderated phase. During this unmoderated phase of the intervention, the experimental group had significantly more health care visits compared with the controls. There was no significant difference between the two phases for either group in terms of exercise, smoking or social support. This study offers insight into the potential implications for health changes of moderating arrangements for online health communities.

 
 
 
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