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1. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

Author

Agyeman, Akosua A, Ahmed, Tanveer, Allcock, Damien, Beltran-Martinez, Adrian, Benedict, Oluseye E, Bird, Nigel, Brennan, Laura, Brown, Julianne, Burns, Gerard, Butler, Mike, Cheng, Zelda, Danson, Ruth, de Kare-Silver, Nigel, Dhasmana, Devesh, Dickson, Jon, Engamba, Serge, Fisher, Stacey, Fox, Robin, Frost, Eve, Gaunt, Richard, Ghosh, Sarit, Gilkar, Ishtiaq, Goodman, Anna, Granier, Steve, Howell, Aleksandra, Hussain, Iqbal, Hutchinson, Simon, Imlach, Marie, Irving, Greg, Jacobsen, Nicholas, Kennard, James, Khan, Umar, Knox, Kyle, Krasucki, Christopher, Law, Tom, Lee, Rem, Lester, Nicola, Lewis, David, Lunn, James, Mackintosh, Claire I., Mathukia, Mehul, Moore, Patrick, Morton, Seb, Murphy, Daniel, Nally, Rhiannon, Ndukauba, Chinonso, Ogundapo, Olufunto, Okeke, Henry, Patel, Amit, Patel, Kavil, Penfold, Ruth, Poonian, Satveer, Popoola, Olajide, Pora, Alexander, Prasad, Vibhore, Prasad, Rishabh, Razzaq, Omair, Richardson, Scot, Royal, Simon, Safa, Afsana, Sehdev, Satash, Sevenoaks, Tamsin, Shah, Divya, Sheikh, Aadil, Short, Vanessa, Sidhu, Baljinder S, Singh, Ivor, Soni, Yusuf, Thalasselis, Chris, Wilson, Pete, Wingfield, David, Wong, Michael, Woodall, Maximillian N J, Wooding, Nick, Woods, Sharon, Yong, Joanna, Yongblah, Francis, Zafar, Azhar, Butler, Christopher C, Hobbs, F D Richard, Gbinigie, Oghenekome A, Rahman, Najib M, Hayward, Gail, Richards, Duncan B, Dorward, Jienchi, Lowe, David M, Standing, Joseph F, Breuer, Judith, Khoo, Saye, Petrou, Stavros, Hood, Kerenza, Nguyen-Van-Tam, Jonathan S, Patel, Mahendra G, Saville, Benjamin R, Marion, Joe, Ogburn, Emma, Allen, Julie, Rutter, Heather, Francis, Nick, Thomas, Nicholas P B, Evans, Philip, Dobson, Melissa, Madden, Tracie-Ann, Holmes, Jane, Harris, Victoria, Png, May Ee, Lown, Mark, van Hecke, Oliver, Detry, Michelle A, Saunders, Christina T, Fitzgerald, Mark, Berry, Nicholas S, Mwandigha, Lazaro, Galal, Ushma, Mort, Sam, Jani, Bhautesh D, Hart, Nigel D, Ahmed, Haroon, Butler, Daniel, McKenna, Micheal, Chalk, Jem, Lavallee, Layla, Hadley, Elizabeth, Cureton, Lucy, Benysek, Magdalena, Andersson, Monique, Coates, Maria, Barrett, Sarah, Bateman, Clare, Davies, Jennifer C, Raymundo-Wood, Ivy, Ustianowski, Andrew, Carson-Stevens, Andrew, Yu, Ly-Mee, and Little, Paul

Published
2023
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2. Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial

Author

Bagewadi, Abhay, Patrick, Abigail, Shenoy, Achuth, Redmond, Aisling, Muddu, Ajay, Northrop, Alex, Groves, Alice, Shiner, Alice, Heer, Amardeep, Takhar, Amrit, Bowles, Amy, Jarman, Andrea, Wong, Angela, Lucas, Angie, Gibbons, Anita, Dhar, Anjan, Curry, Anji, Lalonde, Anna, Swinburn, Anna, Turner, Anne, Lydon, Anne-Marie, Gunstone, Anthony, Lee, Arlene, Nambi, Arul, Ariyarathenam, Arun, Elden, Ashley, Wilson, Ashley, Donepudi, Balaji, Campbell, Barbara, Uszycka, Basia, Bowers, Ben, Coghill, Ben, de Quadros, Bruno, Cheah, Calvin, Bratten, Carla, Brown, Carly, Moorbey, Chantelle, Clisby, Charles, Gordon, Charles, Schramm, Chris, Castle, Chris, Newark, Chris, Norris, Chrissie, A'Court, Christine, Graham, Claire, Fletcher, Clare, Grocott, Clare, Rees, Colin, Bakker, Corinne, Paschalides, Costas, Vickery, Craig, Schembri, Damian, Morris, Danielle, Hagan, Daryl, Cronk, David, Goddard, David, Graham, David, Phillips, Dean, Prabhu, Deeksha, Kejariwal, Deepak, Garg, Dhirendra, Lonsdale, Diane, Butterworth, Dianne, Clements, Donna, Bradman, Drew, Blake, Duncan, Mather, Elizabeth, O'Farrell, Ewan, Markowetz, Florian, Adams, Fran, Pesola, Francesca, Forbes, Gareth, Taylor, Gary, Collins, Glenn, Irvine, Gordon, Fourie, Gysbert, Doyle, Harriet, Barnes, Heather, Bowyer, Helen, Whiting, Helen, Beales, Ian, Binnian, Ian, Bremner, Ian, Jennings, Ian, Troiceanu, Ilona, Modelell, Ines, Emmerson, Ingrid, Ortiz, Jacobo, Lilley, Jacqueline, Harvey, Jacquelyn, Vicars, Jacqui, Takhar, Jagjit, Larcombe, James, Bornschein, Jan, Aldegather, Jehad, Johnson, Jenny, Ducker, Jill, Skinner, Jo, Dash, Joanne, Walsh, Joanne, Miralles, Jose, Ridgway, Josephine, Ince, Julia, Kennedy, Julie, Hampson, Kat, Milne, Kate, Ellerby, Katherine, Priddis, Katherine, Rainsbury, Kathy, Powell, Kelly, Gunner, Kerry, Ragunath, Krish, Knox, Kyle, Baseley, Laura, White, Lauren, Lovat, Laurence, Berney, Lee, Crockett, Lindsay, Murray, Lisa, Westwood, Lisa, Chalkley, Lisa, Leggett, Loraine, Dale, Louise, Scovell, Louise, Brooks, Lucy, Saunders, Lucy, Owen, Lydia, Dilwershah, Maria, Baldry, Marie, Corcoran, Marie, Roy, Marie, Macedo, Mario, Attah, Mark, Anson, Mary-Jo, Rutter, Matt, Wallard, Matthew, Gaw, Matthew, Hunt, Matthew, Lea-Hagerty, Megan, Penacerrada, Melchizedek, Bianchi, Michele, Baker-Moffatt, Michelle, Czajkowski, Michelle, Sleeth, Michelle, Brewer, Nick, Wooding, Nick, Todd, Nicky, Millen, Nicola, Zolle, Olga, Whitehead, Orla, Ojechi, Patrick, Moore, Patrick, Banim, Paul, Spellar, Paula, Bhandari, Pradeep, Kant, Prashant, Nixon, Rachel, Russell, Rebecca, Roberts, Rebekah, Skule, Rene, West, Richard, Fox, Robin, Beesley, Ruth, Gibbins, Ruth, Osborne, Ruth, Thiagarajan, S, Bastiman, Sally, Warburton, Samantha, Pai, Samir, Leith-Russell, Sarah, Utting, Sarah, Watson, Sarah, Wytrykowski, Sarah, Singh, Satish, Malhotra, Shalini, Woods, Sharon, Conway, Shaun, Mateer, Sherrie, Macrae, Shona, Singh, Shruti, Fourie, Simona, Campbell, Siobhan, Parslow-Williams, Siobhan, Goel, Sonica, Dellar, Stephen, Jones, Stephen, Knight, Steve, Mackay-Thomas, Stuart, Mukherjee, Stuti, Allen, Sue, Henry, Suzanne, Evans, Tara, Leighton, Theresa, Bray, Tim, Shackleton, Tom, Santosh, Vanaja, Glover, Vicki, Chandraraj, Vijay, Elson, Will, Briggs, William, Barron, Zoe, Khan, Zohrah, Fitzgerald, Rebecca C, di Pietro, Massimiliano, O'Donovan, Maria, Maroni, Roberta, Muldrew, Beth, Debiram-Beecham, Irene, Gehrung, Marcel, Offman, Judith, Tripathi, Monika, Smith, Samuel G, Aigret, Benoit, Walter, Fiona M, Rubin, Greg, and Sasieni, Peter

Published
2020
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3. Circumstances of child deaths in Mali and Uganda: a community-based confidential enquiry

Author

Willcox, Merlin L, Kumbakumba, Elias, Diallo, Drissa, Mubangizi, Vincent, Kirabira, Peter, Nakaggwa, Florence, Mutahunga, Birungi, Diakité, Chiaka, Dembélé, Eugene, Traoré, Mamadou, Daou, Pierre, Bamba, Drissa, Traoré, Amadou, Berthé, Diafara, Wooding, Nick, Dinwoodie, Kieran, Capewell, Sarah, Foster, Hamish, Neville, Rowena, Ngonzi, Joseph, Kabakyenga, Jerome, Mant, David, and Harnden, Anthony

Published
2018
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4. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

Author

Butler, Christopher C, primary, Hobbs, F D Richard, additional, Gbinigie, Oghenekome A, additional, Rahman, Najib M, additional, Hayward, Gail, additional, Richards, Duncan B, additional, Dorward, Jienchi, additional, Lowe, David M, additional, Standing, Joseph F, additional, Breuer, Judith, additional, Khoo, Saye, additional, Petrou, Stavros, additional, Hood, Kerenza, additional, Nguyen-Van-Tam, Jonathan S, additional, Patel, Mahendra G, additional, Saville, Benjamin R, additional, Marion, Joe, additional, Ogburn, Emma, additional, Allen, Julie, additional, Rutter, Heather, additional, Francis, Nick, additional, Thomas, Nicholas P B, additional, Evans, Philip, additional, Dobson, Melissa, additional, Madden, Tracie-Ann, additional, Holmes, Jane, additional, Harris, Victoria, additional, Png, May Ee, additional, Lown, Mark, additional, van Hecke, Oliver, additional, Detry, Michelle A, additional, Saunders, Christina T, additional, Fitzgerald, Mark, additional, Berry, Nicholas S, additional, Mwandigha, Lazaro, additional, Galal, Ushma, additional, Mort, Sam, additional, Jani, Bhautesh D, additional, Hart, Nigel D, additional, Ahmed, Haroon, additional, Butler, Daniel, additional, McKenna, Micheal, additional, Chalk, Jem, additional, Lavallee, Layla, additional, Hadley, Elizabeth, additional, Cureton, Lucy, additional, Benysek, Magdalena, additional, Andersson, Monique, additional, Coates, Maria, additional, Barrett, Sarah, additional, Bateman, Clare, additional, Davies, Jennifer C, additional, Raymundo-Wood, Ivy, additional, Ustianowski, Andrew, additional, Carson-Stevens, Andrew, additional, Yu, Ly-Mee, additional, Little, Paul, additional, Agyeman, Akosua A, additional, Ahmed, Tanveer, additional, Allcock, Damien, additional, Beltran-Martinez, Adrian, additional, Benedict, Oluseye E, additional, Bird, Nigel, additional, Brennan, Laura, additional, Brown, Julianne, additional, Burns, Gerard, additional, Butler, Mike, additional, Cheng, Zelda, additional, Danson, Ruth, additional, de Kare-Silver, Nigel, additional, Dhasmana, Devesh, additional, Dickson, Jon, additional, Engamba, Serge, additional, Fisher, Stacey, additional, Fox, Robin, additional, Frost, Eve, additional, Gaunt, Richard, additional, Ghosh, Sarit, additional, Gilkar, Ishtiaq, additional, Goodman, Anna, additional, Granier, Steve, additional, Howell, Aleksandra, additional, Hussain, Iqbal, additional, Hutchinson, Simon, additional, Imlach, Marie, additional, Irving, Greg, additional, Jacobsen, Nicholas, additional, Kennard, James, additional, Khan, Umar, additional, Knox, Kyle, additional, Krasucki, Christopher, additional, Law, Tom, additional, Lee, Rem, additional, Lester, Nicola, additional, Lewis, David, additional, Lunn, James, additional, Mackintosh, Claire I., additional, Mathukia, Mehul, additional, Moore, Patrick, additional, Morton, Seb, additional, Murphy, Daniel, additional, Nally, Rhiannon, additional, Ndukauba, Chinonso, additional, Ogundapo, Olufunto, additional, Okeke, Henry, additional, Patel, Amit, additional, Patel, Kavil, additional, Penfold, Ruth, additional, Poonian, Satveer, additional, Popoola, Olajide, additional, Pora, Alexander, additional, Prasad, Vibhore, additional, Prasad, Rishabh, additional, Razzaq, Omair, additional, Richardson, Scot, additional, Royal, Simon, additional, Safa, Afsana, additional, Sehdev, Satash, additional, Sevenoaks, Tamsin, additional, Shah, Divya, additional, Sheikh, Aadil, additional, Short, Vanessa, additional, Sidhu, Baljinder S, additional, Singh, Ivor, additional, Soni, Yusuf, additional, Thalasselis, Chris, additional, Wilson, Pete, additional, Wingfield, David, additional, Wong, Michael, additional, Woodall, Maximillian N J, additional, Wooding, Nick, additional, Woods, Sharon, additional, Yong, Joanna, additional, Yongblah, Francis, additional, and Zafar, Azhar, additional

Published
2023
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6. Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Author

McManus, Richard J., Little, Paul, Stuart, Beth, Morton, Katherine, Raftery, James, Kelly, Jo, Bradbury, Katherine, Zhang, Jin, Zhu, Shihua, Murray, Elizabeth, May, Carl R., Mair, Frances S., Michie, Susan, Smith, Peter, Band, Rebecca, Ogburn, Emma, Allen, Julie, Rice, Cathy, Nuttall, Jacqui, Williams, Bryan, Yardley, Lucy, HOME BP investigators, Jones, Adam, Hussain, Ajmal, McHardy, Alistair, Harrison, Anna, LaLonde, Anna, Malik, Asim, Hernandez-Diaz, Basilio, Cranfield, Ben, Nicholson, Brian, Anandan, Carl, Neden, Catherine, Bobrow, Cathy, Evans, Chloe, Keast, Christopher, Henderson, Clare, Sutherland, Corrine, Kyte, Craig, Henderson, Dan, Noble, Debbie, Capo-Bianco, Ed, Williams, Edward, Shaw, Elizabeth, Mohri, Fatima, Asal, Gaurav, Dougall, Greig, Bhupal, Hardeep, Luckhurst, Heidi, Dosanjh, Hergeven, Nowell, Hilary, Brown, Jan, Flett, Jennifer, Barber, Julian, Rutter, Heather, Thompson, Julian, Ramanan, Kanjhana, Madronal, Karen, Malone, Karen, Etherington, Katie, Tsoi, Kenney, Knox, Kyle, Amin, Laila, Hirst, Lisa, Allen, Lucy, Skellern, Luke, Flynn, Lynne, McEwan, Lorne, Pugsley, Mark, Frassen, Marloes, Gaw, Matthew, Prendergast, Matthew, Wallard, Matthew, Faisal, Muhammad, Wooding, Nick, Lees, Nienke, Wainman, Paul, Nanda, Nithya, Moore, Patrick, Conley, Paul, Johnson, Paul, Wilson, Penny, Jacobs, Phillip, Whitbred, Pippa, Zamir, Rebecca, Reed, Richard, Tribley, Richard, Woof, Richard, Danson, Ruth, Lawes, Ruth, Gallagher, Sarah, Wadsworth, Sarah, Macanovic, Serge, Cartwright, Simon, Pettitt, Simon, Tucker, Simon, Doggett, Stephen, Sevenoaks, Tamsin, Watson, Tara, Talbot, Tess, Imrie, Ruth, Herbert, Thomas, Crockett, Tony, Wright, Tony, Sharma, Vanshika, Telford, Vicki, Almashta, Zaid, Cheng, Zelda, Ali, Zishan, Grube, Alice, Claxton, Andy, Asante, Barbara, Weare, Becki, McKee, Eleanor, Werrett, Bertha, Barwell, Carmel, Mulvihill, Carole, Sherwood, Caroline, MacDonald, Clare, Tabor, Dadirayi, Denning, Dawn, Roberts, Debbie, Adshead, Diane, Clarke, Gemma, Huntley, Heather, Pinder, Heather, Qasim, Irene, Merrison, Jane, King, Jill, Allison, Julie, Johal, Kam, Terry, Karen, Wood, Karine, Balmford, Kathryn, Barnes, Katie, Post, Katie, Bowden, Kelly-Marie, Edmunds, Kirsty, Whittle, Klaire, Peniket, Lara, Carnegie, Leann, Neale, Linda, Davey, Lisa, Bartlett, Liz, Smith, Louise, Clack, Lucy, Brown, Martina, McKenna, Naomi, Kay, Pam, Jacobs, Polly, Cutts, Rebecca, Pearse, Robert, Atkinson, Ruth, Barter, Sally, Mackie, Sally, Norris, Sam, Cook, Sandra, Elderfield, Sarah, Nzante, Sarah, Cronin, Sharon, Maslen, Sophie, Marchant, Stephanie, Wright, Stephanie, Keene, Sue, Smith, Sue, Cimelli, Suzie, Stone, Tracy, Joyce, Tricia, Le Marechal, Trudie, Kettle, Vicky, Osborne, Victoria, Cubiss, Wendy, Marsden, Wendy, Kowalczyk-Williams, Wioletta, and Bailey, Zoe

Abstract

Objective: The 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. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants 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 measures: The 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. Results: After 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. Conclusions: The 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 registration: ISRCTN13790648.

Published
2021

8. Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Author

McManus, Richard J, Little, Paul, Stuart, Beth, Morton, Katherine, Raftery, James, Kelly, Jo, Bradbury, Katherine, Zhang, Jin, Zhu, Shihua, Murray, Elizabeth, May, Carl R, Mair, Frances S, Michie, Susan, Smith, Peter, Band, Rebecca, Ogburn, Emma, Allen, Julie, Rice, Cathy, Nuttall, Jacqui, Williams, Bryan, Yardley, Lucy, Jones, Adam, Hussain, Ajmal, McHardy, Alistair, Harrison, Anna, LaLonde, Anna, Malik, Asim, Hernandez-Diaz, Basilio, Cranfield, Ben, Nicholson, Brian, Anandan, Carl, Neden, Catherine, Bobrow, Cathy, Evans, Chloe, Keast, Christopher, Henderson, Clare, Sutherland, Corrine, Kyte, Craig, Henderson, Dan, Noble, Debbie, Capo-Bianco, Ed, Williams, Edward, Shaw, Elizabeth, Mohri, Fatima, Asal, Gaurav, Dougall, Greig, Bhupal, Hardeep, Luckhurst, Heidi, Dosanjh, Hergeven, Nowell, Hilary, Brown, Jan, Flett, Jennifer, Barber, Julian, Rutter, Heather, Thompson, Julian, Ramanan, Kanjhana, Madronal, Karen, Malone, Karen, Etherington, Katie, Tsoi, Kenney, Knox, Kyle, Amin, Laila, Hirst, Lisa, Allen, Lucy, Skellern, Luke, Flynn, Lynne, McEwan, Lorne, Pugsley, Mark, Frassen, Marloes, Gaw, Matthew, Prendergast, Matthew, Wallard, Matthew, Faisal, Muhammad, Wooding, Nick, Lees, Nienke, Wainman, Paul, Nanda, Nithya, Moore, Patrick, Conley, Paul, Johnson, Paul, Wilson, Penny, Jacobs, Phillip, Whitbred, Pippa, Zamir, Rebecca, Reed, Richard, Tribley, Richard, Woof, Richard, Danson, Ruth, Lawes, Ruth, Gallagher, Sarah, Wadsworth, Sarah, Macanovic, Serge, Cartwright, Simon, Pettitt, Simon, Tucker, Simon, Doggett, Stephen, Sevenoaks, Tamsin, Watson, Tara, Talbot, Tess, Imrie, Ruth, Herbert, Thomas, Crockett, Tony, Wright, Tony, Sharma, Vanshika, Telford, Vicki, Almashta, Zaid, Cheng, Zelda, Ali, Zishan, Grube, Alice, Claxton, Andy, Asante, Barbara, Weare, Becki, McKee, Eleanor, Werrett, Bertha, Barwell, Carmel, Mulvihill, Carole, Sherwood, Caroline, MacDonald, Clare, Tabor, Dadirayi, Denning, Dawn, Roberts, Debbie, Adshead, Diane, Clarke, Gemma, Huntley, Heather, Pinder, Heather, Qasim, Irene, Merrison, Jane, King, Jill, Allison, Julie, Johal, Kam, Terry, Karen, Wood, Karine, Balmford, Kathryn, Barnes, Katie, Post, Katie, Bowden, Kelly-Marie, Edmunds, Kirsty, Whittle, Klaire, Peniket, Lara, Carnegie, Leann, Neale, Linda, Davey, Lisa, Bartlett, Liz, Smith, Louise, Clack, Lucy, Brown, Martina, McKenna, Naomi, Kay, Pam, Jacobs, Polly, Cutts, Rebecca, Pearse, Robert, Atkinson, Ruth, Barter, Sally, Mackie, Sally, Norris, Sam, Cook, Sandra, Elderfield, Sarah, Nzante, Sarah, Cronin, Sharon, Maslen, Sophie, Marchant, Stephanie, Wright, Stephanie, Keene, Sue, Smith, Sue, Cimelli, Suzie, Stone, Tracy, Joyce, Tricia, Le Marechal, Trudie, Kettle, Vicky, Osborne, Victoria, Cubiss, Wendy, Marsden, Wendy, Kowalczyk-Williams, Wioletta, and Bailey, Zoe

Subjects
Male, medicine.medical_specialty, General Practice, Psychological intervention, Blood Pressure, law.invention, Randomized controlled trial, law, Diabetes mellitus, Clinical endpoint, Humans, Medicine, Antihypertensive Agents, Aged, business.industry, Research, Self-Management, General Medicine, Blood Pressure Monitoring, Ambulatory, Middle Aged, medicine.disease, Telemedicine, United Kingdom, Confidence interval, Mean blood pressure, Blood pressure, Hypertension, Physical therapy, Female, Physical and Mental Health, business, Incremental cost-effectiveness ratio
Abstract

Objective The 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. Design Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting 76 general practices in the United Kingdom. Participants 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions Participants 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 measures The 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. Results After 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. Conclusions The 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 registration ISRCTN13790648 .

Published
2020
Full Text
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9. Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial

Author

Fitzgerald, Rebecca C, primary, di Pietro, Massimiliano, additional, O'Donovan, Maria, additional, Maroni, Roberta, additional, Muldrew, Beth, additional, Debiram-Beecham, Irene, additional, Gehrung, Marcel, additional, Offman, Judith, additional, Tripathi, Monika, additional, Smith, Samuel G, additional, Aigret, Benoit, additional, Walter, Fiona M, additional, Rubin, Greg, additional, Sasieni, Peter, additional, Bagewadi, Abhay, additional, Patrick, Abigail, additional, Shenoy, Achuth, additional, Redmond, Aisling, additional, Muddu, Ajay, additional, Northrop, Alex, additional, Groves, Alice, additional, Shiner, Alice, additional, Heer, Amardeep, additional, Takhar, Amrit, additional, Bowles, Amy, additional, Jarman, Andrea, additional, Wong, Angela, additional, Lucas, Angie, additional, Gibbons, Anita, additional, Dhar, Anjan, additional, Curry, Anji, additional, Lalonde, Anna, additional, Swinburn, Anna, additional, Turner, Anne, additional, Lydon, Anne-Marie, additional, Gunstone, Anthony, additional, Lee, Arlene, additional, Nambi, Arul, additional, Ariyarathenam, Arun, additional, Elden, Ashley, additional, Wilson, Ashley, additional, Donepudi, Balaji, additional, Campbell, Barbara, additional, Uszycka, Basia, additional, Bowers, Ben, additional, Coghill, Ben, additional, de Quadros, Bruno, additional, Cheah, Calvin, additional, Bratten, Carla, additional, Brown, Carly, additional, Moorbey, Chantelle, additional, Clisby, Charles, additional, Gordon, Charles, additional, Schramm, Chris, additional, Castle, Chris, additional, Newark, Chris, additional, Norris, Chrissie, additional, A'Court, Christine, additional, Graham, Claire, additional, Fletcher, Clare, additional, Grocott, Clare, additional, Rees, Colin, additional, Bakker, Corinne, additional, Paschalides, Costas, additional, Vickery, Craig, additional, Schembri, Damian, additional, Morris, Danielle, additional, Hagan, Daryl, additional, Cronk, David, additional, Goddard, David, additional, Graham, David, additional, Phillips, Dean, additional, Prabhu, Deeksha, additional, Kejariwal, Deepak, additional, Garg, Dhirendra, additional, Lonsdale, Diane, additional, Butterworth, Dianne, additional, Clements, Donna, additional, Bradman, Drew, additional, Blake, Duncan, additional, Mather, Elizabeth, additional, O'Farrell, Ewan, additional, Markowetz, Florian, additional, Adams, Fran, additional, Pesola, Francesca, additional, Forbes, Gareth, additional, Taylor, Gary, additional, Collins, Glenn, additional, Irvine, Gordon, additional, Fourie, Gysbert, additional, Doyle, Harriet, additional, Barnes, Heather, additional, Bowyer, Helen, additional, Whiting, Helen, additional, Beales, Ian, additional, Binnian, Ian, additional, Bremner, Ian, additional, Jennings, Ian, additional, Troiceanu, Ilona, additional, Modelell, Ines, additional, Emmerson, Ingrid, additional, Ortiz, Jacobo, additional, Lilley, Jacqueline, additional, Harvey, Jacquelyn, additional, Vicars, Jacqui, additional, Takhar, Jagjit, additional, Larcombe, James, additional, Bornschein, Jan, additional, Aldegather, Jehad, additional, Johnson, Jenny, additional, Ducker, Jill, additional, Skinner, Jo, additional, Dash, Joanne, additional, Walsh, Joanne, additional, Miralles, Jose, additional, Ridgway, Josephine, additional, Ince, Julia, additional, Kennedy, Julie, additional, Hampson, Kat, additional, Milne, Kate, additional, Ellerby, Katherine, additional, Priddis, Katherine, additional, Rainsbury, Kathy, additional, Powell, Kelly, additional, Gunner, Kerry, additional, Ragunath, Krish, additional, Knox, Kyle, additional, Baseley, Laura, additional, White, Lauren, additional, Lovat, Laurence, additional, Berney, Lee, additional, Crockett, Lindsay, additional, Murray, Lisa, additional, Westwood, Lisa, additional, Chalkley, Lisa, additional, Leggett, Loraine, additional, Dale, Louise, additional, Scovell, Louise, additional, Brooks, Lucy, additional, Saunders, Lucy, additional, Owen, Lydia, additional, Dilwershah, Maria, additional, Baldry, Marie, additional, Corcoran, Marie, additional, Roy, Marie, additional, Macedo, Mario, additional, Attah, Mark, additional, Anson, Mary-Jo, additional, Rutter, Matt, additional, Wallard, Matthew, additional, Gaw, Matthew, additional, Hunt, Matthew, additional, Lea-Hagerty, Megan, additional, Penacerrada, Melchizedek, additional, Bianchi, Michele, additional, Baker-Moffatt, Michelle, additional, Czajkowski, Michelle, additional, Sleeth, Michelle, additional, Brewer, Nick, additional, Wooding, Nick, additional, Todd, Nicky, additional, Millen, Nicola, additional, Zolle, Olga, additional, Whitehead, Orla, additional, Ojechi, Patrick, additional, Moore, Patrick, additional, Banim, Paul, additional, Spellar, Paula, additional, Bhandari, Pradeep, additional, Kant, Prashant, additional, Nixon, Rachel, additional, Russell, Rebecca, additional, Roberts, Rebekah, additional, Skule, Rene, additional, West, Richard, additional, Fox, Robin, additional, Beesley, Ruth, additional, Gibbins, Ruth, additional, Osborne, Ruth, additional, Thiagarajan, S, additional, Bastiman, Sally, additional, Warburton, Samantha, additional, Pai, Samir, additional, Leith-Russell, Sarah, additional, Utting, Sarah, additional, Watson, Sarah, additional, Wytrykowski, Sarah, additional, Singh, Satish, additional, Malhotra, Shalini, additional, Woods, Sharon, additional, Conway, Shaun, additional, Mateer, Sherrie, additional, Macrae, Shona, additional, Singh, Shruti, additional, Fourie, Simona, additional, Campbell, Siobhan, additional, Parslow-Williams, Siobhan, additional, Goel, Sonica, additional, Dellar, Stephen, additional, Jones, Stephen, additional, Knight, Steve, additional, Mackay-Thomas, Stuart, additional, Mukherjee, Stuti, additional, Allen, Sue, additional, Henry, Suzanne, additional, Evans, Tara, additional, Leighton, Theresa, additional, Bray, Tim, additional, Shackleton, Tom, additional, Santosh, Vanaja, additional, Glover, Vicki, additional, Chandraraj, Vijay, additional, Elson, Will, additional, Briggs, William, additional, Barron, Zoe, additional, and Khan, Zohrah, additional

Published
2020
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10. Circumstances of child deaths in Mali and Uganda: a community-based confidential enquiry

Author

Wilcox, Merlin, Kumbakumba, Elias, Mubangizi, Vincent, Kirabira, Peter, Nakaggwa, Florence, Mutahunga, Birungi, Diakite, Chiaka, Dembele, Eugene, Traore, Mamadou, Daou, Pierre, Bamba, Drissa, Traore, Amadou, Berthe, Diafara, Wooding, Nick, Dinwoodie, Kieran, Capewell, Sarah, Foster, Hamish, Neville, Rowena, Ngonzi, Joseph, Kabakyenga, Jerome, Mant, David, and Harnden, Anthony

Subjects
parasitic diseases
Abstract

Background: \ud Interventions to reduce child deaths in Africa have often underachieved, causing the Millennium Development Goal targets to be missed. We assessed whether a community enquiry into the circumstances of death could improve intervention effectiveness by identifying local avoidable factors and explaining implementation failures.\ud \ud Methods: \ud Deaths of children younger than 5 years were ascertained by community informants in two districts in Mali (762 deaths) and three districts in Uganda (442 deaths) in 2011–15. Deaths were investigated by interviewing parents and health workers. Investigation findings were reviewed by a panel of local health-care workers and community representatives, who formulated recommendations to address avoidable factors and, subsequently, oversaw their implementation.\ud \ud Findings: \ud At least one avoidable factor was identified in 97% (95% CI 96–98, 737 of 756) of deaths in children younger than 5 years in Mali and 95% (93–97, 389 of 409) in Uganda. Suboptimal newborn care was a factor in 76% (146 of 194) of neonatal deaths in Mali and 64% (134 of 194) in Uganda. The most frequent avoidable factor in postneonatal deaths was inadequate child protection (mainly child neglect) in Uganda (29%, 63 of 215) and malnutrition in Mali (22%, 124 of 562). 84% (618 of 736 in Mali, 328 of 391 in Uganda) of families had consulted a health-care provider for the fatal illness, but the quality of care was often inadequate. Even in official primary care clinics, danger signs were often missed (43% of cases in Mali [135 of 396], 39% in Uganda [30 of 78]), essential treatment was not given (39% in Mali [154 of 396], 35% in Uganda [27 of 78]), and patients who were seriously ill were not referred to a hospital in time (51% in Mali [202 of 396], 45% in Uganda [35 of 78]). Local recommendations focused on quality of care in health-care facilities and on community issues influencing treatment-seeking behaviour.\ud \ud Interpretation: \ud Local investigation and review of circumstances of death of children in sub-Saharan Africa is likely to lead to more effective interventions than simple consideration of the biomedical causes of death. This approach discerned local public health priorities and implementable solutions to address the avoidable factors identified.\ud \ud Funding: \ud European Union's 7th Framework Programme for research and technological development.

Published
2018

13. Teaching exchange

Author

Gavriel, Jennifer, primary, O’Reilly, Duane, additional, Hart, Charlotte, additional, Wooding, Nick, additional, and Suchdev, Manjit, additional

Published
2014
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