Disparity in testing for renal function in Primary Care in the UK
JBM Research worked with the Department of Health Care Policy and Management at the University of Surrey to investigate the type of patients who undergo renal function tests in Primary Care. The cross-sectional survey carried out in a London research network revealed that 82% of patients with diabetes had their renal function and protienuria tested, compared with only 0.5% of patients without diabetes. Overall, older patients, those with diabetes and Black or South Asian patients were most likely to undergo renal function tests in Primary Care.
de Lusignan S, Nitsch D, Belsey J et al. Disparities in testing for renal function in UK primary care: cross-sectional study. Fam Pract 2011 Jun 30. PubMed abstract.
JBM works with the Clinical Informatics Research Group to link data from patient databases and aid international research
JBM Research is working with the TRANSFoRm project (Translational Research and Patient Safety in Europe) to develop a tool which will enable researchers to assess the suitability of patient databases (Primary Care databases, Biobanks and Disease Registries) to take part in research. The TIRRE survey (TRANSFoRm International Research Readiness Instrument) is an online survey which explores the potential for data from Primary Care databases, Biobanks and Disease Registries to be linked and used in international research. We are working with Professor Simon de Lusignan at the Clinical Informatics Research Group at the University of Surrey and the wider TIRRE team to analyse the data from the survey and refine the questionnaire further.
For more information see http://www.clininf.eu/jointirre/info.html
JBM's work on classification of diabetes in the news
JBM Research's recent work with Professor Simon de Lusignan of St George's Medical School was discussed in The Guardian. Jonathan worked with Professor de Lusignan's team to assess the proportion of patients with diabetes whose diabetes has been misdiagnosed or misclassified. They found that 4% of the 2.4 million patients with a diagnosis of diabetes in England either do not have diabetes (50,000 people) or are classified as having type 1 diabetes when in fact they have type 2 diabetes, or vice versa (a further 50,000 people).
de Lusignan S, Khunti K, Belsey J, et al. Organisation and delivery of care: A method of identifying and correcting miscoding, misclassification and misdiagnosis in diabetes: a pilot and validation study of routinely collected data. Diab Med 2010; 27:203-209. PubMed abstract.
http://www.guardian.co.uk/society/2011/mar/01/nhs-pledges-to-improve-diabetes-diagnosis
JBM's Dr Jonathan Belsey appears on Channel 4's Grand Designs
Managing Director of JBM, Dr Jonathan Belsey, has appeared on Channel 4's Grand Designs programme (Wednesday 13th October) showcasing his house build, completed in August 2009. The programme followed him through the process of his bid to construct a functional family home, designed to run with as low carbon footprint as possible, including solar hot water panels and an experimental wind turbine.
Dr Jonathan Belsey on Grand Designs
JBM Research's latest publication reviews treatments for postmenopausal osteoporosis
and their impact on bone quality
JBM Research's recent systematic review examines the influence of treatments for postmenopausal osteoporosis (parathyroid hormone [PTH], bisphosphonates, strontium ranelate and denosumab) on bone quality. Bone mineral density (BMD) is the standard measure of bone strength, however, measures of bone quality have the potential to explain, in large part, the underlying impact of treatments for osteoporosis.
PTH has an anabolic mode of action, directly increasing bone formation. Bisphosphonates and denosumab act by reducing bone resorption to prevent the loss of bone. Strontium ranelate is thought to have a mixed mode of action, increasing bone formation and decreasing bone resorption.
PTH has been shown to increase bone strength and BMD during treatment periods, and to reduce fracture risk. However, effects appear to reverse once it is halted and a treatment strategy should consider the appropriate medication post-PTH. Available evidence supports sequential therapy with bisphosphonates (specifically alendronate) and by treating with bisphosphonates after PTH, the benefit on BMD continues into later years, maintaining improvements in bone quality and reducing the risk of fracture.
Gallacher SJ, Dixon T. Impact of treatments for postmenopausal osteoporosis (bisphosphonates, parathyroid hormone, strontium ranelate and denosumab) on bone quality: a systematic review. Calcif Tissue Int 2010 [Epub ahead of print]. PubMed PMID: 20872215
JBM Health economics paper proposes solution to health technology assessment
conflicts for biosimilars
The latest paper by JBM Health economics explores the differences in the data demanded by Health Technology Assessment (HTA) authorities and by regulatory systems for biosimilars, and suggests that the differences potentially deprive cancer patients of reasonably priced, effective treatments and hinder best allocation of resources. The paper argues that regulatory and HTA authorities need to work together to encourage the widespread use of biosimilars which may lead to the release of considerable resources.
The authors believe that HTA demands for comparative efficacy trials data and cost-utility analysis for biosimilars are inappropriate. Such conflicts between licensing and HTA authorities increase the chance of rejection of some biosimilars by HTA authorities, thus leaving only the higher cost patented products available. Ultimately, this could mean a lack of competition for patented drugs from biosimilars which will keep prices high and extend patent protection
The authors go on to propose that HTA authorities should follow the lead of the EMA and accept pharmacokinetic and pharmacodynamic equivalence between the branded drug and the biosimilar, and cost-minimisation analysis as a basis for cost-effectiveness debates. It is also recommended that strict pharmacovigilence protocols should be put in place to exclude rare reactions and that cancer centres and trusts should also regularly audit and publish the impact of biosimilars on clinical outcomes and resource use. Eventually HTA authorities should look to manufacturers of biosimilars for cost-analyses.
These steps would protect patients and provide clinicians with rapid access to low-cost treatments.
Stewart A, Aubrey P, Belsey J. Addressing the health technology assessment of biosimilar pharmaceuticals. Curr Med Res Opin 2010:26;2119-2126. PubMed PMID: 20649394
Latest meta analysis from JBM Research demonstrates that PEG is significantly more efficacious
than lactulose in adult constipation
JBM Research conducted a systematic review and meta analysis to assess efficacy of PEG versus placebo and active comparators in adults with non-organic constipation. The paper is the only quantitative statistical analysis to have been published in the field.
Twenty published randomised controlled trials, with a parallel-group or cross-over design, comparing oral PEG with placebo or a comparator laxative in adults with a history of non-organic constipation were included in the statistical analysis. Ten of the studies were PEG versus placebo (seven of which were high-quality), seven were PEG versus lactulose (four of which were high-quality) and four were versus other agents. A total of 2,240 patients from the US, UK, Spain, France, Italy, Germany, Finland and China were included.
The analysis found that PEG treatment resulted in a highly significant increase in defaecations/week over placebo, and have clearly shown PEG to be more effective than lactulose. For PEG versus placebo, the random effects pooled estimate of weighted mean difference was 1.98 stools/week when all studies were analysed. Using only the seven high-quality studies saw the result increase to 2.34 stools/week. For PEG versus lactulose, the difference was 1.01 stools/week, increasing to 1.65 stools/week in the four high-quality studies.
JBM Research's analysis provides an important insight into the comparative efficacy of PEG.
Belsey JD, Geraint M, Dixon TA. Systematic review and meta-analysis: polyethylene glycol in adults with non-organic constipation. Int J Clin Pract 2010:64;944-955. PubMed PMID: 20584228
JBM Research's paper on hypoglycaemia is most widely cited paper in Diabetic Medicine for 2008
JBM Research's paper on hypoglycaemia, published in Diabetic Medicine in 2008, became the journal's most widely cited paper of that year. In total, the journal published 294 papers in 2008 with a mean citation rate of 3.93 citations/paper, but JBM Research's paper was the most widely cited with 41 citations. Find out more about our original research at JBM Research.
Amiel SA, Dixon T, Mann R et al. Hypoglycaemia in type 2 diabetes. Diab Med 2008;25(3):245-254. PubMed PMID: 18215172
