Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Prognostic Value of Frailty in Major Trauma in Older People(The University of Nottingham, 2024) Alqarni, Abdullah Ghaythan; Ollivere, Benjamin; Gladman, JohnBackground: The incidence of major trauma in older people is rising. Frailty significantly raises the probability of poor trauma outcomes in older people. The purpose of this thesis is to investigate the predictive value of frailty in major trauma as well as to determine the need for developing a frailty evaluation instrument specifically for older individuals who have had major trauma. Methods: An overview and review of relevant literature concerning frailty and major trauma in older people was conducted. A systematic review and meta-analysis were undertaken to investigate the frailty concept's influence on the outcomes of older trauma patients. A trauma frailty index was created as a tool for diagnosing frailty in older people who had experienced trauma using routinely collected data. The index was verified against adverse outcomes using two samples in and out of sample data sets to prove its relevance and validity in a larger population of trauma patients. Two further validations were conducted to determine the index's ideal threshold for the development of adverse outcomes. Results: Frailty status in older persons with major trauma was linked to higher in-patient mortality, duration of hospital stay, discharge location, and comorbidities. Frailty was consistently a better predictor of death and unfavourable discharge location than age or injury severity. Frailty detection methods do not seem to be suitable for use with traumatically injured older people. The Nottingham Trauma Frailty Index (NTFI) has identified five variables that strongly predict frailty (regression coefficient B = 6.383 (95% confidence interval 5.03 to 7.74), p < 0.001): age, Abbreviated Mental Test score, admission haemoglobin concentration (g/l), pre-admission mobility (requiring assistance or not), and mechanism of injury (falls from standing height). During validation, there was a strong agreement between the NTFI and the CFS (mean difference 0.02), with no obvious systematic bias. In two validations against clinical outcomes, growing NTFI was related to adverse outcomes that included in-hospital complications, adverse discharge destinations, the increase in dependency level, and length of stay. NTFI ≥ 4.345 was a significant predictive threshold for adverse outcomes including discharge to rehabilitation unit, discharge to nursing care home, discharge to residential care home, mortality, increase in dependency level, and in-hospital complications. Conclusion: The frailty state of older trauma patients is a better predictor of poor outcomes than their age or injury severity score. The NTFI has shown a noteworthy performance in predicting clinical outcomes in both in-sample and out-of-sample data sets. The NTFI is a practical tool that clinicians and researchers may use to direct patient care and analyse quality improvement and research initiatives. It utilises readily and regularly recorded physiological and functional characteristics.47 0Item Restricted Multimorbidity and Polypharmacy: A Health Informatics Approach(Saudi Digital Library, 2023) Aldhobaie, Ghadah; Pirmohamed, Munir; Coenen, Frans; Walker, LaurenIntroduction: Multimorbidity is increasing in prevalence, and is more common in older age groups. All bodily systems can be affected by multimorbidity (or multiple long-term conditions), and this is associated with increased healthcare utilisation and increased mortality. Additionally, people living with multiple long-term conditions are often on many drugs, which has been termed polypharmacy. This puts them at risk of adverse drug reactions, drug-drug interactions and poor adherence, all of which can increase healthcare costs. In this thesis, I have focused on cardiovascular and gastrointestinal drugs in order to understand the changes which have occurred in the usage of these drugs over the last two decades. Objective: The thesis aims to describe the changing patterns of medication prescription practice over the last two decades in older people with cardiovascular and/or gastrointestinal diseases using the Clinical Practice Research Datalink (CPRD). Methods: We extracted one million patient records from CPRD. Among these patients, we have included cardiovascular (CV) and gastrointestinal (GI) patients with two or more years of follow-up. These patients were then filtered further based on the second chronic condition and the patient’s age (whether they were 50 years and above). After adjusting for the range between the years 2001 and 2020, the number of eligible patients for this study was reduced further (used for the first group analysis). An association rule mining was applied to investigate the prescription pattern between 2001 and 2020. When this is filtered to those who had 20 years of follow-up appointments, it reduced the number and was analysed accordingly for the second group analysis to examine the change in the prescription patterns by applying specifically the Apriori algorithm Association Rules Mining. Results: For the first analysis, the extracted eligible CV and GI patients were 228,376 and 111,355, respectively. The eligible patients for the second analysis with continuous and constant 20 years follow-up were 17,075 and 3,110, respectively. In cardiovascular disease, the most commonly prescribed drug classes were statins followed by calcium channel blockers. The study also showed that there was a statistically significant increase (P-value <0.0001) in the mean number of total cardiovascular drugs prescribed in 2020 in comparison to 2001 (mean 2.201-1.581, standard deviation 1.153-0.860 respectively). In gastrointestinal disease, the most commonly prescribed drug classes were proton pump inhibitors followed by corticosteroids. In the same study period, there was a statistically significant increase (P-value <0.0001) in the mean number of total gastrointestinal drugs prescribed (mean 1.284-1.152, standard deviation 0.586-0.424 respectively). Evaluation of the 20 year follow-up data allowed association rule mining to be applied and the top 10 rules were identified. Conclusions: There was a statistically significant difference in prescription patterns during the study period. In particular, the total number of drugs increased significantly in 2020 when compared to 2001. A limitation of the studies is that only drugs associated with CV and GI diseases were evaluated, and further studies on all systems are needed. Researchers and clinicians need to better understand drug prescribing patterns overall in patients with multiple long-term conditions to develop strategies to overcome the possible adverse consequences of polypharmacy.30 0