These curves show the intervention had high (90%) probability of being cost effective at willingness to pay above £20 per unit reduction. (Credit: David M. Benett/WireImage/20th Century Studios) In one of the most famous near-misses in the history of blockbuster cinema, Dougray Scott was all set to take on the role of adamantium-clawed mutant Wolverine in the 2000 movie X-Men.Russell Crowe had already said no and suggested his then â¦ The next step is an implementation strategy to realise such benefits for the whole population. Trump spends his first weekend as ex-president playing golf at his West Palm Beach club... Scar-free stitch in the stomach could help patients shed up to FIVE stone in six months - and cut their risk... Post-Brexit hiccups 'will add £1.50 to a bottle of fine wine', Labour peer Baroness Helena Kennedy 'asked Julian Assange's alleged victims to drop rape charges', New BBC Three documentary 'DIY Trans Teens' reveals how children can buy sex-change drugs. Mean (standard deviation) blood pressure at baseline, six months, and 12 months using second and third measurements, and adjusted difference. British National Formulary. Anonymised trial data from HOME BP are available on reasonable request from the corresponding author. pmid: 29739782 JR, EM, CRM, SM, FSM, PS, and BW provided senior expertise and leadership, contributing to designing the study, securing funding and supervising the conduct of the study. The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Dennison L, Bradbury K, et al. However, to properly assess this impact on cost effectiveness in the longer term, additional modelling that takes into account these effects with extrapolation to a longer time horizon is needed, and we are in the process of such work. Results After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). 2018. Curtis LB, A. RJM was funded by an NIHR Research Professorship 2013-18 (NIHR-RP-R2-12-015) and is now an NIHR senior investigator. Additional outcomes that will be published elsewhere included long term economic modelling and a detailed process evaluation. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. A further 33 did not complete baseline measures and randomisation, which left 622 people who were randomised to the HOME BP intervention or usual care (305 and 317, respectively; proportions are in line with the minimisation algorithm). Dissemination to participants and related patient and public communities: A lay summary of the results of the study will be shared with participating patients and their practices. All authors commented on drafts of this paper. The 18-year-old raps to a â¦ After randomisation, all patients received a blood pressure drug review from a general practitioner or nurse prescriber (prescribers). Patient and public contributors were involved from the outline application stage (Samantha Hall and Mark Stafford-Watson). Except for an increase in sample size as documented above, no other substantive changes were made to the protocol after the start of the trial. Godzilla Vs. Kong trailer offers epic amounts of action as the monsters go head-to-head in a fresh reimagining. What is an appropriate level of evidence for a digital health intervention? However, less than one third of participants chose to register on one of the optional lifestyle change modules. The comments below have not been moderated. Participants were advised, with automated email reminders, to take two morning blood pressure readings for seven days each month and to enter online each second reading (following methods used in the TASMINH2 and TASMIN-SR studies).2122 Mean home blood pressure was then calculated and feedback provided to the participants and the healthcare practitioners by using a traffic light system (developed from the system used in previous drug titration procedures).2122 When mean home blood pressure was above target for two consecutive months, the prescriber was asked by email to implement the preplanned drug change. A digital intervention enabling self-management of hypertension, including self-monitoring, titration based on self-monitored blood pressure, lifestyle advice, and behavioural support for patients and healthcare professionals, resulted in a worthwhile reduction of systolic blood pressure achieved at modest cost. Minimisation factors were participants’ baseline systolic blood pressure, age, diabetes status, and practice. On December 1, 1955, Parks, a seamstressâ¦ Figure A1 shows the results of bootstrapping the incremental cost and blood pressure gains, which are summarised in the cost effectiveness acceptability curves (fig A2). Self-reported adherence in both groups was high throughout (Medication Adherence Rating Scale questionnaire27: median baseline 24, maximum possible 25, interquartile range 23-25; at 12 months: 24, interquartile range 23-25 in the control group, and 24, interquartile range 24-25 in the intervention group; P=0.97 for the difference). Results were comparable in the complete case analysis and adverse effects were similar between groups. By Sam Joseph Semon For Dailymail.com. The reduction was achieved through increased titration of antihypertensive drugs with no increase in adverse effects, suggesting that the HOME BP digital intervention reduces clinical inertia and leads to optimisation of treatment. 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. Data sharing: The HOME BP trial is a member of the BP SMART consortium of randomised controlled trials of self-monitoring in hypertension and data will be included in future meta-analyses. The patient enablement score showed a reduction over time (that is, increased enablement) in the self-management group. Patient enablement in usual care and intervention groups. This information comprised definitions of hypertension, causes, and brief guidance on treatment, including lifestyle changes and drugs. More than 500 of the DVLA's 6,000 workers in Swansea have caught coronavirus since March - as workers accuse... Britain's coronavirus cases fall again amid 'scaremongering' row: Scientists play down more deadly variant... People who have received first Covid-19 jab must stay at home for THREE WEEKS, says Jonathan Van-Tam as... Diary of a paramedic: We're now rushing a lot of younger patients into hospital and a father, 45, and... What it's like helping Britain to jab its way to freedom: DR ELLIE CANNON tells how vaccine is bring joy to... Britain delivers a record 480,000 Covid-19 vaccines in a day - putting it on track to hit 15m first doses... Kate Moss jets into curfew-hit Paris for birthday weekend at £2,500-per-night Ritz with her boyfriend... Porton Down scientists are 'confident' that all mutant strains of coronavirus can be beaten with vaccines. Please note: your email address is provided to the journal, which may use this information for marketing purposes. This research would not have been possible without the support and encouragement of all patients and practice staff from the 76 participating practices. Sensitivity analyses used complete cases and also a repeated measures technique. 2018 (accessed 24/01/2020). JK led trial implementation along with EO and JA, with advice from JN, and CR was the key public contributor. The main reasons for exclusion (denominator 734 in each case) were blood pressure less than 140/90 mm Hg (652, 89%), postural hypotension (31, 4%), not taking antihypertensive drugs (18, 2%), and blood pressure too high (>180/110 mm Hg; 16, 2%). We know that just under half of patients in the control group reported self-monitoring blood pressure during the trial, and that these records were used by their general practitioners in making treatment decisions; this could reduce the effect size, although self-monitoring outside of a more complex intervention such as HOME BP has similar efficacy to usual care.37 Engagement with the digital intervention was high (70% were still monitoring after nine months) and equivalent to our previous work, but the home monitoring target was not as low as that in TASMINH2 (systolic blood pressure 135 v 130 mm Hg) owing to changes in national guidance, and this might have reduced the effect size.9, The self-monitoring schedule used here was developed in our previous self-management work, but is different to that recommended in subsequent international recommendations.9103839 However, the requirement for 14 readings to be taken per week is in line with these recommendations, and recording the second of two morning readings each day was originally chosen to simplify self-monitoring because morning readings are better correlated with stroke risk.40. After 12 months, a post hoc analysis showed that 112/234 (47%) patients in the usual care group reported monitoring their own blood pressure at home at least once per month during the trial; of these, 78 (70%) said that they took their readings to their general practitioner. Number of drugs and dose changes in usual care and intervention groups. Dougray Scott was originally cast to play the role of Wolverine. The major advantage of a digital intervention is the ability to be deployed at a low marginal cost, and the within trial cost effectiveness analysis supports this assumption. Ofcom. New Zealand actor Julian Dennison, 14, to make... SNP vows to UNILATERALLY hold a second Scottish independence referendum if Sturgeon wins May election - and... We can vaccinate ALL teachers, say schools: Heads send Boris a plan for huge seven-day operation to... Disney+ blocks under-sevens from watching 'racist' Peter Pan, Dumbo and The Aristocats for breaching... We're sadder, poorer... and fatter: Mail on Sunday survey finds Britain is suffering under lockdown - but... PETER HITCHENS: So is this really an epidemic of despair? After 12 months, primary endpoint data were available from 271 (89%) participants in the intervention group and 282 (89%) in the usual care group (fig 1). Todayâs post from Eric Rhodes, intern in the National Archives History Office, highlights the National Archivesâ Native American holdings in celebration of Native American Heritage Month. Participants were not prevented from self-monitoring; data on self-monitoring practices were collected at the end of the trial from patients and practitioners. Analyses were on an intention-to-treat basis and used 100 multiple imputations by chained equations for missing data. In 2018, the youngster revealed what it was like working with Ryan during an interview on Channel Nine's Today Extra. Julian then stands in a skate park while holding a Subway sandwich in one hand. Secondary analyses used similar techniques to assess differences between groups. Surveys suggest that most general practitioners are drawing on self-monitoring in their hypertension management, and that at least one third of patients with hypertension are self-monitoring.4950 Over and above the clinical benefit from the HOME BP digital intervention, the ability to manage blood pressure remotely at scale has never been so important as during the current crisis.13 Therefore, implementation of a cost effective digital intervention that leads to lower blood pressure would now seem to be appropriate. Now lone mothers are banned from FILMING their baby scan despite maternity units already stopping partners... BBC stops Panorama team probing Martin Bashir's Diana interview having easy access to basic documents. Month study ) less deprived ) Centre information Centre information Centre ;.. 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