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7. Russell Cherry

Author

Chudley, Sylvia and Parle, Jim

Published
2012

10. Association of Thyroid Dysfunction With Cognitive Function : An Individual Participant Data Analysis

Author

UCL - SSS/IRSS - Institut de recherche santé et société, van Vliet, Nicolien A., van Heemst, Diana, Almeida, Osvaldo P., Åsvold, Bjørn O., Aubert, Carole E., Bae, Jong Bin, Barnes, Linda E., Bauer, Douglas C., Blauw, Gerard J., Brayne, Carol, Cappola, Anne R., Ceresini, Graziano, Comijs, Hannie C., Dartigues, Jean-Francois, Degryse, Jean-Marie, Dullaart, Robin P. F., van Eersel, Marlise E. A., den Elzen, Wendy P. J., Ferrucci, Luigi, Fink, Howard A., Flicker, Leon, Grabe, Hans J., Han, Ji Won, Helmer, Catherine, Huisman, Martijn, Ikram, M. Arfan, Imaizumi, Misa, de Jongh, Renate T., Jukema, J. Wouter, Kim, Ki Woong, Kuller, Lewis H., Lopez, Oscar L., Mooijaart, Simon P., Moon, Jae Hoon, Moutzouri, Elisavet, Nauck, Matthias, Parle, Jim, Peeters, Robin P., Samuels, Mary H., Schmidt, Carsten O., Schminke, Ulf, Slagboom, P. Eline, Stordal, Eystein, Vaes, Bert, Völzke, Henry, Westendorp, Rudi G. J., Yamada, Michiko, Yeap, Bu B., Rodondi, Nicolas, Gussekloo, Jacobijn, Trompet, Stella, UCL - SSS/IRSS - Institut de recherche santé et société, van Vliet, Nicolien A., van Heemst, Diana, Almeida, Osvaldo P., Åsvold, Bjørn O., Aubert, Carole E., Bae, Jong Bin, Barnes, Linda E., Bauer, Douglas C., Blauw, Gerard J., Brayne, Carol, Cappola, Anne R., Ceresini, Graziano, Comijs, Hannie C., Dartigues, Jean-Francois, Degryse, Jean-Marie, Dullaart, Robin P. F., van Eersel, Marlise E. A., den Elzen, Wendy P. J., Ferrucci, Luigi, Fink, Howard A., Flicker, Leon, Grabe, Hans J., Han, Ji Won, Helmer, Catherine, Huisman, Martijn, Ikram, M. Arfan, Imaizumi, Misa, de Jongh, Renate T., Jukema, J. Wouter, Kim, Ki Woong, Kuller, Lewis H., Lopez, Oscar L., Mooijaart, Simon P., Moon, Jae Hoon, Moutzouri, Elisavet, Nauck, Matthias, Parle, Jim, Peeters, Robin P., Samuels, Mary H., Schmidt, Carsten O., Schminke, Ulf, Slagboom, P. Eline, Stordal, Eystein, Vaes, Bert, Völzke, Henry, Westendorp, Rudi G. J., Yamada, Michiko, Yeap, Bu B., Rodondi, Nicolas, Gussekloo, Jacobijn, and Trompet, Stella

Abstract

IMPORTANCE In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. OBJECTIVE To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. DESIGN, SETTING, AND PARTICIPANTS This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021. EXPOSURES Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. MAIN OUTCOMES AND MEASURES The primary outcomewas global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. RESULTS Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at basel

Published
2021

11. Association of Thyroid Dysfunction With Cognitive Function An Individual Participant Data Analysis

Author

van Vliet, Nicolien A., van Heemst, Diana, Almeida, Osvaldo P., Asvold, Bjorn O., Aubert, Carole E., Bin Bae, Jong, Barnes, Linda E., Bauer, Douglas C., Blauw, Gerard J., Brayne, Carol, Cappola, Anne R., Ceresini, Graziano, Comijs, Hannie C., Dartigues, Jean-Francois, Degryse, Jean-Marie, Dullaart, Robin P. F., van Eersel, Marlise E. A., den Elzen, Wendy P. J., Ferrucci, Luigi, Fink, Howard A., Flicker, Leon, Grabe, Hans J., Han, Ji Won, Helmer, Catherine, Huisman, Martijn, Ikram, M. Arfan, Imaizumi, Misa, de Jongh, Renate T., Jukema, J. Wouter, Kim, Ki Woong, Kuller, Lewis H., Lopez, Oscar L., Mooijaart, Simon P., Moon, Jae Hoon, Moutzouri, Elisavet, Nauck, Matthias, Parle, Jim, Peeters, Robin P., Samuels, Mary H., Schmidt, Carsten O., Schminke, Ulf, Slagboom, P. Eline, Stordal, Eystein, Vaes, Bert, Volzke, Henry, Westendorp, Rudi G. J., Yamada, Michiko, Yeap, Bu B., Rodondi, Nicolas, Gussekloo, Jacobijn, van Vliet, Nicolien A., van Heemst, Diana, Almeida, Osvaldo P., Asvold, Bjorn O., Aubert, Carole E., Bin Bae, Jong, Barnes, Linda E., Bauer, Douglas C., Blauw, Gerard J., Brayne, Carol, Cappola, Anne R., Ceresini, Graziano, Comijs, Hannie C., Dartigues, Jean-Francois, Degryse, Jean-Marie, Dullaart, Robin P. F., van Eersel, Marlise E. A., den Elzen, Wendy P. J., Ferrucci, Luigi, Fink, Howard A., Flicker, Leon, Grabe, Hans J., Han, Ji Won, Helmer, Catherine, Huisman, Martijn, Ikram, M. Arfan, Imaizumi, Misa, de Jongh, Renate T., Jukema, J. Wouter, Kim, Ki Woong, Kuller, Lewis H., Lopez, Oscar L., Mooijaart, Simon P., Moon, Jae Hoon, Moutzouri, Elisavet, Nauck, Matthias, Parle, Jim, Peeters, Robin P., Samuels, Mary H., Schmidt, Carsten O., Schminke, Ulf, Slagboom, P. Eline, Stordal, Eystein, Vaes, Bert, Volzke, Henry, Westendorp, Rudi G. J., Yamada, Michiko, Yeap, Bu B., Rodondi, Nicolas, and Gussekloo, Jacobijn

Abstract

IMPORTANCE In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings.OBJECTIVE To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia.DESIGN, SETTING, AND PARTICIPANTS This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021.EXPOSURES Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values.MAIN OUTCOMES AND MEASURES The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated.RESULTS Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The

Published
2021

12. Association of Thyroid Dysfunction with Cognitive Function:An Individual Participant Data Analysis

Author

Van Vliet, Nicolien A., Van Heemst, Diana, Almeida, Osvaldo P., Åsvold, Bjørn O., Aubert, Carole E., Bae, Jong Bin, Barnes, Linda E., Bauer, Douglas C., Blauw, Gerard J., Brayne, Carol, Cappola, Anne R., Ceresini, Graziano, Comijs, Hannie C., Dartigues, Jean Francois, Degryse, Jean Marie, Dullaart, Robin P.F., Van Eersel, Marlise E.A., Den Elzen, Wendy P.J., Ferrucci, Luigi, Fink, Howard A., Flicker, Leon, Grabe, Hans J., Han, Ji Won, Helmer, Catherine, Huisman, Martijn, Ikram, M. Arfan, Imaizumi, Misa, De Jongh, Renate T., Jukema, J. Wouter, Kim, Ki Woong, Kuller, Lewis H., Lopez, Oscar L., Mooijaart, Simon P., Moon, Jae Hoon, Moutzouri, Elisavet, Nauck, Matthias, Parle, Jim, Peeters, Robin P., Samuels, Mary H., Schmidt, Carsten O., Schminke, Ulf, Slagboom, P. Eline, Stordal, Eystein, Vaes, Bert, Völzke, Henry, Westendorp, Rudi G.J., Yamada, Michiko, Yeap, Bu B., Rodondi, Nicolas, Gussekloo, Jacobijn, Trompet, Stella, Van Vliet, Nicolien A., Van Heemst, Diana, Almeida, Osvaldo P., Åsvold, Bjørn O., Aubert, Carole E., Bae, Jong Bin, Barnes, Linda E., Bauer, Douglas C., Blauw, Gerard J., Brayne, Carol, Cappola, Anne R., Ceresini, Graziano, Comijs, Hannie C., Dartigues, Jean Francois, Degryse, Jean Marie, Dullaart, Robin P.F., Van Eersel, Marlise E.A., Den Elzen, Wendy P.J., Ferrucci, Luigi, Fink, Howard A., Flicker, Leon, Grabe, Hans J., Han, Ji Won, Helmer, Catherine, Huisman, Martijn, Ikram, M. Arfan, Imaizumi, Misa, De Jongh, Renate T., Jukema, J. Wouter, Kim, Ki Woong, Kuller, Lewis H., Lopez, Oscar L., Mooijaart, Simon P., Moon, Jae Hoon, Moutzouri, Elisavet, Nauck, Matthias, Parle, Jim, Peeters, Robin P., Samuels, Mary H., Schmidt, Carsten O., Schminke, Ulf, Slagboom, P. Eline, Stordal, Eystein, Vaes, Bert, Völzke, Henry, Westendorp, Rudi G.J., Yamada, Michiko, Yeap, Bu B., Rodondi, Nicolas, Gussekloo, Jacobijn, and Trompet, Stella

Abstract

Importance: In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. Objective: To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. Design, Setting, and Participants: This multicohort individual participant data analysis assessed 114267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44573 controls. Data analysis was performed from December 2016 to January 2021. Exposures: Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. Main Outcomes and Measures: The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. Results: Among 74565 total participants, 66567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at b

Published
2021

13. Comparing physician associates and foundation year two doctors in training undertaking emergency medicine consultations in England : a mixed methods study of processes and outcomes

Author

Halter, Mary, Drennan, Vari, Wang, Chao, Wheeler, Carly, Gage, Heather, Nice, Laura, de Lusignan, Simon, Gabe, Jonathan, Brearley, Sally, Ennis, James, Begg, Philip, and Parle, Jim

Subjects
alliedhealth
Abstract

To compare the contribution of physician associates to the processes and outcomes of emergency medicine consultations with that of foundation year two doctors-in-training. Mixed-methods study: retrospective chart review using 4 months' anonymised clinical record data of all patients seen by physician associates or foundation year two doctors-in-training in 2016; review of a subsample of 40 records for clinical adequacy; semi-structured interviews with staff and patients; observations of physician associates. Three emergency departments in England. The records of 8816 patients attended by 6 physician associates and 40 foundation year two doctors-in-training; of these n=3197 had the primary outcome recorded (n=1129 physician associates, n=2068 doctor); 14 clinicians and managers and 6 patients or relatives for interview; 5 physician associates for observation. The primary outcome was unplanned re-attendance at the same emergency department within 7 days. consultation processes, clinical adequacy of care, and staff and patient experience. Re-attendances within 7 days (n=194 (6.1%)) showed no difference between physician associates and foundation year two doctors-in-training (OR 0.87, 95% CI 0.61 to 1.24, p=0.437). If seen by a physician associate, patients were more likely receive an X-ray investigation (OR 2.10, 95% CI 1.72 to 4.24), p

Published
2020

15. Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes

Author

Halter, Mary, primary, Drennan, Vari, additional, Wang, Chao, additional, Wheeler, Carly, additional, Gage, Heather, additional, Nice, Laura, additional, de Lusignan, Simon, additional, Gabe, Jonathan, additional, Brearley, Sally, additional, Ennis, James, additional, Begg, Phil, additional, and Parle, Jim, additional

Published
2020
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22. Response to: Is there such a thing as a fair OSCE?

Author

Ghouri, Asim, primary, Boachie, Charles, additional, McDowall, Suzanne, additional, Parle, Jim, additional, Ditchfield, Carol A., additional, McConnachie, Alex, additional, Walters, Matthew R., additional, and Ghouri, Nazim, additional

Published
2018
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27. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial

Author

Shepstone, Lee, primary, Lenaghan, Elizabeth, additional, Cooper, Cyrus, additional, Clarke, Shane, additional, Fong-Soe-Khioe, Rebekah, additional, Fordham, Richard, additional, Gittoes, Neil, additional, Harvey, Ian, additional, Harvey, Nick, additional, Heawood, Alison, additional, Holland, Richard, additional, Howe, Amanda, additional, Kanis, John, additional, Marshall, Tarnya, additional, O'Neill, Terence, additional, Peters, Tim, additional, Redmond, Niamh, additional, Torgerson, David, additional, Turner, David, additional, McCloskey, Eugene, additional, Shepstone, Lee, additional, Fordham, Ric, additional, Crabtree, Nicola, additional, Duffy, Helen, additional, Parle, Jim, additional, Rashid, Farzana, additional, Stant, Katie, additional, Taylor, Kate, additional, Thomas, Clare, additional, Knox, Emma, additional, Tenneson, Cherry, additional, Williams, Helen, additional, Adams, David, additional, Bion, Veronica, additional, Blacklock, Jeanette, additional, Dyer, Tony, additional, Bratherton, Selina, additional, Fidler, Matt, additional, Knight, Katharine, additional, McGurk, Carol, additional, Smith, Katie, additional, Young, Stacey, additional, Collins, Karen, additional, Cushnaghan, Janet, additional, Arundel, Catherine, additional, Bell, Kerry, additional, Clark, Laura, additional, Collins, Sue, additional, Gardner, Sarah, additional, and Mitchell, Natasha, additional

Published
2018
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29. The medical care practitioner: Developing a physician assistant equivalent for the United Kingdom

Author

Parle, Jim V., Doe, William F., and Ross, Nick M.

Subjects
Medicine -- Practice, Medicine -- Social aspects, Medical care -- Quality management, Health
Abstract

Changes in demographic, social and work patterns are creating a crisis in the provision of clinical care in the UK, necessitating the development of registered health care professionals, called medical care practitioners (MCPs), based on the physician assistant model of the US. The introduction of MCPs is expected to provide increasing medical capacity without affecting quality in frontline clinical services and increased flexibility and stability in the medical workforce, also enhancing service effectiveness and efficiency.

Published
2006

34. Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis

Author

van Vliet, Nicolien A, van Heemst, Diana, Almeida, Osvaldo P, Åsvold, Bjørn O, Aubert, Carole E., Bae, Jong Bin, Barnes, Linda E, Bauer, Douglas C, Blauw, Gerard J, Brayne, Carol, Cappola, Anne R, Ceresini, Graziano, Comijs, Hannie C, Dartigues, Jean-Francois, Degryse, Jean-Marie, Dullaart, Robin P F, van Eersel, Marlise E A, den Elzen, Wendy P J, Ferrucci, Luigi, Fink, Howard A, Flicker, Leon, Grabe, Hans J, Han, Ji Won, Helmer, Catherine, Huisman, Martijn, Ikram, M Arfan, Imaizumi, Misa, de Jongh, Renate T, Jukema, J Wouter, Kim, Ki Woong, Kuller, Lewis H, Lopez, Oscar L, Mooijaart, Simon P, Moon, Jae Hoon, Moutzouri, Elisavet, Nauck, Matthias, Parle, Jim, Peeters, Robin P, Samuels, Mary H, Schmidt, Carsten O, Schminke, Ulf, Slagboom, P Eline, Stordal, Eystein, Vaes, Bert, Völzke, Henry, Westendorp, Rudi G J, Yamada, Michiko, Yeap, Bu B, Rodondi, Nicolas, Gussekloo, Jacobijn, and Trompet, Stella

Subjects
endocrine system, endocrine system diseases, 610 Medicine & health, 360 Social problems & social services, 3. Good health
Abstract

Importance In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. Objective To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. Design, Setting, and Participants This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021. Exposures Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. Main Outcomes and Measures The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. Results Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at baseline varied from 57 to 93 years; 42 847 (57.5%) participants were women. Thyroid dysfunction was not associated with global cognitive function; the largest differences were observed between overt hypothyroidism and euthyroidism-cross-sectionally (-0.06 standardized mean difference in score; 95% CI, -0.20 to 0.08; P = .40) and longitudinally (0.11 standardized mean difference higher decline per year; 95% CI, -0.01 to 0.23; P = .09). No consistent associations were observed between thyroid dysfunction and executive function, memory, or risk of dementia. Conclusions and Relevance In this individual participant data analysis of more than 74 000 adults, subclinical hypothyroidism and hyperthyroidism were not associated with cognitive function, cognitive decline, or incident dementia. No rigorous conclusions can be drawn regarding the role of overt thyroid dysfunction in risk of dementia. These findings do not support the practice of screening for subclinical thyroid dysfunction in the context of cognitive decline in older adults as recommended in current guidelines.

35. OBITUARIES.

Author

Davies, Peter, Elliott, Peter, McBride, William, Bill, Moyna, West, Andrew, Chudley, Sylvia, Parle, Jim, Vogt, Stephen, Naftalin, Nicholas J., Naftalin, Alan A., Blake, Heidi, Watson, Alex, and Ramsay, Anne

Subjects
PHYSICIANS
Abstract

The article presents obituaries for psychiatrist Pieter Van Boxel, general practitioner Leslie Naftalin and bacteriologist John Michael Talbot.

Published
2012

36. Investigating beneficial drug reactions.

Author

Parle, Jim, Ross, Nick, and Jones, June

Subjects
*DRUG therapy, *DRUGS, *PHYSICIAN-patient relations, *PATIENT participation
Abstract

The article offers information on the investigation of the beneficial drug reactions. It states the three approaches to generate and test hypotheses on the beneficial drug reactions such as the serendipitous data reporting, the identification for the biological or pharmacological plausibility, and the routine data mining. Moreover, the chance to determine beneficial drug reactions are unappreciated and further investigation is must.

Published
2012

37. Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis.

Author

van Vliet NA, van Heemst D, Almeida OP, Åsvold BO, Aubert CE, Bae JB, Barnes LE, Bauer DC, Blauw GJ, Brayne C, Cappola AR, Ceresini G, Comijs HC, Dartigues JF, Degryse JM, Dullaart RPF, van Eersel MEA, den Elzen WPJ, Ferrucci L, Fink HA, Flicker L, Grabe HJ, Han JW, Helmer C, Huisman M, Ikram MA, Imaizumi M, de Jongh RT, Jukema JW, Kim KW, Kuller LH, Lopez OL, Mooijaart SP, Moon JH, Moutzouri E, Nauck M, Parle J, Peeters RP, Samuels MH, Schmidt CO, Schminke U, Slagboom PE, Stordal E, Vaes B, Völzke H, Westendorp RGJ, Yamada M, Yeap BB, Rodondi N, Gussekloo J, and Trompet S

Subjects
Aged, Cognition physiology, Correlation of Data, Data Analysis, Female, Humans, Male, Mental Status and Dementia Tests statistics & numerical data, Risk Assessment methods, Risk Assessment statistics & numerical data, Thyroid Gland physiopathology, Thyrotropin analysis, Thyroxine analysis, Cognitive Dysfunction diagnosis, Cognitive Dysfunction physiopathology, Hyperthyroidism blood, Hyperthyroidism diagnosis, Hyperthyroidism psychology, Hypothyroidism blood, Hypothyroidism diagnosis, Hypothyroidism psychology, Thyroid Function Tests methods, Thyroid Function Tests statistics & numerical data
Abstract

Importance: In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings., Objective: To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia., Design, Setting, and Participants: This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021., Exposures: Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values., Main Outcomes and Measures: The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated., Results: Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at baseline varied from 57 to 93 years; 42 847 (57.5%) participants were women. Thyroid dysfunction was not associated with global cognitive function; the largest differences were observed between overt hypothyroidism and euthyroidism-cross-sectionally (-0.06 standardized mean difference in score; 95% CI, -0.20 to 0.08; P = .40) and longitudinally (0.11 standardized mean difference higher decline per year; 95% CI, -0.01 to 0.23; P = .09). No consistent associations were observed between thyroid dysfunction and executive function, memory, or risk of dementia., Conclusions and Relevance: In this individual participant data analysis of more than 74 000 adults, subclinical hypothyroidism and hyperthyroidism were not associated with cognitive function, cognitive decline, or incident dementia. No rigorous conclusions can be drawn regarding the role of overt thyroid dysfunction in risk of dementia. These findings do not support the practice of screening for subclinical thyroid dysfunction in the context of cognitive decline in older adults as recommended in current guidelines.

Published
2021
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38. The role of physician associates in secondary care: the PA-SCER mixed-methods study

Author

Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, Gabe J, Gage H, Levenson R, de Lusignan S, Begg P, and Parle J

Abstract

Background: Increasing demand for hospital services and staff shortages has led NHS organisations to review workforce configurations. One solution has been to employ physician associates (PAs). PAs are trained over 2 years at postgraduate level to work to a supervising doctor. Little is currently known about the roles and impact of PAs working in hospitals in England., Objectives: (1) To investigate the factors influencing the adoption and deployment of PAs within medical and surgical teams in secondary care and (2) to explore the contribution of PAs, including their impact on patient experiences, organisation of services, working practices, professional relationships and service costs, in acute hospital care., Methods: This was a mixed-methods, multiphase study. It comprised a systematic review, a policy review, national surveys of medical directors and PAs, case studies within six hospitals utilising PAs in England and a pragmatic retrospective record review of patients in emergency departments (EDs) attended by PAs and Foundation Year 2 (FY2) doctors., Results: The surveys found that a small but growing number of hospitals employed PAs. From the case study element, it was found that medical and surgical teams mainly used PAs to provide continuity to the inpatient wards. Their continuous presence contributed to smoothing patient flow, accessibility for patients and nurses in communicating with doctors and releasing doctors’ (of all grades) time for more complex patients and for attending to patients in clinic and theatre settings. PAs undertook significant amounts of ward-based clinical administration related to patients’ care. The lack of authority to prescribe or order ionising radiation restricted the extent to which PAs assisted with the doctors’ workloads, although the extent of limitation varied between teams. A few consultants in high-dependency specialties considered that junior doctors fitted their team better. PAs were reported to be safe, as was also identified from the review of ED patient records. A comparison of a random sample of patient records in the ED found no difference in the rate of unplanned return for the same problem between those seen by PAs and those seen by FY2 doctors (odds ratio 1.33, 95% confidence interval 0.69 to 2.57; p  = 0.40). In the ED, PAs were also valued for the continuity they brought and, as elsewhere, their input in inducting doctors in training into local clinical and hospital processes. Patients were positive about the care PAs provided, although they were not able to identify what or who a PA was; they simply saw them as part of the medical or surgical team looking after them. Although the inclusion of PAs was thought to reduce the need for more expensive locum junior doctors, the use of PAs was primarily discussed in terms of their contribution to patient safety and patient experience in contrast to utilising temporary staff., Limitations: PAs work within medical and surgical teams, such that their specific impact cannot be distinguished from that of the whole team., Conclusions: PAs can provide a flexible advanced clinical practitioner addition to the secondary care workforce without drawing from existing professions. However, their utility in the hospital setting is unlikely to be fully realised without the appropriate level of regulation and attendant authority to prescribe medicines and order ionising radiation within their scope of practice., Future Research: Comparative investigation is required of patient experience, outcomes and service costs in single, secondary care specialties with and without PAs and in comparison with other types of advanced clinical practitioners., Study Registration: The systematic review component of this study is registered as PROSPERO CRD42016032895., Funding: The National Institute for Health Research Health Services and Delivery Research programme., (Copyright © Queen’s Printer and Controller of HMSO 2019. This work was produced by Drennan et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.)

Published
2019
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