The OXCHECK Study: a nursing perspective. Oxford and Collaborators Health Check. Surrogate outcomes in health technology assessment: an international comparison. Patient compliance with colorectal cancer screening in general practice. A randomised controlled trial of screening for adult hearing loss during preventive health checks. Ebeltoft project: baseline data from a five-year randomized, controlled, prospective health promotion study in a Danish population. [The health project Ebeltoft: health check ups and discussions in general practice. Basic data from a 5-year, prospective, randomized, controlled population study]. Health checks and cardiovascular risk factor values over six years’ follow-up: Matched cohort study using electronic health records in England Prospective cohort study of hostility and the risk of cardiovascular disease mortality. Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adults NHS health checks through general practice: randomised trial of population cardiovascular risk reduction The MRC trial of assessment and management of older people in the community: objectives, design and interventions [ISRCTN23494848] Evaluating a mental health assessment for older people with depressive symptoms in general practice: a randomised controlled trial. Patients' experiences of health checks in general practice: a sample survey. Checking in healthcare safety: theoretical basis and practical application. Dietary Patterns and Cognitive Health in Older Adults: A Systematic Review. A simplified search strategy for identifying randomised controlled trials for systematic reviews of health care interventions: a comparison with more exhaustive strategies Nursing home team-care deprescribing study: a stepped-wedge randomised controlled trial protocol Randomised controlled trial comparing uptake of NHS Health Check in response to standard letters, risk-personalised letters and telephone invitations Predicting the uptake of health checks in general practice: invitation methods and patients' health beliefs. Use of surrogate outcomes in cost-effectiveness models: a review of United Kingdom health technology assessment reports. Improving uptake of influenza vaccination among older people: a randomised controlled trial. A randomized controlled trial to assess the psychological impact of a family history screening questionnaire in general practice. Randomised controlled trial of effect of Baby Check on use of health services in first 6 months of life
The Oxford and Collaborators Health CHECK Trial ( OXCHECK ) was a r and omized controlled trial of the effectiveness of  nurse-administered health checks in the general practice setting . It was design ed primarily to influence risk factors for cardiovascular disease and cancer . The fourth and final year has now been completed , and the data analysis on over 8,100 health checks is under way . The findings from Year I have not been very encouraging in terms of lifestyle changes in moderate risk groups . This article briefly describes the design and methodology of the project , but mainly focuses on the practical issues involved in performing the health checks and on how the nurses and patients have felt about participating in the project . Much has happened to general practice , health promotion and the economy since the inception of OXCHECK in 1988 . The OXCHECK nurses have experienced a variety of responses and attitudes from patients . These are significant insomuch as they may provide a rationale for design ing alternative methods of assessing lifestyle change and individuals ' perception of risk . The importance of providing a strong link between the academic department involved in the project and the local clinical practice s will be discussed in the context of other key facilitating roles . However , the appropriateness of promoting certain preventive measures in the general practice setting can also be question ed OBJECTIVES Our aim was to review the recommendations given by health technology assessment ( HTA ) institutions in their method ological guidelines concerning the use of surrogate outcomes in their assessment s. In a second step , we aim ed at quantifying the role surrogate parameters take in assessment reports . METHODS We analyzed method ological papers and guidelines from HTA agencies with International Network of Agencies for Health Technology Assessment membership as well as from institutions related to pharmaceutical regulation ( i.e. , reimbursement , pricing ) . We analyzed the use of surrogate outcomes in a sample of HTA reports r and omly drawn from the HTA data base . We checked methods , results ( including evidence tables ) , and conclusions sections and extracted the outcomes reported . We report descriptive statistics on the presence of surrogate outcomes in the reports . RESULTS We identified thirty-four method ological guidelines , twenty of them addressing the issue of outcome parameter choice and the problematic of surrogate outcomes . Overall HTA agencies call on caution regarding the reliance on surrogate outcomes . None of the agencies has provided a list or catalog of acceptable and vali date d surrogate outcomes . We extracted the outcome parameter of 140 HTA reports . Only around half of the reports determined the outcomes for the assessment prospect ively .  Surrogate outcomes  had been used in 62 percent of the reports . However , only 3.6 percent were based upon  surrogate outcomes  exclusively . All of them assessed diagnostic or screening technologies and the surrogate outcomes were predominantly test characteristics . CONCLUSIONS HTA institutions seem to agree on a cautious approach to the use of  surrogate outcomes  in technology assessment . Thorough assessment of health technologies should not rely exclusively on surrogate outcomes A r and omized controlled trial to test patient compliance with screening for colorectal cancer in association with general practice health checks was carried out in six practice s ( three urban and three rural ) . A total of 1588 patients aged 45 - 64 years were r and omized to one of four intervention groups . In the first group patients were posted a Haemoccult test ( Kline Beckman ) kit . This group was not invited for a health check . In the second group patients were posted the Haemoccult test kit , together with an invitation to attend for a health check . In the third group patients were posted an invitation for a health check , which explained that the patient would be offered the Haemoccult test kit by the nurse at the health check . In the fourth group patients were just invited for a health check . It was found that combining faecal occult blood testing with the health check did not reduce attendance at the health check--43.5 % of patients attended when the Haemoccult test kit was offered by the nurse at the health check , 43.6 % attended when a test kit was included with the invitation to attend the health check and 42.9 % attended when the health check invitation was posted on its own . Overall , compliance with Haemoccult testing was not significantly increased by associating it with a health check ( 26.2 % versus 25.5 % ) but compliance was higher when the faecal occult blood testing kit was enclosed with the health check invitation than when it was offered at the health check ( 31.7 % versus 20.6 % , P less than 0.001 ) . It is easier and cheaper to combine various screening procedures . Although the overall use of the Haemoccult test in the study population was low , there is no reason why the relatively higher compliance rate obtained on posting the test kit with a health check invitation can not be achieved in previously unscreened population s with higher expected compliance rates . However , faecal occult blood screening for colorectal cancer should not be undertaken on a population basis until its effectiveness in reducing mortality has been proven by r and omized trial BACKGROUND Prophylactic strategies to counter acquired hearing impairment may involve routine audiometric screening of asymptomatic working-age adults attending general practice for regular health checks . AIM To evaluate the effect of adult hearing screening on subsequent noise exposure and hearing . DESIGN OF STUDY A r and omised controlled population -based study of health checks and health discussion s in general practice . SETTING The project was initiated in the district of Ebeltoft , Aarhus county , Denmark . METHOD Intervention group participants '  hearing thresholds were determined audiometrically at 0.5 , 1 , 2 , 3 , and 4 kHz in each ear . Participants were advised to get their ears checked if the average hearing loss exceeded 20 dB hearing level ( dBHL ) in either ear . Noise avoidance was emphasised when thresholds exceeded 25 dBHL bilaterally at 4 kHz . Follow-up included question naires and audiometry . RESULTS Hearing loss was observed among 18.9 % of the study sample at baseline . At the five-year follow-up we recorded no significant differences between the control and the intervention groups regarding subjective or objective hearing , or exposure to occupational noise . However , there was a tendency towards reduction in exposure to leisure noise among intervention participants ( P = 0.045 ) . Approximately 20 % reported hearing problems ; 16.5 % reported tinnitus-related complaints ; 0.8 % used hearing aids ; 35.0 % reported frequent noise exposure ; and occluding wax was suspected in 2.1 % . CONCLUSION Preventive health checks with audiometry did not significantly affect hearing , but leisure noise exposure tended to become less frequent . The poor effect may be ascribed to inadequate audiological counselling or a higher priority to other advice , e.g. on cardiovascular risk or lifestyle BACKGROUND There is increasing political pressure on the medical profession to approach welfare diseases , such as coronary heart disease and diabetes , through prevention . General practitioners are required to offer regular health checks to healthy people  , in spite of the lack of scientific evidence for the universal need , usefulness and side effects of such an intervention . R and omized controlled trials are needed . AIM A study was carried out to investigate people 's interest in participating in health checks and in discussion s about health with their own general practitioner , participants ' health status , the proportion who received health advice following health checks , and the lifestyle goals they set following discussion with their general practitioner . This study reports the baseline data from a five-year r and omized , controlled , prospect i ve , population -based study in general practice s in Ebeltoft , Denmark . METHOD All general practitioners from the four practice s in Ebeltoft and a r and om sample of 2000 people aged between 30 and 50 years were invited to participate . Participants were r and omly divided into three groups -- one control group and two intervention groups . One intervention group were given a health check which included being screened for cardiovascular risk factors , lung and liver function , fitness , sight and hearing and an optional test for the human immunodeficiency virus ( HIV ) ; this group received written feedback from the general practitioner . The other intervention group were also given a health check and written feedback ; in addition , they were given the opportunity to attend their general practitioner to discuss preventive health . RESULTS A total of 1370 people participated in the study ( 69 % response rate ) . Health advice was given to 76 % of 905 participants following health checks . Almost all of the 456 participants ( 96 % ) who were offered the opportunity of discussing their health with their general practitioner took up the offer ; 64 % of the 456 participants reported that they had decided to undertake lifestyle changes . Eleven of those who discussed their health with the doctor were referred to a specialist ( 2 % ) . CONCLUSION There was considerable interest in participating in health promotion . Three out of four of those having a health check were given health advice . Two out of three of those offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes . Long-term follow up is needed to determine effects and side effects of health checks and health talks A study was carried out to investigate people 's interest in participating in health check-up and in discussion s about health with their own general practitioner , participants ' health status , the proportion who received health advice following health check-up , and the lifestyle goals they set following discussion with their general practitioner . This study reports the baseline data from a five-year r and omized , controlled , prospect i ve , population -based study in general practice s in Ebeltoft , Denmark . All general practitioners from the four practice s in Ebeltoft and a r and om sample of 2,000 people aged between 30 and 50 years were invited to participate . Participants were r and omly divided into three groups-one control group and two intervention groups . One intervention group was given a health check-up which included a range og tests ( Table 2 and 3 ) ; this group received written feedback from the general practitioner . The other intervention group was also given a health check-up and written feedback , in addition , they were given the opportunity to attend their general practitioner to discuss health-promoting measures .  A total of 1370 people participated in the study ( 69 % response rate ) . Health advice was given to 76 % of 905 participants following health check-up . Almost all of the 456 participants ( 96 % ) who were offered the opportunity of discussing their health with their general practitioner took up the offer : 64 % of the 456 participants reported that they had decided to undertake lifestyle changes . Eleven of those who discussed their health with the doctor were referred to a specialist ( 2 % ) . There was considerable interest in participating in health promotion . Three out of four of those who had a health check-up were given health advice . Two out of three of those who were offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes . Longterm follow up is needed to determine effects and side effects of health check-up and health talks Background The National Health Service ( NHS ) in Engl and introduced a population -wide programme for cardiovascular disease ( CVD ) prevention in 2009 , known as NHS Health Checks . This research aim ed to measure the cardiovascular risk management and cardiovascular risk factor outcomes of the health check programme during six years ’ follow-up . Methods and findings A controlled interrupted time series study was conducted . Participants were registered with general practice s in the Clinical Practice Research Data link ( CPRD ) in Engl and and received health checks between 1 April 2010 and 31 December 2013 . Control participants , who did not receive a health check  , were matched for age , sex , and general practice . Outcomes were blood pressure , body mass index ( BMI ) , smoking , and total cholesterol ( TC ) and high-density lipoprotein cholesterol ( HDL ) . Analyses estimated the net effect of health check by year , allowing for the underlying trend in risk factor values and baseline differences between cases and controls , adjusting for age , sex , deprivation , and clustering by general practice . There were 127,891 health check participants and 322,910 matched controls . Compared with controls , health check participants had lower BMI ( cases mean 27.0 , SD 4.8 ; controls 27.3 , SD 5.6 , Kg/m2 ) , systolic blood pressure ( SBP ) ( cases 129.0 , SD 14.3 ; controls 129.3 , SD 15.0 , mm Hg ) , and smoking ( 21 % in health check participants versus 27 % in controls ) , but total and HDL cholesterol were similar . Health check participants were more likely to receive weight management advice ( adjusted hazard ratio [ HR ] 5.03 , 4.98 to 5.08 , P < 0.001 ) , smoking cessation interventions ( HR 3.20 , 3.13 to 3.27 , P < 0.001 ) , or statins ( HR 1.24 , 1.21 to 1.27 , P < 0.001 ) . There were net reductions in risk factor values up to six years after the check for BMI ( −0.30 , −0.39 to −0.20 Kg/m2 , P < 0.001 ) , SBP ( −1.43 , −1.70 to −1.16 mm Hg , P < 0.001 ) , and smoking ( 17 % in health check participants versus 25 % in controls ; odds ratio 0.90 , 0.87 to 0.94 , P < 0.001 ) . The main study limitation was that residual confounding may be present because r and omisation was not employed ; health check – associated measurement introduced differential recording that might cause bias . Conclusions Our results suggest that people who take up a health check generally have lower risk factor values than controls and are more likely to receive risk factor interventions .  Risk factor values show net reductions up to six years following a health check in BMI , blood pressure , and smoking , which may be of public health importance BACKGROUND Recent literature review s have question ed hostility as a risk factor for heart disease . However , controversy persists due to the rarity of large-scale prospect i ve cohort studies of initially healthy population s. METHODS We prospect ively investigated the association between hostility and  cardiovascular ( and all-cause ) mortality among 20,550 men and women , 41 - 80 years of age , participating in the European Prospect i ve Investigation into Cancer and Nutrition in Norfolk ( EPIC-Norfolk ) , United Kingdom study . Participants were recruited by post from general practice age-sex registers and subsequently attended health checks that included the assessment of coronary disease risk factors . Hostility assessment  was completed by postal question naire . RESULTS During mean follow-up of 6 years , 1284 deaths were recorded including 481 from cardiovascular disease ( CVD ) . Hostility was not associated with CVD mortality , after adjustment for age and prevalent disease , in either men ( rate ratio for a 1 SD decrease in hostility score , representing increased hostility , 1.09 ; 95 % confidence interval 0.98 - 1.22 ) or in women ( rate ratio 1.00 ; 95 % confidence interval 0.86 - 1.26 ) . Subgroup analysis suggested hostility may be associated with CVD mortality ( independent of age , prevalent disease and cigarette smoking ) for participants reporting very high hostility and for those aged less than 60 years . CONCLUSIONS Hostility was not associated with an increased risk of cardiovascular mortality in this population study of older adults Background Cardiovascular disease is the leading cause of death for adults in Australia . In recent years there has been a shift in health service delivery from institutional to community‐based care for chronic conditions , including cardiovascular disease . The general practice setting is seen to offer greater flexibility , higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector . It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management . To date , significant descriptive research has been conducted exploring the demographics , roles , educational needs and issues facing practice nurses . However , there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes , clinician satisfaction and cost‐effectiveness . Objectives This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults , as well as those with established cardiovascular disease or known cardiac risk factors . Search Strategy A systematic literature search was performed using Medline ( 1966 ‐ 2005 ) , CINAHL ( 1982 −2005 ) , Cochrane Controlled Trials Register ( Issue 4 , 2005 ) and the Joanna Briggs Institute Evidence Library . In addition , the reference lists of retrieved papers , conference proceedings and the Internet , were scrutinised for additional trials . Selection Criteria This review considered any English language r and omised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors . Interventions conducted by specialist cardiac nurses in general practice were excluded . Outcomes measured included blood pressure , smoking cessation , total cholesterol , exercise , body weight/body mass index and cost‐effectiveness . Results Eighteen trials , reported in 33 papers , were included in the review . Ten trials investigated multifaceted interventions , while the remaining eight trials reported targeted interventions . Of the trials that reported multifaceted interventions , three trials investigated risk reduction in those with established cardiovascular disease , four trials focused on those with known cardiovascular disease risk factors and three trials included the general community . The eight trials which examined the efficacy of targeted interventions focused upon dietary intake ( two trials ) , smoking cessation ( three trials ) , weight reduction ( one trial ) and physical activity ( two trials ) . The effect of both the multifaceted and targeted interventions on patient outcomes was variable . However , both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables . Improvements were demonstrated by most studies in blood pressure , cholesterol level , dietary intake and physical activity . The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions . Conclusions While interventions to reduce cardiovascular disease risk factors have produced variable results , they offer significant potential to assist patients in modifying their personal risk profile and should be developed . The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals . Further well‐ design ed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost‐effectiveness Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century . The Department of Health in Engl and has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk . The aims of this study were to monitor population changes in cardiovascular disease ( CVD ) risk factors over the first year of the new service and to assess the value of tailored lifestyle support , including motivational interview with ongoing support and referral to other services . Methods R and omised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent , Engl and . Thirty eight general practice s and 601 ( 365 usual care , 236 additional lifestyle support ) patients were recruited and r and omised independently between September 2009 and February 2010 . Changes in population CVD risk between baseline and one year follow-up were compared , using intention-to-treat analysis . The primary outcome was the Framingham 10 year CVD risk score . Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories . Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for : weight management , physical activity , cook and eat and positive thinking . Results Average population CVD risk decreased from 32.9 % to 29.4 % ( p < 0.001 ) in the NHS Health Check only group and from 31.9 % to 29.2 % ( p < 0.001 ) in the NHS Health Check plus additional lifestyle support group . There was no significant difference between the two groups at either measurement point . Prevalence of high blood pressure , high cholesterol and smoking were reduced significantly ( p < 0.01 ) in both groups . Prevalence of central obesity was reduced significantly ( p < 0.01 ) in the group receiving additional lifestyle support but not in the NHS Health Check only group . Conclusions The NHS Health Check service in Stoke on Trent result ed in significant reduction in estimated population CVD risk . There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction Background The benefit of regular multidimensional assessment of older people remains controversial . The majority of trials have been too small to produce adequate evidence to inform policy . Despite the lack of a firm evidence base , UK primary care practitioners ( general practitioners ) are required to offer an annual health check to patients aged 75 years and over . Design Cluster-r and omised factorial trial in primary care comparing a package of assessment s ( i ) universal versus targeted assessment and ( ii ) management by the primary care team ( PC ) or a multidisciplinary geriatric assessment team ( GM ) . The unit of r and omization is the general practice . Methods Older people aged 75 and over eligible for the over 75s health check and excluding those in nursing homes or terminally ill were invited to participate . All participants receive a  brief assessment covering all areas of the over 75s check . In the universal arm all participants also receive a  detailed health and social assessment by a study nurse while in the targeted arm only participants with a pre-determined number and range of problems at the brief assessment go on to have the detailed assessment . The study nurse follows a st and ard protocol based on results and responses in the detailed assessment to make referrals to ( i ) the r and omised management team ( PC or GM ) ( ii ) other medical services , health care workers or agencies ( iii ) emergency referrals to the GP . The main outcomes are mortality , hospital and institutional admissions and quality of life . 106 practice s and 33,000 older people have been recruited to the trial BACKGROUND There is a lack of evidence on the most effective primary care management of older people with minor depression . AIM To evaluate a follow-up assessment by the community mental health team ( CMHT ) for older people with depressive symptoms identified by practice nurses at a health check for people over the age of 75 years . DESIGN OF STUDY A pragmatic r and omised controlled trial . SETTING A single large general practice in Leicestershire . METHOD Patients receiving a health check administered by a practice nurse and scoring 5 or more on the 15-item Geriatric Depression Scale ( GDS15 ) were r and omised to either follow-up by the CMHT or routine general practitioner ( GP ) care . The GDS15 score was measured at the subsequent health check 18 months later . RESULTS Forty-seven patients were r and omised to CMHT assessment and 46 to routine GP care . Uptake of the intervention was 72 % ( n = 34 ) . At the follow-up health check a greater proportion of the control group had improved GDS15 scores ( P = 0.08 ) . Following assessment , the CMHT recommended their further involvement in the care of 12 patients and this was authorised by patients ' GPs in six cases . CONCLUSIONS A follow-up mental health assessment by a member of the local CMHT was not effective in improving outcomes for mildly depressed older people . Other than r and om error possible reasons for this include the length of follow-up and a failure to meet raised expectations among the intervention group . If complex referral procedures do not improve outcomes for this group , then specialist community services should play a more prominent part in the training of practice staff to care for their depressed older patients The 1990 contract for general practitioners in the UK offered incentives for them to organize health promotion clinics and required them to perform ' lifestyle ' checkups of their patients every 3 years , despite uncertainty about the impact of such checks on patient health . To address this lack of appropriate evaluation , a follow-up study to assess benefits in terms of patient behaviour and health result ing from the introduction of lifestyle checkups in general practice in a sample of more than 7000 patients aged 30 - 70 from 18 practice s in three FHSA areas ( in south London , Surrey and Yorkshire ) has been performed . Eighteen per cent of the r and om sample of patients reported having a health check in the previous year . A full health check comprising measurement of blood pressure , height and weight , urinalysis and question ing about smoking habits , alcohol consumption , exercise , diet and family illnesses had been given to 29 % of respondents reporting a health check of any kind . Respondents in less privileged socioeconomic groups were more likely to have had a health check , but less likely to have had a ' full ' check . Reactions to the checks were mainly positive ; 81 % regarded the check as helpful , and only 6 % reported it to be worrying and 6 % a waste of time . The implication s for the new health promotion b and ing system in the UK are discussed PURPOSE Healthcare includes important processes such as checking to reduce errors . Checking is a prescribed part of many patient care activities with many checks being performed during one hospital admission . Some may be st and ard but unwritten practice s , whereas others are laid down in official guidance . Errors in the bedside checking procedure are the commonest cause of mis-transfusion , so more thorough checking could prevent adverse events . This paper aims to explore and enhance underst and ing regarding healthcare checking procedures . In doing so it seeks to identify a further research agenda . DESIGN / METHODOLOGY /APPROACH The computerised data bases CINAHL , PsycLIT , EMBASE , PubMed , PsycINFO and MEDLINE were search ed using specific indexing terms and free text including " bedside , peri-operative safety , theatre checking and checklists " . Only English publications were included . FINDINGS Like any human activity , checking is part of personality and behaviour . There are several psychological factors relevant to patient safety , including : memory , prospect i ve memory , automaticity and responsibility . All are relevant to healthcare . RESEARCH LIMITATIONS / IMPLICATION S B and olier criteria have not explicitly been used within this review but have been met . It would be beneficial for future review s to explicitly state how B and olier criteria are met . This would possibly enhance the publications ' scientific quality . PRACTICAL IMPLICATION S There is much to learn regarding interacting factors that influence healthcare checking procedures  and ultimately checking performance . The authors recommend that relationships between checking and personality should be explored . Furthermore , exploring how healthcare " mindfulness " might be promoted and what reminder/checking strategies healthcare staff already use in their day-to-day work routines should be examined . ORIGINALITY/VALUE Several psychological factors involved in checking and its relevance to healthcare and patient safety are identified . Additionally , recommendations for further research are indicated While the role of diet and nutrition in cognitive health and prevention of dementia  in older adults has attracted much attention , the efficacy of different dietary patterns remains uncertain . Previous review s have mainly focused on the Mediterranean diet , but either omitted other dietary patterns , lacked more recent studies , were based on cross-sectional studies , or combined older and younger population s. We followed PRISMA guidelines , and examined the efficacy of current research from r and omized controlled trials and cohort studies on the effects of different dietary patterns . We review ed the Mediterranean diet , Dietary Approach to Stop Hypertension ( DASH ) diet , the Mediterranean-DASH diet Intervention for Neurodegenerative Delay ( MIND ) diet , Anti-inflammatory diet , Healthy diet recommended by guidelines via dietary index , or Prudent healthy diets generated via statistical approaches , and their impact on cognitive health among older adults . Of 38 studies , the Mediterranean diet was the most investigated with evidence supporting protection against cognitive decline among older adults . Evidence from other dietary patterns such as the MIND , DASH , Anti-inflammatory , and Prudent healthy diets was more limited but showed promising results , especially for those at risk of cardiovascular disease . Overall , this review found positive effects of dietary patterns including the Mediterranean , DASH , MIND , and Anti-inflammatory diets on cognitive health outcomes in older adults . These dietary patterns are plant-based , rich in poly- and mono-unsaturated fatty acids with lower consumption of processed foods . Better underst and ing of the underlying mechanisms and effectiveness is needed to develop comprehensive and practical dietary recommendations against age-related cognitive decline among older adult Background It is generally believed that exhaustive search es of bibliographic data bases are needed for systematic review s of health care interventions . The CENTRAL data base of controlled trials ( RCTs ) has been built up by exhaustive search ing . The CONSORT statement aims to encourage better reporting , and hence indexing , of RCTs . Our aim was to assess whether developments in the CENTRAL data base , and the CONSORT statement , mean that a simplified RCT search strategy for identifying RCTs now suffices for systematic review s of health care interventions . Methods RCTs used in the Cochrane review s were identified . A brief RCT search strategy ( BRSS ) , consisting of a search of CENTRAL , and then for variants of the word r and om across all fields ( r and om$.af . ) in MEDLINE and EMBASE , was devised and run . Any trials included in the meta-analyses , but missed by the BRSS , were identified . The meta-analyses were then re-run , with and without the missed RCTs , and the differences quantified . The proportion of trials with variants of the word r and om in the title or abstract was calculated for each year . The number of RCTs retrieved by search ing with " r and om$.af . " was compared to the highly sensitive search strategy ( HSSS ) . Results The BRSS had a sensitivity of 94 % . It found all journal RCTs in 47 of the 57 review s. The missing RCTs made some significant differences to a small proportion of the total outcomes in only five review s , but no important differences in conclusions result ed . In the post-CONSORT years , 1997–2003 , the percentage of RCTs with r and om in the title or abstract was 85 % , a mean increase of 17 % compared to the seven years pre-CONSORT ( 95 % CI , 8.3 % to 25.9 % ) . The search using r and om$.af . reduced the MEDLINE retrieval by 84 % , compared to the HSSS , thereby reducing the workload of checking retrievals . Conclusion A brief RCT search strategy is now sufficient to locate RCTs for systematic review s in most cases . Exhaustive search ing is no longer cost-effective , because in effect it has already been done for CENTRAL Introduction An ageing population has become an urgent concern for Asia in recent times . In nursing homes , polypharmacy has also become a compounding issue . Deprescribing practice is an evidence -based strategy to provide a better outcome in this group of patients ; however , its implementation in nursing homes is often challenging , and prospect i ve outcome data on deprescribing practice in the elderly is lacking . Our study assesses the implementation of team-care deprescribing to underst and the benefits of this practice in geriatric setting and to explore the factors affecting deprescribing practice . Methods and analysis This multicentre prospect i ve study consists of a pre study interview question naire , and a preintervention and postintervention study to be conducted in the nursing home setting on residents at least 65 years old and on five or more medications . We will employ a cluster r and omised stepped-wedge interventional design , based on a five-step ( review ing , checking , discussion , communication and documentation ) team-care deprescribing practice coupled with the use of a deprescribing guide ( consisting of Beers and STOPP criteria , as well as drug interaction checking ) , to assess the health and pharmacoeconomic outcome in nursing homes ’ practice . Primary outcome measures of the intervention will consist of fall risks using a fall risk assessment tool . Other outcomes assessed include fall rates , pill burden including number of pills per day , number of doses per day and number of medications prescribed . Cost-related measures will include the use of cost – benefit analysis , which is calculated from the medication cost savings from deprescribing . For the pre study interview question naire , findings will be analysed qualitatively using thematic analysis . Ethics and dissemination This study is approved by the Domain Specific Review Board of National Healthcare Group , Singapore ( 2016/00422 ) and Monash University Human Research Ethics Committee ( 2016 - 1430 - 7791 ) . The study findings shall be disseminated in international conferences and peer- review ed publications . The study is registered with Clinical Trials.gov ( NCT02863341 ) , Pre- Background NHS Health Check is a primary prevention programme offering cardiovascular disease ( CVD ) risk assessment to adults in Engl and aged 40–74 . Uptake remains a challenge and invitation method is a strong predictor of uptake . There is evidence of low uptake when using invitation letters . Telephone invitations might increase uptake , but are not widely used . We explored the potential to improve uptake through personalising letters to patient ’s CVD risk , and to compare this with generic letters and telephone invitations . Methods HEalth Check TRial ( HECTR ) was a three-arm r and omised controlled trial in nine general practice s in Staffordshire ( UK ) . Eligible patients were r and omised to be invited to a NHS Health Check using one of three methods : st and ard letter ( control ) ; telephone invitation ; letter personalised to the patient ’s CVD risk . The primary outcome was attendance/non-attendance . Data were collected on a range of patient- and practice -level factors ( e.g. , patient socio-demographics , CVD risk , practice size , Health Checks outside usual working hours ) . Multi-level logistic regression estimated the marginal effects to explore whether invitation method predicted attendance . Invitation costs were collated from practice s to estimate cost benefit . Results In total , 4614 patients were included in analysis ( mean age 50.2 ± 8.0 yr . ; 52.4 % female ) . Compared with patients invited by st and ard letter ( 30.9 % ) , uptake was significantly higher in those invited by telephone ( 47.6 % , P < .001 ) , but not personalised letter ( 31.3 % , p = .812 ) . In multi-level analysis , compared with the st and ard letter arm , likelihood of attendance was 18 percentage points higher in the telephone arm and 4 percentage points higher in the personalised letter arm . The effect of telephone calls appeared strongest in patients who were younger and had lower CVD risk . We estimated per 1000 patients invited , risk-personalised letters could result in 40 additional attended Health Checks ( at no extra cost ) and telephone invitations could result in 180 additional Health Checks at an additional cost of £ 240 . Conclusions Telephone invitations should be advocated to address the substantial deficit between current and required levels of NHS uptake , and could be targeted at younger and lower CVD risk adults .  Risk-personalised letters should be explored further in a larger sample of high risk individuals . Trial registration Registration number : IS RCT N15840751 date of registration : 24/10/2017 General practice is in an ideal position to encourage people to adopt healthier lifestyles . One way in which this might be achieved is through the offering of health checks . This paper sought to identify some of the factors which may be important in predicting the uptake of health checks . These were seen to fall into two broad areas --the way in which patients are invited and patients ' health beliefs . For the purpose s of the study , 299 middle-aged male patients registered at a single practice were r and omly allocated to be invited to a health check via two invitation methods . In the first , patients were sent an invitation letter with an appointment . In the second patients ' notes were tagged so that they could be invited opportunistically by their GP . After one year , 63.5 % of patients invited opportunistically had attended a health check compared with 61.2 % of patients sent an invitation letter . However , only 51.6 % of the opportunistic group had been invited after one year , meaning that the letter invitation method produced twice as many patients at the health check over the same period of time . Examination of health belief question naires sent to patients prior to the commencement of the health checks ( 50.2 % response rate ) indicated that attenders had a stronger initial intention to attend and placed a greater value on their health . More detailed analysis revealed intention to show strong relationships with beliefs about the benefits of , and barriers to , attendance at a health check . These results suggest that in order to increase uptake of health checks letter invitations need to be employed . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVES The aim of this study was to explore the use of  surrogate outcomes  --a substitute outcome that predicts final patient-related outcomes --in cost-effectiveness models ( CEM ) within health technology assessment ( HTA ) reports and provide guidance for their future use . METHODS Our sampling frame was all UK HTA Program monograph series reports published in 2005 and 2006 . Reports were included if they addressed a treatment effectiveness/efficacy question and included a CEM based on a surrogate outcome . The two authors independently applied inclusion and exclusion criteria , and the following data was extracted from included reports : source of surrogate outcome , level of evidence for validation of the surrogate outcomes , methods used in report to quantify link between surrogate outcome and final outcome , and consideration of the uncertainty associated with using surrogate outcomes in the results or conclusions of report . RESULTS Of 100 HTA reports , 35 complied with the inclusion criteria . Of these , four ( 11 percent ) reports included a CEM based on a surrogate outcome . All four reports source d treatment-related changes in surrogate outcome through a systematic review of the literature . One provided Level 1 surrogate evidence ( r and omized controlled trial data showing a strong association between the change in surrogate outcome and change final outcome ) ; two reported Level 2 evidence ( observational study data ) ; and one provided Level 3 evidence ( disease natural/ history data ) . The transparency of quantification and exploration of uncertainty of the surrogate and final outcome relationship varied considerably across all four reports . CONCLUSIONS Recommendations are made for the use of surrogate outcomes in future HTA reports BACKGROUND The uptake of influenza vaccination  among older people is suboptimal . Contact with a doctor or nurse is associated with older people deciding to accept influenza vaccination . AIM To compare different forms of approach in improving uptake of influenza vaccination  among patients aged 75 years and over in primary care . DESIGN OF STUDY R and omised controlled trial . SETTING One large rural general practice serving the town and surrounding area of Melton Mowbray , Leicestershire . METHOD All 2,052 patients aged 75 years and over , registered with the practice and not living in nursing/residential homes or sheltered accommodation , were included in the study . One-third of patients were r and omised to receive an offer of influenza vaccination as part of an over-75 health check administered by a practice nurse in the patient 's home , and two-thirds of patients were r and omised to receive a personal letter of invitation to attend an influenza vaccination clinic held at the surgery . The main outcome measure was uptake of influenza vaccination .  RESULTS Six hundred and eighty patients were r and omised to the health check arm of the trial and 1,372 were r and omised to receive a personal letter . Of those r and omised to the health check arm , 468 received the health check from the nurse . Overall , the difference in influenza vaccination uptake was 6.4 % ( 95 % confidence interval [ CI ] = 2.2 % to 10.4 % ) with 67.9 % ( n = 932 ) of those who were sent a personal letter actually receiving the vaccine , compared with 74.3 % ( n = 505 ) of those offered a combined health check and influenza vaccination ( P = 0.003 ) . CONCLUSION Combining home-based over- 75 health checks with influenza vaccination can improve uptake among older patients . However this intervention is likely to be costly and its effect on influenza vaccination rates is modest . The difference in uptake is greater among those who do not routinely comeforwardfor vaccination and a more viable option may be to target these patients BACKGROUND It has been postulated that systematic enquiry about patients ' family histories of inherited illnesses would lead to a population of ' worried well ' . OBJECTIVE The purpose of the present study was to evaluate if the use of a family history screening question naire ( FHSQ ) as part of a general practice health check leads to psychological distress . METHOD We conducted a r and omized controlled trial of a self-administered FHSQ in a single general practice . Individuals who had not had a health check within the previous 2 years were r and omized within three age group strata to intervention group ( receiving health check and FHSQ ) or control group ( only receiving health check ) . A total of 156 patients were offered health checks ; 100 accepted and 76 of them were followed through to the 3-month end point . Responses to the six-item Spielberger State-Trait Anxiety Inventory ( STAI ) , Perception of Health question naire and Family History Concern question naire were compared between intervention and control groups . RESULTS A two-way analysis of variance on the STAI scores 1 and 2 weeks after the health check with baseline scores as a covariate showed that at both times anxiety was higher in the intervention group than in the controls ( F = 6.4 ; d.f . = 1,73 ; P = 0.014 ) . Three months later , there was no significant difference between the two groups . The Perception of Health question naire only showed a significant result at 1 week , the intervention group having a more pessimistic response to the question eliciting patient 's concerns about future health ( P = 0.025 ) . CONCLUSION Short-term psychological distress due to the family history screening question naire was identified but did not persist Abstract Objective : To evaluate the effect of Baby Check , an illness scoring system for babies of 6 months or less , on parents ' use of health services for their baby . Design : R and omised controlled trial . Setting : 13 general practice s in Glasgow . Subjects : 997 newly delivered mothers , r and omised to receive either Baby Check and Play It Safe , an accident prevention leaflet ( n=497 ) , or Play It Safealone ( control group , n=500 ) . Main outcome measures : Data on consultations and referrals extracted from general practice notes after 6 months . Results : At the time of recruitment , maternal characteristics were similar for both groups ( mean maternal age 29 years ; deprivation categories 6 and 1 in both groups ; 424 ( 45 % ) mothers were primiparous ) . At 6 months , general practice notes were available for 467 ( 94 % ) of the Baby Check group and 468 ( 94 % ) of the control group . The number of general practitioner consultations did not differ between the groups : median number of consultations was 2 ( interquartile range 1 to 4 ) in the Baby Check group , and 2 ( 1 to 3 ) in the control group . Use of out of hours services did not differ significantly between the two groups ( 86 v 85 ; P=0.93 ) . Conclusion : Distributing Baby Check to an unselected group of mothers does not affect use of health services for infants up to 6 months of age
General practice -based health checks are associated with statistically significant , albeit clinical ly small , improvements in surrogate outcome control , especially among high-risk patients .
BACKGROUND A recent review concluded that general health checks fail to reduce mortality in adults .
AIM This review focuses on general practice -based health checks and their effects on both surrogate and final outcomes .