ObjectiveTo characterise incidence and healthcare costs associated with persistent postoperative pain (PPP) following lumbar surgery.DesignRetrospective, population-based cohort study.SettingClinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.ParticipantsPopulation-based cohort of 10 216 adults who underwent lumbar surgery in England from 1997/1998 through 2011/2012 and had at least 1 year of presurgery data and 2 years of postoperative follow-up data in the linked CPRD–HES.Primary and secondary outcomes measuresIncidence and total healthcare costs over 2, 5 and 10 years attributable to persistent PPP following initial lumbar surgery.ResultsThe rate of individuals undergoing lumbar surgery in the CPRD–HES linked data doubled over the 15-year study period, fiscal years 1997/1998 to 2011/2012, from 2.5 to 4.9 per 10 000 adults. Over the most recent 5-year period (2007/2008 to 2011/2012), on average 20.8% (95% CI 19.7% to 21.9%) of lumbar surgery patients met criteria for PPP. Rates of healthcare usage were significantly higher for patients with PPP across all types of care. Over 2 years following initial spine surgery, the mean cost difference between patients with and without PPP was £5383 (95% CI £4872 to £5916). Over 5 and 10 years following initial spine surgery, the mean cost difference between patients with and without PPP increased to £10 195 (95% CI £8726 to £11 669) and £14 318 (95% CI £8386 to £19 771), respectively. Extrapolated to the UK population, we estimate that nearly 5000 adults experience PPP after spine surgery annually, with each new cohort costing the UK National Health Service in excess of £70 million over the first 10 years alone.ConclusionsPersistent pain affects more than one-in-five lumbar surgery patients and accounts for substantial long-term healthcare costs. There is a need for formal, evidence-based guidelines for a coherent, coordinated management strategy for patients with continuing pain after lumbar surgery.

Oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation is underutilised. One of the impediments to warfarin therapy is the frequent monitoring required, usually at a specialised warfarin clinic. The advent of direct oral anticoagulants (DOACs) facilitates OAC therapy without an onerous monitoring regimen. This benefit may result in the more significant adoption of DOACs in areas without a warfarin clinic. This study analysed national administrative data for reimbursed pharmacy claims to assess OAC prescribing from 2010 to 2017 and compared the use of DOACs in areas with warfarin clinics compared to those without. Over the study period, the number of patients on OAC increased by 84%, due to a rapid increase in DOAC prescribing. The findings demonstrate that DOACs have resulted in an increase in the overall uptake of OAC therapy in Ireland. However, the increased utilisation was not evidently related to populations underserved by warfarin clinics.

No abstract

No abstract

We included 34 systematic reviews, among these 4 reviews evaluate the effect in healthy adults and 7 in children. Authors of 2 reviews state that due to the poor quality or contradictoriness of the available evidence any conclusions in the elderly cannot be drawn. We retrieved only 3 reviews in pregnant women, 11 in patients with co-morbidities (6 -pulmonary diseases, 2 -cardiovascular disease, 3 -cancer, 2 -in acute otitis) and 2 in HIV-positive patients. All 4 reviews in healthcare workers provide limited or no reasonable evidence to support the vaccination. ConClusions: The safety profile of the vaccines is acceptable. Influenza vaccines have a very modest or no effect. The authors of some systematic reviews point to the low methodological quality of the studies, the weakness of the evidence and their unsuitability for conducting meta-analyses.