Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.

ObjectivesStroke is a major cause of morbidity and mortality. This study aimed to investigate secular trends in stroke across the UK.DesignThis study aimed to investigate recent trends in the epidemiology of stroke in the UK. The study was a time-trend analysis from 1999 to 2008 within the UK General Practice Research Database. Outcome measures were incidence and prevalence of stroke, stroke mortality, rate of secondary cardiovascular events, and prescribing of pharmacological therapy for primary and secondary prevention of cardiovascular disease.ResultsThe study cohort included 32 151 patients with a first stroke. Stroke incidence fell by 30%, from 1.48/1000 person-years in 1999 to 1.04/1000 person-years in 2008 (p<0.001). Stroke prevalence increased by 12.5%, from 6.40/1000 in 1999 to 7.20/1000 in 2008 (p<0.001). 56-day mortality after first stroke reduced from 21% in 1999 to 12% in 2008 (p<0.0001). Prescribing of drugs to control cardiovascular risk factors increased consistently over the study period, particularly for lipid lowering agents and antihypertensive agents. In patients with atrial fibrillation, use of anticoagulants prior to first stroke did not increase with increasing stroke risk.ConclusionStroke incidence in the UK has decreased and survival after stroke has improved in the past 10 years. Improved drug treatment in primary care is likely to be a major contributor to this, with better control of risk factors both before and after incident stroke. There is, however, scope for further improvement in risk factor reduction in high-risk patients with atrial fibrillation.

ObjectiveTo assess use of thromboprophylaxis in UK general practise among patients with atrial fibrillation (AF); to investigate whether elderly patients are less likely to receive anticoagulation therapy than younger patients.DesignRetrospective cohort studySettingUK General Practice Research Database (GPRD)PatientsAged ≥60 years with a new diagnosis of AF (2000–2009).InterventionsNone.Main outcome measuresThe main outcome measure was initiation of warfarin in the first year following diagnosis. Patients were categorised by stroke risk (CHADS2 score) and bleeding risk (HAS-BLED score).Results81 381 patients were identified (21% aged 60–69 years, 37% aged 70–79 years, 42% aged 80+ years). Patients aged 80+ years were significantly less likely to be initiated on warfarin than younger patients, adjusted for gender, practice and comorbidities; 32% of patients aged 80+ years received warfarin compared with 57% aged 60–69 years (p<0.0001), and 55% aged 70–79 years (p<0.0001). For all strata of CHADS2/HASBLED scores, patients aged 80+ years were significantly less likely to be treated with warfarin than younger patients. Logistic regression showed that female sex, low Basal Metabolic Index (BMI), age over 80 years, increasing HAS-BLED score and dementia were independently associated with reduced use of warfarin. Stroke/Transient Ischaemic Attack (TIA), hypertension, heart failure and left ventricular systolic dysfunction were associated with increased use. Patients with HAS-BLED>CHADS2 were less likely to be initiated on warfarin. Higher CHADS2 scores were associated with increased anticoagulation use.ConclusionsAnticoagulation is being under-used in patients with AF aged 80+ years, even after taking into account increased bleeding risk in this age group.

EDNOS in adolescents is not trivial. It has milder eating disorder symptoms but more comorbidity than BN.

Objective: To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified. Method: Eighty-five adolescents with bulimia nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for bulimia nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care. Received 1-3 sessions of family therapy (N=4) Received intervention (i.e., attended ≥4 sessions) (N=29) Assigned to guided self-care (N=44): Did not take up treatment (N=6) Received 1-3 sessions of family therapy (N=7) Received intervention (i.e., attended ≥4 sessions) (N=31) Included in analysis (N=41)