Papers by Philip Sedgwick
Clinical and Experimental Obstetrics & Gynecology
Background: Endometrial cancer is the most common gynaecological cancer and has a strong associat... more Background: Endometrial cancer is the most common gynaecological cancer and has a strong association with obesity. Surgical site infection (SSI) carries high morbidity and is more frequent in obese patients. Closed incision negative pressure wound therapy (ciN-PWT) has been proposed to reduce wound morbidity but is more expensive than standard dressings whilst the evidence has been very heterogenous. There is limited evidence to justify this expensive dressing as related to its effectiveness in gynaecological oncology patients. ciNPWT was introduced in New Zealand in 2017 based on the available evidence from studies on SSI in the obstetric population. The aim of this study is to investigate the rate of SSI in patients with endometrial carcinoma undergoing laparotomy using standard surgical dressings compared to ciNPWT. Methods: We performed a retrospective analysis of 170 patients who underwent a laparotomy for endometrial carcinoma between 2018 and 2019 across three hospitals in New Zealand after the introduction of ciNPWT. Dressings were applied according to individual surgeons' preferences. Standard dressings and ciNPWT were compared in the occurrence of SSI, wound dehiscence, readmission and return to theatre rates using logistic regression in order to account for potential confounding due to the patient demographics and oncologic and surgical characteristics. Results: There were 129 patients in the standard dressing group and 41 patients in the ciNPWT group. The mean age was 60.4 years (range 25-86). The mean body mass index (BMI) was 38.2 kg/m 2 (range 20-69 kg/m 2). The percentage of patients who experienced a SSI was higher in the ciNPWT group (34.2% vs. 20.9%; p = 0.159). There was no significant difference between the dressing groups in the occurrence of superficial SSI rate, return to theatre, or readmission. Wound dehiscence and deep/organ space SSI were however worse with ciNPWT (adjusted odds ratio (aOR) 4.09 and aOR 7.19, respectively). Conclusions: This study demonstrated no evidence for the benefit of ciNPWT, and higher rates of deep/organ space SSI. More randomised trials are needed to investigate whether gynaecological oncology patients may benefit from ciNPWT thus justifying the extra cost of this dressing.
The British journal of general practice : the journal of the Royal College of General Practitioners, 2003
Upper respiratory tract infections (URTIs) account for approximately 50% of antibiotic prescripti... more Upper respiratory tract infections (URTIs) account for approximately 50% of antibiotic prescriptions in the United Kingdom. General practitioners (GPs) frequently issue such prescriptions simply because they believe that the patient expects it. Deferred prescribing (issuing a prescription, but with instructions to wait for no spontaneous improvement before deciding whether to use it) might address patients' expectations, while minimising actual antibiotic consumption. Although the technique is quite widely practiced, patients' attitudes and responses to it are unclear. To establish the proportion of recipients who claim to consume their delayed antibiotic prescriptions. To elicit factors associated with patients' decisions to consume their antibiotics, and patients' confidence in taking this decision. Postal questionnaire survey. Patients from 13 group practices in the south of England. Patients who had received a delayed antibiotic prescription for URTI from their G...
Journal of Mental Health, 2001
... provide a sharp contrast to those in the West in that there is a shift from the individual to... more ... provide a sharp contrast to those in the West in that there is a shift from the individual to the social environment (Stockman, 1994), while families also play an integral part in influencing the client's decision to comply with their medication regime (Razali & Yahya, 1995; Okonji & ...
stat.auckland.ac.nz
In terms of teaching statistics to non-statisticians this may be examined from the perspective of... more In terms of teaching statistics to non-statisticians this may be examined from the perspective of both educators and students. It is easy for statistical educators to feel they know what students need to know, but it is also clear that when teaching non-statisticians, these non-specialists, who will be expected to use statistics after graduation, will have a view on what they need to know. We surveyed both current medical students and practicing doctors about what they would like to know and how it should be delivered. This informed a new curriculum covering the topics found to be most important and lead to the development of a new mode of delivery, based around the problembased learning model. The understanding produced provides valuable knowledge for both medical education and other disciplines where understanding statistics is essential.
Bone & Joint Open, 2020
Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe th... more Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested p...
BMJ, May 5, 2010
A randomised controlled trial evaluated the cost and efficacy of community leg ulcer clinics that... more A randomised controlled trial evaluated the cost and efficacy of community leg ulcer clinics that used four layer compression bandaging. The control treatment was provision of usual care by district nurses.1 Over the 12 month follow-up, ulcers of patients in the clinic group healed quicker than those in the control group (P=0.03). However, no difference was seen between treatment groups in mean total NHS costs per patient (P=0.89). All statistical tests were two sided, and the critical level of significance was set at 0.05 (5%). For each of the scenarios below in the total population, determine whether a correct conclusion (a), type I error (b), or type …
BMJ, Sep 15, 2010
Researchers conducted a case-control study to investigate whether sleeping environment was associ... more Researchers conducted a case-control study to investigate whether sleeping environment was associated with sudden infant death syndrome.1 The researchers aimed to include all cases of sudden unexpected death for infants aged between 7 and 364 days from five regions of England with a combined population of more than 17 million people. A total of 325 cases were identified through registers. For every case, four controls matched for age, locality, and time of sleep were included. Interviews were undertaken with the parents of all cases and controls to ascertain past sleeping environment. Infant’s typical sleeping environment in relation to their parents was classified as usual room sleeper (shared room but not bed), usual solitary sleeper (slept in room separate from parents), or usual bed sharer (shared bed with parents for more than two nights per week). The results are presented in the table, which shows the odds ratios of sudden unexpected death for the categories of the infants’ usual sleeping environment.⇓ View this table: Infant’s sleeping environment in …
BMJ, Oct 27, 2010
A randomised controlled trial evaluated the effectiveness of an integrated care programme compare... more A randomised controlled trial evaluated the effectiveness of an integrated care programme compared with usual care in facilitating the return to work for patients with chronic low back pain.1 The integrated care programme was a combined patient and workplace directed intervention. The trial participants were 134 adults aged 18-65 years who had had low back pain for more than 12 weeks, were in paid work, and had been absent or partially absent from work. Variables measured at baseline included patient’s sex, age, and level of education. Level of education was classified as low (preschool or primary school), intermediate (secondary school), and high (tertiary, university, or postgraduate). Trial participants were followed for 12 months. The primary outcome was duration of time off work after randomisation until a fully sustained return …
BMJ, Jul 14, 2010
, statement c is true and not false as indicated. The survival curves presented are "plotted goin... more , statement c is true and not false as indicated. The survival curves presented are "plotted going up." Time zero on the plot represents when patients were randomised to treatment groups. At that stage, none of the participants had achieved a fully sustained return to work and therefore the probability was equal to zero. The probabilities, so called Kaplan-Meier probabilities, are cumulative ones. The curves therefore represent the probability of a fully sustained return to work by a particular time, or earlier, after randomisation (c is true). Kaplan-Meier plots are often "plotted going down." See http:/ /www.bmj.com/content/347/bmj.f7118 for an example. For the trial above, this would entail plotting the proportion of participants that had not experienced a fully sustained return to work. If "plotted going down," the survival curve would start at the probability of 1.0 and decline with time. The probabilities are still cumulative ones and would, in principle, contain the same information as a curve "plotted going up." However, since the time until a fully sustained return to work incorporated censored data then the interpretation of a curve "plotted going down" is slightly different. For such curves, the Kaplan-Meier probabilities would represent the probability of experiencing a fully sustained return to work so many days, or longer, after starting treatment. Then statement c would be false.
The Statistician, 1995
Page 1. Sinai Probability Theory An Introductory Course Springer Textbook ... Sinai, Yakov G.: Pr... more Page 1. Sinai Probability Theory An Introductory Course Springer Textbook ... Sinai, Yakov G.: Probability theory: an introductory course / Yakov G. Sinai. Transl. ...
BMJ, May 12, 2010
Researchers investigated whether vaccination against human papillomavirus (HPV) increased the ris... more Researchers investigated whether vaccination against human papillomavirus (HPV) increased the risk of miscarriage in young women.1 The results of two double blind, multicentre, phase three randomised controlled trials were pooled. Participants had been randomly assigned to receive three doses of bivalent HPV 16/18 VLP vaccine with AS04 adjuvant or hepatitis A vaccine (as control) over six months. The primary outcome was rate of miscarriage after vaccination. Given that a lower miscarriage rate with the HPV vaccine was not a safety concern, a one sided test of statistical significance was performed (P=0.16). Which of the following statements, if any, are true?
Opticon1826, Sep 1, 2011
Do not consider it proof just because it is written in books, for a liar who will deceive with hi... more Do not consider it proof just because it is written in books, for a liar who will deceive with his tongue will not hesitate to do the same with his pen. Maimonides Evidence Based Medicine (EBM) was born on the premise that some commonly used treatments are not evidence-based. The EBM philosophy is that Randomised Clinical Trials (RCTs) alongside systematic reviews offer stronger evidential support than observational studies, mechanistic reasoning and expert judgement (Howick, 2011, 10). This paper argues that RCTs provide better evidential support than observational studies in two halves. Section I outlines EBM principles: it dissects RCTs and observational studies from an internal perspective. The foundation of Section I is that as long as RCTs entail less confounding factors than observational studies, they will provide superior evidential support 1 (Howick, 2011, p.61). Section II will critique EBM ideology from an external perspective: if RCTs survive the criticisms then it is established that RCTs provide better evidential support than observational trials. It will start by analysing general principles and progress into scrutinising specific RCT devices. The conclusion is that RCTs withstand the criticism and are superior. Section one-internal analysis Before delving into any deeper theory, it is already apparent there is an intrinsic flaw within EBM ideology: it condemns expert opinion to the lowest form of evidence but the EBM hierarchy is based on expert opinion. This is a profound weakness and it cannot be fully answered; the reason this is so fundamental is because if the theory is questionable then surely so are the tenets of theory. This has been acknowledged by the proponents of EBM (Howick, 2011, 12) and that must be credited. However Howick, always so keen to defend EBM, ignores this weakness. The only neutral opinion is to judge the deeper tenets of EBM philosophy by their own merit. Defining randomised controlled trials and observational studies Firstly it is important to understand the purpose of a trial: classical statistical theory dictates that it is to reject the null hypothesis 2. If the null hypothesis can be rejected in a traditional superiority
BMJ, Nov 16, 2010
Researchers investigated the effects of long term treatment with metformin on the risk of vitamin... more Researchers investigated the effects of long term treatment with metformin on the risk of vitamin B12 deficiency in patients with type 2 diabetes receiving insulin treatment.1 A multicentre randomised placebo controlled trial was used. A total of 390 patients were randomly assigned to receive 850 mg metformin or 850 mg placebo three times a day. Primary outcome measures included percentage change in the serum concentration of homocysteine from baseline at 4, 17, 30, 43, and 52 month follow-up. At baseline, the metformin group (n=196) had a mean homocysteine concentration of 14.4 μmol/l (standard deviation 9.7 μmol/l), compared with a mean concentration of 14.6 μmol/l (standard deviation 10.3 μmol/l) for the placebo group (n=194). Which of the following statements, if any, are true for the metformin group at baseline?
BMJ, Dec 30, 2010
A 79 year old white woman had her bone mineral density (BMD) measured to assess for osteoporosis ... more A 79 year old white woman had her bone mineral density (BMD) measured to assess for osteoporosis and fracture risk. The table⇓ shows the results of dual energy x ray absorptiometry (DXA). View this table: Results of dual energy x ray absorptiometry on the right hip of a 79 year old patient Which of the following statements, if any, are true? Answers a , b , and d are true, whereas c is false. Measurement of BMD in the hip and spine is the gold standard for the diagnosis of osteoporosis and assessment of fracture risk. BMD is the ratio of bone mineral content to bone area (expressed in g/cm²). Measurements for three regions of the woman’s right hip are given—the femoral neck, tronchanteric region, and intertrochanteric region. A total BMD measurement was obtained by scanning the entire hip …
BMJ, May 25, 2011
Last week’s question described a trial that assessed the effectiveness of topical intranasal cort... more Last week’s question described a trial that assessed the effectiveness of topical intranasal corticosteroids in children aged 4-11 years who had bilateral otitis media with effusion.1 A randomised double blind, placebo controlled superiority trial was performed.2 The primary end point was proportion of children cured of bilateral otitis media with effusion in one or both ears at one month. In total, 105 children were allocated to receive nasal mometasone furoate 50 μg, given once daily into each nostril for three months, and 112 to placebo spray. At one month, 40.6% of the topical steroid group and 44.9% of the placebo group were cured. The …
Education in Medicine Journal, Mar 1, 2013
Objective: To determine relationships between student personality and learning styles and their s... more Objective: To determine relationships between student personality and learning styles and their satisfaction with components of the PBL process. Method: A questionnaire was sent to 137 students in a PBL centred undergraduate medical course. Personality and Learning Styles were assessed with standard questionnaires. Satisfaction with PBL as a teaching method was assessed by a 26-item questionnaire that asked about the utility and enjoyment of the various components of the PBL process. Principle component analysis was used to examine relationships between the variables. Result: Factor analysis showed two clearly distinguishable factors. Factor 1 (26% variance), labelled Personal Learning, related to whether students felt PBL helped them personally in clarifying and remembering new information; Factor 2 (16% variance), labelled Contribution to Case Discussion, related to whether students enjoyed and found it useful to take part in the PBL group and found it useful to make suggestions about the case. Students who found it easy to learn from PBL tended to be more conscientious and more open to experience, with higher deep learning scores and lower surface learning scores. In contrast those who found it easy to contribute to case discussions tended to be less neurotic and more agreeable, and to have higher deep learning scores, and, somewhat surprisingly, lower strategic learning scores. Conclusion: Students who enjoy PBL and find it effective share certain personality and learner types. This has potential implications for the implementation and evaluation of PBL in medical schools and the wider education system.
BMJ, Jun 9, 2010
Researchers undertook a randomised controlled trial to assess the effect of zinc supplementation ... more Researchers undertook a randomised controlled trial to assess the effect of zinc supplementation on the severity and duration of diarrhoea caused by cholera in children.1 Children were recruited if they had watery diarrhoea and dark field microscopy examination of stool was positive for Vibrio cholerae (confirmed by stool culture). Children were randomly allocated to zinc supplementation or placebo. The table compares the primary outcomes (duration of diarrhoea and stool output) and secondary outcomes for the zinc supplementation and placebo groups⇓. All hypothesis tests were performed using a two sided, independent samples t test, with a 0.05 (5%) critical level of significance. Zinc supplementation was found to reduce the duration and severity of diarrhoea in children with cholera. View this table: Impact of zinc supplementation on clinical outcomes in children with cholera Which of the following statements, if any, are true?
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Papers by Philip Sedgwick