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BackgroundPrevious cohort studies demonstrate diabetes as a risk factor for tuberculosis (TB) disease. Public Health England has identified improved TB control as a priority area and has proposed a primary care-based screening program for latent TB.We investigated the association between diabetes and risk of tuberculosis in a UK General Practice cohort in order to identify potential high-risk groups appropriate for latent TB screening.MethodsUsing data from the UK Clinical Practice Research Datalink we constructed a cohort of patients with incident diabetes. We included 222,731 patients with diabetes diagnosed from 1990–2013 and 1,218,616 controls without diabetes at index date who were matched for age, sex and general practice. The effect of diabetes was explored using a Poisson analysis adjusted for age, ethnicity, body mass index, socioeconomic status, alcohol intake and smoking. We explored the effects of age, diabetes duration and severity. The effects of diabetes on risk of incident TB were explored across strata of chronic disease care defined by cholesterol and blood pressure measurement and influenza vaccination rates.ResultsDuring just under 7 million person-years of follow-up, 969 cases of TB were identified. The incidence of TB was higher amongst patients with diabetes compared with the unexposed group: 16.2 and 13.5 cases per 100,000 person-years, respectively. After adjustment for potential confounders the association between diabetes and TB remained (adjusted RR 1.30, 95 % CI 1.01 to 1.67, P = 0.04). There was no evidence that age, time since diagnosis and severity of diabetes affected the association between diabetes and TB. Diabetes patients with the lowest and highest rates of chronic disease management had a higher risk of TB (P <0.001 for all comparisons).ConclusionsDiabetes as an independent risk factor is associated with only a modest overall increased risk of TB in our UK General Practice cohort and is unlikely to be sufficient cause to screen for latent TB. Across different consulting patterns, diabetes patients accessing the least amount of chronic disease care are at highest risk for TB.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0381-9) contains supplementary material, which is available to authorized users.

Background Standardising outcome collection and reporting in pre‐eclampsia trials requires an appraisal of current outcome reporting. Objectives To map maternal and offspring outcome reporting across randomised trials evaluating therapeutic interventions for pre‐eclampsia. Search strategy Randomised trials were identified by searching bibliographical databases from inception to January 2016. Selection criteria Randomised controlled trials. Data collection and analysis We systematically extracted and categorised outcome reporting. Main results Seventy‐nine randomised trials, reporting data from 31 615 maternal participants and 28 172 of their offspring, were included. Fifty‐five different interventions were evaluated. Included trials reported 119 different outcomes, including 72 maternal outcomes and 47 offspring outcomes. Maternal outcomes were inconsistently reported across included trials; for example, 11 trials (14%) reported maternal mortality, reporting data from 12 422 participants, and 16 trials (20%) reported cardiovascular morbidity, reporting data from 14 963 maternal participants. Forty‐three trials (54%) reported fetal outcomes and 23 trials (29%) reported neonatal outcomes. Twenty‐eight trials (35%) reported offspring mortality. There was poor reporting of childhood outcomes: six trials (8%) reported neurodevelopmental outcomes. Less than half of included trials reported any relevant information regarding harms for maternal participants and their offspring. Conclusions Most randomised trials evaluating interventions for pre‐eclampsia are missing information on clinically important outcomes, and in particular have neglected to evaluate efficacy and safety in the offspring of participants. Developing and implementing a minimum data set, known as a core outcome set, in future pre‐eclampsia trials could help to address these issues. Tweetable abstract Future #preeclampsia research requires a core outcome set to reduce #research waste. https://twitter.com/coreoutcomes https://twitter.com/jamesmnduffy International Prospective Register of Systematic Reviews: CRD42015015529; http://www.crd.york.ac.uk/PROSPERO/display_record.aspID=CRD42015015529.

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ObjectivesHypertensive disorders of pregnancy (HDP) affect one in ten pregnancies and often persist postpartum when complications can occur. We aimed to determine the effectiveness and safety of pharmacological interventions, other interventions and different care models for postpartum hypertension management.DesignA systematic review was undertaken. Nine electronic databases, including Medline, were searched from inception to 16 March 2017. After duplicate removal, 4561 records were screened. Two authors independently selected studies, extracted study characteristics and data, and assessed methodological quality.SettingRandomised controlled trials, case–control studies and cohort studies from any country and healthcare setting.ParticipantsPostnatal women with HDP.InterventionsTherapeutic intervention for management of hypertension, compared with another intervention, placebo or no intervention.Primary and secondary outcome measuresOutcome data were collected for maternal mortality and severe morbidity; systolic, diastolic and mean arterial blood pressure (BP) control; and safety data. Secondary outcome data collected included the length of postnatal hospital stay and laboratory values.Results39 studies were included (n=2901). Results were heterogeneous in terms of intervention, comparison and outcome requiring a narrative approach. There were insufficient data to recommend any single pharmacological intervention. 18 studies reported calcium-channel blockers, vasodilators and beta-blockers lowered BP postpartum. 12 of these reported safety data. Limited data existed regarding management in the weeks following hospital discharge. Neither loop diuretics (three studies) nor corticosteroids (one study) produced clinical benefit. Uterine curettage significantly reduced BP over the first 48 hours postpartum (range 6–13 mm Hg) compared with standard care (eight studies), with safety data only reported by four of eight studies.ConclusionThere was insufficient evidence to recommend a particular BP threshold, agent or model of care, but three classes of antihypertensive appeared variably effective. Further comparative research, including robust safety data, is required. Curettage reduced BP, but without adequate reporting of harms, so it cannot currently be recommended.

In randomized trials evaluating interventions for pre-eclampsia, critical information related to the primary outcome, including definition and measurement, is regularly omitted. Developing a core outcome set for pre-eclampsia trials would help to inform primary outcome selection and outcome measure reporting.

To define the relationship between arm and leg blood pressure to inform the interpretation of leg blood pressure readings in routine clinical practice where arm readings are not available. Methods: Systematic review of all existing studies comparing arm and leg blood pressure measurements. A search strategy was designed in MEDLINE and adapted to be run across six further databases. Articles were deemed eligible for inclusion if they measured and reported arm and leg blood pressure taken in the supine position and/or the difference between the two. Mean values for arm-leg blood pressure difference and measures of precision (95% confidence intervals [CI] or standard deviation) were extracted and entered into a random-effects meta-analysis. Results: A total of 887 articles were screened and 44 were included in the descriptive analyses, including 9,771 patients. In the general population, ankle systolic blood pressure was 17.0 mmHg (95%CI 15.4 to 21.3 mmHg) higher than arm blood pressure in the supine position. For diastolic blood pressure, there was no difference between arm and ankle blood pressure (-0.3 mmHg, 95%CI-1.5 to 1.0 mmHg). In patients with vascular disease, systolic blood pressure was-33.3 mmHg (95%CI-59.1 to-7.6 mmHg) lower in the ankle compared to the arm. Conclusions: This is the first review to provide empirical data defining the difference between blood pressure in the arm and leg in the general population. Findings suggest a diagnostic threshold of 155/90 mmHg could be used for diagnosing hypertension when only ankle measurements are available in routine practice.

Developing @coreoutcomes could help to improve safety reporting in #preeclampsia trials. @NIHR_DC.