{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:51:46Z","timestamp":1779274306327,"version":"3.51.4"},"reference-count":13,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,5,2]]},"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To measure the rates of lower respiratory tract infection (LRTI) and mortality following feeding gastrostomy (FG) placement in patients with learning disability (LD). Following this to compare these rates between those having LRTI prior to FG placement and those with no recent LRTI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>The study population included patients with LD undergoing FG placement in the \u2018The Health Improvement Network\u2019 database. Patients with LRTI in the year prior (LYP) to their FG placement were compared with patients without a history of LRTI in the year prior (non-LYP) to FG placement. FG placement and LD were identified using Read codes previously developed by an expert panel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Incidence rate ratio (IRR) of developing LRTI and mortality following FG, comparing patients with LRTI in the year prior to FG placement to patients without a history of LRTI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>214 patients with LD had a FG inserted including 743.4 person years follow-up. 53.7% were males and the median age was 27.6 (IQR 19.6 to 38.6) years. 27.1% were in the LYP patients. 18.7% had a LRTI in the year following FG, with an estimated incidence rate of 254 per 1000-person years. Over the study period the incidence rate of LRTI in LYP patients was 369 per 1000-person years, in non-LYP patients this was 91 per 1000-person years (adjusted IRR 4.21 (95% CI 2.68 to 6.63)\u2009p&lt;0.001). 27.1% of patients died during study follow-up. Incidence rate of death was 80 and 45 per 1000-person year for LYP and non-LYP patients, respectively (adjusted IRR 1.80 (1.00 to 3.23) p=0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In LD patients, no clinically meaningful reduction in LRTI incidence was observed following FG placement. Mortality and LRTI were higher in patients with at least one LRTI in the year preceding FG placement, compared with those without a preceding LRTI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026714","type":"journal-article","created":{"date-parts":[[2019,6,20]],"date-time":"2019-06-20T05:29:11Z","timestamp":1561008551000},"page":"e026714","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database"],"prefix":"10.1136","volume":"9","author":[{"given":"Philip R","family":"Harvey","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Thomas","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9561-5141","authenticated-orcid":false,"given":"Joht Singh","family":"Chandan","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neeraj","family":"Bhala","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishnarajah","family":"Nirantharakumar","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nigel J","family":"Trudgill","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,6,19]]},"reference":[{"key":"2025121222101639000_9.6.e026714.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2008.03057.x"},{"key":"2025121222101639000_9.6.e026714.2","unstructured":"NPSA. Understanding the patient safety issues for people with learning disabilities. London: National Patient Safety Agency, 2004."},{"key":"2025121222101639000_9.6.e026714.3","doi-asserted-by":"publisher","DOI":"10.1017\/S001216229900122X"},{"key":"2025121222101639000_9.6.e026714.4","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1469-8749.1998.tb15356.x","article-title":"Mortality in people with learning disability: risks, causes, and death certification findings in London","volume":"40","author":"Hollins","year":"1998","journal-title":"Dev Med Child Neurol"},{"key":"2025121222101639000_9.6.e026714.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0594.2008.00442.x"},{"key":"2025121222101639000_9.6.e026714.6","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/j.1445-5994.2009.02108.x","article-title":"Long-term percutaneous endoscopic gastrostomy feeding in young adults with multiple disabilities","volume":"40","author":"Lee","year":"2010","journal-title":"Intern Med J"},{"key":"2025121222101639000_9.6.e026714.7","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s00455-008-9153-4","article-title":"People with a learning disability and dysphagia: a cinderella population?","volume":"24","author":"Leslie","year":"2009","journal-title":"Dysphagia"},{"key":"2025121222101639000_9.6.e026714.8","doi-asserted-by":"publisher","DOI":"10.14236\/jhi.v12i3.124"},{"key":"2025121222101639000_9.6.e026714.9","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2532.1994.1130177.x"},{"key":"2025121222101639000_9.6.e026714.10","unstructured":"The NHS Information Centre PSaPCS. Access to Healthcare for People with Learning Disabilities, 2010."},{"key":"2025121222101639000_9.6.e026714.11","unstructured":"Statacorp. Stata Statistical Software: release 14. Texas: StataCorp LP, 2015."},{"key":"2025121222101639000_9.6.e026714.12","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.clnu.2016.01.008","article-title":"A large prospective audit of morbidity and mortality associated with feeding gastrostomies in the community","volume":"36","author":"Clarke","year":"2017","journal-title":"Clin Nutr"},{"key":"2025121222101639000_9.6.e026714.13","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/S2215-0366(14)00079-0","article-title":"Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study","volume":"1","author":"Buszewicz","year":"2014","journal-title":"Lancet Psychiatry"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-026714","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:10:22Z","timestamp":1765606222000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-026714"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":13,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6,19]]},"published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1136\/bmjopen-2018-026714"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-026714","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}