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Dickstein DR, Lehrer EJ, Bloom JR, Hsieh K, Jones B, Runnels J, Powers A, Barlow J, Chen S, Monrose E, Sindhu K, Factor O, Liu JT, Gupta V, Roof S, Kirke D, Misiukiewicz K, Posner M, Genden E, Bakst RL. Is 80 the New 70? Octogenarians with Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e577-e578. [PMID: 37785756 DOI: 10.1016/j.ijrobp.2023.06.1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) As the human papilloma virus (HPV) pandemic evolves and life expectancy increases, the number of older adults with oropharyngeal squamous cell carcinoma (OPSCC) continues to increase. However, there is a paucity of data regarding the fastest growing subset of this population: octogenarians (OGs). We sought to understand differences in treatment tolerability and clinical outcomes between septuagenarians (SGs) and OGs with OPSCC. MATERIALS/METHODS We identified SGs (age 70-79) and OGs (age 80-89) with OPSCC from a cohort of older adults with nonrecurrent, nonmetastatic head and neck squamous cell carcinoma (HNSCC) treated curatively from 2007-2020. We compared demographics, treatment characteristics and toxicities using Fischer's exact test. Time-to-event outcomes, overall survival (OS), locoregional control (LRC), and disease-specific survival (DSS), were evaluated using the Kaplan-Meier method. RESULTS Of 293 patients (age 70-89) with HNSCC, 39% (n = 114) had OPSCC: 93 SGs (median age: 73; interquartile range [IQR]: 71-76), and 21 OGs (median age: 81, IQR: 80-84). The median follow-up for included patients was 2.4 years; 82% were male, 64% white, 48% > 20 pack year smoking history, 37% ECOG 1. Patients had AJCC 8th edition Stage: I (27%); II (33%); III (18%); IV (22%) OPSCC. Treatment consisted of adjuvant radiation (RT) (19%), adjuvant chemoradiation (CRT) (8%), surgery alone (6%), induction/concurrent CRT (27%), concurrent CRT (28%), or RT (12%), with no significant differences in stage or treatment modalities noted between SGs and OGs. Of note, 69% of SGs and 76% of OGs were HPV+. Among 107 patients who received any RT, 24% experienced a treatment interruption (19% of SGs vs. 48% of OGs, p = 0.001) and 2 patients (both HPV- SGs) died on treatment due to unrelated health conditions. Percutaneous endoscopic gastrostomy (PEG) tubes were placed prior to or during treatment in 43% of SGs and 62% of OGs, with OGs more likely to have a PEG placed during treatment (p = 0.025). There was no difference in the prevalence of late (> 6 months) CTCAE grade 2+ dysphagia (36%) or xerostomia (31%) between SGs and OGs. Estimated 3-year LRC, DSS, and OS were not significantly different between SGs (LRC:85%; DSS:87%; OS:76%) and OGs (LRC: 81%; DSS:94%; OS: 55%, p-values: 0.98, 0.42, 0.052, respectively). However, HPV+ disease significantly increased estimated 3-year OS for both SGs (HPV+: 84%; HPV-: 56%, p = 0.0006) and OGs (HPV+: 68%; HPV-: 20%, p = 0.008). CONCLUSION In our cohort, OGs had a higher proportion of HPV+ OPSCC, which was associated with improved OS. This finding may provide insight into the latency of the virus. While there were similar amounts of toxicities among SGs and OGs, OGs more frequently underwent PEG tube placement and experienced more treatment interruptions. Given high rates of HPV+ OPSCC in OGs, our findings suggest that de-escalation strategies should be further investigated to improve tolerability and maximize outcomes for this neglected population.
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Affiliation(s)
- D R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J R Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - B Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Runnels
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - A Powers
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Barlow
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S Chen
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E Monrose
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - O Factor
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - V Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S Roof
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - D Kirke
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Misiukiewicz
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - M Posner
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E Genden
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - R L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Seretny M, Barlow J, Sidebotham D. The credibility plot for extreme explanations and all explanations in between. Anaesthesia 2023; 78:535. [PMID: 36480424 DOI: 10.1111/anae.15935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Affiliation(s)
- M Seretny
- Auckland City Hospital, Auckland, New Zealand
| | - J Barlow
- Auckland City Hospital, Auckland, New Zealand
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3
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Sheikh Y, Ali A, Khasati A, Hasanic A, Bihani U, Ohri R, Muthukumar K, Barlow J. Benefits and Challenges of Video Consulting for Mental Health Diagnosis and Follow-Up: A Qualitative Study in Community Care. Int J Environ Res Public Health 2023; 20:2595. [PMID: 36767957 PMCID: PMC9915222 DOI: 10.3390/ijerph20032595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Mental health services continue to experience rising demand that exceeds capacity. The COVID-19 pandemic exacerbated this crisis, with access to services being reduced. Although video consultations (VCs) are a solution, usage in UK community mental healthcare settings remains limited. This study aims to investigate psychiatrists' and general practitioners' (GPs) perceptions of the benefits and challenges of VC for the diagnosis and follow-up of general adult mental health patients in the community during the COVID-19 pandemic. Semi-structured interviews in NHS community mental healthcare settings were conducted. Psychiatrists (n = 11) and GPs (n = 12) were recruited through purposive sampling. An explorative qualitative approach was employed. Data were analysed using thematic analysis. Four key themes were identified: (1) patient access to VC, (2) suitability of VC for mental health consultations, (3) information gathering with VC and (4) clinician satisfaction with VC. This study provides valuable insights into the experiences of psychiatrists and GPs working in the UK during the COVID-19 pandemic. To facilitate a digital-first future for the NHS, greater investment in remote technologies is required, particularly in the context of growing mental healthcare demand. Though face-to-face consultations remain the gold standard, VC provides an efficient way of communicating with patients, particularly those with less severe forms of mental illness.
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4
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Hidefjäll P, Laurell H, Johansson J, Barlow J. Institutional logics and the adoption and implementation of remote patient monitoring. Innovation 2023. [DOI: 10.1080/14479338.2022.2162907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Patrik Hidefjäll
- Department of Learning, Informatics, Management and Ethics, Unit for Bioentrepreneurship, Karolinska Institutet, LIME, Stockholm, Sweden
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
| | - Hélène Laurell
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
| | - Jeaneth Johansson
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
- Department of Social Sciences, Technology and Arts, Luleå University of Technology, Luleå, Sweden
| | - James Barlow
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
- Imperial College Business School, Centre for Health Economics & Policy Innovation, London, UK
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5
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Seretny M, Barlow J, Sidebotham D. Multicentre randomised trials in anaesthesia: an analysis using Bayesian metrics. Anaesthesia 2023; 78:73-80. [PMID: 36128627 DOI: 10.1111/anae.15867] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 12/13/2022]
Abstract
Are the results of randomised trials reliable and are p values and confidence intervals the best way of quantifying efficacy? Low power is common in medical research, which reduces the probability of obtaining a 'significant result' and declaring the intervention had an effect. Metrics derived from Bayesian methods may provide an insight into trial data unavailable from p values and confidence intervals. We did a structured review of multicentre trials in anaesthesia that were published in the New England Journal of Medicine, The Lancet, Journal of the American Medical Association, British Journal of Anaesthesia and Anesthesiology between February 2011 and November 2021. We documented whether trials declared a non-zero effect by an intervention on the primary outcome. We documented the expected and observed effect sizes. We calculated a Bayes factor from the published trial data indicating the probability of the data under the null hypothesis of zero effect relative to the alternative hypothesis of a non-zero effect. We used the Bayes factor to calculate the post-test probability of zero effect for the intervention (having assumed 50% belief in zero effect before the trial). We contacted all authors to estimate the costs of running the trials. The median (IQR [range]) hypothesised and observed absolute effect sizes were 7% (3-13% [0-25%]) vs. 2% (1-7% [0-24%]), respectively. Non-zero effects were declared for 12/56 outcomes (21%). The Bayes factor favouring a zero effect relative to a non-zero effect for these 12 trials was 0.000001-1.9, with post-test zero effect probabilities for the intervention of 0.0001-65%. The other 44 trials did not declare non-zero effects, with Bayes factors favouring zero effect of 1-688, and post-test probabilities of zero effect of 53-99%. The median (IQR [range]) study costs reported by 20 corresponding authors in US$ were $1,425,669 ($514,766-$2,526,807 [$120,758-$24,763,921]). We think that inadequate power and mortality as an outcome are why few trials declared non-zero effects. Bayes factors and post-test probabilities provide a useful insight into trial results, particularly when p values approximate the significance threshold.
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Affiliation(s)
- M Seretny
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - J Barlow
- University of Auckland, Auckland, New Zealand
| | - D Sidebotham
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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6
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Mindell JS, Parag Y, Bartington SE, Stoll L, Barlow J, Janda KB. The Middle-Out Perspective: an approach to formalise 'normal practice' in public health advocacy. Perspect Public Health 2022:17579139221138451. [PMID: 36583536 DOI: 10.1177/17579139221138451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS The middle-out perspective (MOP) provides a lens to examine how actors positioned between government (top) and individuals (bottom) act to promote broader societal changes from the middle-out (rather than the top-down or bottom-up). The MOP has been used in recent years in the fields of energy, climate change, and development studies. We argue that public health practitioners involved with advocacy activities and creating alliances to amplify health promotion actions will be familiar with the general MOP concept if not the formal name. The article aims to demonstrate this argument. METHODS This article introduces the MOP conceptual framework and customises it for a public health audience by positioning it among existing concepts and theories for actions within public health. Using two UK case studies (increasing signalised crossing times for pedestrians and the campaign for smoke-free legislation), we illustrate who middle actors are and what they can do to result in better public health outcomes. RESULTS These case studies show that involving a wider range of middle actors, including those not traditionally involved in improving the public's health, can broaden the range and reach of organisations and individuals involving in advocating for public health measures. They also demonstrate that middle actors are not neutral. They can be recruited to improve public health outcomes, but they may also be exploited by commercial interests to block healthy policies or even promote a health-diminishing agenda. CONCLUSION Using the MOP as a formal approach can help public health organisations and practitioners consider potential 'allies' from outside traditional health-related bodies or professions. Formal mapping can expand the range of who are considered potential middle actors for a particular public health issue. By applying the MOP, public health organisations and staff can enlist the additional leverage that is brought to bear by involving additional middle actors in improving the public's health.
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Affiliation(s)
- J S Mindell
- Professor of Public Health, Institute of Epidemiology & Health Care, UCL, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Y Parag
- Professor of Energy Policy, Vice Dean, School of Sustainability, Reichman University, Herzliya, Israel
| | - S E Bartington
- Clinical Research Fellow, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - L Stoll
- Public Health Specialty Registrar, Institute of Epidemiology & Health Care, UCL, London, UK
| | - J Barlow
- Professor of Technology & Innovation Management (Healthcare), Imperial College Business School, London, UK
| | - K B Janda
- Principal Research Fellow, Energy Institute, UCL, London, UK
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7
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Bolous NS, Graetz DE, Ashrafian H, Barlow J, Bhakta N, Sounderajah V, Dowdeswell B. Harnessing a clinician-led governance model to overcome healthcare tribalism and drive innovation: a case study of Northumbria NHS Foundation Trust. J Health Organ Manag 2022; ahead-of-print:1-16. [PMID: 36520658 PMCID: PMC10430796 DOI: 10.1108/jhom-05-2022-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/26/2022] [Accepted: 10/04/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation. DESIGN/METHODOLOGY/APPROACH This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale. FINDINGS The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure. PRACTICAL IMPLICATIONS This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result. ORIGINALITY/VALUE Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.
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Affiliation(s)
- Nancy S. Bolous
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Dylan E. Graetz
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London
, London,
UK
- Department of Surgery and Cancer,
Imperial College London
, London,
UK
| | - James Barlow
- Business School,
Imperial College London
, London,
UK
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London
, London,
UK
- Department of Surgery and Cancer,
Imperial College London
, London,
UK
| | - Barrie Dowdeswell
- Management Center Innsbruck, Internationale Hochschule GmbH
, Innsbruck,
Austria
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8
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Hofer MP, Criscuolo P, Shah N, ter Wal ALJ, Barlow J. Regulatory policy and pharmaceutical innovation in the United Kingdom after Brexit: Initial insights. Front Med (Lausanne) 2022; 9:1011082. [PMID: 36590956 PMCID: PMC9797847 DOI: 10.3389/fmed.2022.1011082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Brexit was presented as an opportunity to promote innovation by breaking free from the European Union regulatory framework. Since the beginning of 2021 the Medicines and Healthcare products Regulatory Agency (MHRA) has operated as the independent regulatory agency for the United Kingdom. The MHRA's regulatory activity in 2021 was analyzed and compared to that of other international regulatory bodies. The MHRA remained reliant on EU regulatory decision-making for novel medicines and there were significant regulatory delays for a small number of novel medicines in the UK, the reasons being so far unclear. In addition, the MHRA introduced innovation initiatives, which show early promise for quicker authorization of innovative medicines for cancer and other areas of unmet need. Longer-term observation and analysis is needed to show the full impact of post-Brexit pharmaceutical regulatory policy.
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Affiliation(s)
| | | | - Nilay Shah
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | | | - James Barlow
- Imperial College Business School, London, United Kingdom,*Correspondence: James Barlow
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Gleeson LL, Ludlow A, Clyne B, Ryan B, Argent R, Barlow J, Mellon L, De Brún A, Pate M, Kirke C, Moriarty F, Flood M. Pharmacist and patient experiences of primary care during the COVID-19 pandemic: An interview study. Explor Res Clin Soc Pharm 2022; 8:100193. [PMID: 36268130 PMCID: PMC9557137 DOI: 10.1016/j.rcsop.2022.100193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction A number of significant changes designed to reduce the spread of COVID-19 were introduced in primary care during the COVID-19 pandemic. In Ireland, these included fundamental legislative and practice changes such as permitting electronic transfer of prescriptions, extending duration of prescription validity, and encouraging virtual consultations. Although such interventions served an important role in preventing the spread of infection, their impact on practice and patient care is not yet clear. The aim of this study was to investigate patient and healthcare professional (pharmacist and general practitioner) experiences to understand the impact of COVID-19 on primary care and medication safety during the first two years of the COVID-19 pandemic in Ireland. Methods A qualitative study using semi-structured interviews was undertaken between October 2021 and January 2022. Participants included twelve patients, ten community pharmacists, and one general practitioner. Interviews were transcribed verbatim and analysed using thematic analysis. Only patient and pharmacist interviews were included. Findings Themes from the interviews included: 1) Access to care, 2) Technological changes, 3) Experiences of care, and 4) Patient safety. Particular challenges identified included the difficulty faced by patients when accessing care, impacts on experiences of patient care, and extensive changes to pharmacy practice during the pandemic. Conclusions This study found that COVID-19 countermeasures considerably impacted patient and pharmacist experiences of primary care in terms of care and medication safety. While many changes were welcomed, others such as virtual consultations were received more cautiously likely due to the rapid and unplanned nature of their introduction. Further research is needed to identify how to optimise these changes to improve pharmacist and patient experience, and to understand the impact on patient safety.
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Affiliation(s)
- Laura L. Gleeson
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Aoife Ludlow
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Ben Ryan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Rob Argent
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - James Barlow
- Department of Pharmaceutical and Medicinal Chemistry, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Lisa Mellon
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Muriel Pate
- National Quality and Patient Safety Directorate, Health Service Executive, Dr Steevens' Hospital, Dublin 8, Ireland
| | - Ciara Kirke
- National Quality and Patient Safety Directorate, Health Service Executive, Dr Steevens' Hospital, Dublin 8, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Corresponding author.
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Nilsen P, Reed J, Nair M, Savage C, Macrae C, Barlow J, Svedberg P, Larsson I, Lundgren L, Nygren J. Realizing the potential of artificial intelligence in healthcare: Learning from intervention, innovation, implementation and improvement sciences. Front Health Serv 2022; 2:961475. [PMID: 36925879 PMCID: PMC10012740 DOI: 10.3389/frhs.2022.961475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/22/2022] [Indexed: 06/18/2023]
Abstract
Introduction Artificial intelligence (AI) is widely seen as critical for tackling fundamental challenges faced by health systems. However, research is scant on the factors that influence the implementation and routine use of AI in healthcare, how AI may interact with the context in which it is implemented, and how it can contribute to wider health system goals. We propose that AI development can benefit from knowledge generated in four scientific fields: intervention, innovation, implementation and improvement sciences. Aim The aim of this paper is to briefly describe the four fields and to identify potentially relevant knowledge from these fields that can be utilized for understanding and/or facilitating the use of AI in healthcare. The paper is based on the authors' experience and expertise in intervention, innovation, implementation, and improvement sciences, and a selective literature review. Utilizing knowledge from the four fields The four fields have generated a wealth of often-overlapping knowledge, some of which we propose has considerable relevance for understanding and/or facilitating the use of AI in healthcare. Conclusion Knowledge derived from intervention, innovation, implementation, and improvement sciences provides a head start for research on the use of AI in healthcare, yet the extent to which this knowledge can be repurposed in AI studies cannot be taken for granted. Thus, when taking advantage of insights in the four fields, it is important to also be explorative and use inductive research approaches to generate knowledge that can contribute toward realizing the potential of AI in healthcare.
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Affiliation(s)
- Per Nilsen
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Julie Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Monika Nair
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Carl Savage
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Carl Macrae
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, United Kingdom
| | - James Barlow
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Lina Lundgren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Rojas-Bracho L, Taylor B, Booth C, Thomas L, Jaramillo-Legorreta A, Nieto-García E, Cárdenas Hinojosa G, Barlow J, Mesnick SL, Gerrodette T, Olson P, Henry A, Rizo H, Hidalgo-Pla E, Bonilla-Garzón A. More vaquita porpoises survive than expected. ENDANGER SPECIES RES 2022. [DOI: 10.3354/esr01197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In 2018, it was estimated that fewer than 20 of Mexico’s endemic vaquita porpoise Phocoena sinus remained, and the species was declining by 47% yr-1. Entanglement in gillnets is the sole threat to the species, and since the last population size estimate, gillnetting has increased in the small area where most vaquitas remain—a 12 × 24 km area in the Gulf of California near San Felipe, Mexico. We conducted research efforts in 2019 and 2021 in that area to estimate the minimum numbers of adults and calves and look for any signs that vaquitas are unhealthy. Through expert elicitation, we estimated between 7 and 15 unique individuals were seen in 2019 and 5-13 were seen in 2021. Calves were seen in both years, and all vaquitas appeared healthy. Population projections from the last full survey indicated that more vaquitas have survived than expected. We suggest that these surviving adult vaquitas may have learned to avoid entanglement in gillnets. These vaquitas and their calves provide hope that the species can survive. However, given the high levels of illegal gillnetting and the theft of equipment which hindered our monitoring efforts, and with only around 10 individuals remaining, survival can only be assured if vaquita habitat is made gillnet-free.
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Affiliation(s)
- L Rojas-Bracho
- PNUD/Sinergiaen en la Comisión Nacional de Áreas Naturales Protegidas, Ensenada, BC, México
| | - B Taylor
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - C Booth
- SMRU Consulting, St Andrews, Fife KY16 8LB, UK
| | - L Thomas
- Centre for Research into Ecological and Environmental Modelling, University of St Andrews, St Andrews, Fife KY16 9LZ, UK
| | | | - E Nieto-García
- Comisión Natural de Áreas Naturales Protegidas, Ensenada, BC, México
| | | | - J Barlow
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - SL Mesnick
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - T Gerrodette
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - P Olson
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - A Henry
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - H Rizo
- Museo de la Ballena y Ciencias del Mar, La Paz, BC 23000, México
| | - E Hidalgo-Pla
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA 92037, USA
| | - A Bonilla-Garzón
- K. Lisa Yang Center for Conservation Bioacoustics, Ithaca, NY 14850, USA
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12
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Dallera G, Skopec M, Battersby C, Barlow J, Harris M. Review of a frugal cooling mattress to induce therapeutic hypothermia for treatment of hypoxic-ischaemic encephalopathy in the UK NHS. Global Health 2022; 18:43. [PMID: 35449006 PMCID: PMC9027044 DOI: 10.1186/s12992-022-00833-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Hypoxic ischaemic encephalopathy (HIE) is a major cause of neonatal mortality and disability in the United Kingdom (UK) and has significant human and financial costs. Therapeutic hypothermia (TH), which consists of cooling down the newborn’s body temperature, is the current standard of treatment for moderate or severe cases of HIE. Timely initiation of treatment is critical to reduce risk of mortality and disability associated with HIE. Very expensive servo-controlled devices are currently used in high-income settings to induce TH, whereas low-income settings rely on the use of low-tech devices such as water bottles, ice packs or fans. Cooling mattresses made with phase change materials (PCMs) were recently developed as a safe, efficient, and affordable alternative to induce TH in low-income settings. This frugal innovation has the potential to become a reverse innovation for the National Health Service (NHS) by providing a simple, efficient, and cost-saving solution to initiate TH in geographically remote areas of the UK where cooling equipment might not be readily available, ensuring timely initiation of treatment while waiting for neonatal transport to the nearest cooling centre. The adoption of PCM cooling mattresses by the NHS may reduce geographical disparity in the availability of treatment for HIE in the UK, and it could benefit from improvements in coordination across all levels of neonatal care given challenges currently experienced by the NHS in terms of constraints on funding and shortage of staff. Trials evaluating the effectiveness and safety of PCM cooling mattresses in the NHS context are needed in support of the adoption of this frugal innovation. These findings may be relevant to other high-income settings that experience challenges with the provision of TH in geographically remote areas. The use of promising frugal innovations such as PCM cooling mattresses in high-income settings may also contribute to challenge the dominant narrative that often favours innovation from North America and Western Europe, and consequently fight bias against research and development from low-income settings, promoting a more equitable global innovation landscape.
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Affiliation(s)
- Giulia Dallera
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Mark Skopec
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Cheryl Battersby
- Department of Primary Care and Public Health, Imperial College London, London, UK.,Consultant Neonatologist, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - James Barlow
- Imperial College Business School, Imperial College London, London, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, London, UK.
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13
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Gama F, Tyskbo D, Nygren J, Barlow J, Reed J, Svedberg P. Implementation Frameworks for Artificial Intelligence Translation Into Health Care Practice: Scoping Review. J Med Internet Res 2022; 24:e32215. [PMID: 35084349 PMCID: PMC8832266 DOI: 10.2196/32215] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/02/2021] [Accepted: 12/27/2021] [Indexed: 01/22/2023] Open
Abstract
Background Significant efforts have been made to develop artificial intelligence (AI) solutions for health care improvement. Despite the enthusiasm, health care professionals still struggle to implement AI in their daily practice. Objective This paper aims to identify the implementation frameworks used to understand the application of AI in health care practice. Methods A scoping review was conducted using the Cochrane, Evidence Based Medicine Reviews, Embase, MEDLINE, and PsycINFO databases to identify publications that reported frameworks, models, and theories concerning AI implementation in health care. This review focused on studies published in English and investigating AI implementation in health care since 2000. A total of 2541 unique publications were retrieved from the databases and screened on titles and abstracts by 2 independent reviewers. Selected articles were thematically analyzed against the Nilsen taxonomy of implementation frameworks, and the Greenhalgh framework for the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health care technologies. Results In total, 7 articles met all eligibility criteria for inclusion in the review, and 2 articles included formal frameworks that directly addressed AI implementation, whereas the other articles provided limited descriptions of elements influencing implementation. Collectively, the 7 articles identified elements that aligned with all the NASSS domains, but no single article comprehensively considered the factors known to influence technology implementation. New domains were identified, including dependency on data input and existing processes, shared decision-making, the role of human oversight, and ethics of population impact and inequality, suggesting that existing frameworks do not fully consider the unique needs of AI implementation. Conclusions This literature review demonstrates that understanding how to implement AI in health care practice is still in its early stages of development. Our findings suggest that further research is needed to provide the knowledge necessary to develop implementation frameworks to guide the future implementation of AI in clinical practice and highlight the opportunity to draw on existing knowledge from the field of implementation science.
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Affiliation(s)
- Fábio Gama
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden.,School of Administration and Economic Science, Santa Catarina State University, Florianópolis, Brazil
| | - Daniel Tyskbo
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - James Barlow
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Julie Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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14
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Thompson B, Philcox S, Devereaux B, Metz A, Croagh D, Windsor J, Davaris A, Gupta S, Barlow J, Rhee J, Tagkalidis P, Zimet A, Sharma A, Manocha R, Neale RE. A decision support tool for the detection of pancreatic cancer in general practice: A modified Delphi consensus. Pancreatology 2021; 21:1476-1481. [PMID: 34483054 DOI: 10.1016/j.pan.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Diagnosis of pancreatic cancer is often delayed, contributing to patient and family distress and leading to worse survival. We aimed to develop a decision support tool to support primary care providers to identify patients that should undergo investigations for pancreatic cancer, and to recommend initial diagnostic pathways. METHODS A modified Delphi process, including a series of three surveys, was undertaken to ascertain clinical expert opinion on which combinations of signs, symptoms and risk factors should be included in a tool for the early identification of pancreatic cancer. A group of clinical specialists finalised the development of the tool during a focus group meeting. RESULTS The tool presents individual or combinations of signs, symptoms, and risk factors in three tiers which direct the urgency of investigation. Tier 1 includes 5 clinical presentation and risk factors clusters that indicate the need for urgent investigation of the pancreas. A further five clusters are included as Tier 2 aiming to elimate other causes and reduce the time to investigating the pancreas. Tier 3 includes a list of non-specific signs, symptoms and risk factors that indicate the need to consider pancreatic cancer as a potential diagnosis, but without specific recommendations for investigation. CONCLUSIONS Prospective validation studies are now required prior to implementation in the primary care setting. Implementation into primary care practice and as an educational resource may facilitate rapid diagnosis and improve outcomes such as distress and survival.
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Affiliation(s)
- B Thompson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia.
| | - S Philcox
- Gastroenterology Department, John Hunter Hosptial, New South Wales, Australia
| | - B Devereaux
- The Gastroenterology and Hepatology Department, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Clinical Medicine, University of Queensland, Queensland, Australia
| | - A Metz
- Gastroenterology and Hepatology, Royal Melbourne Hospital, Victoria, Australia
| | - D Croagh
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Victoria, Australia
| | - J Windsor
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - A Davaris
- Royal Australian College of General Practitioners, Australia
| | - S Gupta
- Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - J Barlow
- Bankstown Family Medical Practice, Sydney, Australia
| | - J Rhee
- Royal Australian College of General Practitioners, Australia; General Practice Academic Unit, Graduate Medicine, University of Wollongong, New South Wales, Australia
| | - P Tagkalidis
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - A Zimet
- Epworth Hospital, Victoria, Australia
| | - A Sharma
- School of Clinical Medicine, University of Queensland, Queensland, Australia
| | - R Manocha
- HealthEd, Melbourne, Victoria, Australia
| | - R E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia; School of Public Health, University of Queensland, Queensland, Australia
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15
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Svedberg P, Reed J, Nilsen P, Barlow J, Macrae C, Nygren J. Towards successful implementation of artificial intelligence in healthcare practice: A research program (Preprint). JMIR Res Protoc 2021; 11:e34920. [PMID: 35262500 PMCID: PMC8943554 DOI: 10.2196/34920] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Julie Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Per Nilsen
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - James Barlow
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Carl Macrae
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, United Kingdom
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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16
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Mindell JS, Bartington S, Janda KB, Stoll L, Barlow J, Parag Y. Using the Middle-Out Perspective to augment advocacy for smokefree legislation. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
Complementing ‘Bottom-up' and ‘Top-down' approaches, the Middle-Out Perspective (MOP) conceptual framework focuses on how middle actors can influence action by enhancing other actors' interest and ability to act. Middle actors exert influence sideways on other middle actors, upwards on policymakers and downwards on individuals. Middle actors can be immediate targets as potential allies or communication channels.
Description of the problem
Successive governments' longstanding voluntary agreements with industry have not protected children and non-smokers from secondhand smoke. Can the MOP enhance effectiveness of small organisations whose voices are ignored?
Results
The NGO Action on Smoking and Health (ASH) built a coalition of NGOs, practitioners' organisations, and others to advocate for smokefree legislation. Aggregating these voices made them more visible and their demand more influential. Involvement of trade unions and lawyers threatened legal action by exposed employees. Local government support and threats of local legislation changed the hospitality trade's opposition to support. Middle actors' supporters and members lobbied their MPs. ASH's professional expertise and reputation made them a trustworthy actor with legitimacy. The consortium led to the national government in England passing smokefree legislation in 2006.
Lessons
Middle actors can be agents of change, promoting desirable public health goals in a middle-out manner. Formal MOP mapping at the start of work can help public health staff identify potential non-traditional ‘allies' to expand the range of who are considered potential middle actors for a particular issue, enlisting powerful additional leverage in improving the public's health. However, middle actors are not neutral. They can contribute to better public health, but they may also be exploited by commercial interests to block healthy policies or promote a health-diminishing agenda.
Key messages
The Middle-Out Perspective (MOP) provide a lens to examine how actors positioned between government (top) and individuals (bottom) act to promote changes in a middle-out manner. Using MOP as a formal approach can help public health organisations and practitioners consider potential ‘allies’ from outside traditional health-related bodies or professions.
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Affiliation(s)
- JS Mindell
- Epidemiology & Public Health, University College London, London, UK
| | - S Bartington
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - KB Janda
- Energy Institute, University College London, London, UK
| | - L Stoll
- Epidemiology & Public Health, University College London, London, UK
| | - J Barlow
- Imperial College Business School, Imperial College, London, UK
| | - Y Parag
- School of Sustainability, Interdisciplinary Center, Herzliya, Israel
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17
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Kerr A, Strawbridge J, Kelleher C, Barlow J, Sullivan C, Pawlikowska T. A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training. BMC Med Educ 2021; 21:325. [PMID: 34092216 PMCID: PMC8180382 DOI: 10.1186/s12909-021-02776-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Effective communication between pharmacists and patients is essential and improves health outcomes. Simulated patients (SPs) are trained to reproduce real-life situations and can help pharmacy students to develop and adapt their communication skills in a safe, learner-centred environment. The aim of this research was to explore how SP and pharmacy student role-play supports communication training. METHODS A mixed methods realist evaluation approach was adopted to test an initial theory relating to SP role-play for pharmacy students. The intervention tested involved complex communication cases in a men's and women's health module in year three of a new MPharm programme. This SP session was the first such session, of the programme which exclusively focused on complex communication skills for the students. Data collected comprised video-recordings of both training and mock OSCE sessions, and from student focus groups. Communication videos were scored using the Explanation and Planning Scale (EPSCALE) tool. Scores from SP and mock OSCE sessions were compared using the Wilcoxon-signed rank test. Focus groups were conducted with students about their experience of the training and analysed thematically, through a realist lens. Data was analysed for Context-Mechanism-Outcome configurations to produce modified programme theories. RESULTS Forty-six students (n = 46/59, 78 %) consented to their video-recorded interactions to be used. Students identified contextual factors relating to the timing within the course and the setting of the intervention, the debrief and student individual contexts. Mechanisms included authenticity, feedback, reflection, self-awareness and confidence. Negative responses included embarrassment and nervousness. They distinguished outcomes including increased awareness of communication style, more structured communication and increased comfort. However quantitative data showed a decrease (p < 0.001) in communication scores in the mock OSCE compared with scores from training sessions. Modified programme theories relating to SP training for pharmacy students were generated. CONCLUSIONS SP role-play is a valuable communication skills training approach. Emphasis should be placed on multiple stakeholder feedback and promotion of reflection. Time limits need to be considered in this context and adjusted to meet student needs, especially for students with lower levels of communication comfort and those communicating in languages different to their first language.
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Affiliation(s)
- Aisling Kerr
- School of Pharmacy and Biomolecular Sciences, RCSI School of Medicine and Health Sciences, RCSI University of Medicine and Health Sciences, 1st floor Ardilaun House Block B, 111 St, Stephen's Green, Dublin 2, Ireland.
| | - Judith Strawbridge
- School of Pharmacy and Biomolecular Sciences, RCSI School of Medicine and Health Sciences, RCSI University of Medicine and Health Sciences, 1st floor Ardilaun House Block B, 111 St, Stephen's Green, Dublin 2, Ireland
| | - Caroline Kelleher
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - James Barlow
- Department of Chemistry, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Clare Sullivan
- Department of Simulation, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Teresa Pawlikowska
- Health Professions Education Centre (HPEC), RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
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18
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Abstract
INTRODUCTION Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. METHODS We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC-Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. RESULTS The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. CONCLUSION The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. TRIAL REGISTRATION Prospero ID: CRD42017082140.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
| | - James Barlow
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Liz Evans
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
| | - Julie Reed
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
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19
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Huddy JR, Ni MZ, Barlow J, Hanna GB. Qualitative analysis of stakeholder interviews to identify the barriers and facilitators to the adoption of point-of-care diagnostic tests in the UK. BMJ Open 2021; 11:e042944. [PMID: 33849848 PMCID: PMC8051412 DOI: 10.1136/bmjopen-2020-042944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigated the barriers and facilitators to the adoption of point-of-care tests (POCTs). DESIGN Qualitative study incorporating a constant comparative analysis of stakeholder responses to a series of interviews undertaken to design the Point-of-Care Key Evidence Tool. SETTING The study was conducted in relation to POCTs used in all aspects of healthcare. PARTICIPANTS Forty-three stakeholders were interviewed including clinicians (incorporating laboratory staff and members of trust POCT committees), commissioners, industry, regulators and patients. RESULTS Thematic analysis highlighted 32 barriers in six themes and 28 facilitators in eight themes to the adoption of POCTs. Six themes were common to both barriers and facilitators (clinical, cultural, evidence, design and quality assurance, financial and organisational) and two themes contained facilitators alone (patient factors and other (non-financial) resource use). CONCLUSIONS Findings from this study demonstrate the complex motivations of stakeholders in the adoption of POCT. Most themes were common to both barriers and facilitators suggesting that good device design, stakeholder engagement and appropriate evidence provision can increase the likelihood of a POCT device adoption. However, it is important to realise that while the majority of identified barriers may be perceived or mitigated some may be absolute and if identified early in device development further investment should be carefully considered.
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Affiliation(s)
- Jeremy R Huddy
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Melody Zhifang Ni
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - James Barlow
- Imperial College Business School, Imperial College London, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
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20
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Barlow J. What is the role of video feedback in supporting parents experiencing mental health problems? Eur Psychiatry 2021. [PMCID: PMC9471298 DOI: 10.1192/j.eurpsy.2021.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract Body Parental mental health problems have been found to have a significant impact on a range of aspects of parental caregiving during the postnatal period, with significant implications in terms of key aspects of the child’s development. Video feedback is a generic term that refers to the use of videotaped interactions of the parent and child to promote parental sensitivity, and a recent meta‐analysis of 20 studies (1757 parent‐child dyads) found that video feedback can improve parental sensitivity compared with a control or no intervention up to six months’ follow‐up. This paper will examine the ways in which video feedback might contribute to the ability of parents with mental health problems to provide the type of caregiving that will promote the development of a secure attachment in the infant. Disclosure No significant relationships.
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21
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Sounderajah V, Patel V, Varatharajan L, Harling L, Normahani P, Symons J, Barlow J, Darzi A, Ashrafian H. Are disruptive innovations recognised in the healthcare literature? A systematic review. ACTA ACUST UNITED AC 2020; 7:208-216. [PMID: 33489312 PMCID: PMC7802637 DOI: 10.1136/bmjinnov-2020-000424] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/01/2020] [Accepted: 07/25/2020] [Indexed: 12/16/2022]
Abstract
The study aims to conduct a systematic review to characterise the spread and use of the concept of ‘disruptive innovation’ within the healthcare sector. We aim to categorise references to the concept over time, across geographical regions and across prespecified healthcare domains. From this, we further aim to critique and challenge the sector-specific use of the concept. PubMed, Medline, Embase, Global Health, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium were searched from inception to August 2019 for references pertaining to disruptive innovations within the healthcare industry. The heterogeneity of the articles precluded a meta-analysis, and neither quality scoring of articles nor risk of bias analyses were required. 245 articles that detailed perceived disruptive innovations within the health sector were identified. The disruptive innovations were categorised into seven domains: basic science (19.2%), device (12.2%), diagnostics (4.9%), digital health (21.6%), education (5.3%), processes (17.6%) and technique (19.2%). The term has been used with increasing frequency annually and is predominantly cited in North American (78.4%) and European (15.2%) articles. The five most cited disruptive innovations in healthcare are ‘omics’ technologies, mobile health applications, telemedicine, health informatics and retail clinics. The concept ‘disruptive innovation’ has diffused into the healthcare industry. However, its use remains inconsistent and the recognition of disruption is obscured by other types of innovation. The current definition does not accommodate for prospective scouting of disruptive innovations, a likely hindrance to policy makers. Redefining disruptive innovation within the healthcare sector is therefore crucial for prospectively identifying cost-effective innovations.
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Affiliation(s)
- Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, UK.,Institute of Global Health Innovation, Imperial College London, London, UK
| | - Vanash Patel
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of General Surgery, Watford General Hospital, West Hetfordshire NHS Trust, Watford, UK
| | - Lavanya Varatharajan
- Department of Bariatric Surgery, Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Pasha Normahani
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Joshua Symons
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - James Barlow
- Imperial College Business School, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK.,Institute of Global Health Innovation, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK.,Institute of Global Health Innovation, Imperial College London, London, UK
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22
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Hibbitts AJ, Ramsey JM, Barlow J, MacLoughlin R, Cryan SA. In Vitro and In Vivo Assessment of PEGylated PEI for Anti-IL-8/CxCL-1 siRNA Delivery to the Lungs. Nanomaterials (Basel) 2020; 10:nano10071248. [PMID: 32605011 PMCID: PMC7407419 DOI: 10.3390/nano10071248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Abstract
Inhalation offers a means of rapid, local delivery of siRNA to treat a range of autoimmune or inflammatory respiratory conditions. This work investigated the potential of a linear 10 kDa Poly(ethylene glycol) (PEG)-modified 25 kDa branched polyethyleneimine (PEI) (PEI-LPEG) to effectively deliver siRNA to airway epithelial cells. Following optimization with anti- glyceraldehyde 3-phosphate dehydrogenase (GAPDH) siRNA, PEI and PEI-LPEG anti-IL8 siRNA nanoparticles were assessed for efficacy using polarised Calu-3 human airway epithelial cells and a twin stage impinger (TSI) in vitro lung model. Studies were then advanced to an in vivo lipopolysaccharide (LPS)-stimulated rodent model of inflammation. In parallel, the suitability of the siRNA-loaded nanoparticles for nebulization using a vibrating mesh nebuliser was assessed. The siRNA nanoparticles were nebulised using an Aerogen® Pro vibrating mesh nebuliser and characterised for aerosol output, droplet size and fine particle fraction. Only PEI anti-IL8 siRNA nanoparticles were capable of significant levels of IL-8 knockdown in vitro in non-nebulised samples. However, on nebulization through a TSI, only PEI-PEG siRNA nanoparticles demonstrated significant decreases in gene and protein expression in polarised Calu-3 cells. In vivo, both anti-CXCL-1 (rat IL-8 homologue) nanoparticles demonstrated a decreased CXCL-1 gene expression in lung tissue, but this was non-significant. However, PEI anti-CXCL-1 siRNA-treated rats were found to have significantly less infiltrating macrophages in their bronchoalveolar lavage (BAL) fluid. Overall, the in vivo gene and protein inhibition findings indicated a result more reminiscent of the in vitro bolus delivery rather than the in vitro nebulization data. This work demonstrates the potential of nebulised PEI-PEG siRNA nanoparticles in modulating pulmonary inflammation and highlights the need to move towards more relevant in vitro and in vivo models for respiratory drug development.
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Affiliation(s)
- Alan J. Hibbitts
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland; (A.J.H.); (J.M.R.); (R.M.)
- Trinity Centre for Biomedical Engineering, Trinity College, Dublin D02 R590, Ireland
| | - Joanne M. Ramsey
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland; (A.J.H.); (J.M.R.); (R.M.)
| | - James Barlow
- Department of Chemistry, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland;
| | - Ronan MacLoughlin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland; (A.J.H.); (J.M.R.); (R.M.)
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin D02 PN40, Ireland
- Aerogen Ltd. Galway Business Park, Galway H91 HE94, Ireland
| | - Sally-Ann Cryan
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland; (A.J.H.); (J.M.R.); (R.M.)
- Trinity Centre for Biomedical Engineering, Trinity College, Dublin D02 R590, Ireland
- Correspondence: ; Tel.: +353-14022741
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Abstract
Using the example of mosquitoes that are genetically modified for malaria eradication through gene drive methods, a scientifically complex ‘living technology’, we show how complexity, uncertainty and risk can propel NPD processes towards a linear sequence of stages. Although the need to control risks associated with gene drive technology imposes linearity to the NPD process, there are possibilities for deviation from a structured sequence of stages. This is due to the effects of feedback loops in the wider system of evidence creation and learning at the population and governance levels, which cumulatively impact on acceptance of the innovation. The NPD and adoption processes involved in the use of gene drive technology are closely intertwined, and the endpoint for R&D and beginning of ‘mainstream’ adoption and diffusion are unclear.
When there is significant uncertainty in an innovation project, research literature suggests that strictly sequencing actions and stages may not be an appropriate mode of project management. We use a longitudinal process approach and qualitative system dynamics modelling to study the development of genetically modified (GM) mosquitoes for malaria eradication in an African country. Our data were collected in real time, from early scientific research to deployment of the first prototype mosquitoes in the field. The 'gene drive' technology for modifying the mosquitoes is highly complex and controversial due to risks associated with its characteristics as a living, self-replicating technology. We show that in this case the innovation journey is linear and highly structured, but also embedded within a wider system of adoption that displays emergent behaviour. Although the need to control risks associated with the technology imposes a linearity to the NPD process, there are possibilities for deviation from a more structured sequence of stages. This arises from the effects of feedback loops in the wider system of evidence creation and learning at the population and governance levels, which cumulatively impact on acceptance of the innovation. The NPD and adoption processes are therefore closely intertwined, meaning that the endpoint for R&D and beginning of 'mainstream' adoption and diffusion are unclear. A key challenge for those responsible for NPD and its regulation is to plan for the adoption of the technology while simultaneously conducting its scientific and technical development.
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Affiliation(s)
- Valentina Cisnetto
- Imperial College London, Department of Life Sciences, South Kensington Campus, London, SW7 2AZ, United Kingdom
| | - James Barlow
- Imperial College Business School, South Kensington Campus, London, SW7 2AZ, United Kingdom
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Duperret EK, Perales-Puchalt A, Stoltz R, Hiranjith G, Mandloi N, Barlow J, Chaudhuri A, Sardesai NY, Weiner DB. Abstract B67: Synthetic DNA multi-neoantigen vaccine drives predominately MHC class I CD8+ T cell-mediated effector immunity impacting tumor challenge. Cancer Immunol Res 2020. [DOI: 10.1158/2326-6074.tumimm18-b67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
T-cell recognition of cancer neoantigens is important for effective immune checkpoint blockade therapy, and there is increasing interest in developing personalized tumor neoantigen vaccines. Previous studies utilizing RNA and synthetic long peptide neoantigen vaccines in preclinical and early-phase clinical studies have shown immune responses predominantly driven by MHC class II CD4+ T cells. Although it has been established that CD4+ T cells are able to recognize tumor neoantigens, the majority of naturally occurring tumor antigen-specific killer T cells identified in patients have been of CD8+ origin, indicating that additional immunization strategies aimed to stimulate neoantigen-specific CD8+ T cells may be useful. Here, we report the first preclinical study utilizing a synthetic DNA vaccine platform to target tumor neoantigens in mice. For this study, we identified neoepitopes by sequencing syngeneic mouse tumors, and designed optimized DNA plasmids encoding long strings of neoepitopes separated by highly efficient cleavage sites preserving epitope integrity. We tested the immunogenicity of 84 independent neoepitopes encoded into optimized DNA plasmids delivered by adaptive electroporation in mice in vivo. We observed that this approach generated robust T-cell immunity against a similar proportion of epitopes compared to other vaccine platforms (20/84, 24%). Strikingly, however, the synthetic neoantigen DNA vaccine platform generated a much larger proportion of CD8+ T-cell responses compared to the prior studies. Synthetic neoantigen DNA vaccines generated 75% CD8+ only or CD4/CD8+ T-cell responses, and 25% CD4+ only T-cell responses, showing a dramatic and important CD8+ T-cell bias. Inclusion of only high-affinity MHC class I (<500nM) epitopes selected for a larger proportion of immunogenic epitopes, and for 100% CD8+ or CD8+/CD4+ T-cell epitopes. These neoantigen vaccines were able to control tumor growth therapeutically in vivo in both lung and ovarian cancer models, and T cells expanded from immunized mice were able to kill tumor cells ex vivo. Because of the potential for rapid synthesis of vaccine constructs, the capacity to deliver a large number of neoepitopes simultaneously, and the potent CD8+ stimulatory capacity, this advanced DNA vaccine platform represents a likely important new approach for cancer immunotherapy.
Citation Format: Elizabeth K. Duperret, Alfredo Perales-Puchalt, Regina Stoltz, G.H. Hiranjith, Nitin Mandloi, James Barlow, Amitabha Chaudhuri, Niranjan Y. Sardesai, David B. Weiner. Synthetic DNA multi-neoantigen vaccine drives predominately MHC class I CD8+ T cell-mediated effector immunity impacting tumor challenge [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr B67.
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25
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Ali A, Amaryan M, Anassontzis EG, Austregesilo A, Baalouch M, Barbosa F, Barlow J, Barnes A, Barriga E, Beattie TD, Berdnikov VV, Black T, Boeglin W, Boer M, Briscoe WJ, Britton T, Brooks WK, Cannon BE, Cao N, Chudakov E, Cole S, Cortes O, Crede V, Dalton MM, Daniels T, Deur A, Dobbs S, Dolgolenko A, Dotel R, Dugger M, Dzhygadlo R, Egiyan H, Ernst A, Eugenio P, Fanelli C, Fegan S, Foda AM, Foote J, Frye J, Furletov S, Gan L, Gasparian A, Gauzshtein V, Gevorgyan N, Gleason C, Goetzen K, Goncalves A, Goryachev VS, Guo L, Hakobyan H, Hamdi A, Han S, Hardin J, Huber GM, Hurley A, Ireland DG, Ito MM, Jarvis NS, Jones RT, Kakoyan V, Kalicy G, Kamel M, Kourkoumelis C, Kuleshov S, Kuznetsov I, Larin I, Lawrence D, Lersch DI, Li H, Li W, Liu B, Livingston K, Lolos GJ, Lyubovitskij V, Mack D, Marukyan H, Matveev V, McCaughan M, McCracken M, McGinley W, McIntyre J, Meyer CA, Miskimen R, Mitchell RE, Mokaya F, Nerling F, Ng L, Ostrovidov AI, Papandreou Z, Patsyuk M, Pauli P, Pedroni R, Pentchev L, Peters KJ, Phelps W, Pooser E, Qin N, Reinhold J, Ritchie BG, Robison L, Romanov D, Romero C, Salgado C, Schertz AM, Schumacher RA, Schwiening J, Seth KK, Shen X, Shepherd MR, Smith ES, Sober DI, Somov A, Somov S, Soto O, Stevens JR, Strakovsky II, Suresh K, Tarasov V, Taylor S, Teymurazyan A, Thiel A, Vasileiadis G, Werthmüller D, Whitlatch T, Wickramaarachchi N, Williams M, Xiao T, Yang Y, Zarling J, Zhang Z, Zhao G, Zhou Q, Zhou X, Zihlmann B. First Measurement of Near-Threshold J/ψ Exclusive Photoproduction off the Proton. Phys Rev Lett 2019; 123:072001. [PMID: 31491124 DOI: 10.1103/physrevlett.123.072001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/05/2019] [Indexed: 05/24/2023]
Abstract
We report on the measurement of the γp→J/ψp cross section from E_{γ}=11.8 GeV down to the threshold at 8.2 GeV using a tagged photon beam with the GlueX experiment. We find that the total cross section falls toward the threshold less steeply than expected from two-gluon exchange models. The differential cross section dσ/dt has an exponential slope of 1.67±0.39 GeV^{-2} at 10.7 GeV average energy. The LHCb pentaquark candidates P_{c}^{+} can be produced in the s channel of this reaction. We see no evidence for them and set model-dependent upper limits on their branching fractions B(P_{c}^{+}→J/ψp) and cross sections σ(γp→P_{c}^{+})×B(P_{c}^{+}→J/ψp).
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Affiliation(s)
- A Ali
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - M Amaryan
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - E G Anassontzis
- National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - A Austregesilo
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - M Baalouch
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - F Barbosa
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - J Barlow
- Florida State University, Tallahassee, Florida 32306, USA
| | - A Barnes
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - E Barriga
- Florida State University, Tallahassee, Florida 32306, USA
| | - T D Beattie
- University of Regina, Regina, Saskatchewan, Canada S4S 0A2
| | - V V Berdnikov
- National Research Nuclear University Moscow Engineering Physics Institute, Moscow 115409, Russia
| | - T Black
- University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - W Boeglin
- Florida International University, Miami, Florida 33199, USA
| | - M Boer
- The Catholic University of America, Washington, D.C. 20064, USA
| | - W J Briscoe
- The George Washington University, Washington, D.C. 20052, USA
| | - T Britton
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - W K Brooks
- Universidad Técnica Federico Santa María, Casilla 110-V Valparaíso, Chile
| | - B E Cannon
- Florida State University, Tallahassee, Florida 32306, USA
| | - N Cao
- Institute of High Energy Physics, Beijing 100049, People's Republic of China
| | - E Chudakov
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Cole
- Arizona State University, Tempe, Arizona 85287, USA
| | - O Cortes
- The George Washington University, Washington, D.C. 20052, USA
| | - V Crede
- Florida State University, Tallahassee, Florida 32306, USA
| | - M M Dalton
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T Daniels
- University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - A Deur
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Dobbs
- Florida State University, Tallahassee, Florida 32306, USA
| | - A Dolgolenko
- National Research Centre Kurchatov Institute, Institute for Theoretical and Experimental Physics, Moscow 117259, Russia
| | - R Dotel
- Florida International University, Miami, Florida 33199, USA
| | - M Dugger
- Arizona State University, Tempe, Arizona 85287, USA
| | - R Dzhygadlo
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - H Egiyan
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Ernst
- Florida State University, Tallahassee, Florida 32306, USA
| | - P Eugenio
- Florida State University, Tallahassee, Florida 32306, USA
| | - C Fanelli
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - S Fegan
- The George Washington University, Washington, D.C. 20052, USA
| | - A M Foda
- University of Regina, Regina, Saskatchewan, Canada S4S 0A2
| | - J Foote
- Indiana University, Bloomington, Indiana 47405, USA
| | - J Frye
- Indiana University, Bloomington, Indiana 47405, USA
| | - S Furletov
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - L Gan
- University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - A Gasparian
- North Carolina A&T State University, Greensboro, North Carolina 27411, USA
| | - V Gauzshtein
- Tomsk State University, 634050 Tomsk, Russia
- Tomsk Polytechnic University, 634050 Tomsk, Russia
| | - N Gevorgyan
- A.I. Alikhanian National Science Laboratory (Yerevan Physics Institute), 0036 Yerevan, Armenia
| | - C Gleason
- Indiana University, Bloomington, Indiana 47405, USA
| | - K Goetzen
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - A Goncalves
- Florida State University, Tallahassee, Florida 32306, USA
| | - V S Goryachev
- National Research Centre Kurchatov Institute, Institute for Theoretical and Experimental Physics, Moscow 117259, Russia
| | - L Guo
- Florida International University, Miami, Florida 33199, USA
| | - H Hakobyan
- Universidad Técnica Federico Santa María, Casilla 110-V Valparaíso, Chile
| | - A Hamdi
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - S Han
- Wuhan University, Wuhan, Hubei 430072, People's Republic of China
| | - J Hardin
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - G M Huber
- University of Regina, Regina, Saskatchewan, Canada S4S 0A2
| | - A Hurley
- College of William and Mary, Williamsburg, Virginia 23185, USA
| | - D G Ireland
- University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - M M Ito
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - N S Jarvis
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - R T Jones
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - V Kakoyan
- A.I. Alikhanian National Science Laboratory (Yerevan Physics Institute), 0036 Yerevan, Armenia
| | - G Kalicy
- The Catholic University of America, Washington, D.C. 20064, USA
| | - M Kamel
- Florida International University, Miami, Florida 33199, USA
| | - C Kourkoumelis
- National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - S Kuleshov
- Universidad Técnica Federico Santa María, Casilla 110-V Valparaíso, Chile
| | - I Kuznetsov
- Tomsk State University, 634050 Tomsk, Russia
- Tomsk Polytechnic University, 634050 Tomsk, Russia
| | - I Larin
- University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - D Lawrence
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D I Lersch
- Florida State University, Tallahassee, Florida 32306, USA
| | - H Li
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - W Li
- College of William and Mary, Williamsburg, Virginia 23185, USA
| | - B Liu
- Institute of High Energy Physics, Beijing 100049, People's Republic of China
| | - K Livingston
- University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - G J Lolos
- University of Regina, Regina, Saskatchewan, Canada S4S 0A2
| | - V Lyubovitskij
- Tomsk State University, 634050 Tomsk, Russia
- Tomsk Polytechnic University, 634050 Tomsk, Russia
| | - D Mack
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - H Marukyan
- A.I. Alikhanian National Science Laboratory (Yerevan Physics Institute), 0036 Yerevan, Armenia
| | - V Matveev
- National Research Centre Kurchatov Institute, Institute for Theoretical and Experimental Physics, Moscow 117259, Russia
| | - M McCaughan
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M McCracken
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - W McGinley
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - J McIntyre
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - C A Meyer
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - R Miskimen
- University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - R E Mitchell
- Indiana University, Bloomington, Indiana 47405, USA
| | - F Mokaya
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - F Nerling
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - L Ng
- Florida State University, Tallahassee, Florida 32306, USA
| | - A I Ostrovidov
- Florida State University, Tallahassee, Florida 32306, USA
| | - Z Papandreou
- University of Regina, Regina, Saskatchewan, Canada S4S 0A2
| | - M Patsyuk
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - P Pauli
- University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - R Pedroni
- North Carolina A&T State University, Greensboro, North Carolina 27411, USA
| | - L Pentchev
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - K J Peters
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - W Phelps
- The George Washington University, Washington, D.C. 20052, USA
| | - E Pooser
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - N Qin
- Northwestern University, Evanston, Illinois 60208, USA
| | - J Reinhold
- Florida International University, Miami, Florida 33199, USA
| | - B G Ritchie
- Arizona State University, Tempe, Arizona 85287, USA
| | - L Robison
- Northwestern University, Evanston, Illinois 60208, USA
| | - D Romanov
- National Research Nuclear University Moscow Engineering Physics Institute, Moscow 115409, Russia
| | - C Romero
- Universidad Técnica Federico Santa María, Casilla 110-V Valparaíso, Chile
| | - C Salgado
- Norfolk State University, Norfolk, Virginia 23504, USA
| | - A M Schertz
- College of William and Mary, Williamsburg, Virginia 23185, USA
| | - R A Schumacher
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - J Schwiening
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - K K Seth
- Northwestern University, Evanston, Illinois 60208, USA
| | - X Shen
- Institute of High Energy Physics, Beijing 100049, People's Republic of China
| | - M R Shepherd
- Indiana University, Bloomington, Indiana 47405, USA
| | - E S Smith
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D I Sober
- The Catholic University of America, Washington, D.C. 20064, USA
| | - A Somov
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Somov
- National Research Nuclear University Moscow Engineering Physics Institute, Moscow 115409, Russia
| | - O Soto
- Universidad Técnica Federico Santa María, Casilla 110-V Valparaíso, Chile
| | - J R Stevens
- College of William and Mary, Williamsburg, Virginia 23185, USA
| | - I I Strakovsky
- The George Washington University, Washington, D.C. 20052, USA
| | - K Suresh
- University of Regina, Regina, Saskatchewan, Canada S4S 0A2
| | - V Tarasov
- National Research Centre Kurchatov Institute, Institute for Theoretical and Experimental Physics, Moscow 117259, Russia
| | - S Taylor
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Teymurazyan
- University of Regina, Regina, Saskatchewan, Canada S4S 0A2
| | - A Thiel
- University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - G Vasileiadis
- National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - D Werthmüller
- University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - T Whitlatch
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | | | - M Williams
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - T Xiao
- Northwestern University, Evanston, Illinois 60208, USA
| | - Y Yang
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Zarling
- Indiana University, Bloomington, Indiana 47405, USA
| | - Z Zhang
- Wuhan University, Wuhan, Hubei 430072, People's Republic of China
| | - G Zhao
- Institute of High Energy Physics, Beijing 100049, People's Republic of China
| | - Q Zhou
- Institute of High Energy Physics, Beijing 100049, People's Republic of China
| | - X Zhou
- Wuhan University, Wuhan, Hubei 430072, People's Republic of China
| | - B Zihlmann
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
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26
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Strawbridge J, Barlow J, O’Leary A, Spooner M, Clarke E, Arnett R, Langley C, Wilson K, Gallagher P. Design and Evaluation of a New National Pharmacy Internship Program in Ireland. Am J Pharm Educ 2019; 83:6678. [PMID: 31223152 PMCID: PMC6581339 DOI: 10.5688/ajpe6678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/20/2017] [Indexed: 05/11/2023]
Abstract
Objective. To design, deliver, and evaluate a National Pharmacy Internship Program that met the educational requirements of pharmacy graduates to register as competent pharmacists and earned graduates a master's level degree. Methods. The National Pharmacy Internship Program was designed as a 12-month, full-time, blended-learning, competency-based program leading to a master's degree. Intern performance was assessed academically and by pharmacy preceptor (tutor) appraisals. Interns who demonstrated competency were invited to sit for the Professional Registration Examination (PRE). Feasibility and performance were evaluated and a longitudinal approach allowed intern and preceptor views to be compared to the former preregistration year. Results. Overall performance in the PRE was good and relatively consistent with almost all interns proceeding to register as pharmacists. Interns believed that the program had enabled them to develop the knowledge, skills, and overall competencies required for future independent practice as a pharmacist. Preceptors considered the program to have built on prior learning and provided a sufficiently rounded experience for professional practice. Preceptors also stated that the program was an improved educational experience over the former, less structured, preregistration training. Conclusion. The National Pharmacy Internship Program was perceived to be an improvement on the previous preregistration year. The program quality assured pharmacy education outcomes at the entry-to-practice level on a national basis, and uniquely recognized the students' accomplishment by awarding them a master's degree.
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Affiliation(s)
- Judith Strawbridge
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James Barlow
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aisling O’Leary
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Muirne Spooner
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eric Clarke
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Arnett
- Quality Enhancement Office, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chris Langley
- Aston Pharmacy School, Aston University, Birmingham, England
| | - Keith Wilson
- Aston Pharmacy School, Aston University, Birmingham, England
| | - Paul Gallagher
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
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27
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Duperret EK, Perales-Puchalt A, Stoltz R, Hiranjith GH, Mandloi N, Barlow J, Chaudhuri A, Sardesai NY, Weiner DB. A Synthetic DNA, Multi-Neoantigen Vaccine Drives Predominately MHC Class I CD8 + T-cell Responses, Impacting Tumor Challenge. Cancer Immunol Res 2019; 7:174-182. [PMID: 30679156 PMCID: PMC6622455 DOI: 10.1158/2326-6066.cir-18-0283] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/21/2018] [Accepted: 01/04/2019] [Indexed: 01/07/2023]
Abstract
T-cell recognition of cancer neoantigens is important for effective immune-checkpoint blockade therapy, and an increasing interest exists in developing personalized tumor neoantigen vaccines. Previous studies utilizing RNA and long-peptide neoantigen vaccines in preclinical and early-phase clinical studies have shown immune responses predominantly driven by MHC class II CD4+ T cells. Here, we report on a preclinical study utilizing a DNA vaccine platform to target tumor neoantigens. We showed that optimized strings of tumor neoantigens, when delivered by potent electroporation-mediated DNA delivery, were immunogenic and generated predominantly MHC class I-restricted, CD8+ T-cell responses. High MHC class I affinity was associated specifically with immunogenic CD8+ T-cell epitopes. These DNA neoantigen vaccines induced a therapeutic antitumor response in vivo, and neoantigen-specific T cells expanded from immunized mice directly killed tumor cells ex vivo These data illustrate a unique advantage of this DNA platform to drive CD8+ T-cell immunity for neoantigen immunotherapy.
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Affiliation(s)
| | | | - Regina Stoltz
- The Wistar Institute, Vaccine & Immunotherapy Center, Philadelphia PA
| | | | | | - James Barlow
- Inovio Pharmaceuticals, Plymouth Meeting, PA,Geneos Therapeutics, Plymouth Meeting, PA
| | | | - Niranjan Y. Sardesai
- Inovio Pharmaceuticals, Plymouth Meeting, PA,Geneos Therapeutics, Plymouth Meeting, PA
| | - David B. Weiner
- The Wistar Institute, Vaccine & Immunotherapy Center, Philadelphia PA,Corresponding author: David B. Weiner, Vaccine & Immunotherapy Center, The Wistar Institute, 3601 Spruce Street, Philadelphia, PA 19104,
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Galel D, Crisostomo C, Ortega J, Peters K, Neveu S, Davila C, Barlow J. Nucleated red blood cells as a novel indicator of CD34 + cell content in umbilical cord blood. Transfusion 2018; 59:681-685. [PMID: 30537299 DOI: 10.1111/trf.15080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/15/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Umbilical cord blood (UCB) has become an important source of transplantable CD34+ hematopoietic progenitor cells. Cord blood banks (CBBs) can increase their efficiency by minimizing the processing of UCB units with low CD34+ content, which have a lower likelihood of transplant utilization. We sought to identify a readily available preprocessing metric that would correlate with CD34+ cell counts, without the cost of additional analysis. STUDY DESIGN AND METHODS Data were compiled for 131 UCB units processed at the regional CBB. Preprocessing hematologic metrics, including complete blood count and differential, were compared to postprocessing CD34+ cell quantities. The data were divided into six groups of varying preprocessing metrics, then compared for significant differences in postprocessing CD34+ cell quantities to develop a screening guidance. RESULTS UCB units with nucleated RBC (nRBC) content of 15% or greater were found to have a significant increase in CD34+ cell percentage (p < 0.00001) and total CD34+ cell content (p < 0.0001). Units with preprocessing total nucleated cell count (TNC) of ≥ 1.50 × 109 with nRBC content of 15% or greater, and for TNC ≥ of 2.00 × 109 with nRBC content less than15%, had a significant increase in CD34+ content (p < 0.05 and p < 0.001, respectively). Applied as a screening guideline, these units had an increase in mean CD34+ content from 6.24 × 106 to 9.27 × 106 . Units originally in the bottom and top quartiles of CD34+ content constitute 5% and 53% of processed units meeting these TNC/nRBC criteria, respectively. CONCLUSION These screening criteria utilizing nRBC provides a guideline that public CBBs may use to increase their efficiency by minimizing the processing of UCB units with lower CD34+ cell content.
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Affiliation(s)
- David Galel
- Cell Therapy Laboratory, San Diego Blood Bank, San Diego, California
| | | | - Jennifer Ortega
- Cell Therapy Laboratory, San Diego Blood Bank, San Diego, California
| | - Kirstin Peters
- Cell Therapy Laboratory, San Diego Blood Bank, San Diego, California
| | - Sara Neveu
- Cell Therapy Laboratory, San Diego Blood Bank, San Diego, California
| | - Carolina Davila
- Cell Therapy Laboratory, San Diego Blood Bank, San Diego, California
| | - James Barlow
- Cell Therapy Laboratory, San Diego Blood Bank, San Diego, California
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Chatterjee A, Modarai M, Naylor NR, Boyd SE, Atun R, Barlow J, Holmes AH, Johnson A, Robotham JV. Quantifying drivers of antibiotic resistance in humans: a systematic review. Lancet Infect Dis 2018; 18:e368-e378. [PMID: 30172580 DOI: 10.1016/s1473-3099(18)30296-2] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/26/2018] [Accepted: 05/01/2018] [Indexed: 02/06/2023]
Abstract
Mitigating the risks of antibiotic resistance requires a horizon scan linking the quality with the quantity of data reported on drivers of antibiotic resistance in humans, arising from the human, animal, and environmental reservoirs. We did a systematic review using a One Health approach to survey the key drivers of antibiotic resistance in humans. Two sets of reviewers selected 565 studies from a total of 2819 titles and abstracts identified in Embase, MEDLINE, and Scopus (2005-18), and the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and WHO (One Health data). Study quality was assessed in accordance with Cochrane recommendations. Previous antibiotic exposure, underlying disease, and invasive procedures were the risk factors with most supporting evidence identified from the 88 risk factors retrieved. The odds ratios of antibiotic resistance were primarily reported to be between 2 and 4 for these risk factors when compared with their respective controls or baseline risk groups. Food-related transmission from the animal reservoir and water-related transmission from the environmental reservoir were frequently quantified. Uniformly quantifying relationships between risk factors will help researchers to better understand the process by which antibiotic resistance arises in human infections.
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Affiliation(s)
- Anuja Chatterjee
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.
| | - Maryam Modarai
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Nichola R Naylor
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Sara E Boyd
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK; Imperial College London Healthcare NHS Trust, London, UK; Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Rifat Atun
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK; Department of Global Health and Population, and Department of Health Policy and Management, Harvard University, Boston, MA, USA
| | - James Barlow
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London, UK
| | - Alison H Holmes
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK; Imperial College London Healthcare NHS Trust, London, UK
| | - Alan Johnson
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK; Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Julie V Robotham
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK; Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
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Huddy JR, Ni M, Misra S, Mavroveli S, Barlow J, Hanna GB. Development of the Point-of-Care Key Evidence Tool (POCKET): a checklist for multi-dimensional evidence generation in point-of-care tests. ACTA ACUST UNITED AC 2018; 57:845-855. [DOI: 10.1515/cclm-2018-1089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023]
Abstract
Abstract
Background
This study aimed to develop the Point-of-Care Key Evidence Tool (POCKET); a multi-dimensional checklist to guide the evaluation of point-of-care tests (POCTs) incorporating validity, utility, usability, cost-effectiveness and patient experience. The motivation for this was to improve the efficiency of evidence generation in POCTs and reduce the lead-time for the adoption of novel POCTs.
Methods
A mixed qualitative and quantitative approach was applied. Following a literature search, a three round Delphi process was undertaken incorporating a semi-structured interview study and two questionnaire rounds. Participants included clinicians, laboratory personnel, commissioners, regulators (including members of National Institute for Health and Care Excellence [NICE] committees), patients, industry representatives and methodologists. Qualitative data were analysed based on grounded theory. The final tool was revised at an expert stakeholder workshop.
Results
Forty-three participants were interviewed within the semi-structured interview study, 32 participated in the questionnaire rounds and nine stakeholders attended the expert workshop. The final version of the POCKET checklist contains 65 different evidence requirements grouped into seven themes. Face validity, content validity and usability has been demonstrated. There exists a shortfall in the evidence that industry and research methodologists believe should be generated regarding POCTs and what is actually required by policy and decision makers to promote implementation into current healthcare pathways.
Conclusions
This study has led to the development of POCKET, a checklist for evidence generation and synthesis in POCTs. This aims to guide industry and researchers to the evidence that is required by decision makers to facilitate POCT adoption so that the benefits they can bring to patients can be effectively realised.
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Affiliation(s)
- Jeremy R. Huddy
- Department of Surgery and Cancer , Imperial College London, Academic Surgical Unit, 10th Floor, QEQM Building, St Mary’s Hospital , London , UK
| | - Melody Ni
- Department of Surgery and Cancer , Imperial College London, Academic Surgical Unit, 10th Floor, QEQM Building, St Mary’s Hospital , London , UK
| | - Shivani Misra
- Diabetes, Endocrinology and Metabolism , St Mary’s Hospital, Imperial College London , London , UK
| | - Stella Mavroveli
- Department of Surgery and Cancer , Imperial College London, Academic Surgical Unit, 10th Floor, QEQM Building, St Mary’s Hospital , London , UK
| | - James Barlow
- Imperial College Business School , South Kensington Campus , London , UK
| | - George B. Hanna
- Department of Surgery and Cancer , Imperial College London, Academic Surgical Unit, 10th Floor, QEQM Building, St Mary’s Hospital , London , UK
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Antonacci G, Reed JE, Sriram V, Barlow J. ISQUA18-1682Quality Improvement through Interactive Simulation. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Antonacci
- NIHR CLAHRC NWL, Imperial College
- Imperial College Business School, London, United Kingdom
| | - J E Reed
- NIHR CLAHRC NWL, Imperial College
| | - V Sriram
- NIHR CLAHRC NWL, Imperial College
| | - J Barlow
- Imperial College Business School, London, United Kingdom
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Abstract
Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK's National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants' experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator's experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.
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Affiliation(s)
- Grazia Antonacci
- 1 Department of Public Health and Primary Care, 4615 Imperial College London , London, UK.,2 NIHR CLAHRC for Northwest London, London, UK.,3 Department of Management and Centre for Health Economics and Policy Innovation, Imperial College Business School, Imperial College London, London, UK
| | - Julie E Reed
- 1 Department of Public Health and Primary Care, 4615 Imperial College London , London, UK.,2 NIHR CLAHRC for Northwest London, London, UK
| | - Laura Lennox
- 1 Department of Public Health and Primary Care, 4615 Imperial College London , London, UK.,2 NIHR CLAHRC for Northwest London, London, UK
| | - James Barlow
- 3 Department of Management and Centre for Health Economics and Policy Innovation, Imperial College Business School, Imperial College London, London, UK
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Chrysanthaki T, Hendy J, Barlow J. Stimulating whole system redesign: Lessons from an organizational analysis of the Whole System Demonstrator programme. J Health Serv Res Policy 2018; 18:47-55. [PMID: 27552779 DOI: 10.1177/1355819612474249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Whole system integration of health and social care has been positioned as key to improving care, increasing efficiency and controlling costs. However, evidence for the benefits of whole system integration is scarce. Drawing on organizational theory, this study uses the implementation of remote care services, viewed as an enabler for whole system working, to explore the reality of achieving this policy objective. METHODS Qualitative, longitudinal data were collected across nine UK sites adopting remote care over three years. Three sites formed the Department of Health's Whole Systems Demonstrator (WSD) programme for remote care. In addition, the implementation of remote care was explored in six other sites unconstrained by the randomized control trial procedures of the WSD programme. The methods were ethnographic (including 235 hours of observations and 184 interviews). Participants were health and social care staff and Government policy makers. RESULTS Remote care did not lead to system redesign; however, local 'ownership' of new services did lead to more collaborative practices across the care system. Lack of integration was an enduring and endemic challenge across all sites, relating to differences in statutory responsibilities, absence of shared budgets and hybrid organizational roles, differences in work practices and organizational philosophies, and ambiguity around what 'whole system working' actually entailed. CONCLUSIONS Policy initiatives like the WSD programme provide opportunities to phase in collaborative practices and create an awareness of the need for joint working. However, the progress observed suggests that the concept of whole system redesign around remote care is currently unrealistic.
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Affiliation(s)
- Theopisti Chrysanthaki
- Research Associate, Healthcare Management Group, Imperial College, Business School, Imperial College, London, UK
| | - Jane Hendy
- Senior Lecturer in Health Care Management, Department of Health Care Management and Policy, University of Surrey, UK
| | - James Barlow
- Professor of Technology and Innovation Management, Imperial College Business School, Imperial College, London, UK
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Myron R, French C, Sullivan P, Sathyamoorthy G, Barlow J, Pomeroy L. Professionals learning together with patients: An exploratory study of a collaborative learning Fellowship programme for healthcare improvement. J Interprof Care 2017; 32:257-265. [PMID: 29240524 DOI: 10.1080/13561820.2017.1392935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Improving the quality of healthcare involves collaboration between many different stakeholders. Collaborative learning theory suggests that teaching different professional groups alongside each other may enable them to develop skills in how to collaborate effectively, but there is little literature on how this works in practice. Further, though it is recognised that patients play a fundamental role in quality improvement, there are few examples of where they learn together with professionals. To contribute to addressing this gap, we review a collaborative fellowship in Northwest London, designed to build capacity to improve healthcare, which enabled patients and professionals to learn together. Using the lens of collaborative learning, we conducted an exploratory study of six cohorts of the year long programme (71 participants). Data were collected using open text responses from an online survey (n = 31) and semi-structured interviews (n = 34) and analysed using an inductive open coding approach. The collaborative design of the Fellowship, which included bringing multiple perspectives to discussions of real world problems, was valued by participants who reflected on the safe, egalitarian space created by the programme. Participants (healthcare professionals and patients) found this way of learning initially challenging yet ultimately productive. Despite the pedagogical and practical challenges of developing a collaborative programme, this study indicates that opening up previously restricted learning opportunities as widely as possible, to include patients and carers, is an effective mechanism to develop collaborative skills for quality improvement.
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Affiliation(s)
- Rowan Myron
- a CLAHRC NWL , Imperial College London/University of West London , London , UK
| | | | - Paul Sullivan
- c Improvement Science , CLAHRC NWL/Imperial College London , UK
| | | | - James Barlow
- e Business School , Imperial College London , London
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Affiliation(s)
- Brice Dattée
- Department of Strategy and Organization, emlyon business school, 69134 Ecully, France
| | - James Barlow
- Imperial College Business School, London SW7 2AZ, United Kingdom
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Abstract
Six people with multiple health problems living in an extra care housing scheme for older people with vision impairment agreed to take part in a telecare trial. An average of 14.8 sensors was installed in each of the flats. The monitoring period began in January 2006 and lasted for 10 months. The data acquired by the sensors installed in each flat was transmitted from the home unit to a central computer. Four interviews were conducted with each participant. Halfway through the study we created a number of case studies of sensor activity at the time of known events in the lives of the participants, together with an attempt to interpret these patterns of activity with the benefit of available contextual information. Although our investigation showed that sensors are capable of identifying some changes in daily routines at the time of important events, the interpretation of such changes requires a large amount of contextual information and the involvement of participants themselves. Various technical and operational difficulties will need to be resolved before it will be possible to use lifestyle monitoring predictively.
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Affiliation(s)
- Julienne Hanson
- Bartlett School of Graduate Studies, University College London
| | - Dorota Osipoviĉ
- Bartlett School of Graduate Studies, University College London
| | - Nick Hine
- School of Computing, University of Dundee
| | | | | | - James Barlow
- Tanaka Business School, Imperial College London, UK
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Maben J, Griffiths P, Penfold C, Simon M, Anderson JE, Robert G, Pizzo E, Hughes J, Murrells T, Barlow J. One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs. BMJ Qual Saf 2016; 25:241-56. [PMID: 26408568 PMCID: PMC4819646 DOI: 10.1136/bmjqs-2015-004265] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. METHODS Mixed methods pre/post 'move' comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms. RESULTS Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time. CONCLUSIONS Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms.
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Affiliation(s)
- Jill Maben
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Clarissa Penfold
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Directorate of Nursing/AHP, Inselspital Bern University Hospital, Bern, Switzerland
| | - Janet E Anderson
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Elena Pizzo
- Faculty of Population Health Sciences, Institute of Epidemiology & Health, UCL,London, UK
| | | | - Trevor Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Huddy JR, Ni MZ, Barlow J, Majeed A, Hanna GB. Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption. BMJ Open 2016; 6:e009959. [PMID: 26940107 PMCID: PMC4785316 DOI: 10.1136/bmjopen-2015-009959] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Point-of-care (POC) C reactive protein (CRP) is incorporated in National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis of pneumonia, reduces antibiotic prescribing and is cost effective. AIM To determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection. DESIGN The study followed a qualitative methodology based on grounded theory. The study was undertaken in 2 stages. Stage 1 consisted of semistructured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. Stage 2 was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios. Emergent theme analysis was undertaken. PARTICIPANTS Participants included general practitioners (including those with commissioning experience), biochemists, pharmacists, clinical laboratory scientists and industry representatives from the UK and abroad. RESULTS Barriers to the implementation of POC CRP exist, but successful adoption has been demonstrated abroad. Analysis highlighted 7 themes: reimbursement and incentivisation, quality control and training, laboratory services, practitioner attitudes and experiences, effects on clinic flow and workload, use in pharmacy and gaps in evidence. CONCLUSIONS Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services. Incorporating antimicrobial stewardship into quality improvement frameworks may incentivise adoption. Further research is needed to develop scaling-up strategies to address the resourcing, clinical governance and economic impact of widespread NHS implementation.
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Affiliation(s)
- Jeremy R Huddy
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Melody Z Ni
- Department of Surgery and Cancer, Imperial College, London, UK
| | - James Barlow
- Imperial College Business School, South Kensington Campus, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College, London, UK
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Greenhalgh T, Annandale E, Ashcroft R, Barlow J, Black N, Bleakley A, Boaden R, Braithwaite J, Britten N, Carnevale F, Checkland K, Cheek J, Clark A, Cohn S, Coulehan J, Crabtree B, Cummins S, Davidoff F, Davies H, Dingwall R, Dixon-Woods M, Elwyn G, Engebretsen E, Ferlie E, Fulop N, Gabbay J, Gagnon MP, Galasinski D, Garside R, Gilson L, Griffiths P, Hawe P, Helderman JK, Hodges B, Hunter D, Kearney M, Kitzinger C, Kitzinger J, Kuper A, Kushner S, Le May A, Legare F, Lingard L, Locock L, Maben J, Macdonald ME, Mair F, Mannion R, Marshall M, May C, Mays N, McKee L, Miraldo M, Morgan D, Morse J, Nettleton S, Oliver S, Pearce W, Pluye P, Pope C, Robert G, Roberts C, Rodella S, Rycroft-Malone J, Sandelowski M, Shekelle P, Stevenson F, Straus S, Swinglehurst D, Thorne S, Tomson G, Westert G, Wilkinson S, Williams B, Young T, Ziebland S. An open letter to The BMJ editors on qualitative research. BMJ 2016; 352:i563. [PMID: 26865572 DOI: 10.1136/bmj.i563] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Halland M, Ravi K, Barlow J, Arora A. Correlation between the radiological observation of isolated tertiary waves on an esophagram and findings on high-resolution esophageal manometry. Dis Esophagus 2016; 29:22-6. [PMID: 25327483 DOI: 10.1111/dote.12292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Barium esophagrams are a frequently performed test, and radiological observations about potential abnormal esophageal motility, such as tertiary contractions, are commonly reported. We sought to assess the correlation between tertiary waves, and in particular isolated tertiary waves, on esophagrams and findings on non-synchronous high-resolution esophageal manometry. We retrospectively reviewed reports of esophagrams performed at a tertiary referral center and identified patients in whom tertiary waves were observed and a high-resolution esophageal manometry had been performed. We defined two groups; group 1 was defined as patients with isolated tertiary waves, whereas group 2 had tertiary waves and evidence of achalasia or an obstructing structural abnormality on the esophagram. We collected data on demographics, dysphagia score, associated findings on esophagram, and need for intervention. We reviewed the reports of 2100 esophagrams of which tertiary waves were noted as an isolated abnormality in 92, and in association with achalasia or a structural obstruction in 61. High-resolution manometry was performed in 17 patients in group 1, and five had evidence of a significant esophageal motility disorder and 4 required any intervention. Twenty-one patients in group 2 underwent manometry, and 18 had a significant esophageal motility disorder. An isolated finding of tertiary waves on an esophagram is rarely associated with a significant esophageal motility disorder that requires intervention. All patients with isolated tertiary waves who required intervention had a dysphagia to liquids. Tertiary contractions, in the absence of dysphagia to liquids, indicate no significant esophageal motility disorder.
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Affiliation(s)
- M Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - K Ravi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - J Barlow
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - A Arora
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
BACKGROUND AND OBJECTIVES Patient and public involvement (PPI) is seen as a way of helping to shape health policy and ensure a patient-focused health-care system. While evidence indicates that PPI can improve health-care decision making, it also consumes monetary and non-monetary resources. Given the financial climate, it is important to start thinking about the costs and benefits of PPI and how to evaluate it in economic terms. DESIGN We conducted a literature review to assess the potential benefits and costs of involvement and the challenges in carrying out an economic evaluation of PPI. RESULTS The benefits of PPI include effects on the design of new projects or services, on NHS governance, on research design and implementation and on citizenship and equity. Economic evaluation of PPI activities is limited. The lack of an appropriate analytical framework, data recording and understanding of the potential costs and benefits of PPI, especially from participants' perspectives, represent serious constraints on the full evaluation of PPI. CONCLUSIONS By recognizing the value of PPI, health-care providers and commissioners can embed it more effectively within their organizations. Better knowledge of costs may prompt organizations to effectively plan, execute, evaluate and target resources. This should increase the likelihood of more meaningful activity, avoid tokenism and enhance organizational efficiency and reputation.
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Affiliation(s)
- Elena Pizzo
- Imperial College, Business School, London, UK
| | - Cathal Doyle
- NIHR CLAHRC for Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rachel Matthews
- NIHR CLAHRC for Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - James Barlow
- Technology and Innovation Management, Imperial College, Business School, London, UK
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Abstract
Purpose
– The purpose of this paper is to investigate what happens when a lack of role-sending results in ambiguous change agent roles during a large scale organisational reconfiguration. The authors consider the role of sensemaking in resolving role ambiguity of middle manager change agents and the consequences of this for organisational restructuring.
Design/methodology/approach
– Data were collected from a case study analysis of significant organisational reconfiguration across a local National Health Service Trust in the UK. Data consists of 82 interviews, complemented by analysis of over 100 documents and field notes from 51 hours of observations collected over five phases covering a three year period before, during and after the reconfiguration. An inductive qualitative analysis revealed the sensemaking processes by which ambiguity in role definition was resolved.
Findings
– The data explains how change agents collectively make sense of a role in their own way, drawing on their own experiences and views as well as cues from other organisational members. The authors also identified the organisational outcomes which resulted from this freedom in sensemaking. This study demonstrates that by leaving too much flexibility in the definition of the role, agents developed their own sensemaking which was subsequently very difficult to manipulate.
Practical implications
– In creating new roles, management first needs to have a realistic vision of the task and roles that their agents will perform, and second, to communicate these expectations to both those responsible for recruiting these roles and to the agents themselves.
Originality/value
– Much of the focus in sensemaking research has been on the importance of change agents’ sensemaking of the change but there has been little focus on how change agents sensemake their own role in the change.
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Abstract
Calls for successful knowledge translation (KT) in health care have multiplied over recent years. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) program is a policy initiative in the United Kingdom aimed at speeding-up the translation of research into health care practice. Using multiple qualitative research methods and drawing on the ongoing processes used by individuals to interpret and contextualize information, we explore how new organizational forms for KT bridge the gap between research and practice. We pay particular attention to the relationship between the organization and practices of KT and leadership. Our empirical data demonstrate how the relationship between leadership and KT shifted over time from a push model where the authoritarian top-down leadership team set outcome measures by which to judge KT performance to one which aimed to distribute leadership capacity across a wide range of stakeholders in health and social care systems. The relationship between the organization and practices of KT and leadership is affected by local contextual influences on policies directed at increasing the uptake of research in clinical practice. Policy makers and service leaders need to recognize that more dispersed type of leadership is needed to accommodate the idiosyncratic nature of collective action.
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Affiliation(s)
- Dimitrios Spyridonidis
- Henley Business School, University of Reading, United Kingdom Imperial College Business School, London, United Kingdom
| | - Jane Hendy
- Surrey Business School, University of Surrey, Surrey, United Kingdom
| | - James Barlow
- Imperial College Business School, London, United Kingdom
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Huddy JR, Ni M, Mavroveli S, Barlow J, Williams DA, Hanna GB. A research protocol for developing a Point-Of-Care Key Evidence Tool 'POCKET': a checklist for multidimensional evidence reporting on point-of-care in vitro diagnostics. BMJ Open 2015; 5:e007840. [PMID: 26163033 PMCID: PMC4499707 DOI: 10.1136/bmjopen-2015-007840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Point-of-care in vitro diagnostics (POC-IVD) are increasingly becoming widespread as an acceptable means of providing rapid diagnostic results to facilitate decision-making in many clinical pathways. Evidence in utility, usability and cost-effectiveness is currently provided in a fragmented and detached manner that is fraught with methodological challenges given the disruptive nature these tests have on the clinical pathway. The Point-of-care Key Evidence Tool (POCKET) checklist aims to provide an integrated evidence-based framework that incorporates all required evidence to guide the evaluation of POC-IVD to meet the needs of policy and decisionmakers in the National Health Service (NHS). METHODS AND ANALYSIS A multimethod approach will be applied in order to develop the POCKET. A thorough literature review has formed the basis of a robust Delphi process and validation study. Semistructured interviews are being undertaken with POC-IVD stakeholders, including industry, regulators, commissioners, clinicians and patients to understand what evidence is required to facilitate decision-making. Emergent themes will be translated into a series of statements to form a survey questionnaire that aims to reach a consensus in each stakeholder group to what needs to be included in the tool. Results will be presented to a workshop to discuss the statements brought forward and the optimal format for the tool. Once assembled, the tool will be field-tested through case studies to ensure validity and usability and inform refinement, if required. The final version will be published online with a call for comments. Limitations include unpredictable sample representation, development of compromise position rather than consensus, and absence of blinding in validation exercise. ETHICS AND DISSEMINATION The Imperial College Joint Research Compliance Office and the Imperial College Hospitals NHS Trust R&D department have approved the protocol. The checklist tool will be disseminated through a PhD thesis, a website, peer-reviewed publication, academic conferences and formal presentations.
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Affiliation(s)
- Jeremy R Huddy
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Melody Ni
- Department of Surgery and Cancer, Imperial College, London, UK
| | | | - James Barlow
- Imperial College Business School, South Kensington Campus, London, UK
| | | | - George B Hanna
- Department of Surgery and Cancer, Imperial College, London, UK
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Cravo Oliveira T, Barlow J, Bayer S. The association between general practitioner participation in joint teleconsultations and rates of referral: a discrete choice experiment. BMC Fam Pract 2015; 16:50. [PMID: 25896515 PMCID: PMC4443603 DOI: 10.1186/s12875-015-0261-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 03/27/2015] [Indexed: 11/17/2022]
Abstract
Background Joint consultations – such as teleconsultations – provide opportunities for continuing education of general practitioners (GPs). It has been reported this form of interactive case-based learning may lead to fewer GP referrals, yet these studies have relied on expert opinion and simple frequencies, without accounting for other factors known to influence referrals. We use a survey-based discrete choice experiment of GPs’ referral preferences to estimate how referral rates are associated with participation in joint teleconsultations, explicitly controlling for a number of potentially confounding variables. Methods We distributed questionnaires at two meetings of the Portuguese Association of General Practice. GPs were presented with descriptions of patients with dermatological lesions and asked whether they would refer based on the waiting time, the distance to appointment, and pressure from patients for a referral. We analysed GPs’ responses to multiple combinations of these factors, coupled with information on GP and practice characteristics, using a binary logit model. We estimated the probabilities of referral of different lesions using marginal effects. Results Questionnaires were returned by 44 GPs, giving a total of 721 referral choices. The average referral rate for the 11 GPs (25%) who had participated in teleconsultations was 68.1% (range 53-88%), compared to 74.4% (range 47-100%) for the remaining physicians. Participation in teleconsultations was associated with reductions in the probabilities of referral of 17.6% for patients presenting with keratosis (p = 0.02), 42.3% for psoriasis (p < 0.001), 8.4% for melanoma (p = 0.14), and 5.4% for naevus (p = 0.19). Conclusions The results indicate that GP participation in teleconsultations is associated with overall reductions in referral rates and in variation across GPs, and that these effects are robust to the inclusion of other factors known to influence referrals. The reduction in range, coupled with different effects for different clinical presentations, may suggest an educational effect. However, more research is needed to establish whether there are causal relationships between participation in teleconsultations, continuing education, and referral rates.
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Affiliation(s)
- Tiago Cravo Oliveira
- Research Associate, Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - James Barlow
- Chair in Technology and Innovation Management, Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Steffen Bayer
- Assistant Professor, Program in Health Services & Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
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Forney KA, Becker EA, Foley DG, Barlow J, Oleson EM. Habitat-based models of cetacean density and distribution in the central North Pacific. ENDANGER SPECIES RES 2015. [DOI: 10.3354/esr00632] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Maben J, Griffiths P, Penfold C, Simon M, Pizzo E, Anderson J, Robert G, Hughes J, Murrells T, Brearley S, Barlow J. Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. Health Services and Delivery Research 2015. [DOI: 10.3310/hsdr03030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jill Maben
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Peter Griffiths
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Clarissa Penfold
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Michael Simon
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Elena Pizzo
- Imperial College Business School, London, UK
| | - Janet Anderson
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Glenn Robert
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Jane Hughes
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Trevor Murrells
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Sally Brearley
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
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Miller BS, Barlow J, Calderan S, Collins K, Leaper R, Olson P, Ensor P, Peel D, Donnelly D, Andrews-Goff V, Olavarria C, Owen K, Rekdahl M, Schmitt N, Wadley V, Gedamke J, Gales N, Double MC. Validating the reliability of passive acoustic localisation: a novel method for encountering rare and remote Antarctic blue whales. ENDANGER SPECIES RES 2015. [DOI: 10.3354/esr00642] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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50
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Ferreira J, Aragão LEOC, Barlow J, Barreto P, Berenguer E, Bustamante M, Gardner TA, Lees AC, Lima A, Louzada J, Pardini R, Parry L, Peres CA, Pompeu PS, Tabarelli M, Zuanon J. Environment and Development. Brazil's environmental leadership at risk. Science 2014; 346:706-7. [PMID: 25378611 DOI: 10.1126/science.1260194] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- J Ferreira
- See the supplementary materials for author af liations.
| | | | - J Barlow
- See the supplementary materials for author af liations
| | - P Barreto
- See the supplementary materials for author af liations
| | - E Berenguer
- See the supplementary materials for author af liations
| | - M Bustamante
- See the supplementary materials for author af liations
| | - T A Gardner
- See the supplementary materials for author af liations
| | - A C Lees
- See the supplementary materials for author af liations
| | - A Lima
- See the supplementary materials for author af liations
| | - J Louzada
- See the supplementary materials for author af liations
| | - R Pardini
- See the supplementary materials for author af liations
| | - L Parry
- See the supplementary materials for author af liations
| | - C A Peres
- See the supplementary materials for author af liations
| | - P S Pompeu
- See the supplementary materials for author af liations
| | - M Tabarelli
- See the supplementary materials for author af liations
| | - J Zuanon
- See the supplementary materials for author af liations
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